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References Javier, R. t., & Herron, W. G. (2002). Psychoanalysis and the Disenfranchised: Countertransference Issues. Psychoanalytic Psychology, 19(1), 149-166.

Psychoanalysis and the Disenfranchised: Countertransference Issues Rafael Art. Javier, PHD, ABPP William G. Herron, PHD, ABPP This article examines basic psychoanalytic principles and their applications to the understanding and treatment of individuals not historically included in psychoanalytic formulations. It looks at the impact of culture, ethnicity, and class, but particularly poverty. The hope is to develop successful application of psychoanalytic theory and technique to the psychological problems of people living in poverty. Careful examination of their psychological reality may offer a unique opportunity to broaden vision of assessment to what constitutes dysfunctional condition, the concept of adaptation, the development of the working alliance, the nature of resistance and transference reactions, and the like. The analyst's personal discomfort, motivations, and stubborn adherence to specific theoretical and technical stances are considered the most damaging obstacles in this endeavor.

Contemporary psychoanalysis has been extending its reach to understand the impact of culture on both theory and practice. Thus, significant consideration is beginning to be given to the roles of race, ethnicity, gender, and class in the formulation of psychoanalytic hypotheses and the practice of psychoanalytic principles. This is in contrast to a manifestly pancultural, but actually restrictive, attitude that had prevailed to limit both the population served by psychoanalytic work and the development of theory. Although the history of psychoanalysis was particularly attached to the idea of being a universal description of experience (Mayer, 1996), it was primarily a depiction of the developmental phases and descriptions of a relatively single homogeneous culture, a Western European-American identity that

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emphasized middle-class, phallocentric, Anglo-Saxon attitudes and values.

The ineffectiveness of such a view has become apparent through both a greater recognition of the subjectivity of the psychoanalytic enterprise and the therapeutic needs of a markedly multicultural patient population. Thus, the applicability of psychoanalysis in the United States to previously underserved groups is becoming more discernible (Altman, 1995; Javier & Herron, 1998; Leary, 1997). Our focus here is on one of the primary cultural forces, namely poverty, although it is clearly intertwined with other forces, particularly minority status.

A Look at Poverty Through the Psychoanalytic Lens Our interest is in developing a way to successfully apply psychoanalytic theory and technique to the psychological problems of people who are living in poverty. “Poverty is less than the average expectable environment, and is relative to a given society” (Herron & Javier, 1996, p. 612). Thus, poverty refers to real limitations of choices due to economic scarcity. Disenfranchisement in the political, education, housing, health, and mental health delivery systems is a normal consequence of poverty (Herron, Javier, Warner, & Primavera, 1998). Specifically, individuals living in poverty are people who do not have enough economic resources to maintain a decent standard of living, and whose treatment options are generally limited to public or charitable institutions and whoever may be available as therapists. Educational opportunities are equally limited. Although strong dependency on public assistance or low-level manual labor to survive characterizes the lives of many of the poor, people who may have a steady and relatively reasonably paid job may still fall under the definition of poor. This is the case when their lives are entrapped in inescapable debts that keep their viable options extremely limited. The entrapment is more severe when confronted with an inability to find a better-paying job because of inadequate preparation to deal with the increasingly technology-driven job market. Patients with these types of life experience are now arriving at our offices through the managed care system that provides for only a limited number of sessions, and with no real options for continuing to pay for treatment on their own. The fact that many of these patients live in the slums and dilapidated areas of our land, and that their children are not protected against the worst of what our society has to offer, such as drugs, violence, alcoholism, and prostitution, demonstrates that the concept of poverty still applies to them. They are part of what has been referred to as the “underclass” (Wilson, 1990), and the poorest of all are unlikely to appear in the practices of most analysts. These features reinforce the idea that poor people have limited psychic resources and will not be able to do much for themselves, such as making use of insight (Javier, Herron, & Yanos, 1998). As a result, the psychoanalytic treatment of the poor is easily overlooked, creating a situation that is in dire need of remediation.

Poverty limits the power of the individual in so many ways that it has become customary to designate poor people as disadvantaged, deprived, and disenfranchised. Although throughout history there have been repeated attempts to decrease poverty, the problem is that these attempts have been accompanied by programs that either maintain or increase poverty in these individuals. It would be a strong and contentious statement to conclude that social

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forces have for centuries been engaged in a calculated balancing act, but poverty is notable as a tragic element in contemporary culture (Herron & Javier, 1996). Thus, the poor person is someone who is in need of psychological sustenance based on disruptions to the psyche that are part of the fabric of deprivation. But the poor person has not been well understood by psychoanalysis. The misunderstanding is rooted in the selectivity of who indeed can function as analytic patients and the use of valued psychodynamics that are most congruent with middle-class culture. Elliott and Spezzano (1996) noted the impact of the surrounding culture on psychoanalysis, in that revisions essentially have to occur. For example, Renik (1990) raised the possibility of changes in the stages of psycho-sexual development. Leary (1997) pointed out the need for revision of theories of family development given the variety of existing ethnic and racial styles. On a broader level, Samuels (1993) commented,

The assumption that a good-enough environment is all that the innate potential of an individual requires to flower, and that this is determined within the nuclear family and in the first month of life, is hopelessly passive in the face of problematic social and political structures. (p. 583)

It is useful to consider the problem in spatial terms. The mental content that has been the focus of theory and treatment has been only a part of the space that could be considered in the psychoanalytic endeavor. Now, it is time to consider the rest of the space, and to understand that the contents of all of the space are interactive, so the entire space becomes available for investigation. Of course, there has always been a recognition of an influential role of environmental and constitutional factors beyond the impact of the family or the strength of an instinctual urge, but the concerns of psychoanalysis have primarily reflected the intrapsychic content of the individual mind as though it existed in a relatively constant and limited space. The idea of constancy may seem questionable in light of the dynamic nature of the unconscious and the concept of psychic conflict, but the constancy lay in the repetitive action and form of the conflict, as for example, the possible and probable expressions of the Oedipal conflict.

On the one hand, given that individuals create cultures and societies, it is helpful to begin with the individual. On the other hand, individuals are born into existing cultures that immediately affect them and in the developmental process have, for some time, a potentially greater influence on the individual than the individual can have on the culture given his or her developmental immaturity and the accompanying relative lack of power. Yet, the social and cultural diversity increase relativity and make generalities suspect in most instances.

The point is that the poor person brings a particular set of characteristics to a therapeutic situation that are distinct from the patterns of the usual patient who has provided the clinical material for most of the existing psychoanalytic theory and technique. Thus, for most analysts who find themselves working with a patient who is economically deprived, there is a sense of confusion. At some point, the analysts find themselves perplexed by the unfamiliarity of the life of the patient and feel themselves struggling with how to make the process helpful. The

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distinction between analyst and patient here is in itself an unfamiliar one, in comparison with the patient having pathologies that the analyst has never personally experienced but has been trained to anticipate. Gender differences tend to fall in the latter category and occur with such frequency that there is plenty of opportunity to learn about the differences. Ethnic differences, particularly between White people and Black people or people with language barriers, are closer to the category of unfamiliarity, but are happening more frequently. However, when these occur they often have the bond of middle-class membership, whereas this is absent when the patient is poor, and the difference is often compounded by an accompