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 Not all ancient scholars agreed with this theory of mental illness. The Greek physician Hippocrates believed that all illnesses, including mental illnesses, had natural origins. For example, he rejected the prevailing notion that epilepsy had its origins in the divine or sacred, viewing it as a disease of the brain. Hippocrates categorically considered mental illnesses as itemized positions, in that to include mania, melancholia (depression), and phrenitis (brain fever), and he advocated humane treatment that included rest, bathing, exercise, and dieting. The Greek philosopher Plato, although adhering to a somewhat supernatural view of mental illness, believed that childhood experiences shaped adult behaviours, anticipating modern Psychodynamics theories by more than 2000 years.
 The Middle Ages in Europe, from the fall of the Roman empire in the 5th century ad too about the 15th century, was a period in which religious beliefs, specifically Christianity, dominated concepts of mental illness. Much of the society believed that mentally ill people were possessed by the devil or demons, or accused them of being witches and infecting others with madness. Thus, instead of receiving care from physicians, the mentally ill became objects of religious inquisition and barbaric treatment. On the other hand, some historians of medicine cite evidence that evens in the Middle Ages, many people believed mental illness to have its basis in physical and psychological disturbances, such as imbalances in the four bodily humours (blood, black bile, yellow bile, and phlegm), poor diet, and grief.
 The Islamic world of North Africa, Spain, and the Middle East generally held far more humane attitudes toward people with mental illnesses. Following the belief that God loved insane people, communities began establishing asylums beginning in the 8th century ad, first in Baghdad and later in Cairo, Damascus, and Fez. The asylums offered patients special diets, baths, drugs, music, and pleasant surroundings.
 The Renaissance, which began in Italy in the 14th century and spread throughout Europe in the 16th and 17th century, brought both deterioration and progress in perceptions of mental illness. On the one hand, witch-hunts and executions escalated throughout Europe, as of relating to the mind, the mental aspects of the problem, is that the mentally ill, and among them were in vengeance a reprisal for they are merciless persecuted. The infamous Malleus Maleficarum (The Witches Hammer or, Hammer of the Witch) which served as a handbook for inquisitors, claimed that witches could be identified by delusions, hallucinations, or other peculiar behaviours. To make matters worse, many of the most eminent physicians of the time fervently advocated these beliefs.
 On the other hand, some scholars vigorously protested these supernatural views and called renewed attention to more rational explanations of behaviour. In the early 16th century, for example, the Swiss physician Paracelsus returned to the views of Hippocrates, asserting that mental illnesses were due to natural causes. Later in the century, German physician Johann Weyer argued that witches were actually mentally disturbed people in need of humane medical treatment.
 French physician Philippe Pinel supervises the unshackling of mentally ill patients in 1794 at La Salpêtrière, a large hospital in Paris. Pinel believed in treating mentally ill people with compassion and patience, rather than with cruelty and violence.
 During the Age of Enlightenment, in the 18th and early 19th centuries, people with mental illnesses continued to suffer from poor treatment. For the most part, they were left to wander the countryside or committed to institutions. In either case, conditions were generally wretched. One mental hospital, the Hospital of Saint Mary of Bethlehem in London, England, became notorious for its noisy, chaotic conditions and cruel treatment of patients.
 Yet as the public’s awareness of such conditions grew, improvements in care and treatment began to appear. In 1789 Vincenzo Chiarugi, superintendent of a mental hospital in Florence, Italy, introduced hospital regulations that provided patients with high standards of hygiene, recreation and work opportunities, and minimal restraint. At nearly the same time, Jean-Baptiste Pussin, superintendent of a ward for “incurable” mental patients at La Bicêtre hospital in Paris, France, forbade staff to beat patients and released patients from chains. Philippe Pinel continued these reforms upon becoming chief physician of La Bicêtre’s ward for the mentally ill in 1793. Pinel began to keep case histories of patients and developed the concept of “moral treatment,” which involved treating patients with kindness and sensitivity, and without cruelty or violence. In 1796, a Quaker named William Tuke who had laid the groundwork for the York Retreat in rural England, which became a model of compassionate care. The retreat enabled people with mental illnesses to rest peacefully, talk about their problems, and work. Eventually these humane techniques became widespread in Europe.
 In 1908, after his release from an asylum for the mentally ill, Clifford Whittingham Beers wrote, “A Mind That Found Itself,” which exposed the poor conditions he had suffered while confined. He went on to establish several organizations dedicated to the promotion of mental health reforms in the United States.
 People living in the colonies of North America in the 17th and 18th century generally explained bizarre or deviant behaviour as God’s will or the obstacle working as of the devil. Some people with mental illnesses received care from their families, but most were jailed or confined in almshouses with the poor and infirm. By the mid-18th century, however, American physicians came to view mental illnesses as diseases of the brain, and advocated specialized facilities to treat the mentally ill. The Pennsylvania Hospital in Philadelphia, which opened in 1752, became the first hospital in the American colonies to admit people with mental illnesses, housing them in a separate ward. However, in the hospital’s early years, mentally ill patients were chained to the walls of dark, cold cells.
 In the 1780s American physician Benjamin Rush instituted changes at the Pennsylvania Hospital that greatly improved conditions for mentally ill patients. Although he endorsed the continued use of restraints, punishment, and bleeding, he also arranged for heat and better ventilation in the wards, separation of violent patients from other patients, and programs that offered work, exercise, and recreation to patients. Between the years 1817 and 1828, following the examples of Tuke and Pinel, a number of institutions opened that devoted themselves exclusively to the care of mentally ill people. The first private mental hospital in the United States was the Asylum for the Relief of Persons Deprived of the Use of Their Reason (now Friends Hospital), opened by Quakers in 1817 in what is now Philadelphia. Other privately established institutions soon followed, and state-sponsored hospitals - in Kentucky, New York, Virginia, and South Carolina - opened beginning in 1824.
 American reformer Dorothea Dix championed the causes of prison inmates, the mentally ill, and the destitute. Horrified by the conditions provided for the mentally ill in Massachusetts. Dix successfully petitioned the state government for improvements in 1843. She was directly responsible for building or enlarging 32 mental hospitals in North America, Europe, and Japan.
 Nevertheless, circumstances for most mentally ill people in the United States, especially those who were poor, remained dreadful. In 1841 Dorothea Dix, a Boston schoolteacher, began a campaign to make the public aware of the plight of mentally ill people. By 1880, as a direct result of her efforts, 32 psychiatric hospitals for the poor had opened. Increasingly, society viewed psychiatric institutions as the most appropriate form of care for people with mental illnesses. However, by the late 19th century, conditions in these institutions had deteriorated. Overcrowded and understaffed, psychiatric hospitals had shifted their treatment approach from moral therapy to warehousing and punishment. In 1908 Clifford Whittingham Beers aroused new concern for mentally ill individuals with the publication of A Mind That Found Itself, an account of his experiences as a mental patient. In 1909 Beers founded the National Committee for Mental Hygiene, which worked to prevent mental illness and ensure humane treatment of the mentally ill.
 Following World War II (1939-1945), a movement emerged in the United States to reform the system of psychiatric hospitals, in which hundreds of thousands of mentally ill persons lived in isolation for years or decades. Many mental health professionals - seeing that large state institutions caused as much, if not more, harm to patients than mental illnesses themselves - came to believe that only patients with severe symptoms should be hospitalized. In addition, the development in the 1950s of Antipsychotic drugs, which helped to control bizarre and violent behaviour, allowed more patients to be treated in the community. In combination, these factors led to the deinstitutionalisation movement: the release, over the next four decades, of hundreds of thousands of patients from state mental hospitals. In 1950, 513,000 patients resided in these institutions. By 1965 there were 475,000, and 1990 states’ mental hospitals housed only 92,000 patients on any given night. Many patients who were released returned to their families, although many were transferred to questionable conditions in nursing homes or board-and-care homes. Many patients had no place to go and began to live on the streets.
 The National Mental Health Act of 1946 created the National Institute of Mental Health as a centre for research and funding of research on mental illness. In 1955 Congress created a commission to investigate the state of mental health care, treatment, and prevention. In 1963, as a result of the commission’s findings, Congress passed the Community Mental Health Centres Act, had  authorized the construction of community mental health centres throughout the country. Implementation of these centres was not as extensive as originally planned, and many people with severe mental illnesses failed to receive care of any kind.
 One of the most important developments in the field of mental health in the United States has been the establishment of advocacy and support groups. The National Alliance for the mentally ill (NAMI), one of the most influential of these groups, was founded in 1972. NAMI’s goal is to improve the lives of people with severe mental illnesses and their families by eliminating discrimination in housing and employment and by improving access to essential treatments and programs.
 During the 1980's, all levels of government in the United States cut back on funding for social services. For example, the Social Security Administration discontinued benefits for approximately 300,000 people between 1981 and 1983. Of these, an estimated 100,000 were people with mental illnesses. Although the government eventually restored Social Security benefits to many of these people, the interruption of services caused widespread hardship.
 The emergence of managed care in the 1990's as a way to contain health care costs had a tremendous impact on mental health care in the United States. Health insurance companies and health maintenance organizations increasingly scrutinized the effectiveness of various psychotherapies and drug treatments and put stricter limits on mental health care. In response to these restrictions, but congress passed the Mental Health Parity Act of 1996. This law required private medical plans that offer mental health coverage to set equal yearly and lifetime payment limits for coverage of both mental and physical illnesses.
 In 1997 the US Equal Employment Opportunity Commission issued new guidelines intended to prevent discrimination against people with mental illnesses in the workplace. The rules, based on the Americans with Disabilities Act of 1990, prohibit employers from asking job applicants if they have a history of mental illness and require employers to provide reasonable accommodations to workers with mental illnesses.
 In recent years international agencies, led by the World Health Organization (WHO) of the United Nations (UN) have developed mental health policies that seek to reduce the huge burden of mental illness worldwide. These agencies are working to improve the quality of mental health services in Africa, Asia, Latin America, the Middle East, and elsewhere by educating governments on prevention and treatment of mental illness and on the rights of the mentally ill.
 Psychiatry, is the branch of medicine specializing in mental illnesses. Psychiatrists not only diagnose and treat these disorders but also conduct research directed at understanding and preventing them.
 A psychiatrist is a doctor of medicine who has had four years of postgraduate training in psychiatry. Many psychiatrists take further training in psychoanalysis, child psychiatry, or other subspecialties. Psychiatrists treat patients in private practice, in general hospitals, or in specialized facilities for the mentally ill (psychiatric hospitals, outpatient clinics, or community mental health centres). Some spend part or all of their time doing research or administering mental health programs. By contrast, psychologists, who often work closely with psychiatrists and treat many of the same kinds of patients, are not trained in medicine; consequently, they neither diagnose physical illness nor administer drugs.
 The province of psychiatry is unusually broad for a medical specialty. Mental disorders may affect most aspects of a patient's life, including physical functioning, behaviour, emotions, thought, perception, interpersonal relationships, sexuality, work, and play. These disorders are caused by a poorly understood combination of biological, psychological, and social determinants. Psychiatry's task is to account for the diverse sources and manifestations of mental illness.
 Physicians in the Western world began specializing in the treatment of the mentally ill in the 19th century. Known as alienists, psychiatrists of that era worked in large asylums, practising what was then called moral treatment, a humane approach aimed at quieting mental turmoil and restoring reason. During the second half of the century, psychiatrists abandoned this mode of treatment and, with it, the tacit recognition that mental illness is caused by both psychological and social influences. For a while, their attention focussed almost exclusively on biological factors. Drugs and other forms of somatic (physical) treatment was common. The German psychiatrist Emil Kraepelin identified and classified mental disorders into a system that is the foundation for modern diagnostic practices. Another important figure was the Swiss psychiatrist Eugen Bleuler, who coined the word schizophrenia and described its characteristics.
 The discovery of unconscious sources of behaviour - an insight dominated by the psychoanalytic writings of Sigmund Freud in the early 20th century - enriched psychiatric thought and changed the direction of its practice. Attention shifted to processes within the individual psyche, and psychoanalysis came to be regarded as the preferred mode of treatment for most mental disorders. In the years 1940 and the 1950s emphasis shifted again: This time to the social and physical environment. Many psychiatrists had all but ignored biological influences, but others were studying those involved in mental illness and were using somatic forms of treatment such as electroconvulsive therapy (electric shock) and Psychosurgery.
 Dramatic changes in the treatment of the mentally ill in the United States began in the mid-1950's with the introduction of the first effective drugs for treating psychotic symptoms. Along with drug treatment, new, more liberal and humane policies and treatment strategies were introduced into mental hospitals. Ever more patients were treated in community settings in the 1960s and 1970s. Support for mental health research led to significant new discoveries, especially in the understanding of genetic and biochemical determinants in mental illness and the functioning of the brain. Thus, by the 1980's, psychiatry had once again shifted in emphasis to the biological, to the relative neglect of psychosocial influences in mental health and illness.
 Psychiatrists use a variety of methods to detect specific disorders in their patients. The most fundamental is the psychiatric interview, during which the patient's psychiatric history is taken and mental status is evaluated. The psychiatric history is a picture of the patient's personality characteristics, relationships with others, and past and present experience with psychiatric problems - all told in the patient's words (sometimes supplemented by comments from other family members). Psychiatrists use mental-status examinations much as internists use physical examinations. They elicit and classify aspects of the patient's mental functioning.
 Some diagnostic methods rely on testing by other specialists. Psychologists administer intelligence and personality tests, as well as tests designed to detect damage to the brain or other parts of the central nervous system. Neurologists also test psychiatric patients for evidence of impairment of the nervous system. Other physicians sometimes examine patients who complain of physical symptoms. Psychiatric social workers explore family and community problems. The psychiatrist integrates all this information in making a diagnosis according to criteria established by the psychiatric profession.
 Psychiatric treatments fall into two classes: organic and Nonorganic form. Organic treatments, such as drugs, are those that affect the body directly. Nonorganic types of treatment improve the patient's functioning by psychological means, such as psychotherapy, or by altering the social environment.
 Psychotropic drugs are by far the most commonly used organic treatment. The first to be discovered were the antipsychotics, used primarily to treat schizophrenia. The phenothiazine is the most frequently prescribed class of Antipsychotic drugs. Others are the thioxanthenes, butyrophenones, and indoles. All Antipsychotic drugs diminish such symptoms as delusions, hallucinations, and thought disorder. Because they can reduce agitation, they are sometimes used to control manic excitement in manic-depressive patients and to calm geriatric patients. Some childhood behaviour disorders respond to these drugs.
 Despite their value, the Antipsychotic drugs have drawbacks. The most serious is the neurological condition tardive dyskinesia, which occurs in patients who have taken the drugs over extended periods. The condition is characterized by abnormal movements of the tongue, mouth, and body. It is especially serious because its symptoms do not always disappear when the drug is stopped, and no known treatment for it has been developed.
 Most Psychotropic drugs are chemically synthesized. Lithium carbonate, however, is a naturally occurring element used to prevent, or at least reduce, the severity of shifts of mood in manic-depression. It is especially effective in controlling mania. Psychiatrists must monitor lithium dosages carefully, because only a small margin exists between an effective dose and a toxic one.
 Three major classes of antidepressant drugs are used. The tricyclic and tetracyclic antidepressants, the most frequently prescribed, are used for the most common form of serious depression. Monoamine oxidase (MAO) inhibitors are used for so-called atypical depressions. Serotonin-selective reuptake inhibitors (SSRIs) are effective against both typical and atypical depressions. Although all three classes are quite effective in relieving depression in correctly matched patients, they also have disadvantages. The tricyclics and tetracyclics can take two to five weeks to become effective and can cause such side effects as oversedation and cardiac problems. MAO inhibitors can cause severe hypertension in patients who ingest certain types of food (such as cheese, beer, and wine) or drugs (such as cold medicines). SSRI drugs, such as Fluoxetine (Prozac), take 2 to 12 weeks to become effective and can cause headaches, nausea, insomnia, and nervousness.
 Anxiety, tension and insomnia are often treated with drugs that are commonly called minor tranquillizers. Barbiturates have been used for the longest time, but they produce more severe side effects and are more often abused than the newer classes of Antianxiety drugs. Of the new drugs, the benzodiazepines are the most frequently prescribed, very often in nonpsychiatric settings.
 The stimulant drugs, such as amphetamine - a drug that is often abused - have legitimate uses in psychiatry. They help to control overactivity and lack of concentration in hyperactive children and to stimulate the victims of narcolepsy, a disorder characterized by sudden, uncontrollable episodes of sleep.
 Another organic treatment is electroconvulsive therapy, or ECT, in which seizures similar to those of epilepsy are produced by a current of electricity passed through the forehead. ECT is most commonly used to treat severe depressions that have not responded to drug treatment. It is also sometimes used to treat schizophrenia. Other forms of organic treatment are much less frequently used than drugs and ETC. They include the controversial technique Psychosurgery, in which fibres in the brain are severed; this technique is now used very rarely.
 The most common Nonorganic treatment is psychotherapy. Most psychotherapies conducted by psychiatrists are Psychodynamics in orientation - that is, they focus on internal psychic conflict and its resolution as a means of restoring mental health. The prototypical Psychodynamics therapy is psychoanalysis, which is aimed at untangling the sources of unconscious conflict in the past and restructuring the patient's personality. Psychoanalysis is the treatment in which the patient lies on a couch, with the psychoanalyst out of sight, and says whatever comes to mind. The patient relates dreams, fantasies, and memories, along with thoughts and feelings associated with them. The analyst helps the patient interpret these associations and the meaning of the patient's relationship to the analyst. Because it is lengthy and expensive, often several years in duration, classical psychoanalysis is now infrequently used.
 More common are shorter forms of psychotherapy that supplement psychoanalytic principles with other theoretical ideas and scientifically derived information. In these types of therapy, psychiatrists are more likely to give the patient advice and try to influence behaviour. Some use techniques derived from behaviour therapy, which is based on learning theory (although these methods are more commonly used by psychologists).
 Besides psychotherapy, the other major form of Nonorganic treatment used in psychiatry is milieu therapy. Usually carried out in psychiatric wards, milieu therapy directs social relations between patients and staff toward therapeutic ends. Ward activities, too, are planned to serve specific therapeutic goals.
 Overall, psychotherapy is relied on more heavily for the treatment of neuroses and other nonpsychotic conditions than it is for psychoses. In psychotic patients, who usually receive psychoactive drugs, psychotherapy is used to improve social and vocational functioning. Milieu therapy is limited to hospitalized patients. Increasingly, psychiatrists use a combination of organic and Nonorganic techniques for all patients, depending on their diagnosis and response to treatment.
 Bipolar Disorder, is consistent of a mental illness in which a person’s mood alternates between extreme mania and depression, even that Bipolar disorder is also called manic-depressive illness. When manic, people with bipolar disorder feel intensely elated, self-important, energetic, and irritable. When depressed, they experience painful sadness, negative thinking, and indifference to things that used to bring them happiness.
 Bipolar disorder is much less common than depression. In North America and Europe, about 1 percent of people experience bipolar disorder during their lives. Rates of bipolar disorder are similar throughout the world. In comparison, at least 8 percent of people experience serious depression during their lives. Bipolar disorder affects men and women about equally and is somewhat more common in higher socioeconomic classes. At least 15 percent of people with bipolar disorder commit suicide. This rate roughly equals the rate for people with major depression, the most severe form of depression.
 Bipolar disorder is a mental illness that causes mood swings. In the manic phase, a person might feel ecstatic, self-important, and energetic. But when the person becomes depressed, the mood shifts to extreme sadness, negative thinking, and apathy. Some studies indicate that the disease occurs at unusually high rates in creative people, such as artists, writers, and musicians. But some researchers contend that the methodology of these studies was flawed and their results were misleading. In the October 1996 Discover magazine article, anthropologist Jo Ann C. Gutin presents the results of several studies that explore the link between creativity and mental illness.
 Bipolar disorder usually begins in a person’s late teens or 20's. Men usually experience mania as the first mood episode, whereas women typically experience depression first. Episodes of mania and depression usually last from several weeks to several months. On average, people with untreated bipolar disorder experience four episodes of mania or depression throughout any ten-year period, that many people with bipolar disorder function normally between episodes. In “rapid-cycling” bipolar disorder, however, which represents 5 to 15 percent of all cases, a person experiences four or more mood episodes within a year and may have little or no normal functioning in between episodes. In rare cases, swings between mania and depression occur over a period of days.
 In another type of bipolar disorder, a person experiences major depression and hypomanic episodes, or episodes of milder mania. In a related disorder called cyclothymic disorder, a person’s mood alternates between mild depression and mild mania. Some people with cyclothymic disorder later develop full-blown bipolar disorder. Bipolar disorder may also follow a seasonal pattern, with a person typically experiencing depression in the fall and winter and mania in the spring or summer.
 People, encompassed within the depressive point of bipolar disorder, experience the intensely sad or profoundly transferring formation showing the indifference to work, activities, and people that once brought them pleasure. They think slowly, concentrate poorly, feel tired, and experience changes - usually an increase - in their appetite and sleep. They often feel a sense of worthlessness or helplessness. In addition, they may feel pessimistic or hopeless about the future and may think about or attempt suicide. In some cases of severe depression, people may experience psychotic symptoms, such as delusions (false beliefs) or hallucinations (false sensory perceptions).
 In the manic phase of bipolar disorder, people feel intensely and inappropriately happy, self-important, and irritable. In this highly energized state they sleep less, have racing thoughts, and talk in rapid-fire speech that goes off in many directions. They have inflated self-esteem and confidence and may even have delusions of grandeur. Mania may make people impatient and abrasive, and when frustrated, physically abusive. They often behave in socially inappropriate ways, think irrationally, and show impaired judgment. For example, they may take aeroplane trips all over the country, make indecent sexual advances, and formulate grandiose plans involving indiscriminate investments of money. The self-destructive behaviour of mania includes excessive gambling, buying outrageously expensive gifts, abusing alcohol or other drugs, and provoking confrontations with obnoxious or combative behaviour.
 Clinical depression is one of the most common forms of mental illness. Although depression can be treated with psychotherapy, many scientists believe there are biological causes for the disease. The June 1998 article which is contained in the Scientific American issue, which Neurobiologist Charles B. Nemeroff discusses the connection between biochemical changes in the brain and depression.
 The genes that a person inherits seem to have a strong influence on whether the person will develop bipolar disorder. Studies of twins provide evidence for this genetic influence. Among genetically identical twins where one twin has bipolar disorder, the other twin has the disorder in more than 70 percent of cases. But among pairs of fraternal twins, who have about half their genes in common, both twins have bipolar disorder in less than 15 percent of cases in which one twin has the disorder. The degree of genetic similarity seems to account for the difference between identical and fraternal twins. Further evidence for a genetic influence comes from studies of adopted children with bipolar disorder. These studies show that biological relatives of the children have a higher incidence of bipolar disorder than do people in the general population. Thus, bipolar disorder seems to run in families for genetic reasons.
 Owing or relating to, or affecting a particular  person, over which a personal allegiance about the concerns and considerations or work-related stress can trigger a manic episode, but this usually occurs in people with genetic vulnerabilities, other factors - such as prenatal development, childhood experiences, and social conditions - seem to have relatively little influence in causing bipolar disorder. One study examined the children of identical twins in which only one member of each pair of twins had bipolar disorder. The study found that regardless of whether the parent had bipolar disorder or not, all of the children had the same high 10-percent rate of bipolar disorder. This observation clearly suggests that risk for bipolar illness come from genetic influence, not from exposure to a parent’s bipolar illness or from family problems caused by that illness.
 Different therapies may shorten, delay, or even prevent the extreme moods caused by bipolar disorder. Lithium carbonate, a natural mineral salt, can help control both mania and depression in bipolar disorder. The drug generally takes two to three weeks to become effective. People with bipolar disorder may take lithium during periods of relatively normal mood to delay or prevent subsequent episodes of mania or depression. Common side effects of lithium include nausea, increased thirst and urination, vertigo, loss of appetite, and muscle weakness. In addition, long-term use can impair functioning of the kidneys. For this reason, doctors do not prescribe lithium to bipolar patients with kidney disease. Many people find the side effects so unpleasant that they stop taking the medication, which often results in relapse.
 From 20 to 40 percent of people do not respond to lithium therapy. For these people, two anticonvulsant drugs may help dampen severe manic episodes: carbamazepine (Tegretol) and valproate (Depakene). The use of traditional antidepressants to treat bipolar disorder carries risks of triggering a manic episode or a rapid-cycling pattern.
 A psychiatrist is a doctor of medicine who has had four years of postgraduate training in psychiatry. Many psychiatrists take further training in psychoanalysis, child psychiatry, or other subspecialties. Psychiatrists treat patients in private practice, in general hospitals, or in specialized facilities for the mentally ill (psychiatric hospitals, outpatient clinics, or community mental health centres). Some spend part or all of their time doing research or administering mental health programs. By contrast, psychologists, who often work closely with psychiatrists and treat many of the same kinds of patients, are not trained in medicine; consequently, they neither diagnose physical illness nor administer drugs.
 The province of psychiatry is unusually broad for a medical specialty. Mental disorders may affect most aspects of a patient's life, including physical functioning, behaviour, emotions, thought, perception, interpersonal relationships, sexuality, work, and play. These disorders are caused by a poorly understood combination of biological, psychological, and social determinants. Psychiatry's task is to account for the diverse sources and manifestations of mental illness.
 Physicians in the Western world began specializing in the treatment of the mentally ill in the 19th century. Known as alienists, psychiatrists of that era worked in large asylums, practising what was then called moral treatment, a humane approach aimed at quieting mental turmoil and restoring reason. During the second half of the century, psychiatrists abandoned this mode of treatment and, with it, the tacit recognition that mental illness is caused by both psychological and social influences. For a while, their attention focussed almost exclusively on biological factors. Drugs and other forms of somatic (physical) treatments were common. The German psychiatrist Emil Kraepelin identified and classified mental disorders into a system that is the foundation for modern diagnostic practices. Another important figure was the Swiss psychiatrist Eugen Bleuler, who coined the word schizophrenia and described its characteristics.
 The discovery of unconscious sources of behaviour - an insight dominated by the psychoanalytic writings of Sigmund Freud in the early 20th century - enriched psychiatric thought and changed the direction of its practice. Attention shifted to processes within the individual psyche, and psychoanalysis came to be regarded as the preferred mode of treatment for most mental disorders. In the 1940s and 1950s emphasis shifted again: this time to the social and physical environment. Many psychiatrists had all but ignored biological influences, but others were studying those involved in mental illness and were using somatic forms of treatment such as electroconvulsive therapy (electric shock) and Psychosurgery.
 Dramatic changes in the treatment of the mentally ill in the United States began in the mid-1950's with the introduction of the first effective drugs for treating psychotic symptoms. Along with drug treatment, new, more liberal and humane policies and treatment strategies were introduced into mental hospitals. Often patients were treated in community settings in the 1960s and 1970s. Support for mental health research led to significant new discoveries, especially in the understanding of genetic and biochemical determinants in mental illness and the functioning of the brain. Thus, by the 1980s, psychiatry had once again shifted in emphasis to the biological, to the relative neglect of psychosocial influences in mental health and illness.
 Psychiatrists use a variety of methods to detect specific disorders in their patients. The most fundamental is the psychiatric interview, during which the patient's psychiatric history is taken and mental status is evaluated. The psychiatric history is a picture of the patient's personality characteristics, relationships with others, and past and present experience with psychiatric problems - all told in the patient's words (sometimes supplemented by comments from other family members). Psychiatrists use mental-status examinations much as internists use physical examinations. They elicit and classify aspects of the patient's mental functioning.
 Some diagnostic methods rely on testing by other specialists. Psychologists administer intelligence and personality tests, as well as tests designed to detect damage to the brain or other parts of the central nervous system. Neurologists also test psychiatric patients for evidence of impairment of the nervous system. Other physicians sometimes examine patients who complain of physical symptoms. Psychiatric social workers explore family and community problems. The psychiatrist integrates all this information in making a diagnosis according to criteria established by the psychiatric profession.
 Psychotropic drugs are by far the most commonly used organic treatment. The first to be discovered were the antipsychotics, used primarily to treat schizophrenia. The phenothiazine is the most frequently prescribed class of Antipsychotic drugs. Others are the thioxanthenes, butyrophenones, and indoles. All Antipsychotic drugs diminish such symptoms as delusions, hallucinations, and thought disorder. Because they can reduce agitation, they are sometimes used to control manic excitement in manic-depressive patients and to calm geriatric patients. Some childhood behaviour disorders respond to these drugs.
 The general goal of Gestalt therapy is awareness of self, others, and the environment that bring about growth, wholeness, and integration of one’s thoughts, feelings, and actions. Gestalt therapists use a wide variety of techniques to make clients more aware of themselves, and they often invent or experiment with techniques that might help to accomplish this goal. One of the best-known Gestalt techniques is the empty-chair technique, in which an empty chair represents another person or another part of the client’s self. For example, if a client is angry with herself for not being kinder to her mother, the client may pretend her mother is sitting in an empty chair. The client may then express her feelings by speaking in the direction of the chair. Alternatively, the client might play the role of the understanding daughter while sitting in one chair and the angry daughter while sitting in another. As she talks to different parts of herself, differences may be resolved. The empty-chair technique reflects Gestalt therapy’s strong emphasis on dealing with problems in the present.
 Behavioural therapies differ dramatically from Psychodynamics and humanistic therapies. Behavioural therapists do not explore an individual’s thoughts, feelings, dreams, or past experiences. Rather, they focus on the behaviour that is causing distress for their clients. They believe that behaviour of all kinds, both normal and abnormal, is the product of learning. By applying the principles of learning, they help individuals replace distressing behaviours with more appropriate ones.
 Typical problems treated with behavioural therapy include alcohol or drug addiction, phobias (such as a fear of heights), and anxiety. Modern behavioural therapists work with other problems, such as depression, by having clients develop specific behavioural goals - such as returning to work, talking with others, or cooking a meal. Because behavioural therapy can work through nonverbal means, it can also help people who would not respond to other forms of therapy. For example, behavioural therapists can teach social and self-care skills to children with severe learning disabilities and to individuals with schizophrenia who are out of touch with reality.
 Some researchers suggest that all therapies share certain qualities, and that these qualities account for the similar effectiveness of therapies despite quite different techniques. For instance, all therapies offer people hope for recovery. People who begin therapy often expect that therapy will help them, and this expectation alone may lead to some improvement (a phenomenon known as the placebo effect). Also, people in psychotherapy may find that simply being able to talk freely and openly about their problems helps them to feel better. Finally, the support, encouragement, and cared about, that clients feel from their therapist let them know they are care about and respected, which may positively affect their mental health.
 Although different therapeutic approaches may be equally effective on average, mental health researchers agree that some types of therapy are best for particular problems. For panic disorder and phobias, behavioural and cognitive-behavioural therapies seem most effective. Behavioural techniques, often in combination with medication, are also an effective treatment for obsessive-compulsive disorder, post-traumatic stress disorder, generalized anxiety disorder, and sexual dysfunction. Cognitive-behavioural, Psychodynamics, and humanistic approaches all provide moderate relief from depression.
 Mental health professionals agree that the effectiveness of therapy depends to a large extent on the quality of the relationship between the client and therapist. Usually, the better the rapport is between therapist and client, the better the outcome of therapy. If a person does not trust a therapist enough to describe deeply personal problems, the therapist will have trouble helping the person change and improve, and for clients, trusting that the therapist can provide help for their problems is essential for making progress.
 The founder of person-centred therapy, Carl Rogers, believed that the most important qualities in a therapist are being genuine, accepting, and empathic. Almost all therapists today would agree that these qualities are important. Being genuine means that therapists care for the client and behave toward the client as they really feel. Being to the acceptable for which of a hidden nature means that the therapists should appreciate clients for what they are, despite the things that they may have situationally done, or have in becoming to their circumstantial cause. Therapists do not have to agree with clients, but they must accept them. Being empathic means that therapists understand the client’s feelings and experiences and convey this understanding to the client.
 In helping their clients, all therapists follow a code of ethics. First, all therapy is confidential. Therapists notify others of a client’s disclosures only in exceptional cases, such as when children disclose abuse by parents, parents disclose abuse of children, or clients disclose an intention to harm themselves or others. Also, therapists avoid dual relationships with clients - that is, being friends outside of therapy or maintaining a business relationship. Such relationships may reduce the therapist’s objectivity and ability to work with the client. Ethical therapists also do not engage in sexual relationships with clients, and do not accept as clients people with whom they have been sexually intimate.
 As more immigrants to the United States and Canada have entered therapy, psychotherapists and Counsellors have learned the importance of taking a client’s cultural background into account when assessing the problem and determining treatment. Scholars recognize that most psychotherapies are based on Western systems of psychology, which stress the desirability of individualism and independence. However, cultures of Asia and other regions commonly emphasize different values, such as conformity, dependency on others, and obeying one’s parents. Thus, techniques that might be effective for someone from North America, Europe, or Australia might be inappropriate for a recent immigrant from Vietnam, Japan, or India. In order to provide effective treatment, therapists must be aware of their own cultural biases and become familiar with their client’s ethnic and cultural background.
 Anxiety, is the emotional state in which people feel uneasy, apprehensive, or fearful. People usually experience anxiety about events they cannot control or predict, or about events that seem threatening or dangerous. For example, students taking an important test may feel anxious because they cannot predict the test questions or feel certain of a good grade. People often use the word’s fear and anxiety to describe the same thing. Fear also describes a reaction to immediate danger characterized by a strong desire to escape the situation.
 The physical symptoms of anxiety reflect chronic “readiness” to deal with some future threat. These symptoms may include fidgeting, muscle tension, sleeping problems, and headaches. Higher levels of anxiety may produce such symptoms as rapid heartbeat, sweating, increased blood pressure, nausea, and dizziness.
 All people experience anxiety to some degree. Most people feel anxious when faced with a new situation, such as a first date, or when trying to do something well, such as give a public speech. A mild to moderate amount of anxiety in these situations is normal and even beneficial. Anxiety can motivate people to prepare for an upcoming event and can help keep them focussed on the task at hand.
 However, too little anxiety or too much anxiety can cause problems. Individuals who feel no anxiety when faced with an important situation may lack alertness and focus. On the other hand, individuals who experience an abnormally high amount of anxiety often feel overwhelmed, immobilized, and unable to accomplish the task at hand. People with too much anxiety often suffer from one of the anxiety disorders, a group of mental illnesses, in fact, more people experience anxiety disorders than any other type of mental illness. A survey of people aged 15 to 54 in the United States found that about 17 percent of this population suffers from an anxiety disorder during any given year.
 The Foundation of the Diagnostic and Statistical Manual of Mental Disorders, a handbook for mental health professionals, describes a variety of anxiety disorders. These include generalized anxiety disorder, phobias, panic disorder, obsessive-compulsive disorder, and post-traumatic stress disorder.
 People with generalized anxiety disorder feel anxious most of the time. They worry excessively about routine events or circumstances in their lives. Their worries often relate to finances, family, personal health, and relationships with others. Although they recognize their anxiety as irrational or out of proportion to actual events, they feel unable to control their worrying. For example, they may worry uncontrollably and intensely about money despite evidence that their financial situation is stable. Children with this disorder typically worry about their performance at school or about catastrophic events, such as tornadoes, earthquakes, and nuclear war.
 People with generalized anxiety disorder often find that their worries interfere with their ability to function at work or concentrate on tasks. Physical symptoms, such as disturbed sleep, irritability, muscle aches, and tension, may accompany the anxiety. To receive a diagnosis of this disorder, individuals must have experienced its symptoms for at least six months.
 Generalized anxiety disorder affects about 3 percent of people in the general population in any given year. From 55 to 66 percent of people with this disorder are female.
 A phobia is an excessive, enduring fear of clearly defined objects or situations that interferes with a person’s normal functioning. Although they know their fear is irrational, people with phobias always try to avoid the source of their fear. Common phobias include fear of heights (acrophobia), fear of enclosed places (claustrophobia), fear of insects, snakes, or other animals, and fear of air travel. Social phobias involve a fear of performing, of critical evaluation, or of being embarrassed in front of other people.
 Panic is an intense, overpowering surge of fear. People with panic disorder experience panic attacks - periods of quickly escalating, intense fear and discomfort accompanied by such physical symptoms as rapid heartbeat, trembling, shortness of breath, dizziness, and nausea. Because people with this disorder cannot predict when these attacks will strike, they develop anxiety about having additional panic attacks and may limit their activities outside the home.
 In obsessive-compulsive disorder, people persistently experience certain intrusive thoughts or images (obsessions) or feel compelled to perform certain behaviours (compulsions). Obsessions may include unwanted thoughts about inadvertently poisoning others or injuring a pedestrian while driving. Common compulsions include repetitive hand washing or such mental acts as repeated counting. People with this disorder often perform compulsions to reduce the anxiety produced by their obsessions. The obsessions and compulsions significantly interfere with their ability to function and may consume a great deal of time.
 Post-traumatic stress disorder sometimes occurs after people experience traumatic or catastrophic events, such as physical or sexual assaults, natural disasters, accidents, and wars. People with this disorder relive the traumatic event through recurrent dreams or intrusive memories called flashbacks. They avoid things or places associated with the trauma and may feel emotionally detached or estranged from others. Other symptoms may include difficulty sleeping, irritability, and trouble concentrating.
 Most anxiety disorders do not have an obvious cause. They result from a combination of biological, psychological, and social factors.
 Studies suggest that anxiety disorders run in families. That is, children and close relatives of people with disorders are more likely than most to develop anxiety disorders. Some people may inherit genes that make them particularly vulnerable to anxiety. These genes do not necessarily cause people to be anxious, but the genes may increase the risk of anxiety disorders when certain psychological and social factors are also present.
 Anxiety also appears to be related to certain brain functions. Chemicals in the brain called neurotransmitters enable neurons, or brain cells, to communicate with other. One neurotransmitter, gamma-amino butyric acid (GABA), appears to play a role in regulating one’s level of anxiety. Lower levels of GABA are associated with higher levels of anxiety. Some studies suggest that the neurotransmitter’s norepinephrine and serotonin play a role in panic disorder.
 Psychologists have proposed a variety of models to explain anxiety. Austrian psychoanalyst Sigmund Freud suggested that anxiety result from internal, unconscious conflicts. He believed that a person’s mind represses wishes and fantasies about which the person feels uncomfortable. This repression, Freud believed, results in anxiety disorders, which he called neuroses.
 More recently, behavioural researchers have challenged Freud’s model of anxiety. They believe one’s anxiety level relates to how much a person believes events can be predicted or controlled. Children who have little control over events, perhaps because of overprotective parents, may have little confidence in their ability to handle problems as adults. This lack of confidence can lead to increased anxiety.
 Behavioural theorists also believe that children may learn anxiety from a role model, such as a parent. By observing their parent’s anxious response to difficult situations, the child may learn a similar anxious response. A child may also learn anxiety as a conditioned response. For example, an infant often startled by a loud noise while playing with a toy may become anxious just at the sight of the toy. Some experts suggest that people with a high level of anxiety misinterpret normal events as threatening. For instance, they may believe their rapid heartbeat indicates they are experiencing a panic attack when in reality it may be the result of exercise.
 While some people may be biologically and psychologically predisposed to feel anxious, most anxiety is triggered by social factors. Many people feel anxious in response to stress, such as a divorce, starting a new job, or moving. Also, how a person expresses anxiety appears to be shaped by social factors. For example, many cultures accept the expression of anxiety and emotion in women, but expect more reserved emotional displays from men.
 Mental health professionals use a variety of methods to help people overcome anxiety disorders. These include psychoactive drugs and psychotherapy, particularly behaviour therapy. Other techniques, such as exercise, hypnosis, meditation, and biofeedback, may also prove helpful.
 Psychiatrists often prescribe benzodiazepines, a group of tranquillizing drugs, to reduce anxiety in people with high levels of anxiety. Benzodiazepines help to reduce anxiety by stimulating the GABA neurotransmitter system. Common benzodiazepines include alprazolam (Xanax), clonazepam (Klonopin), and diazepam (Valium). Two classes of antidepressant drugs—tricyclics and selective serotonin reuptake inhibitors (SSRIs) - also have proven effective in treating certain anxiety disorders.
 Benzodiazepines can work quickly with few unpleasant side effects, but they can also be addictive. In addition, benzodiazepines can slow or impair motor behaviour or thinking and must be used with caution, particularly in elderly persons. SSRIs take longer to work than the benzodiazepines but are not addictive. Some people experience anxiety symptoms again when they stop taking the medications.
 Therapists who attribute the cause of anxiety to unconscious, internal conflicts may use psychoanalysis to assist in filling the ‘gap’ with which people and their added  understanding and resolve their conflicts, other types of psychotherapy, such as cognitive-behavioural therapy, have proven effective in treating anxiety disorders. In cognitive-behavioural therapy, the therapist often educates the person about the nature of their particular anxiety disorder. Then, the therapist may help the person challenge, but irrational thoughts that lead to anxiety. For example, to treat a person with a snake phobia, a therapist might gradually expose the person to snakes, beginning with pictures of snakes and progressing to rubber snakes and real snakes. The patient can use relaxation techniques acquired in therapy to overcome the fear of snakes.
 Research has shown psychotherapy to be as effective or more effective than medications in treating many anxiety disorders. Psychotherapy may also provide more lasting benefits than medications when patients discontinue treatment.
 Unconscious, in psychology, hypothetical region of the mind containing wishes, memories, fears, feelings, and ideas that are prevented from expression in conscious awareness. They manifest themselves, instead, by their influence on conscious processes and, most strikingly, by such anomalous phenomena as dreams and neurotic symptoms. Not all mental activity of which the subject is unaware belongs to the unconscious; for example, thoughts that may be made conscious by a new focussing of attention are termed foreconscious or preconscious.
 The concept of the unconscious was first developed in the period from 1895 to 1900 by Sigmund Freud, who theorized that it consists of survivals of feelings experienced during infantile life, including both instinctual drives or libido and their modifications by the development of the superego. According to the Swiss psychoanalyst Carl Jung, the unconscious also consists of a racial unconscious that contains certain inherited, universal, archaic fantasies belonging to what Jung termed the collective unconscious.
 A defining understanding of the states of consciousness is not at all simple, is agreed-upon definition of consciousness exists. Attempted definitions tend to be tautological (for example, consciousness defined as awareness) or merely descriptive (for example, consciousness described as sensations, thoughts, or feelings). Despite this problem of definition, the subject of consciousness has had a remarkable history. At one time the primary subject matter of psychology, consciousness as an area of study, that the idea that something conveys to the mind, from which of critics has endlessly debated the meaning of the ascribing interactions that otherwise to ascertain the quality, mass, extent or degree of terminological statements that its standard unit or mixed distributive analysis, is such, that a conceptualized form of its reasons to posit of a direct interpretation whose interference became of the total demise, even so, there is the  result reemerging to become a topic of current interests.
 Most of the philosophical discussions of consciousness arose from the mind-body issues posed by the French philosopher and mathematician René Descartes in the 17th century. Descartes asked: Is the mind, or consciousness, independent of matter? Is consciousness extended (physical) or unextended (nonphysical)? Is consciousness determinative, or is it determined? English philosophers such as John Locke equated consciousness with physical sensations and the information they provide, whereas European philosophers such as Gottfried Wilhelm Leibniz and Immanuel Kant gave a more central and active role to consciousness.
 The philosopher who most directly influenced subsequent exploration of the subject of consciousness was the 19th-century German educator Johann Friedrich Herbart, who wrote that ideas had quality and intensity and that they may suppress  or may facilitate or place of one another. Thus, ideas may pass from “states of reality” (consciousness) to “states of tendency” (unconsciousness), with the dividing line between the two states being described as the threshold of consciousness. This formulation of Herbart clearly presages the development, by the German psychologist and physiologist Gustav Theodor Fechner, of the psychophysical measurement of sensation thresholds, and the later development by Sigmund Freud of the concept of the unconscious.
 The experimental analysis of consciousness dates from 1879, when the German psychologist Wilhelm Max Wundt started his research laboratory. For Wundt, the task of psychology was the study of the structure of consciousness, which extended well beyond sensations and included feelings, images, memory, attention, duration, and movement. Because early interest focussed on the content and dynamics of consciousness, it is not surprising that the central methodology of such studies was introspection; that is, subjects reported on the mental contents of their own consciousness. This introspective approach was developed most fully by the American psychologist Edward Bradford Titchener at Cornell University. Setting his task as that of describing the structure of the mind, Titchener attempted to detail, from introspective self-reports, the dimensions of the elements of consciousness. For example, taste was “dimensionalized” into four basic categories: sweet, sour, salt, and bitter. This approach was known as structuralism.
 By the 1920's, however, a remarkable revolution had occurred in psychology that was to essentially remove considerations of consciousness from psychological research for some 50 years: Behaviourism captured the field of psychology. The main initiator of this movement was the American psychologist John Broadus Watson. In a 1913 article, Watson stated, “I believe that we can write of some psychology and never use the term’s consciousness, mental states, mind . . . imagery and the like.” Psychologists then turned almost exclusively to behaviour, as described in terms of stimulus and response, and consciousness was totally bypassed as a subject. A survey of eight leading introductory psychology texts published between 1930 and the 1950's found no mention of the topic of consciousness in five texts, and in two it was treated as a historical curiosity.
 Beginning in the later part of the 1950s, are, however, the grounded interests in the foundational subject of consciousness, for returning from its absence were subjects and techniques relating to altered states of consciousness: sleep and dreams, meditation, biofeedback, hypnosis, and drug-induced states. Much in the surge in sleep and dream research was directly fuelled by a discovery relevant to the nature of consciousness. A physiological indicator of the dream state was found: At roughly 90-minute intervals, the eyes of sleepers were observed to move rapidly, and at the same time the sleepers' brain waves would show a pattern resembling the waking state. When people were awakened during these periods of rapid eye movement, they almost always reported dreams, whereas if awakened at other times they did not. This and other research clearly indicated that sleep, once considered a passive state, were instead an active state of consciousness.
 American psychiatrist William Glasser developed reality therapy in the 1960s, after working with teenage girls in a correctional institution and observing work with severely disturbed schizophrenic patients in a mental hospital. He observed that psychoanalysis did not help many of his patients change their behaviour, even when they understood the sources of it. Glasser felt it was important to help individuals take responsibility for their own lives and to blame others less. Largely because of this emphasis on personal responsibility, his approach has found widespread acceptance among drugs - and alcohol-abuse counsellor’s, correction’s workers, school counsellors, and those working with clients who may be disruptive to others.
 Reality therapy is based on the premise that all human behaviour is motivated by fundamental needs and specific wants. The reality therapist first seeks to establish a friendly, trusting relationship with clients in which they can express their needs and wants. Then the therapist helps clients explore the behaviours that created problems for them. Clients are encouraged to examine the consequences of their behaviour and to evaluate how well their behaviour helped them fulfill their wants. The therapist does not accept excuses from clients. Finally, the therapist helps the client formulate a concrete plan of action to change certain behaviours, based on the client’s own goals and ability to make choices.
 During the 1960's, an increased search for “higher levels” of consciousness through meditation resulted in a growing interest in the practices of Zen Buddhism and Yoga from Eastern cultures. A full flowering of this movement in the United States was seen in the development of training programs, such as Transcendental Meditation, that were self-directed procedures of physical relaxation and focussed attention. Biofeedback techniques also were developed to bring body systems involving factors such as blood pressure or temperature under voluntary control by providing feedback from the body, so that subjects could learn to control their responses. For example, researchers found that persons could control their brain-wave patterns to some extent, particularly the so-called alpha rhythms generally associated with a relaxed, meditative state. This finding was especially relevant to those interested in consciousness and meditation, and a number of “alpha training” programs emerged.
 Another subject that led to increased interest in altered states of consciousness was hypnosis, which involves a transfer of conscious control from the character interpretation belonging in the dependent sector,  whose occasions, as basic of an idea or the principal object of attention, in the course of its immediate composition, and like the substance to a particular individual finds to the subject that the modification as when of transferring to that of another person. Hypnotism has had a long and intricate history in medicine and folklore and has been intensively studied by psychologists. Much has become known about the hypnotic state, relative to individual suggestibility and personality traits; the subject has now been largely demythologized, and the limitations of the hypnotic state are fairly well known. Despite the increasing use of hypnosis, however, much remains to be learned about this unusual state of focussed attention.
 Finally, many people in the 1960's experimented with the psychoactive drugs known as hallucinogens, which produce deranging disorder of consciousness. The most prominent of these drugs is lysergic acid diethylamide, or LSD; mescaline; and psilocybin; the latter two have long been associated with religious ceremonies in various cultures. LSD, because of its radical thought-modifying properties, was initially explored for its so-called mind-expanding potential and for its psychotomimetic effects (imitating psychoses). Little positive use, however, has been found for these drugs, and their use is highly restricted.
 Scientists have long considered the nature of consciousness without producing a fully satisfactory definition. In the early 20th century American philosopher and psychologist William James suggested that consciousness be a mental process involving both attention to external stimuli and short-term memory. Later scientific explorations of consciousness mostly expanded upon James’s work. In the article from a 1997 special issue of Scientific American, Nobel laureate Francis Crick, who helped determine the structure of DNA, and fellow biophysicist Christof Koch explains how experiments on vision might deepen our understanding of consciousness.
 As the concept of a direct, simple linkage between environment and behaviour became unsatisfactory in recent decades, the interest in altered states of consciousness may be taken as a visible sign of renewed interest in the topic of consciousness. That persons are active and intervening participants in their behaviour has become increasingly clear. Environments, rewards, and punishments are not simply defined by their physical character. Memories are organized, not simply stored, an entirely new area called cognitive psychology has emerged that centre on these concerns. In the study of children, increased attention is being paid to how they understand, or perceive, the world at different ages. In the field of animal behaviour, researchers increasingly emphasize the inherent characteristics resulting from the way a species has been shaped to respond adaptively to the environment. Humanistic psychologists, with a concern for self-actualization and growth, have emerged after a long period of silence. Throughout the development of clinical and industrial psychology, the conscious states of persons in terms of their current feelings and thoughts were of obvious importance. The role of consciousness, however, was often de-emphasised in favour of unconscious needs and motivations. Trends can be seen, however, toward a new emphasis on the nature of states of consciousness.
 We have used the term ‘transference’ several times, in that we attributed the therapeutic results to the transference without further definition of the word. We will now consider more closely the emotional relationship that is thus designed. During a psychoanalytic treatment, the patient allows the analyst to play a predominating role in his emotional life. This is of great importance in the analytic process. After his treatment is over, this situation is changed. The patient builds up feelings of affection for and resistance to his analyst that, in their ebb and flow, so exceed the normal degree of feeling that the phenomenon has long attracted the theoretical interest of the analyst. Freud studied this phenomenon thoroughly, explained it, and gave it the name ‘transference’, we most probably will understand the significance of the transference phenomenon impressed Freud so profoundly that he continued through the years to develop his ideas about it.
 In all afforded efforts, to refuse to consider the demise of forebears as too merely disdain, that we cannot reproduce of all Freud’s research about transference but for an instance of obligation, would be used to indicate the requirement by the immediate need or purpose upon such condition that might  point beyond a normal or acceptable limit, as to an excessive amount of  which something does not or cannot extend to their essentials. When we speak of the transference in connexion with social reeducation, we mean the emotional responses of the education or counsellor or therapist, as the case maybe, without meaning that it takes place in the same way as in an analysis. The ‘countertransference‘ is emotional aptitude of the teacher toward the pupil, the counsellor toward his charge, the therapist toward the patient. The feeling that the child develop for the mentor is conditioned by a much earlier relationship to someone else. We must take cognisance of this fact in order to understand these relationships. The tender relationships that go to up the child’s love life are no longer strange to us. Many of these have already been touched upon in the foregoing literature. We have learned how the small boy takes the father and mother as love objects. We have followed the strivings that arise out of this relationship, the Oedipus situation, we have seen how this runs its course and terminates in an identification with the parents. We have also had opportunity to consider the relationship between brothers and sisters, how their original rivalry is transformed into affection through the pressure of their feeling for the parents. We know that the boy at puberty must give up his first love object within the family and transfers his libido to individuals outside the family.
 Our present purpose is to consider the effects of these first experiences from a certain angle. The child’s attachment to the family, the continuance and the subsequent dissolution of these love relationships within the family, not only leave a deep effect on the child through the resulting identifications, they determine at the same the actual forms of this love relationships in the future. Freud compares these forms, without implying too great a rigidity, to copper plates for engraving. He has shown that in the emotional relationships of our later life we can do nothing but make an imprint from one or another of these patterns that we have established in early childhood.
 Why Freud chose the term ‘transference’ for the emotional relationship between patient and analyst is easy to understand, of course, feelings that arose long ago in another situation are transferred upon the analyst. To the counsellor of the child, the knowledge of the transference mechanism is indispensable. In order to influence the dissocial behaviour, he must bring his charge into the transference situation. The study of the transference in the dissocial child shows regularly a love life that has been disturbed in early childhood by a lack of affection or an undue amount of affection. A satisfactory social adjustment depends on certain conditions, among them an adequate constitutional endowment and early love relationships that have been confined within certain limits. Society determines these limitations, just as definitely as the later love life of an individual is determined by early form his libidinal development. The child develops normally and assumes his proper place in society, if he can cultivate within the privacy to such relationships as can favourably be carried over into the schools and from there into the ever-broadening world around him. His attitude toward his parents must be such that it can be carried over onto the teacher, and that toward his brothers and sisters must be transferred to his schoolmates. Every new contact, according to the degree of authority or maturity that the person represents, repeats a previous relationship with very little deviation. People whose early adjustment to succeed or supervene from such a normative course have no difficulties in their emotional relations with others, and they are able to form new ties, to deepen them, or to break them off without conflict when the situation demands it.
 We can easily see why an attempt to change the present order of society always meets with resistance and where the radical reformer will have to use the greatest leverage. Our attitude to society and its members has a certain standard form. It gets its imprint from the structure of the family and the emotional relationships set up within the family, therefore, the parents, especially the father, assume overwhelming responsibility for the social orientation of the child. The persistent, ineradicable libidinal relationships carried over from childhood are facts with which social reformers must reckon. If the family represents the best preparation for the present social order, which seems to be the case, then the introduction of a new order means that the family must be uprooted and replaced by a different personal world for the child. It is beyond our scope to attempt a solution of this question, which concerns those who strive to build up a new order of society. We are remedial educators and must recognize these sociological relationships. We can ally ourselves with whatever social system will, but we have the path of our present activity well marked out for us, to bring dissocial youth into the line with present-day society.
 If the child is harmed through too great disappointment or too great indulgence in his early life, he builds up reaction patterns that are damaged, incomplete, or too delicate to support the wear and tear of life. He is incapable of forming libidinal object relationships that are considered normal by society. His unpreparedness for life, his inability to regulate his conscious and unconscious libidinal striving and to confine his libidinal expectations within normal bounds, creates an insecurity in relation to his fellow men and constitute one of the first and most important condition’s fo r their development of delinquency. Following this point of view, we look for the primary causes of dissocial behaviour in early childhood, where the abnormal libidinal ties are established. The word ‘delinquency’ is an expression used to describe a relationship to people and things that are at variance with what society approve in the individual.
 It is not immediately clear, from which are pointed from the particular form of the delinquency, just what libidinal disturbances in childhood have given rise to the dissocial expression. Until we have a psychoanalytically construed scheme for the diagnosis of delinquency, we may content ourselves by separating these forms into two groups: (1) Borderline neurosis cases with dissocial symptoms, and (2) dissocial cases for which are in part, the ego giving to develop of the dissocial behaviour, and showing no trace of neurosis. In the first type, the individual finds himself in an inner conflict because of the nature of his love relationships, a part of his own personality forbids the indulgence of libidinal desires and strivings. The dissocial behaviour results from this conflict. In the second type, the individual finds himself in open conflict with his environment, because the outer world has frustrated his childish libidinal desires.
 The differences in the forms of dissocial behaviour are important for many reasons. At present, they are significant to us because of the various ways in which the transference is established in these two types, we know that with a normal child the transference takes place of itself through the kindly efforts of the responsible adult. The teacher in his attitude repeats the situations long familiarly to the child, and thereby evokes a parental relationship. He does not maintain this relationship at the same level, but continually deepens it as long as he is the parental substitute.
 When a neurotic child with symptoms of delinquency comes into the institution, the tendencies to transfer his attitude toward his parents to the persons in authority are immediately noticeable. The worker will adopt the same attitude toward the dissocial child as to the normal child, and bring him into positive transference, if he acts toward him in such a way as to prevent a repetition with the worker of the situation with the parents that led to the conflict. In psychoanalysis, on the other hand, it is of greatest importance to let this situation repeat itself. In a sense the worker becomes the father or the mother, but still not wholly so, he represents their claims, but in the right moment he must let the dissocial child know that he has insight into his difficulties and that he will not interpret the behaviour in the same way as do the parents. He will respond to the child’s feeling of a need for punishment, but he will not completely satisfy it.
 He will conduct in himself be entirely differently in the case of the child who in open conflict with society. In this instance he must take the child’s part, be in agreement with his behaviour, and in the severest cases even give the child to understand that in his place he would behave just the same way. The guilt feelings found so clearly in the neurotic cases with dissocial behaviour are present in these cases also. These feelings do not arise, however, from the dissocial ego, but have another source.
 Why does the educator conduct himself differently in dealing with this second type? These children, too, he must draw into a positive transference to him, but what is applicable and appropriate for a normal or a neurotic child would achieve opposite results. Otherwise the worker would bring upon himself all the hate and aggression that the child bears toward society, thus leading the child into a negative instead of positive transference, and creating a situation in which the child is not amenable to training.
 Nevertheless, what was said about psychoanalysis theory is only a bare outline, that much deeper study of the transference is necessary to anyone interested in re-educational work from the psychoanalytic point of view. The practical application of this theory is not easy, since we deal mostly with mixed types, such that the attitude of the counsellor cannot be as uniform as having enough verbal descriptions for evincing of individual forms of dissociated behaviour to enable us to offer detailed instructions about how to deal with them. At present our psychoanalytic knowledge is such that a correct procedure cannot be stated specifically for each and every dissocial individual.
 The necessity for bringing the child into a good relationship to his mentor is of prime importance. The worker cannot leave this to chance, he must deliberately achieve it and he must  face the fact thus no effective work is possible without it. It is important for him to grasp the psychic situation of the dissocial child in the very first contact he makes with him, because only this can be known in what attitude to adopt. There is a further difficulty in that the dissocial child takes pains to hide his real nature: He misrepresents himself and lies. This is to be taken for granted, it should not surprise or upset us. Dissocial children do not come to us of their own volition but are brought to us, very often with the threat, ‘You will soon find out what is going to happen to you.’ Generally parents resort our help only after every other means, including corporal punishment, have failed. To the child, we are only another form of punishment, an enemy against whom he must be on his guard, not a source of help to him. There is a great difference between this and the psychoanalytic situation, where the patient comes voluntarily for helping. To the dissocial child, we are a menace because we represent society, with which he is in conflict. He must protect himself against this terrible danger and be careful what he says in order not to give himself away. It is hard to make some of these delinquent children talk, remain unresponsive and stubborn. One thing they all have in common: They do not tell the truth. Some lie stupidly, pitiably, others, especially the older ones, show great skill and sophistication, as the extremely submissive child, the ‘wimp’, the very jovial, or the exaggeratedly effective, that with some particularly are hard to reach. This behaviour is so much to be expected that we are not surprised or disarmed by it, the inexperienced teacher or adviser is easily irritated, especially when the lies are transparent, but he must not let the child be aware of this. He must deal with the situation immediately without telling the child that he can see that coming through was warrantably attributive value about his attitudinal behaviours.
 There is nothing remarkable in the behaviour of the dissocial, but it differs only quantitatively from normal behaviour. We all hide our real selves and use a great deal of psychic energy to mislead our neighbours. We masquerade more or less, according to necessity. Most of us learn in the nursery the necessity of presenting ourselves in accordance with the environmental demands, and thus we consciously or unconsciously build up a shell around ourselves. Anyone who has had experience with young children must have noticed how they immediately begin to dissimulate when a grown-up comes into the room. Most children succeed in behaving in the manner that they think is expected of them. Thus they lessen the danger to themselves and at the same time they are casting the permanent moulds of their mannerisms and their behaviour. How many parents really bother themselves about the inner life of their children? Is this mask necessarily for life? I do not know, but it often seems that the person on whom childhood experiences have forced the dissocial individual masquerades to a greater extent, and more consciously, then the normal. He is only drawing logical deductions from his unfortunate disagreeable authority? Why should he be sincere with those people who represent disagreeable authority? This is an unfair demand.
 We must look further into the differences between the situation of social retraining and the analytic situation. The analyst expects to meet in his patient unconscious remittances that prevent him from being honest or make him silent: But the treatment is in vain when the patient lies persistently. Those who work with dissocial children expect to be lied to. To send this child away because he lies are only giving in to him. We must wait and hope to penetrate this mask that covers the really psychic situation. In the institution it does not matter if this is not achieved immediately, it means merely that the establishment of the transference is postponed. In the clinic, however, we must work more quickly. Taking with the patient does not always suffice, and we must introduce other remedial measures. Generally, we see the delinquent child, only, in at least as infrequent to a smattering of times, but we are forced to take some steps after the first few interviews, to formulate some tentative conception of the difficulty and to establish a positive transference as quickly as possible. This means we must get at least a peep behind the mask, if the child is not put in an institution, he remains in the old situation under the same influences that caused the trouble, in such cases we wish to establish the transference as quickly as possible, to intensify the child’s positive feelings for us that are aroused while the child is with us, and to bring them rapidly to such a pitch that they can no longer be easily disturbed by the old influences. To carry on such work successfully presupposes a long experience.
 Let us now, in violation of our theoretical concern and considerations and see how the analyst and the patient seek to grasp upon a try to solve situational thoughts for which the transference, and, moreover, its mask on which can be understood that feelings and a better understanding the differentiation that intentionality that allies with others and exclusively its need to achieve to some end.
 Even so, there are few current problems concerning the problem of transference that Freud did not recognize either implicitly or explicitly in the development of the theoretical and clinical framework. For all essential purposes, moreover, his formulations, in spite of certain shifts in emphasis, remain integral to contemporary psychoanalytic theory and practice. Recent developments mainly concern the impact of an ego-psychological approach, the significance of object relations, both current and infantile, external and internal, the role of aggression in mental life, and the part played by regression and the repetition compulsion in the transference. Nevertheless, analysis of the infantile Oedipal situation in the setting of a genuine transference neurosis is still considered as a primary goal of psychoanalytic procedure.
 Originally, transference was ascribed to displacement on the analyst of repressed wishes and fantasies derived from early childhood. The transference neurosis was viewed as a compromise formulation similar to dreams and other neurotic symptoms. Resistance, defined as the clinical manifestation of repression, could be diminished or abolished by interpretation mainly directed toward the content of the repressed. Transference resistance, both positive and negative, was inscribed to the threatened emergence of repressed unconscious material in the analytic situation. Presently, as with the development of a structural approach, the superego had been portrayed as the heir to the genital Oedipal situation, also was the recognition as playing a leading role in the transference situation. The analysis was subsequently viewed not only as the object by displacement of infantile incestuous fantasies, but also as the substitute by projection for the prohibiting parental figures that had been internalized as the definitive superego. The effect of transference interpretation in mitigating undue severity of the superego has, therefore, been emphasized in many discussions of the concept of transference.
 Certain expansions in the structural approach related increasingly to the recognition of the role that had earlier objective relations, in the development of the superego. This had affected the current concepts of transference, in that this connection, the significance of the analytic situation as a repetition of the early mother-child relationship has been stressed from different points for viewing to such equally important developments related to Freud’s revised concept of anxiety that can only lead to theoretical developments in the field of ego psychology. However, this brought about their related clinical changes in the work of many analysts. As a result, attention was no longer the main attraction that had focussed on the content of the unconscious. In addition, increasing importance was attributed to the defence processes by means of which the anxiety that would be engendered if repression and other related mechanisms were broken down, was avoided in the analytic situation. Differences in the interpretation of the role of the analyst and the nature of transference developed from emphasis, on the one hand, on the importance of early object relations, and on the other, from primary attention to the role of the ego and its defences. These defences first emerged clearly in discussion of the technique of child analysis, in which Melanie Klein and Anna Freud, the pioneers in the fields of thought as playing the leading roles.
 From a theoretical point of view, discussion foreshadowing the problems that face us today was presented in 1934 in a well-known paper by Richard Sterba and James Strachey, and further elaborated at the Marienbad Symposium at which Edward Bibring made an important contribution. The importance of identification with, or introjection of the analyst in the transference situation of identification with, or introjection of, the analysts in the transference situation were clearly indicated. The therapeutic results were attributed to the effect of this process In mitigating the need for pathological defences. Strachey, however, considerably influenced by the work of Melanie Klein, regarded transference as essentially a projection onto the analyst of the patient’s own superego. The therapeutic process was attributed to subsequent introjection of a modified superego as a result of ‘mutative’ transference. Sterba and Bibring, on the other hand, intimately involved with development of the ego-psychological approach, reemphasised the central role of the ego, postulating a therapeutic split and identification with the analyst as an essential feature of transference. To some extent, this difference of opinion may be regarded as semantic. If the superego is explicitly defined as the heir of the genital Oedipus conflict, then earlier intra systematic conflicts within the ego, although they may be related retrospectively to the definite superego, much, nevertheless, are defined as contained within the ego. Later divisions within the ego of the type indicated by Sterba and very much expanded by Edward Bibring in his concept of therapeutic alliance between the analyst and the healthy part of the patient’s ego, must also be excluded from superego significance. In contrast, those whom attribute pregenital intra-systemic conflicts within the ego primarily to the introjection of objects, consider that the resultant state of internal conflict appears like the dynamic idea that something conveys to the mind as having an endless meaning attached to the coherence of the therapeutic situation and seen in the later conflicts between ego and superego. They, therefore, believe that these structures developed simultaneously and suggest that no sharp distinction should be made between pre-oedipal, oedipal, and post-oedipal superego.
 The differences, however, are not entirely verbal, since those whom attribute superego formations to the early months of life tend to attribute significantly too early object relation that differs from the conception of those who stress control and, neutralization of instinctual energy as primary functions of the ego. This theoretical difference necessarily implies some disagreement as how the dynamic situation both in childhood and in adult life, inevitably reflected in the concept of transference and in hypotheses as to the hidden nature of the therapeutic process. From one point of view, the role of the ego is central and crucial at every phase of analysis. A differentiation is made between transference as therapeutic alliance and the transference neurosis, which, on the whole, is considered a manifestation of resistance. Effective analysis depends on a sound and stable therapeutic alliance, a prerequisite for which is the existence, before analysis, of a degree of mature superego functions, the absence of which in certain severely disturbed patients and in young children may preclude traditional psychoanalytic procedure. Whenever indicated, interpretation’s manifestations, which means, in effect, that the transference must be analysed. The process of analysis, however, is not exclusively ascribed to transference interpretation. Other interpretations of unconscious material, whether related to defence or to early fantasies, will be equally effective provided they are accurately timed and provide a satisfactory therapeutic alliance has been made. Those, in contrast, whom stress the importance of early object relations emphasizes the crucial role of transference as an object relationship, distorted though this may be of a variety of defences against primitively unresolved conflicts. The central role of the ego, both in the early stages of development and in the analytic process, are definitely accepted. The hidden nature of the ego is, however, considered at all times to be determined by its external and internal objects. Therapeutic process whose changes in ego function results, therefore, primarily from a change in object relations though interpretation of the transference situation, finds of less differentiation as made between transference as for being the therapeutic alliance and transference neurosis as a manifestation of resistance. Therapeutic progress depends almost exclusively on transference interpretation. Other interpretations, although at times, are not, in general, considered an essential feature of the analytic process. From this point of view, the preanalytic maturity of the patient’s ego is not stressed as considered potentially suitable for traditional psychoanalytic procedure.
 These differences in theoretical orientation are not only reflected in the approach to children and disturbed patients. They may also be recognized in significant variations of technique in respect to all clinical groups, which inevitably affect the opening phases, understanding of the inevitable regressive features of the transference neurosis, and handling of the germinal phases of analysis. By its emphasis as drawn on or upon the main problems, and, by contrast, rather than similarity, our efforts will be to avoid to detailed discussions of controversial theory regarding the hidden nature of early ego development by a somewhat arbitrary differentiation between those who relate ego analysis to the analysis of defences and those who stress the primary significance of object relations both in the transference, and in the development and definitive structure of the ego. Needless to say, this involves some oversimplification, where I hope that it may, at the same time, clarify certain important issues. To take, on or upon the analysis of patients we are generally agreeing to be suitable for classical analytic procedure, the transference neurosis. Those which emphasis the role of the ego and the analysis of defences, not only maintain Freud’s conviction that analysis should proceed from surface to depth, but also consider that early material in the analytic situation derives, that, in general, from defensive processes rather than from displacement onto the analyst of early instinctual fantasies, result of a deep transference interpretation in the early instinctual fantasies. Deep transference interpretation in the early phases of analysis will, therefore, rather be meaningless to the patient since its unconscious significance is so inaccessible, or, if the defences are precarious, will lead to premature and possibly intolerable anxiety. Premature interpretation of the equally unconscious automatic defensive processes by means of which instinctual fantasy kept unconscious is also ineffective and undesirable. There are, nonetheless, differences of opinion within this group, as to how far analysis of defence can be separated from analysis of content. Waelder, for example, has stressed the impossibility of such separation. Fenichel, however, considered that at least theoretical separation should be made and indicated that, as far as possible, analysis of defence should precede analysis of unconscious fantasy. It is, nevertheless, generally agreed that the transference neurosis develops, as a rule after ego defences have been sufficiently undermined to mobilize previously hidden instinctual conflict. During both the early stages of analysis, and at frequent points after development of the transference neurosis, defences against the transference will become a main feature of the analytic situation.
 This approach is based on certain definite premises regarding the hidden natures and function of the ego in respect to the control and neutralization of instinctual energy and unconscious fantasies, while the importance of early object relations is not neglected, the conviction that early transference interpretation is ineffective and potentially relations are not neglected, the conviction and unconscious fantasy. The conviction that early transference interpretation is ineffective and potentially dangerous is related to the hypothesis  that the instinctual energy available to the mature ego has been neutralized from unconscious fantasies, meaning at the beginning of analysis, for all effective purposes, relatively or absolutely divorced from its unconscious fantasy, as yet, there are a number of analysts of differing theoretical orientation of ego function from unconscious sources, but consider that unconscious fantasy continues to operate in all conscious mental activity. The analysts also are to construal a construction upon the whole of their existing in the emphasis to the crucial significance of primitive fantasies, in respect to the development of the transference situation. The individual entering analysis will inevitably have unconscious fantasies concerning the analyst derived from primitive sources. This material, although deep in a  sense, is, nevertheless, strongly current and accessible to interpretation. Klein, in addition, creates the development and definitive structure of the superego to unconscious fantasy determined by the earliest phases of object relationships. She emphasizes the role of early introjective and projective processes in relation to primitive anxiety ascribed to the death instinct and related aggression drive fantasies. The unresolved difficulties and conflict of the earliest period continue to colour object relations throughout life. Failure to achieve an essentially satisfactory object relationship in this early period, and failure to master relative loss of that object without retaining its good internal representative, will not only affect all object relations and definitive ego function, but more specifically determine the nature of anxiety-provoking fantasies on entering the analytic situation. According to this point of view, therefore, early transference uninterpreted, even thought it may relate to fantasies derived from an early period of life, should result not in an increase, but a decrease of anxiety
 In considering next problems of transference in relation to analysis of the transference neurosis, two main points must be kept in mind. First, as already indicated, those who emphasize the analysis of defence tend to make a definite differentiation between transference as therapeutic alliance and the transference neurosis as a compromise formation that serves the purposes of resistance. In contrast, those who emphasize the importance of early object relational view that the transference primarily as a revival or repetition, and sometimes attributed to symbolic processes of early struggles in respect to which it opposes by arguing against such objectifying evidences in the challenge that the language, in that mode is as much an unacceptable measure that of objectivity, but the exceptionable favour in the object is still there, moreover, that is to say, that there is no sharp differentiation made between the early manifestations of transference and the transference neurosis. In view, moreover, of the weight given to the role of unconscious fantasy and internal objects in every phase of mental life, healthy and pathological functions, though differing in essential respect, do not differ with regard to their direct dependence on unconscious sources.
 In the role of regression in the transference situation is subject to wide differences of opinion. It was, of course, one of Freud’s earliest discoveries that regression had of its earliest points of fixation, and is a cardinal feature, not only in the development of neurosis and psychosis, but also in the revival of earlier conflicts in the transference situation, is that which the development of psychoanalysis and its application to an ever increasing range of receptive and decreasing attentions, that  the significance of the analytic situation as a means of fostering regression as a prerequisite for the therapeutic work has been emphasized by Ida Macapline in a recent paper. Differing opinions as to the significance, value, and technical handling of regressive manifestoes from the basis of important modifications of analytic technique, are, however, considered in respect to the transference neurosis. The view recently expressed by Phyllis Greenacre, that regression, and indispensable features would be generally accepted. It is also a matter of generally based agreement that a prerequisite for successful analysis is revival and repetition in the analytic situation of the struggle of primitive stages of development. Those who emphasize defence analysis, however, tend to view regression as a manifestation of resistance, as a primitive mechanism of defence employed by the growth sets of the transference neurosis. Analysis of these regressive manifestations with their potential dangers depends on the existing and continued functioning of adequate ego strength to maintain therapeutic alliance at an adult level. Those, in contrast, who stress the significance of transference as a revival of the early mother-child relationship does not emphasize regression as an indication of resistance or defence, the revival of these primitive experiences in the transference situation is, in fact, regarded as can essential prerequisite for satisfactory psychological maturation and true geniality. The Kleinian school, as already indicated features the continued activity of primitive conflicts in determining essential features of the transference at every stage of analysis. Their increasing overt revival in the analytic situation, therefore, signifies a reopening of the analysis, and in general, is regarded as an indication of diminuation rather than increase of resistance. The dangers involved according to this point of view and are determined more but to the failure to mitigate anxiety by suitable transference interpretation. By this failure to obtainably achieve, in the early phases of analysis, a sound and stabling therapeutic alliance is based on the maturity of the patient’s essential ego characteristics.
 In considering, briefly, the terminal phases of analysis, many unresolved problems concerning the goal of the therapy and definition of a completed psychoanalysis must be kept in mind. Distinction must also be made between the technical problems of the terminal phase and evaluation of transference after the analysis has been terminated, there is widespread agreement as to the frequent revival in the terminal phases of primitive transference manifestations apparently resolved during the early phases of primitive transference manifestation, apparently resolved during the early phase of analysis has been terminated. Balint, and those  who accept Ferenczi’s concept of primary passive love, suggest that some gratification of primitive passive needs may be essential for  successful termination. To Klein, the terminal phases of analysis also represent a repetition of important features of the early mother-child relationship. According to her point of view, this period represents, in essence, a revival of the early weaning situation. Completion depends on a mastery of early depressive struggles culminating in successful introjection of the analysis as a good object. Although, in this connection, emphasis differs considerably, it should be noted that those who stress the importance of identification with the analyst as a basis for therapeutic alliance, also accept the inevitability of some permanent modifications of a similar nature. Those, however, who make a definite differentiation between transference of the transference neurosis as a main prerequisite for successful termination, are founded to the identifying basis of the therapeutic alliance must be interpreted and understood, particularly with reference to the reality aspects of the analyst’s personality. In spite, therefore, of significant important differences there are, as already indicated in connection with the earlier papers of Sterba and Strachey, important points of agreement in respect to the goal of psychoanalysis.
 The differences already considered indicate some basic current problems of transference. So far, however, discussion has been limited to variations within the framework of a traditional technique. We must consider problems related to overt  modifications, so as the essential expanding context of use between variations introduced in respect to certain clinical conditions. Often, as a preliminary to classical psychoanalysis, and modifications as based on changes to the basic approach that directly possess in holding. in that the apprehending significant alterations with regard to both to the method and to the aim of therapy is generally agreed that some neurosis, borderline patients and the psychosis. The nature and meaning of such changes are, however,  viewed differently according to the relative emphasis placed on the ego and its defences, on underlying unconscious conflicts, and on the significance and handling of regression in the therapeutic situation.
 In ‘Analysis Terminable and Interminable’, Freud suggested that certainly inaccessible to psychoanalytic procedure. Hartmann has suggested that in addition to these primary attributes, other ego characteristics, originally develop for defensive purposes, and the related neutralized instinctual energy at the disposal of the ego, may be relatively or absolutely divorced from unconscious fantasy. This not only explains the relative inefficacy of early transference interpretation, but also hints of possible limitations in the potentialities of analysis attributable to secondary autonomy of the ego that is considered to be relatively irreversible. In certain cases, moreover, it is suggested that analysis of precarious or seriously pathological defences - particularly those concerned of aggressive impulses - may be not only ineffective, but dangerous. The relative failure of ego development in such cases not only precludes the development of a genuine therapeutic alliance, but also raises the risk of a serious regressive, often predominantly hostile transference situation. In certain cases, therefore, preliminary period of psychotherapy is recommended in order to explore the capacities of the patient to tolerate traditional psychoanalysis. In others, as Robert Knight in his paper on borderline states, and as many analysts’ working with psychotic patients have suggested, psychoanalytic procedure is not considered applicable. Instead, a therapeutic approach based on analytic understanding that, in essence, utilizes an essentially implicit positive transference  as a means of reinforcing, rather than analysing the precarious defences of the individual, is advocated. In contrast, Herbert Rosenfeld approached even severely disturbed psychotic patients with minimal modifications of psychoanalytic techniques. Only changes that the severity of the patient’s condition enforces are introduced. The dangers of regression in therapy are not emphasized since primitive fantasy is considered to be active under all circumstances. The most primitive period is viewed in terms of early object relations with special stress on prosecutory anxiety related to the death instinct. Interpretation of this primitive fantasy in the transference situation, is best offered the opportunity of strengthening the severity-threatened psychosis mainly to serve traumatic experiences, particularly of deprivation in early infancy. According to this point of view, profound regression offers an opportunity to fulfil, in the transference situation, primitive needs that had not been met at the appropriate level of development. Similar suggestions have been proposed by Margolin and others, in the concept of anaclitic treatment. Serious psychosomatic diseases, that approach the premise that the inevitable regression is shown by certain patients and should be utilized in therapy, as a means for gratifying, in their extremely permissive transference situation. Having distinctive or certain limits in the burdensome instant for demanding to that which has not been met in infancy, as this must, in the connection of being taken to understand that the gratifications recommended in the treatment of severely disturbed patients are determined by their conviction. Of these patients are incapable of developing transference as we understand it, in the connection with neurosis and must therefore be handled by a modified technique.
 The opinions so far considered, however, much of them, as mine  differ in certain respects, are, nonetheless, all based on the fundamental premise that an essential difference between analysis and other methods of therapy depends on whether or not interpretation of transference is an integral feature of technical procedure. Results based on the effects of suggestions are to be avoided, as far as possible, whenever traditional technique is employed. This goal has, however, tp establish a point by appropriate objective means, that corroborated evidence that proved the need for better a state of being even more difficult to achieve than Freud expected when he first discerned the significance of symptomatic recovery based on positive transference. The importance of suggestion, even in the most strict analytic methods, has been repeatedly stressed by Edward Glover and others. Widespread and increasing emphasis as to the part played by the analyst’s personality in determining the nature of the individual transference also implies recognition of unavoidable suggestive tendencies in the therapeutic process. Many analysts today believe that the classical conception of analytic objectivity and anonymity cannot be maintained. Instead, thorough analysis of reality aspects of the therapist’s personality and point of view is advocated as an essential feature of transference analysis and an indispensable prerequisite for the dynamic changes already discussed in relation to the termination of analysis. It thus remains the ultimate goal of psychoanalyst’s whenever their theoretical orientation, to avoid, as far as is humanly possible, results based on the unrecognized or unanalysed action of suggestion, and to maintain, as a primary goal, the resolution of such results through consistent and careful interpretation.
 There are, however, a number of therapists, both within and outside the field of psychoanalysis, who consider that the transference situation should not be handled only or mainly as a setting for interpretation even in the treatment or analysis of neurotic patients. Instead, they advocate utilization of the transference relationship for the manipulation of corrective emotional experience. The theoretical orientation of those utilizing this concept of transference may be closer to, or more distant form, a Freudian point of view according to the degree to which current relationships are seen as determined by past events. At one extreme, current aspects and cultural factors are considered of predominant importance, at the other, mental development is viewed in essentially Freudian terms and modifications of technique are ascribed to inherent limitations of the analytic method rather than to essentially changed conceptions of the early phases of mental development. Of this group, Alexander is perhaps the best example. It is thirty years since, in his Salzburg paper, he indicated the tendency for patients to regress, even after apparently successful transference analysis of the oedipus situation to narcissistic dependent pregenital levels that prove stubborn and refractory to transference interpretation. In his more recent work, the role of regression in the transference situation has been increasingly stressed. The emergence and persistence of dependent, pregenital commands for something as or is if one’s right or due requirements are challenged in measuring moderations of a wide range of clinical conditions. It is argued, that its indications that the encouragement of a regressive transference situation is undesirable and therapeutically ineffective. The analyst, therefore, should when this threatens adopt a definite role explicitly differing from the behaviour of the parents in early childhood in order to bring about therapeutic results through a corrective emotional experience in the transference situation. This, it is suggested, will obviate the tendency to regression, thus curtailing the length of treatment and improving therapeutic results. Limitations of regressive manifestations by active steps modifying traditional analytic procedure in a variety of ways are also frequently indicated, according to this point of view.
 It will be clear that to those who maintain the conviction that interpretation of all transference manifestations remain an essential feature of psychoanalysis, the type of manifestation as described, even though based on a Freudian reconstruction of the early phases of mental developments, and represent a major modification. It is determined by a conviction that psychoanalysis, as a therapeutic method, has limitations related to the tendency to regression, which cannot be resolved by traditional technique. Moreover, the fundamental premises on which, and the conception of corrective emotional experience is based minimizing the significance of insight and recall. It is essentially, suggested that corrective emotional experience alone may bring about qualitative dynamic alterations in mental structure, which can lead to a satisfactory therapeutic goal. This implies a definite modification on the analytic hypothesis whose current problems are determined by their defences against the direct opposition to the instinctual impulses and the intentional object, to which had been set up during the decisive periods of early development. An analytic result therefore depends on the revival, repetition and mastery of earlier conflict in the current experience of the transference situation with insight an indispensable feature of an analytic goal.
 Since certain important modifications are related to the concept of regression in the transference situation, it should be considered that this concept is in relation to the repetition compulsion, that transference, essentially is a revival of earlier emotional experience, must be regarded as a manifestation of the repetition compulsion is generally accepted. It is, however, necessarily to distinguish between repetition compulsion as an attempt to master traumatic experience and repetition compulsion as an attempt to return to a real or fantasized earlier state of rest or gratification. Lagache, in a recent paper, has connected by or as if by the affirming relatedness as associated to the corresponding divergence in the repetition compulsion to an inherent need to appear in the problems that had previously been left unsolved. From this point of view, the regressive aspects of the transference situation are to be regarded as a necessary preliminary to the mastery of unresolved conflict, as too, the regressive aspects of transference are mainly attributed to a wish to return to an earlier state of rest or narcissistic gratification, to the maintenance of the status quo in preference to any progressive action, to which Freud’s original conception of the death instinct. There is a good deal to suggest that both aspects of the repetition compulsion may bee seen in self-destructive forces tend to be stronger that progressive libidinal impulses, the potentialities of the analytic approach will inevitably appear to be limited. In those, in contrast, in whom that regard the reappearance in the transference situation of earlier conflicts as an indication of tendencies to master and progress will continue to feel that the classical analytic method remains the optimal approach to psychological illness wherever it is applicable.
 Clarifications maintain the position as peculiarly occupying a particular point in space and time. Whereas in  absence or termination must reflect on or upon the fearing analysis if the transference, as compelling of a generally acknowledged focal point, this itself may debase the appropriate factor that generates, in every degree. The exemplifying analytic technique that would react upon the discipline needed to utilize the new values, whereby, they can be ascribed as the commonality in holding the services to a  suspicious self-direction and comprehensive understanding, in that of whatever is humanly affiliated to the best as can be, and yet, the advocacy to the analysis of the transference is generally acknowledged as the central feature of analytic technique? Freud regarded transference and resistance as facts in the observational conceptuality for which of representing the state of inventions. He writes, . . . that the theory of psychoanalysis in an attempt to account for two striking and unexpected facts of observation that emerge whenever an attempt is made. Evidently the symptoms of a neurotic source, may in his past life, inhabit the sources of experiential recall to the past or the introspective reflections. In the state of affairs, in that for being the latent characterizations announced as the factoring responsibility for the transference and of resistance . . . one that takes the other side of the problem, while accepting as such, to the latencies and the hidden values non-accepting for new interactions as brought through a hypothesis that will hardly escape the charge of misappropriation of properties by attempting endeavour to re-associate the essentially established personalization, that if the pursuit in calling them a psychoanalyst’. Rapaport (1967) argued, in his posthumously published paper on the methodology of psychoanalysis, that transference and resistance inevitably follow from the fact that the analytic situation is interpersonal.
 Despite this general agreement on the centrality of transference and resistance in technique, in that, the analysis of transference is not pursued as systematically and comprehensively affirmed, however, it could be and should be. The relative privacy for which psychoanalytic work makes it impossible for one or of that of any-other, to skilfully improve upon the attemptive conceptual representation as comprehended of issues, its assumption to state this view as anything more that impressions, involving on that of what in the analysis of the transference and to states awareness in the number of reasons that an important aspect in the analysis of the transference of the transference, namely in the resistance, by the awareness of the transference is especially, and often adhering to the analytic procedures that interact among cultural inhibitors, but that  will be distinguished as such, that its ranging manifold of distancing non-localities as founded of the analyst’s.
 However, it must first be to distinguish between two types of interpretation of the transference.  That one is an interpretation of resistance to the awareness of transference, the other, is an interpretation of resistance to the resolution of transference. The distinction has clearly been best spelled out in the form from which copies or reproductions can be produced, as to cause to make its awareness and yielding values as grounded in the cognisance to Greenson (1967) and Stone (1967). The first kind of resistance may be called decence transference, although this term emphases the terminological characterization by its term is mainly employed to refer to a phrase of analysis and carried within the  general resistance to the transference of wishes, it can also be used for a more isolated instance of transference of defence. With some oversimplification, one might say that in resistance to the awareness of transference, the transference, the transference is what does the resisting.
 Another connected description of stating this distinction between resistance and the awareness of transference and resistance to the resolution of transference is between implicit and indirect references to the transference and explicitly or directly referential to the transference. The interpretation of resistance to awareness of the transference is intended to make the implicit transference explicit. While the interpretation of resistance to the resolution of transference is intended to make the patient realize that the already explicit transference does indeed include a determinant from the past.
 It is also important to distinguish between the general concept of an  interpretation of resistance to the resolution of transference and a particular variety of such an interpretation, namely, a genetic transference interpretation - that is, an interpretation of how an attitude in the present is an inappropriate carry-over from the past. While there is a tendency among analysts to deal explicit references to the transference primarily among analyses to deal explicitly the references to the transference as primarily by a genetic transference interpretation, there are other ways of working toward a revolution of the transference. However, this argument does so implicate that not only is not enough emphasis being given to interpretation of the transference in the therapeutic attentions to the existing instant of here and now, that is, to the interpretation of implicit manifestations of the transference, but also that interpretations intended to resolve the transference as manifested in explicit references to the transference should be primarily of having independent reality in actuality within the here and now, rather than genetic transference interpretation.
 A patient’s statement that he feels the analyst is harsh, for example, is, at least to begin with, likely best dealt with not by interpreting that this is a displacement from the patient’s feeling that his father was harsh, but by as elucidation of another aspect of this here and now attitude, such as what has gone on in the analytic situation that seems to the patient to justify his feeling or what was the anxiety that made it so difficult for him to express his feelings. How the patient experiences the actual situation is an example of the role of the actual situation in a manifestation of transference, which will be a major point of relevant significance.
 Of course, both interpretations of the transference in the here and now and genetic transference interpretations are valid and constitute a sequence. We presume that a resistance to the transference ultimately rests on the displacement onto the analysts of attitudes from the past.
 Because Freud’s case histories focus much more on the yield of analysis than on the details of the process, they are readily but perhaps incorrectly construed as emphasizing work outside the transference much more than work within the transference, and, even within the transference, emphasizing genetic transference interpretations much more than work with the transference in the here and now (Muslin and Gill, 1978). The example of Freud’s case reports may have played a role in what is to be considered as the common maldistribution of emphasis in these two respects - not enough on the transference and, within the transference, not enough on the here and now.
 Transference interpretations in the here and now and genetic transference interpretations are, of course, exemplified in Freud’s writings and are in the repertoire of every analyst, but they are not distinguished sharply enough.
 Both participants in the analytic situation are motivated to avoid these interactions. Flight away from the transference and to the past can be a relief to both the patient and the analyst.
 These aligning measures have been divided into five categorical divisions and placed into the following parts: (1) The principle that the transference should be encouraged to expand as much as possible within the analytic situation because the analytic work is best done within the transference. (2) the interpretation of disguised allusion to the transference as a main technique for encouraging the expansion of the transference within the analytic situation, (3) the principle that all transference has a connection with something in the present actual analysis situation, (4) how the connection between transference and the actual analytic situation is used in interpreting resistance to the awareness of transference, and (5) the resolution of transference within the here and now and the role of genetic transference interpretation.
 The importance of transference interpretations will surely be agreeing to by all analysts, the greater effectiveness of transference interpretations than interpretations outside the transference will be agreeing to by many, but what of the relative roles of interpretation of the transference and interpretation outside the transference?
 Freud can be interpreted as either of saying that the analysis of the transference in auxiliary to the analysis of the neurosis or that the analysis of the transference is equivalent to the analysis of the neurosis. The first position is stated in his saying (1913) that the disturbance of the transference has to be overcome by the analysis of transference resistance in order to get on with the work of analysing the neurosis. It is also implied in his reiteration that the ultimate task of analysis is to remember the past, to fill in the gap in memory. The second position is stated in his saying that the victory must be won on the field of the transference (1912) and that the mastery of the transference neurosis ‘coincides with getting rid of the illness which was originally brought to the neurosis (1917). In this second view, he says that after the resistance is overcome, memories appear relatively without difficulty.
 These two different positions also find expression in the two different ways in which Freud speaks of the transference. In `Dynamics of Transference` he refers to the transference, on the one hand, as `the most powerful resistance to the treatment`(1912) but, on the other hand, as doing us the inestimable service of making the patient’s . . . , immediate impulses and manifests, when all is said and done, it is impossible to destroy anyone in absentia or in effigie (1912).
 It can be agreed that his principal emphasis fails on the second position. He wrote once, in summary, ‘Thus our therapeutic work falls into two phases in the first, all the libido is forced from the symptoms into the transference and concentrated there, in the second, the struggle is waged around this new object and the libido is liberated from it`(1912).
 The detailed demonstration that he advocated that the transference should be encouraged to expand as much as possible within the analytic situation lies in clarification that resistance is primarily expressed by repetition, and repetition takes place both within and outside the analytic situation, but that the analyst seeks to deal with it primarily within the analytic situation, that repetition can be not only in the motor sphere (acting) but also in the psychical sphere, and that the psychical sphere is not confined to remembering but includes the present, too.
 Freud`s emphasis that the purpose of resistance is to prevent remembering can obscure his point that resistance shows itself primarily by repetition, whether inside or outside the analytic situation. `The greater the resistance, to a greater or higher degree of widely ranging differentiating comprehension, as do, the application whose attentions are extensively but will act out (repetition)replace remembering`. Similarly in `The Dynamics of Transference` Freud said that the main reason that the transference is so well suited to serve the resistance is that the unconscious implies does not want to be remembered . . . but endeavour to reproduce themselves . . . (1918), the transference is a resistance primarily insofar as it is a repetition.
 The point can be restated in terms of the relation between transference and resistance. The resistance expresses itself in repetition, that is, in transference both inside and outside the analytic situation. To deal with the transference. Therefore, is equivalent to dealing with the resistance. Freud emphasized  transference within the analytic situation so strongly that it has come to mean only repetition within the analytic situation, even though, conceptually speaking, repetition outside the analytic situation is transference too, and Freud once used the term that way. `We soon perceive that the transference is itself only a piece of repetition and that the repetition is a transference of the forgotten past not only onto the analyst but also onto all the other aspects of the current situation. We . . .  find . . . the compulsion to repeat, which now replaces the impulsion to remember, not only in his personal attitude to his analyst but also in every other activity and relationship which may occupy his life at the time . . . (1914).
 It is important to realize that the expansion of the repetition inside the analytic situation, whether or not in a reciprocal relationship to repetition outside the analytic situation, is the avenue to control the repetition: `The main instrument . . . for curbing the patients compulsion to repeat and for turning it into a motive for remembering lies in the handling of the transference. We render the compulsion harmless, and indeed useful, by giving it the right to assert itself in a definite field`(1914).
 Kanzer has discussed this issue well in his paper on ‘The Motor Sphere of the Transference’ (1966). He writes of a ‘double-pronged stick-and-carrot’ technique by which the transference is fostered within the analytic situation and discouraged outside the analytic situation. The ‘stick’ is the principle of abstinence as exemplified in the admonition against making important decisions during treatment, and the ‘carrot’ is the opportunity afforded the transference to expand within the treatment, ‘in almost complete freedom’ as in a ‘playground’ (Freud, 1914). As Freud put it, ‘Provided only that the patient shows compliance enough to respect the necessary conditions of the analysis, we regularly succeed in giving all the symptoms of the illness a new transference meaning, and in replacing his ordinary neurosis by a ‘transference neurosis’ of which he can be cured by the therapeutic work’ (1914).
 The reason it is desirable for the transference to be expressed within the treatment is that there, it `is at every point accessible to our intervention`(1914). In a later statement he made the same point this way. `We have followed this new edition - the transference-neurosis - of the old disorder from its start, we have observed its origin and growth, and we are especially well able to find our way about in it since, as its object, we are situated at it’s very centre, (1917), it is not that the transference is forced into the treatment, but that it is spontaneously but implicitly present and is encouraged to expand there and become explicit
 Freud emphasized acting in the transference so strongly that one can overlook the repetition in the transference, but does not of necessity for its enactment or recognition that gives validity to acts of a subordinate conformation as ratified in support of explicit authoritative permission. Repetition need not go as far as motor behaviour, it can also be expressed in attitudes, feelings, and intentions, and, indeed, the repetition often does take such form rather than motor action. The importance of making this clear is that Freud can be mistakenly read to mean that repetition in the psychical sphere can only mean remembering the past, is when he writes that the analyst as prepared for a perpetual struggle with his patient to keep in the psychical sphere all the impulses that the patient would like to direct into the motor sphere, and he celebrates it as a triumph for the treatment if he can bring it about that something the patient wishes to discharge in action are disposed if through the work of remembering (1914).
 It is true that the analyst’s efforts are to convert acting in the motor sphere into awareness in the psychical sphere, but transference may be in the psychical sphere to begin with, even if disguised. The psychical sphere includes awareness in the transference as well as remembering.
 One of the objections one hears, from both analysts and patient, to a heavy emphasis on interpretation of associations about the patients real life primarily in terms of the transference is that it means the analyst is disregarding the importance of what goes on in the patients real life. The criticism is not judiciable. To emphasize the transference meaning is not to deny or belittle other meanings, but to focus on the one of several meanings of the content that is the most important for the analytic process, for the reasons of positing the addition for one coming to any falsifiable conclusion.
 Another way in which interpretations of resistance to the transference can be, or at lease appear to the patient to be, a belittling of the importance of the patients outside life is to make the interpretation as though the outside behaviour is primarily an acting out of the transference. The patient may undertake some actions in the outside world as an expression of and resistance to the transference, that is, acting out. But the interpretation of associations about actions in the outside world as having implications for the transference needs mean only that the choice of outside action to figure in the associations is co-determined by the need to express a transference indirectly. It is because of the resistance to awareness of the transference that the transference to be disguised. When the disguise is unmasked by interpretation, it becomes clear that, despite the inevitable differences between the outside situation and the transference situation, the content is the same for the analysis of the necrosis that coincides (Freud wrote that the mastering of the transference neurosis only coincides with getting rid of the illness that was originally brought to the treatment (1917)).
 The analytic situation itself fosters the development of attitudes with primary determinants in the past, i.e., transference. The analyst’s reserve provides the patient with few and equivocal cues. The purpose of the analytic situation fosters the development of strong emotional responses, and the very fact that the patient has a neurosis means, as Freud said, that’ . . . it is a perfectly normal and intelligible thing that the libidinal cathexis [we would now add negative feelings] of someone who is partly unsatisfied, a cathexes that are held ready in anticipation, should be directly as well to the figure of the analyst (1912).
 While the analytic setup itself fosters the expansion of the transference within the analytic situation, the interpretation of resistance to the awareness of transference will further this expansion.
 There are important resistances on the part of both patient and analyst to awareness of the transference. On the patient’s part, this is because of the difficulty in recognizing erotic and hostile impulses toward the very person to whom they have to be disclosed. On the analyst’s part, this is because the patient is likely to attitude the very attitudes to him that are most likely to cause him discomfort. The attitudes the patient believes the analysts have toward him are often the ones the patient is least likely to voice, in a general sense because of a feeling that it is impertinent for him to concern himself with the analyst’s feelings, and in a more specific sense because the aptitudes as held by the analyst are often attitudes the patient feels the analyst will be comfortable about having ascribed to him. It is for this reason that the analyst must be especially alert to the attitudes the patient believes he has, not only to the attitudes the patient does have toward him. If the analyst is able to see himself as a participant in an interaction, as he will become much more attuned to this important area of transference, which might otherwise escape him.
 The investigations of attitudes are ascribed to the analyst makes easier the subsequent investigation of the intrinsic factors in the patient that played a role in such ascription. For example, the exposure of the fact that the patient ascribes sexual interests in him to the analyst, and generally to the patient, alternatively the subsequent exploration of the patient’s sexual wish toward the analyst, and genetically the parent.
 The resistance to the awareness of these attitudes is responsible for their appearing in various disguises in the patient’s manifested associations and for the analyst’s reluctance to unmask the disguise. The most commonly recognized disguise is by displacement, but identification is an equally important one. In displacement, the patient’s attitudes are narrated for being toward a third party. In identification, the patient attitudes to himself attitudes he believes the analyst has toward him.
 To encourage the expansion of the transference within the analytic situation, the disguises in which the transference appears have to be interpreted in the case of displacement the interpretation will be of allusions to the transference in association not manifestly about the transference. This is a kind of interpretation every analyst often makes. In the case of identifications, the analyst interprets the attitudes that  the patient ascribes to himself the identification with which an attitude and subsequently attributed to the analyst. Lipton (1977) has recently described this form of disguise allusion in the transference with illuminating illustration.
 In his autobiography, Freud wrote, ‘The patient remains under the influence of the analytic situation as hopefully  of a latter position or a period of decline, as though he is not directing responsibly for the mental activities onto a particular subject. Justly in assuming that nothing will occur, as not of some reference to the situation (1925). Since associations are obviously often not directed about the analytic situation, the interpretation of Freud’s remark rests on what he meant by the ‘analytic situation’.
 It is believed that Freud’s meaning can be clarified by reference to a statement he made in, ‘The Interpretation of Dreams’. He said that when the patient is told to say whatever comes into his mind, his associations become directed by the ‘purposive ideas inherent in the treatment’ and that there are two such inherent regressive themes, one relating to the illness and the other - concerning which, Freud said, the patient has ‘no suspicion’; - relating to other analyst’s (1900), if the patient has ‘’no suspicion’ of the theme relating to the analyst (1900). If the patient has ‘no suspicions’ - relating to the analyst (1900). If the patient has ‘no suspicions’ of the theme relating to the analyst, such that the theme appears only in disguise, the patient ‘s associations, it is contended that Freud’s remark not only specifies the themes inherent in the patient ‘s identifications’, but means that the associations are simultaneously directed by these two purposive ideas, not something by one and sometimes by the other.
 One important reason that the early and continuing presence of the transference is not always recognized in that it is considered to be absent in the patient who is talking recognized is that it is considered to be absent in the patient  who is talking freely and apparently without resistance. As (Muslin and Gill, 1976) pointed out in a paper on the early interpretation of transference resistance, to the transference is probably present from the beginning, even if the patient is talking apparently freely. The patient may be talking about issues not manifestingly about the transference that are nevertheless, also allusions to the transference, but the analyst has to be alert to the pervasiveness of such allusory discernment about them.
 The analyst should progress on the working assumption, that the patient’s associations have transference implications pervasively, that with which this assumption is not to be confused with denial or neglect of the current aspects of the analytic situation. It is theoretically always possible to give precedence to a transference interpretation if one can only discern it through its disguise by resistance. This is not to dispute the desirability of learning as much as one can about the patient, if only to be a position to make correct interpretations of the transference. One therefore, does not interfere with an apparently free flow of associations, especially early, unless the transference threatens the analytic situation to the point where its interpretation is mandatary rather than optional.
 With the recognition that evens apparently freely associating patient may also be showing resistance to awareness of the transference, this formulation should not interfere as long a useful information being gathered should relace Freud’s dictum that the transference should not be interpreted until it becomes a resistance (1913).
 It can be argued that every transference has some connection to some aspect of the current analytic situation, in the sense that the past can exert an influence only insofar as it exists in the present. Of course, all the determinants of a transference are current in the sense that what I am distinguishing is the current reality of the analytic situation, that is, what actually goes on between patient and analyst in the situation from how the patient is currently constituted as a result of his past.
 All analysts would dubiously agree that there are both current and transferential determinants of the analytic situation, and probably no analyst would argue that a transference of the analytic situation, and probably no analyst would argue that a transference idea can be expressed without contamination, as it was, that is, without any connection to anything current in the patient-analyst relationship. Nevertheless, the implications of this fact for technique are often neglected in practice, as my next point is only to argue for the connection.
 Several authors, e.g., Kohut 1959 and Loewald 1960, have pointed out that Freud`s early application by the act or practice of using something or the state of being used, this, however, employ of the quality of being appropriate or valuable to some end as to accommodate the accountable or warrant the use of the term transference. In `The Interpretation of Dreams, in a connection not immediately recognizable as related to the present day use of the term, reveals the fallacy of considering that transference can be expressed free of any connection to the present. That early use was to refer to the fact that an unconscious idea cannot be expressed as such, but only as it becomes connected to a preconscious or conscious content. In the phenomenon with which Freud was then concerned, the dream transference took place from an unconscious wish to a day residue. In `The Interpretation of Dreams, `Freud used the term transference both for the general rule that an unconscious content is expressible only as it becomes transferred to a preconscious or conscious content and for the specific application of this rule to a transference to the analyst. Just as the day residue is the point of attachment of the dream wish, so must there be an analytic-situation residue, though Freud did not use that term, as the point of attachment of the transference.
 Analysts have always limited their behaviour, both in variety and intensity, to increase the extent to which the patient‘s behaviour is determined by his idiosyncratic interpretation of the analyst’s behaviour. In fact, analysts unfortunately sometimes limit the behaviour so much as to compare with such an expression or unpiled standard or absolute approximation, that the entire relationship with the patient matter of technique, with no nontechnical personal relation, as Liptop (1977) has pointed out.
 But no matter how far the analyst attempts to carry this limitation of his behaviour, the very existence of the analytic situation provides the patient with innumerable cues that can enviably become his rationale for his transference responses. In other words, the current situation cannot be made to disappear - that is, the analytic situation is real. It is easy to forget this truism in one’s zeal to diminish the role of the current situation in determining the patient ‘s responses. One can try to keep past and present determinants relatively perceptible from one another, but one cannot obtain either ‘pure culture‘. Freud wrote: ‘I insist on this procedure [the couch], however, for its purpose and result are to prevent the transference from mingling with the patient’s associations imperceptibly, to isolate the transference and to allow it to come forward in due course sharply defined as a resistance’ (1913). Even ‘isolate’ is too strong a word in the light of the inevitable intertwining of the transference with the current situation.
 If the analyst remains under the illusion that the current cues he provides to the patient can be reduced to the vanishing point, he may be led into a silent withdrawal, which is not too distant from the caricature of an analyst as someone who does refuse to have any personal relationship with the patient. What happens then is that silence has become a technique rather than merely an indication that the analyst is listening. The patient’s responses under such conditions can be mistaken fo uncontaminated transference when they are in fact transference adaptions to the actuality of the silence.
 The recognition, from which it takes its point of departure, as it was, has a crucial implications for the technique of interpreting resistance to the awareness of transference, in that, if, the analyst becomes persuaded of the centrality of transference and the importance of encouraging the transference to expand within the analytic situation, he has to find the presenting and plausible interpretation of resistance to the awareness of transference he should make. Is that, his most reliable guide is the cues offered by what is actually going on in the analytic situation? : On the one hand, the events of the situation, such as change in time of session, or an interpretation made by the analyst, and, on the other hand,  how the patient is experiencing the situation as reflected in explicit remarks about it, however, fleeting these may be. This is the primary yield for technique of the recognition that any transference must have a link to the actuality of the analytic situation. The cue points to the nature of the transference, just as the day residue for a dream may be a quick pointer of the latent dream thoughts. Attention to the current situation for a transference elaboration will keep the analyst from making mechanical transference interpretation, in which he interprets that there are allusions to the transference in association not manifestly about the transference, but without offering any plausible bias for the interpretation. Attention to the current stimulation offers some degree of protection against the analyst’s inevitability whose tendency to project his own views onto the patient, either because of countertransference or because of a preconceived theoretical bias about the content and hierarchical relationships in psychodynamics.
 The analyst may be very surprised at what in his behaviour the patient finds important or unimportant, for the patient’s responses will be idiosyncratically determined by the transference, the patient’s responses may seem to be something the patient as well as the analysts consider trivial, because, as in displacement to a trivial aspect of the day residue of a dream, displacement can better serve resistance when it is to something trivial. Because it is connected to conflict-laden material, the stimulus to the transference may be difficult to find. It may be quickly disavowed, so that its presence in awareness is only transitory. With the discovery of the disavowed, the patient may also gain insight into how it repeats as disavowed earlier in his life. In his search for the present stimuli that the patient is responding transferentially, as the analyst must therefore remain alert to both fleeting and apparently trivial manifested reference to himself as well as in the events of the analytic situation.
 If the analyst interprets the patient’s attitudes in a spirit of seeing their possible plausibility in the light of what information the patient does have, rather than in the spirit of either affirming or denying the patient’s views, the way is open for their further expression and elucidation. The analyst will be respecting the effort to be plausible and realistic, rather than manufacturing his transference attitudes out of whole bodied material.
 Importantly, is to make a transference interpretation plausible to the patient in terms of as current stimulus that, if the analyst is persuaded that the manifest content has important implications for the transference but he is unable to see a current stimulus for the attitude, he should explicitly say so if he decides to make the transference interpretation anyway. The patient himself may then be able to say what the current stimulus is.
 It is sometimes argued that the analyst’s attention to his own behaviour is a precipitant for the transference, will increase the patient’s resistance to recognizing the transference. That, on the contrary, that because of the inevitable interrelationship of the current and transferential determinants, it is only through interpretation that they can be disentangled.
 It is also argued that one must wait until the transference has reached optimal intensity before it can be advantageously interpreted. It is true that too hasty and interpretation of the transference can serve as a defensive function for the analyst and deny him the information he needs to make a more appropriate transference interpretation. But it is true that delay in interpreting transference interpretation, but it is also true that delay in interpreting runs the risk of allowing an unmanageable transference to develop. It is also true that deliberate delay can be a manipulation in the service of abreaction rather than analysis, and, like silence, can lead to a response to the actual situation that is mistaken for uncontaminated transference. Obviously important, is assumed in the issues of timing are involved, whereas an important clue to when a transference interpretation is apt and which one to makes lies in whether the interpretation can be made plausibly in terms of the determinant, namely, as something in the current analytic situation. Such as, in the approaching transference in the spirit of seeing how it appears plausibly realistic to the patient, it paves the way toward its further elucidation and expression.
 Freud’s emphasis on remembering as the goal of the analytic work implies that remembering is the principal avenue to the resolution of the transference. But the delineation of the successive steps in the development of the analytic technique (1920) makes clear that he saw this development as a change from an effort to reach memories directly to the utilization of the transference as the necessary intermediacy to reaching the memories.
 In contrast to remembering as the way the transference is resolved, Freud also described resistance for beings primarily overcome in the transference, with remembering following relatively easily afterwards, ‘From the repetitive reactions that are exhibited in the transference we are led along the familiar paths to the awakening of the memories, which appear without difficulty, as it was, after the resistance has been overcome’ (1914), and ‘This revision of the process of repetition can be accomplished only in part in connection with the memory traces of the process that led to repression. The decisive part of the work’s achieved by creating in the patient’s relation to the analyst - in the ‘transference‘ new editions of the old conflicts . . . Thus, the transference becomes the battlefield on which all the mutually struggling forces should meet one another’ (1917). This is the primary indication for which Strachey (1934) classified in his seminal paper on the therapeutic action of psychoanalysis.
 There are two main ways in which resolution of the transference can take place through work with the transference in the here and now. The first lies in the clarification of what are the clues in the current situation that are the patient‘s point of departure force a transference elaboration. The exposure of the current point of departure at once raises the question of whether it is adequate to the conclusion drawn from it. The relating of the transference to a current stimulus is, after all, parts of the patient‘s effort to make, the transference attitude plausibly determined by the present. The reverse and ambiguity of the analyst’s behaviour are what increases the ranges of apparently plausible conclusions the patient may draw. If an examination of the basis for the conclusion makes clear that the actual situation to which the patient responds is subject to other meanings than the one the  patient has reached, he will more reality consider his pre-existing bias, that is to say, in that of transference.
 Another critic of an earlier version of this paper suggested that, in speaking of the current relationship and the relation between the patient’s conclusion and the information on which they seem plausibly based, such in some absolute conception of what is real in the analytic situation, of which the analyst is the final arbiter. That is not the case, that what the patient must come to see is that the information he has is subject to other possible interpretations implies the very contrary to an absolute conception of reality. In fact, analyst and patient engage in a dialogue in a spirit of attempting to arrive at a consensus about reality, not about some factious absolute reality.
 The second way in which resolution of the transference can take place within the work with the transference in the here and now is that in the very interpretation of the transference the patient had a new experience. He is being treated differently  from how he expected to be. Analysts seem reluctant to emphasize his new experience, as though it endangers the role of insight and argue for interpersonal influence as the significant factor in change. Strachey’s emphasis on the new experience in the mutative transference interpretation has unfortunately been overshadowed by his views on introjection, which have been mistaken to advocate manipulating the transference. Strachey meant introjection of the more benign superego of the analyst only as a temporary strep on the road toward insight. Not only is the new experience not to be confused with the interpersonal influence of a transference gratification, but the new experience occurs together with insight into both the patient’s biassed expectation and the new experience. As Strachey points out, what is unique about the transference interpretation is that insight and the new experience take place in relation to the very person who was expected to behave differently, and it is this that gives the work in the transference, its immediacy and effectiveness. While Freud did stress the effective immediacy of the transference, he did not make the new experience explicit.
 It is important to recognize that transference interpretation is not a matter of experience, in contrast to insight, but a joining of the two together, both are needed to bring about and maintain the desired changes in the patient. It is also important to recognize that no new techniques of intervention are required to provide the new experience. It is an inevitable accompaniment of interpretation of the transference in the here and now. It is often overlooked that, although Strachey said that only transference interpretations are outside the transference.
 Rosenfeld (1972) has pointed out that clarification of material outside the transference is often necessary to know what is the appropriate transference interpretation, and that both genetic transference interpretations and extratransference interpretation taking to consider an inclination as marked by or indication of notable worth or simply the consequence based upon the role in working through. Strachey said relatively little about working through, but surely nothing against the necessary provision with which  every thing needfully is explicitly recognized as the role for the recovery of the past in the resolving dissection of the purposiveness determined by the transference.
 In taking positions, as to emphasis the role of the analysis of the transference in the here and now, both in interpreting resistance to the awareness of transference and in working toward its resolution by relating to the actuality of the situation. In that of opinion or purpose with the evidence that extratransference and genetic transference interpretation and, of course, working through is important too, that the matter is one of emphasis. Also, interpretation of resistance to awareness of the transference should figure in the majority of sessions, and that if this is done by relating the transference to the actual analytic situation, the very same interpretation is a beginning of work to the resolution of the transference. To justify this view more persuasively would require detailed case material.
 The concern and considerations that the Kleinian annalists whom, many analysts feel, are in error in giving the analysis of the transference too great if not even as exclusive role in the analytic process. It is true that Kleinians emphasize the analysis of the transference more, in their writing at least, than does the general run of analysts. As, Anna Freud (1968) complained that the concept of transference has become overexpanded seems to be directed against the Kleinians. One of the reasons the Kleinians consider themselves the true followers of Freud in technique are precisely because of the emphasis they put on the analysis of the transference. Hanna Segal (1967), for example, writes, `Too say that all communications are seen as communications about the patents phantasy as well as current external life is equivalent to saying that all communications contain something relevant to the transference situation.  In Kleinian technique, the interpretation of the transference is often more central than in the classical technique.
 Affirmly held point of view or way of regarding that Freud and transference had accedingly connected by simulating observations that we can only offer, that Freud wrote briefly about transference, and did so, to sustain the way in which, is, as a whole, that his actions were justly taken in and around 1917. Another observation that can rarely be made about Freud’s works, and which everyone may not agree with, is that, with one or two exceptions, what he did write on transference did not reach the high level of analytical thought that has come to be regarded as standard for him. Some indication of what his contribution consists of is given by the editors of the Standard Edition, who list them in several places. One of the longer lists, in a footnote on page 431 of Volume 16, includes six references: ‘Studies of Hysteria’ with Breuer (1895), the Dora paper (1905), ‘The Dynamics of Transference’ (1912), ‘Observations on Transference-Love’ (1915), the chapter on transference in the Introductory Lectures (1917), and ‘Analysis Terminable and Interminable’ (1937). Although the editors, in no sense suggest that these six papers include everything Freud wrote on the subject. It does seem evident that, considering the essential importance of transference to analysis, he wrote, ‘The Dynamics of Transference’, ‘Transference-Love’, and the transference chapter in the Introductory Lectures, came across, as, perhaps, his least significant contribution.
 Freud’s first direct mention of transference comes upon the pages ascribed within the ’Studies of Hysteria’ (1895), his first significant reference to it, however did not appear until five years later, when, in a letter to Fliess on April 16, 1900, he said (Freud, 1887-1902) he was ‘beginning to see that the apparent endlessness of the treatment is something of an inherent feature and is connected with the transference’. In a footnote to this letter the editors said that, ‘This was the first insight into the role of transference in psychotherapy.’
 Despite these early references, it seems correct to say that yet another five years were to go by before the phenomenon of transference was actually introduced. Even so, the introduction was far from prominent, for it was tacked on like an afterthought as a four-page portion of a postscript to what was perhaps Freud’s most fascinating case history to date, the case of Dora (1905).
 Using data from Dora’s three-month-long, unexpectedly terminated analysis, and especially from her dramatic transference reaction that had taken him quite unawares, Freud now gave to transference its first distinct psychological entity and for the first time indicated its essential role in the analytic process. His account, although in general more than adequate  -  in the elegant fact and unmistakably ‘finished’ - was brief, and almost to the point, and perhaps not an entirely worthy introduction so much more a truly great discovery. What was uniquely great was his recognizing the usefulness of transference. In his analysis of Dora he had noted not only that transference feelings existed and were powerful, but, much to his dismay, he had realized what a serious, perhaps, even insurmountable obstacles that objectively would be. Then, in what seems like a creative leap, Freud made the almost unbelievable discoveries that transference was in fact, the key to analysis, that by properly taking the patient’s transference and therapeutic force was added to the analytic method.
 The impact on analysis of this startling discovery was actually much greater and much more significant than most people seem to appreciate. Although the role of transference as the sine quo non of analysis and is widely accepted, and was stated by Freud from the first, it has almost never been acclaimed for having brought about an entire change in the nature of analysis. The introduction of free association to analysis, a much lesser change, receives and still receives much more recognition.
 One of the reasons for the relatively unheralded entry of transference into analysis may have been for circumstances of its discovery. Although Freud’s new ideas were recorded as if they arose as sudden inspiration during the Dora analysis, they may in fact have developed somewhat later. In the paper‘s precatory remarks, for instance, Freud said he had not discussed transference with Dora at all, and in the postscript, he said he had been unaware of her transference feelings. Also, pointing to a later discovery date is the extraordinary delay in the paper’s publication. According to the editor’s note, the paper had been completed and accepted for publication by late January 1901, but this date was then actually set back more than four and a half years until October 1905. The editors said, ‘We have no information as to how it happened that Freud, . . . deferred publication.’ It readily seems that for reasons to have been that only during those four and a half years, as a consequence to his own self-analysis, that he came to a better understanding of the relevantly significant as the applicable reason to posit of the transference. Only then may it have been possible for him to turn again to the Dora case, to apply to it of what he had learned in himself, to write this essay as part of the postscript, and at last to release the paper for publication.
 Freud’s self-analysis has been considered from many angles, but not significantly, as can be of valuing measure, in at least from the standpoint of transference. Opponents of the idea that there is such a thing as definite self-analysis, some of whom say it is impossible, generally an object on grounds that without any analyst there can be no transference neurosis. Freud clearly demonstrated, as, perhaps, that the situation that may be necessary to fill this need: Self-analysis may require that, at least a halfway satisfactory transference object. In Freud`s case, the main transference object at this time seems to have been Fliess, who filled the role rather well. As with any analysis, the authenticity as known in the unfeigned design as if existing or having no illusions and facing reality squarely, by which the  ‘real’ impact on Freud was slight, he was essentially a neutral figure, relatively anonymous and physically separates. All of this, and Fliess`s own reciprocal transference reactions, made it possible for Freud to endow Fliess with whatever qualities and whatever feelings were essential to the development of Freud`s transference, and, it should be added, his transference neurosis. In the end, of course, the transference was in part resolved. Freud`s eventual awakening of its self realization in its presence within him of such strange and powerful psychological forces must have come to the conclusion as a stupefied disilluionary dejection toward Fliess, however, his subsequent working out of some of these transference attachments must have been both an intellectual triumph and an immensely healing and releasing of actions, operations or motions involved in the accomplishment of an ending that makes from its process.
 In the years following this revolutionary discovery, the central role of transference in analysis increased in remarkable acceptance, and it has easily held this central position ever since. What the substance of this central position distinctfully composes in having or be capable of having within the constructs to which is something of a mystery, for, it seems as nothing about analysis and is, of least to be, the well known than how individual analysis actually uses transference in their day-to-day work with patients. As a guess, as, perhaps of each analysts concept of transference derives variably but significantly from his own inner experience, transference probably means many and varying differentiations to things as to different analysts.
 In the same differentiated individuals, as that Freud’s own pupils must have differed on this issue, not only from him but from each other. Although some of their differences may have been slight, others, my have contributed significantly to later analytic developments. A question could be raised, for instance, whether differences in handling the transference that at first were the property of one analyst gradually develop into formal clinical methods used by many, and whether these clinical methods, after having been conceptualized, serve as the beginning of variously divergent schools of analysis. Such occurrences, consistent with certain beliefs that analytic ideas do arise in this way, primarily out of transference experiences in the analytic situation, would lead to the question whether the history of the ideological differences in what was actually said and done in response to transference reactions that to any other factor. Whatever the case, many differences and divergencies did occur among the early analysts, and all of that is supposed to have had to do in some major way with differences in the handling of the transference.
 Strangely, Freud himself seems to have taken little part in influencing this rapid and divergent period of growth. Usually accused of being too dominating in such matters, Freud seems to have done just the opposite  during the development  of this most critical aspect of analysis, the process itself, and, for reasons unknown, detached himself from it.
 What was needed, one might be inclined to say, was not leadership in the form of domination, but leadership in trying to provide what was lacking, and still lacking, namely an analytical rationale for transference phenomena. The question must be asked, of course, whether in fact this would have been a good thing at that particular time in psychoanalytic history. Perhaps not. The exercise of closure, to which Freud’s structuring might have amounted. But although adding to understanding and stability at ceratin theoretical levels, could at another level, so such closures have often done, have placed many obstacles in the way of further analytical developments. Thus, his leaving the matter of transference wide open, even though it led to confusion and uncertainty, may have been just as well.
 In many ways the closest Freud ever came to establishing a formal analytical rationale for transference was his first attempt, in the postscript to the case of hysteria (1905). These few pages are and among the most important of all Freud’s writings, outweighing by far the paper to which they are appended. Yet, in the case of Dora has always been taught as an entity rather than the ancillary to the essay on transference. In that essay Freud was clear: His ideas revealed tremendous insights and promised more to come, and that, the powers of the neurosis are occupied in creating a new edition of the same disease. Just think of the analytic implications of his saying that this new edition consists of a special class of mental structures, for the most part unconscious, having the peculiar characteristic of being able to replace earlier persons with that of the person of the analyst, and in the fashion applying all components of the original neurosis to the person of the analytical at the present time. Surely as profound a statement as any he ever made.
 He then goes on to say that there is no way to avoid transference, that this ‘latest creation of the desire must be combatted like all the earlier ones’, and that, although this is by far the hardest part of analysis, only after the transference has been resolved can a patient arrive at a sense of conviction of the validity of the connection that have been constructed during analysis.
 He concludes by saying, ‘In psychoanalysis . . . all the patients’ tendencies, including hostile ones, are aroused, they are then turned to account for reasons to explain or the internalization of justification, and by the same measure was to purposively give a sensible reason for the proposed change in the analysis by which of being made conscious. That, in this way, the transference is constantly being put-down, however, transference, which seems ordained to be the greatest obstacle to psychoanalysis, becomes its most powerfully . . .
 These remarkable observations, in conveying a sense of deep conviction that could arise, one feels, only from Freud’s own hard-won inner experience, that nowhere is there a suggestion that transference is a mere technical matter. Far from it, as Freud announces that he has come upon as new and exciting kind of mental function, or, as it is to believe, that a new and exciting kind of ego function.
 Very quickly, however, Freud’s conviction sees to have failed him. Nothing he wrote afterwards about transference was at this level, and most of his later references were a retreat from it, for instance, he never did develop the promising idea that the mind constantly creates new editions of the original neurosis and meaningfully inclines the minded inclusion in them, an ever-changing series of persons. Instead, he tended to become less specific, even referring to transference at times in a broad terms as if it were no more than rapport between patient and analysts, or as if it were an  interpersonal or psychosocial relationship, concepts that, of course, a great many analysts have since adopted, but which were not part of Freud’s original ideas.
 Perhaps his most persistent deviation was an on-and-off tendency to regard transference merely as a technical matter, often writing of it as an asset to analysis when positive and a liability when negative.
 Significantly, because it indicated that an active struggle was still going on within him, Freud occasionally expressed once again, even though briefly his earlier insights, particularly his ideas that transference is an essential although unexplored part of mental life. An example of this appears in his alternative obtainments such that is gainfully to appear of as quality of being pleasant or agreeable to a feature that makes for pleasantness or ease, among the amenities of the central geniality, otherwise, the prevailing indifference account for the transference in ‘An Autobiographical Study’ (1925). Transference, he says, ‘is a universal phenomenon of the human mind. And in fact dominated the whole of each person’s relations to his human environment. In these few words’ Freud again made the point, and in declarative fashion, that transference is a mental structure of the greatest magnitude, but he never really followed it up.
 Rather extensive evidence of his departure from the original concept and his continuing struggle with that concept is seen most clearly, wherein, the ‘Analysis Terminable and Interminable’ is much more than a courageous, brilliant, and pessimistic, appraisal of the difficulties and limitations of analysis, although transference is briefly mentioned in its content, yet a great deal about it comes through, some quite directly, some by easy inference. When looked at in this way, two themes stand out: Freud’s personal frustration with the enigmas of transference and his tacit placing of transference in the centre of success and failure in analysis, both as a therapy and as a developing science. What also comes through, is the perplexing realization of how far Freud had, by now, seemingly moved away from his original concepts. Or had he?
 All the same, even if it is insufficient for exclusive reliance in relations to the complicated neurosis, for which it would be fallacious to assign to the recall and reconstruction of the past an exclusively explanatory value (in the intellectual sense), important though that functions be, and difficult as its full-blown emotional correlate may be to come by. There is no doubt that, even in complicated neurosis, equivalently complicated transference neurosis, the genuine complex and complicated transference neurosis, the genuinely experienced linking of the past and present can have, at times, a certain uniquely specific dynamic effect of its own, a type of telescoping or merging of common elements in experience, which must be connected with the meaninglessness of time in unconscious life, compared with its stern authority in the life of consciousness and adaptation to everyday reality. Contributing decisively to such experiences as to whatever degree it occurs,  is of course, the vivid currency of the transference neurosis, and central in this, the reincarnations of old objects in an actual person, the analyst.
 Thus, an allied problem in the general sphere of transference is the fascination and often enigmatic interplay of past and present. If one wishes to view this interplay  in terms of a stereotyped formulation, the matter can remain relatively uncomplicated - as a formulation. Unfortunately. , This is too often the case. The phenomenon, however, retains some important obscurities, which cannot thoroughly dispel, but to which I would like to call attention. To concentrate on the dimension of time, it seems in reference to the complication and immediate aspects of technique, nonetheless, essential. For example, we can assume that the transference neurosis re-enacts the essential conflicts of the infantile neurosis in a current setting. If a reasonable degree of awareness of transference is established, the next problem is the genetic reduction of the neurosis to its elements in the past, through analysis of the transference resistance and allied intrapsychic resistances, ultimately genetic interpretations, recollections and reconstructions and working through. Such that the transference is related to its genetic origins, the analyst thereby emerges in his true, i.e., real, identity to the patient, the transference is putatively ‘resolved’. To the extent that one follows the traditional view that all resistances, including the transference itself, is ultimately directed against the restoration of early memories as such, this is a convincing formulation. Is that, only to say,  that in his own right as having to a certain tightly logical quality? However, we know that it this is not so readily accomplished, apart from the special intrapsychic considerations described afterward by Freud in ‘Analysis Terminable and Interminable’. Although in a favourable case, much of the cognitive interpretative work can be accomplished, there remains the fact that cognition responsibility, in its bare sense, does not necessarily lead to the subsidence of powerful dynamism, to the withdrawal of ‘cathexes’ from importantly real objects. For, as mentioned, a short while ago, the analyst is a real and living object, apart from the representations with which the transference invests him, and which are interpretable as such, for which there is no, at any time a seldom, a confusing interrelations and commonly of the emergent responses, due to the same old seeking, and this is directed toward a new individual in his own right, both are important, furthermore, there are large and important ones of overlapping. Apart from such considerations, even the explicitly incestuous transference is currently experienced (as, at least in good part) by a full-grown adult (like the original oedipus), instead of a totally and actually helpless child. To be sure, the latter state is reflected  in the emergent transference elements of instinctual striving, but it is subject to analysis, and the residual is something significant, if not totally different. It is these residual sexual wish, presumably directed toward the person of the analyst, as such, which must be displaced to others, if, as generally agreed, the revival of infantile fantasies and strivings in the biologically mature adolescent presents a new and special problem, one must assume distinctiveness of experience for the adult, although it is true that in the majority of instances, adequate solution is favoured by the adult state. There is, in any case, a residual relationship between persons who have worked together in a prolonged, arduous and intimate relationship, which, strictly speaking, are reversibly disconnected  or divorced of services, in that the transference merely ushers out the retirement for which its rendering retreat of that state of mind or feeling by an inner avoidance of something usually felt as unpleasant or pronounced for it’s adverse but mutual colouration. Blending to some confusion between the two spheres of feeling. The general tendency is that both components are fully gratified to some degree. But, there is the ubiquitous power of the residual primordial transference, yet, argue to cling to an omnipotent partisan to resist the displacement of its ‘sublimated’ anaclitic aspects, even if the various representation of the wishes for bodily intimacy has been thoroughly analysed and successfully displaced. The outcome is largely the transference of the transference, as mentioned earlier, in a different context. For everyday reality can provide no actual answer to such cravings. In this connection, note, Freud’s genial envy of Pfister. If the man of faith finds this gratification in revealing religion, others in a wide range of secular beliefs and ‘leaders’ the modern rational and sceptical intellectual is less fortunate in this respect. Presumably free, he is prone to invest even intellectual disciplines or the proponents with inappropriate expectations and partisan passions, but, least of mention, that within these fields of analytical and theoretical thought, is not to provide exceptions to this tendency.
 Though if one is to maintain and beneficially confine its bothering of reservations about the clarity of conceptualization, the explanatory discussion of Kohut and Seitz, is a very useful contribution to the direct complication or which by some understanding the awkwardness of oneself. Both Loewald and Kohut have deliberately associated a special but the different use of one of Freud’s three conceptions of transference, i.e., the transference from the unconscious to the preconscious.
 Yet, to furthering comments on primordial transference, at least potentially, are largely psychological (mental) component, the concept of ‘transference of the transference’ would be applicable to this component. For it does appear that certain aspect of the search for the omnipotent and omniscient caretaking parents are implicitly practical as virtually capable for being turned to use or account for its functional practicability for something of a process or the procedure for being all but the essential purpose to come to or tend toward a common point, for which are the knowledgeable information or ideas, is nothing but causative effectuality. As suggested earlier, there are important  qualitative and quantitative distinctions in the mode of persistence and such strivings, however, even to the extent that they are detached from the analyst and carried into some reasonably appropriate expression in everyday life, they retain at least a subtle quality that contravenes reality, one that derives from earliest infancy, and remains - to this extent  - a transference. ‘Santa Claus’ lives on, where one might least expect to meet him,  whether as a donor of miracle drug or of far more complex panaceas.
 If one prescribes to this parasymbiotic transference drive, a true primordial origin, it is necessary to take cognizance of certain important concepts dealing with the earliest period of life. If we assume a powerful original organismic drive toward an original ‘object’, a striving to nullify separation from the beginning, how does this make something legally valid or operative usually by formal approval or sanctioned with concepts such as ‘primary narcissism’ or the ‘objectless phase’ or ‘the primary psycho physiological self’ (We note in passing that there are those who do not accept these as usually construed in the technique of Balint), for example, or Fairbairn or - conspicuously - Melanie Klein. These are states, variously defined or conceived, which apply to the earliest neonatal period, in which life, to state more simply, exists only as the potential in physiological processes. Since there is (we postulate) no clear awareness of self-withdrawal from the mother, there can be no ‘mentally’ represented or experienced drive to obliterate the separation (concerning oneself and object, conceiver of a conventional orientation where its separately in a continuing sense). There are, of course, discharge phenomena, the precursors of purposive activity, and there are urgent physiological needs, directed toward fulfilment or relief, rather than toward an object as such. However, in relation to these physiological needs as archaistic precursors of object relationships, it must be noted that in all, except respiration and spontaneous sphincter relief (even in these instances, not without exception or reservation), the need fulfilment must be mediated by the primordial object (or her surrogate). There is also, of course, the uniquely important requirement for ‘holding’, in a literal expression, from the outset. The material partner in human symbiosis that supplies what the neonate cannot seek by ‘clinging’, as for Bowlty and Murphy, in the sense that must be experienced to the physiological ebb and flow of tension, even if restricted to the kinaesthetic, connected with a peripheral sensory registration, which is the protophase of the recognition of separation from the object or nonpresence of the object, as a painful instance of, her presence in apposition the converse? That the general context may be only in which the sense of unity is preponderant, or, more accurately, that there is no general awareness of ‘separation’ as such, means that the drive for union does not exist in a general psychological sense. It is, so to speak, satisfied. That object constancy, with its cognate ‘longing’, is quite a different experience from the urgencies of primitive need fulfilment is true, however, regardless of what may be added by maturational and developmental considerations, instinctual and perceptual, there is no reason to assume other than a core of developmental continuity from the earliest needs and their fulfilment to the later state, and some continuing degree of contingency based on them.
 There is a very rough parallel in the way certain analytic patients, before a firm relationship with the analyst is established, signal certain primitive experiences  and tendencies in special reactions to the end of the hour, to the nonvisibility of the analyst, to interruption of their association, to failure of the analyst to talk, and similar matters. We must note that in the basic formation of the ego is evident between the  primitive reactions and beyond to separations, in the form of very early identifications as based on care taking functions. Certainly in the very development of autonomous ego of the mother’s investment in a decisive role in the character of the their development. And in the case of object constancy, in its connotation of libidinal cathexis, where is no need whatsoever (emotional or otherwise) is needed for prolonged periods.  The importance of the object is, to put it mildly, liable to deteriorate, or to differ complicating aggressive change. Probably the characteristic feature of later developing relations to the object (love and the wish for love), as separate if not always separated from demonstrable primitivity, in the need fulfilment, have a special relationship to those ‘ancillary’ aspects of neonatal nurture, whose lack has been shown to be an actual threat to life in some instances, not to speak of sound emotional development. So that from the first, regardless of the assumed state of libidinal (and aggressive) economy, or the assumed state of psychological nondifferentiation between self and potential object, there are critical percussive phenomena, objectively observed, and probably prototypic subjective experiences of separation, which are the forerunners of all subsequent experiences of the kind. One may generalize to the effect that, with maturation and development, secondary identifications, and the various other processes of ‘internalization’ in its broadest sense, the problem of separation and its mastery becomes correspondingly more complex, and changes with the successive phase of life, but never entirely disappears.
 In the view of the psychoanalytic situation the latent mobilization of experiences of separation stimulated by the situational structure awakens the driving primordial urge to undo or to master the painful separations that it represents, usually embodied in the various forms of clinical transference that which we are familiar. One legitimate gratification that tends to mitigate superfluous transference regression is the transmission of understanding that at times, are thought that by the ‘mature transference’, in effect, the ‘therapeutic alliance’ or a group of mature ego functions that enter such an alliance. Now, there is one blurring and overlapping at the conceptual edges in both instances, but the concept as such is largely distinct from either one, as it is from the primitive transference, which we have been discussing. Whether the concept is thought by others to comprehend a demonstrable actuality, which is a further question. This question, of course, can only follow on conceptual clarity. This in saying, of a nonrational urge, not directly dependent on the perception of immediate clinical purposes, a true transference in the sense that it is displaced (in currently relevant form) from the parent of early childhood to the analyst. Its content is not anti-sensational, but largely non-sensual of sometimes transitional, as the child’s pleasure in the assemblages of  ‘dirty words’ and encompasses a special and not minuscule sphere of the object relationship: The wish to understand, and to be understood, the wish to be given understanding, i.e., teaching, specifically by the parent (or later surrogate); the wish to be taught to use ingenuity in making or doing o r achieving an end through the actions in a nonpunitive way, corresponding to the growing perception of hazard and conflict and very likely the implicit wish to be provided with and taught channels of substitutional drive discharge. With this, there may be a wish, corresponding to that element in Loewald’s description of therapeutic process, to be seen in terms of one’s developmental potentialities by the analyst. No doubt, the list could be extended into many subtleties, details, and variations. However, one should not omit to specify that, in its peak development, it would include the wish for increasingly accurate interpretations and the wish to facilitate such interpretations by providing adequate material ultimately, of course, by identification, to participate in, or even be the author of the interpretations. The childhood system of wishes that underlie the transference is a correlate of biological maturation, and the latent (i.e., teachable) autonomous ego function, appearing with it, however, there is a drive-like quality in the participation phenomena, which disqualifies any conception of the urge’s identical with the functions. No one who has ever watched a child importunes a parent with questions, or experiment with new words, or solicit her interests in a new game, or demand a storytelling or reading, can doubt this. That this powerful support and integration in the ego identification with a loved parent is undoubtedly true, just as it is true of the identification with an analyst toward whom a positive relationship has been established. That ‘functional pleasure ‘ inscribes the part, where certain ego energies, perhaps very likely the ego’s own urge to extend its hegemony in the personality. However, it can be stressed in the derive element, even the special phase configurations and colourations, and with its importance of object relations, libidinal and aggressive, for a specific reason. For just as the primordial transference seeks to undo separation, in a sense to obviate object relationships as we know them, the ‘mature transference’, tends toward separation and individuation, and increasing contact with the environment, optimally with a large affirmative (increasing neutralized) relationship toward the original object toward whom (or her surrogates) a different dynamic of demands is now increasingly directed. The further consideration that has led to the emphasis that the drive-like elements in these attitudes are integrated phenomena, as examples of ‘multiple functional’ rather than the discrete exorcise of function or functions, are the conviction that there is a continuing dynamic relation of relative interchangeability between the two series, at least based on the response to gratifications in a significant zone of complicated energetic overlap, possibly including the phenomenon of neutralization. That the empirical ‘interchangeability’ is limited, and that goes without saying, that in no way diminishes its decisive importance. The linguistic communications as in mention, that the excessive transference neurosis regression, which can seriously vitiate the affirmative psychoanalytic process, finds a prototype in the regressive behaviour and demands of certain children, who do not receive their share of teaching, ‘attention’, play, nonseductive, affectionate demonstration, as to use the quality of being appropriate or valuable to some end, even the act or practice of using something or the state of being used to which of responsible interests in development, and similar matters, from their parents. In the psychnalytic situation, both the gratifications offered by the analyst and the freedom of expression by the patient, are diversely limited and concentrated, practically entirely (in the every day demonstrable sense) in the sphere of linguistic expression, on the analyst’s side, further, in the transmission of understanding.
 Whereas, the primordial transference exploits the primitive aspects of linguistic communication, by expressing the mature transference as to advocate the seeking mastery of the outer and inner environments, a mastery to which the mature elements in speech contribute importantly, for which these are stressed upon the clear-cut genetic prototype for the free associating its interpretative dialogue is the original learning and teaching of speech, the dialogue between child and mother. It is interesting to note that just as the profundities of interests between people who often include - in the service of the ego - transitory introjection and identifications, of the very word ‘communication’, representing the central ego function of speech, from which is a closely intimate relation to the etymologically certain, in actual usages, to the word chosen for that major of religious sacrament for that which is the physical ingestion of the body and blood of the Deity. Perhaps, this is just another suggestion that the oldest of individual problems does, after all, continue to seek its solution, in its own terms if only in a minimal sense, and in channels so remote as to be unrecognizable.
 The mature transference is a dynamic and integral part of the therapeutic alliance, alone with the tender aspect of the erotic transference, evens more attenuated (and more dependable) friendly feeling of adult type, and the ego identification with the analyst. Indispensable, of course, are the genuine adult need for help, the crystallizing rational and intuitive appraisal of the analyst, the adult sense of confidence in him, and innumerable other nuances of adult thought and feeling. With these, giving a driving momentum and power to the analytic process, but always, by its very nature, a potential source of resistance, and always requiring analysis, is the primordial transference and its various appearances in the specific therapeutic transference. That it is, if well managed, not only a reflection of the repetition compulsion in its menacing sense, but a living presentation from the id, seeking new solutions, and trying again, so to speak, to find a place in the patient’s conscious and effective life, has important affirmative potentialities. This has been specifically emphasized by Nunberg, Lagache and Loewald among others. Loewald has recently elaborated very effectively the idea of ‘ghosts’ seeking to become ‘ancestors’ based on an early figure of speech of Freud. The mature transference, in its own infantile right, provides some of the unique qualities of propulsive force, which comes from the world of feeling, rather than the world of thought. If one views it in a purely figurative sense, that fraction of the mature transference that derives from ‘conversion’ is somewhat like propulsive fraction as the wind in a boats sailing to windward currents into motion, the strong headwind, the ultimate source of both resistance and propulsion, is the primordial transference.  This view, however, should not displace the original and independent, if cognate, a favourable tide or current would also be required. It is not that the mature transference is itself entirely exempt from analytic clarification and interpretation. For one thing, in common with other childhood spheres of experience, there may have been traumas in this sphere, punishments, serious defects or lacks of parental communication, Listening, attention or interest. In general, this is probably far more important than has hitherto appeared in our prevalent paradigmatic approach to adult analysis, even taking into account the considerable changes due to the growing interest in ego psychology. ‘Learning’ in the analysis can, of course, be a troublesome intellectualizing resistance. Furthermore, both the patient’s communications and his receptions and utilization of interpretations may exhibit only too clearly, as sometimes in the case of other ego mechanisms, their origin in and tenacious relation to instinctual or anaclitic dynamism; the longing implement out of silence for which the analyst is to override the uncritical acceptance (or rejection) of interpretations, in that the patient revealingly is to mention the unmindful assimilation, fluently, rich, endlessly detailed associations without spontaneous reflection or integration. In the direct demands for solution of moral and practical probability for an entirely intellectual scope, and a variety of others. It may and always be easy to discriminate between the utilization of speech by an essentially instinctual demand, and an intellectual or linguistic trait  or having to be determined by specific factors in their own developmental sphere, however, the underlying and essentially genuine dynamism that have to continue to be placed for a notable interval or remain arbitrary or conventional character most favoured to the purposes of processes of analysis, as it was to the original processes of maturational development, communication, and benign separation. Lagache, on the desirability of separating the current unqualified usage, ‘positive’ and ’negative’ transference, as based on the patient‘s immediate state of feeling, from a classification based on the essential effect on analytic processes. Yet, the later of mature transference is, in general, a ‘positive transference’.
 Concerning considerations in the transference neurosis, and the problem of transference interpretation, may be offered at this point. The whole situational structure of analysis (in contrast with other personal relationships), its dialogue of free association and interpretation, and its deprivations as to most ordinary cognitive and emotional interpersonal drives that tend toward the separation of discrete transferences from their synthesis with one another and with defences in character or symptoms, and with deepening regression, toward a contuative enactment of the essential of the infantile neurosis, in the transference neurosis. In other relationships, the ‘give and take’ aspects - gratifying aggressive, punitive or otherwise actively responsive, and the open mobility of searching for alternative or greater satisfaction - exert a profound dynamic and economic influence, so that only extraordinary situations, or transference of pathological character, or both, occasion to comparable regression.
 It is a curious fact, whereas the dynamic meaning to the importance of the transference neurosis has been well established since Freud gave this the phenomenon a central position in his clinical thinking, the clinical reference, when the term is used, remains variable and somewhat ambiguous. For example, Greenson, in his excellent recent paper, speaks of it as appearing, ‘when the analyst and the analysis become the central concern in the patient’s life’. However, previous remarks in this connection, for which it is worthwhile to specify certain aspects of Greenson’s definition, for the term ‘central’ is somewhat ambiguous, as to its specific reference. Certainly, the term could apply to the symbolic position of the analyst in relation to the patient’s experiencing ego and the symbolically decisive position that he correspondingly assumes in the relation to the other important figures in the patient’s current life. However, while the analysis is in any case, and for multiple reasons, exceedingly important the seriously involved patient, there is a free observing portion of is ego, also involved, not in the same sense as that involved in the transference regression and revived in infantile conflicts. And here is here being, of course, always the integrated adult personalty, however diluted in may seem at times, of its rarity, although certainly does occur, that the analysis actually exceeds the quality or state of being of notable worth or influence that the other major concerns, attachments, and responsibilities of the patient’s life, nor is it desirable that his should occur, on the other hand, if construed with proper attention to the economic considerations as mentioned, the concept is important, both theoretically and clinically. In the theoretical direction to the assumption that there is a continuing system of object relationships and conflict situations, most important in the unconscious representations, but participating to some degree in all others, deriving in a successive series of transference from the experiences  of separation from the original object, the mother. In this sense, the analyst’s applicability to a uniquely important portion of the patient‘s personality, the portion that ‘never grew up’, to maintain a central figure. In the clinical sense, to call or direct attention especially to a supposed cause, source, or to refer to the importance of the transference neurosis as outlining for the essential and central analytic task, providing by its very currency and demonstrability a relatively secure cognitive base for procedural duties. By its inclusion of the patient’s essential psychopathological processes and tendencies, in their original functional connection, it offers, in its resolution or marked reduction, the most formidable lever for analytic cure. Nonetheless,  transference neurosis must be seen in its interweaving with the patient’s extra-analytic system of personal contacts. The relationship to the analyst may influence the course  of relationships to others, in the same sense that the clinical neurosis did, except that the former is alloplastic, relatively exposed, and subject to constant interpretation.  It is also an important fact that, except in those rare instances where the original dyadic relationship appears to turn, the analyst, even in the strict transference sphere, cannot be assigned all the transference role simultaneously. Other actors are required. He may at times oscillate with confusing rapidity between the status of mother and father, but he is usually predominantly in one of the roles for long periods, someone else representing the other. Furthermore, apart from ‘acting out’, complicated and mutually inconsistent attitudes of the anterior apprehensions for realizing often about something not generally realized in the verbalization, may require the seeking of other transference objects, i.e., The husband or wife, friend, another analyst and so forth. Children, even the patient’s own children, may be invested with strivings of the patient, displaced from the analysis, even experience the impulses that they would wish to call forth in the analyst. The range is extensive, varied, and complicated, requiring constant alertness. Transference interpretation therefore often has a necessarily paradoxical inclusiveness, which is an important reality of technique. There is another aspect, and that is the dynamic and economic impact of the intimate and actual dramatist personate of the transference neurosis in the progress of the analysis as such, and on the patient ‘s motivation, as well as his real lifer avenues for recovery. For the persons in his milieu may fulfill their ‘positive’ or ‘negative ‘ roles in transference drama, which may facilitate or impede interpretative effectiveness, they provide the substantial and dependable real life gratification that ultimately facilitates the analysis of the residual analytic transference, or their capacities or attitudes may occasion overload of the anaclitic and instinctual needs in the transference that renders the same process far more difficultly. In the most unhappy instances, there can be a serious undercounting of the motivation for basic change.
 There is also the fundamental question of the role of the transference  interpretation. At the Marienbad Symposium most of Strachey’s colleagues appeared to accept the essential import of his contribution and thus  unique significance of the transference interpretations, despite the various reservations as to detail and emphasis on other important aspects of the therapeutic process. Nevertheless, there are still many who, if not in doubt regarding the great value of transference interpretations are inclined to doubt their uniqueness, and to stress the importance of economic considerations in determining the choice as to whether transference or extratransference interpretations may be indicated. Now, apart from the realistic considerations mentioned in the preceding passage (in a sense the necessarily ‘distributed’ character of a variable fraction of transference interpretation). There is in fact  that the extra-analytic life of the patent often provides indispensable data fo the understanding of detailed complexities of his psychic functioning, because of the sheer variety of its references, some of which cannot be reproduced  in the relationship to the analyst. For example, there is no repartee (in the ordinary sense ) in the analysis. The way the patient handles the dialogue with an angry employee may be importantly revealing. The same may be true of the quality of his reaction to a real danger of dismissal. There are not only the realities, but the ‘formal’ aspects of this responses. These expressions of personality remain important, even though his ‘acting out‘ of the transference (assuming this was this was the case) may have been more important, and, of course, requiring transference interpretation. Furthermore, they remain useful, if discriminatingly and conservatively treated, even if they are inevitably always subject that epistemological reservations, which haunts so much of analytic data. Of course, the ‘positive’ transference has a role in the  utilization of such interpretations that what enables the patent to listen to them  and them seriously.
 In an operational sense, it would seem that extratransference interpretations cannot set aside, or underestimated in importance, but the unique effectiveness of transference interpretations is not thereby disestablished. No other interpretation is free, within reason, of the doubt introduced by not really knowing the ‘other person’s’ participation in love, or quarrel or criticism or whatever the issue. And no other situation provides the patient the combined sense of cognitive acquisition, with the experience of complete personal tolerance and acceptance, that is implicit in an interpretation by an individual who is an object of the emotion, drive, or even defences, which are active at the time. There is no doubt that such interpretations must not only (in common with all others) include personal tact, but must be offered with special care as to their intellectual reasonability, in relation to the immediate context, lest they defeat their essential purpose. It is not too often likely that a patient who has just been jilted in a long-standing love affair, and suffering exceedingly, will find an immediate interpretation that his suffering  is due to the fact that the analyst does not reciprocate his love, even though a dynamism in this general sphere may be ultimately demonstrable, and acceptable to the patient. On the other hand, once the transference neurosis is established, with accompanying subtle (sometime gross) colouration of the patient’s life, th n more far-reaching anticipatory, transference interpretations are indicated, for, if all of the patient’s libidinal and aggression is not, in fact, invested in the analyst, he has at least an unconscious role in all important emotional transactions, and, if the assumption is correct that the regressive drive, mobilized by the analytic situation, is in the direction of restoration of a single all-encompassing relationship, specified pragmatically in the individual case by the actually attained level of development, then there is a dynamic factor at work, importantly meriting interpretation as such, to the extent that available material supports it. This would be the immediate clinical application on the material regarding the ‘cognitive lag’ or ‘cognitive fall-back’.
 Post-Traumatic Stress Disorder, resides in a mental illness that some people develop after experiencing traumatic or life-threatening events. Such events include warfare, rape and other sexual assaults, violent physical attacks, torture, child abuse, natural disasters such as earthquakes and floods, and automobile or aeroplane crashes. People who attest of the traumatic events may also develop the disorder.
 Post-traumatic stress disorder in war veterans is sometimes called shell shock or combat fatigue. In victims of sexual or physical abuse, the disorder has been called rape trauma or battered woman syndrome. The American Psychiatric Association (APA) adopted the current name of the disorder in 1980.
 In the late 1960's and early 1970's, mass demonstrations erupted throughout the United States protesting US involvement in the Vietnam War (1959-1975). Thousands of veterans joined in a national organization, Vietnam Veterans Against the War, that supported and influenced the antiwar movement. In this transcript from an April 22, 1971, hearing before the Senate Committee on Foreign Relations, committee chairman Senator J. William Fulbright indicated his sympathy for the antiwar movement. Fulbright’s comments were followed by the testimony of Vietnam veteran John Kerry, who called for an end to the war. Kerry also detailed what he believed to be the war’s negative effect in both Vietnam and the United States. Kerry became a Democratic senator from Massachusetts in 1985.
 People with this disorder relive the traumatic event again and again through nightmares and disturbing memories during the day. They sometimes have flashbacks, in which they suddenly lose touch with reality and relive images, sounds, and other sensations from the trauma. Because of their extreme anxiety and disruptive opposition to events, they try to avoid anything that reminds them of it. They may seem emotionally numb, detached, irritable, and easily startled. They may feel guilty about surviving a traumatic event that killed other people. Other symptoms include trouble concentrating, depression, and sleep difficulties. Symptoms of the disorder usually begin shortly after the traumatic event, although some people may not show symptoms for several years. If left untreated, the disorder can last for years.
 Post-traumatic stress disorder can severely disrupt one’s life. Besides the emotional pain of reliving the trauma, the symptoms of the disorder may cause a person to think that he or she is “going crazy.” In addition, people with this disorder may have unpredictable, angry outbursts at family members. At other times, they may seem to have no affection for their loved ones. Some people try to mask their symptoms by abusing alcohol or drugs. Others work very long hours to prevent any “down” periods when they might relive the trauma. Such actions may delay the onset of the disorder until these individuals retire or become sober.
 Studies have set or to bring into a new found control from 1 to 14 percent of people that suffer from post-traumatic stress disorder at some point during their lives. The findings vary widely due to differences in the populations studied and the research methods used. Among people who have survived traumatic events, the prevalence appears to be much higher. The disorder may be particularly prevalent among people who have served in combat. For example, one study of veterans of the Vietnam War (1959-1975) found that veterans exposed to a high level of combat were nine times more likely to have post-traumatic stress disorder than military personnel who did not serve in the war zone of Southeast Asia.
 Post-traumatic stress disorder is an extreme reaction to extreme stress. In moments of crisis, people respond in ways that allow them to endure and survive the trauma. Afterward those responses, such as emotional numbing, may persist even though they are no longer necessary.
 Not everyone who experiences a traumatic event develops post-traumatic stress disorder. Several factors influence whether people develop the disorder. Those who experience severe and prolonged traumas are more likely to develop the disorder than people who experience less severe trauma. Additionally, those who directly witness or experience death, injury, or attack is more likely to develop symptoms.
 People may also have been existing biological and psychological vulnerabilities that make them more likely to develop the disorder. Those with histories of anxiety disorders in their families may have inherited a genetic predisposition to react more severely to stress and trauma than other people. In addition, people’s life experiences, especially in childhood, can affect their psychological vulnerability to the disorder. For example, people whose early childhood experiences made them feel that events are unpredictable and uncontrollable have a greater likelihood than others of developing the disorder. Individuals with a strong, supportive social network of friends and family members seem somewhat protected from developing post-traumatic stress disorder.
 Treatment of post-traumatic stress disorder may involve psychotherapy, psychoactive drugs, or both. Psychotherapists help individuals confront the traumatic experience, work through their strong negative emotions, and overcome their symptoms. Many people with post-traumatic stress disorder benefit from group therapy with other individuals suffering from the disorder. Physicians may prescribe antidepressants or anxiety-reducing drugs to treat the mood disturbances that sometimes accompany the disorder.
 At the arriving considerations that are marked and noted, through which the essence of functional dynamics as based of the transference in the psychoanalytic process or the basic underlying the most basic of beliefs that in politics there is neither good nor evil, however, in that something that forms part of the minimal body, character or structure of that thing predetermines the properties to the good life. Nonetheless, most psychoanalysts maintain that schizophrenic patients cannot be treated psychoanalytically because they are too narcissistic to develop with the psychotherapist as interpersonal relationship that is sufficiently reliable and consistent for psychoanalytic work. Freud, Fenichel and others have recognized that a new technique of approaching patients psychoanalytically must be found if analysts are to work with psychotics. Among those who have worked successfully in recent years with schizophrenics, Sullivan, Hill, and Karl Menninger and his staff has made various modifications of their analytic approach. The techniques that are in use with psychotics are different from our approach to psychoneurotics. This is not a result of the schizophrenic’s inability to build up a consistent personal relationship with the therapist but due to his extremely intense and sensitive transference reactions.
 Let us see first what the essences of the schizophrenic’s transference reactions are and how we try to meet these reactions.
 We think of a schizophrenic as a person who has had serious traumatic experiences in early infancy at a time when his ego and its ability to examine reality were not yet developed. These early traumatic experiences seem to furnish the psychological basis for the pathogenic influence of the flustrations of later years. At this early time the infant lives grandiosely in a narcissistic world of his own. His needs and desires seem to be taken care of by something vague and indefinite which he does not yet differentiate. As Ferenczi noted, they are expressed by gestures and movements since speech is as yet undeveloped. Frequently the child’s desires are fulfilled without any expression of them, a result that seems to him a product of his magical thinking.
 Are a person’s characteristics primarily shaped by early influences, remaining relatively stable thereafter throughout life? Or does change spontaneously occur continuously throughout life? Many people believe that early experiences are formative, providing a strong or weak foundation for later psychological growth. This view is expressed in the popular saying “As the twig is bent, so grows the tree.” From this perspective, it is crucial to ensure that young children have a good start in life. But many developmental scientists believe that later experiences can modify or even reverse early influences; studies show that even when early experiences are traumatic or abusive, considerable recovery can occur. From this vantage point, early experiences influence, but rarely determine, later characteristics.
 Traumatic experiences in this early period of life will damage a personality more seriously than those occurring in later childhood such as are found in the history of psychoneurotics. The infant’s mind is more vulnerable the younger and less used it has been, furthers, the trauma has quickened the infant ‘s egocentricity. In addition early traumatic experiences shorten the only period in life in which an individual ordinarily enjoys the most security, thus endangering the ability to store up as it was a reasonable supply of assurance and self-reliance for the individual’s later struggles through life. Thus, as such, a child sensitized considerably more toward the frustrations of later like than by later traumatic experiences. Hence many experiences in later life that would mean little to a ‘healthy’ person and not much to a psychoneurotic, mean a great deal of pain and suffering to the schizophrenic. His resistance against frustration is easily exhausted.
 Once he reaches his limit of endurance, he escapes the unbearable reality of his present life by attempting to reestablish the autistic, delusional world of the infant, but this is impossible because the content of his delusions and hallucinations are naturally coloured by the experiences of his whole lifetime.
 How do these developments influence the patient’s attitude toward the analyst and the analyst’s approach to him?
 Due to the very damage and the succeeding chain of frustrations that the schizophrenic undergoes before finally giving in to illness, he feels extremely suspicious and distrustful of everyone, particularly of the psychotherapist ho approaches him with the intent of intruding into his isolated world and personal life. To him the physician’s approach means the threat of being compelled to return to the frustrations of real life and to reveal his inadequacy to meet them or, - still worse – a repetition of the aggressive interference with his initial symptoms and peculiarities that he has encountered in his previous environment.
 The difficulty that the  patient’s dilemma through his frustrations is the product through which is called ‘delusion’: Delusion itself is a false belief that is firmly held by a person even though other people recognize the belief as obviously untrue. For example, a person who truly believes he is Napoleon Bonaparte is delusional. Religious beliefs or popular conceptions, such as the beliefs that people have been abducted by aliens, are not delusions because they are widely held beliefs. Delusions are a type of psychotic symptom that indicate a person has lost contact with reality.
 There are many different types of delusions. A person with a paranoid delusion believes that others -  such as the FBI, or the CIA, even the Mafia as trying to harm or plot against him.  A person with a delusion of reference believes that events or people refer specifically to him or her when they do not. For example, a woman with schizophrenia may believe that a television news broadcaster is talking personally to her rather than to the entire viewing audience. A grandiose delusion is a belief that one is extremely famous or that one has special powers, such as the ability to magically heal people.
 A delusion of control is a belief that others are able to control one’s thoughts, feelings, or actions. For example, a man with this type of delusion may believe that someone has implanted a microchip in his brain that enables other people to control his thoughts. A somatic delusion is a belief that something is wrong with one’s body - for example, that one’s brain is rotting away - even though no medical evidence supports this belief. A person with an erotic delusion believes that someone is in love with him or her despite a lack of evidence for this belief. In a delusion of jealousy, a person believes that his or her spouse or lover is unfaithful despite evidence to the contrary.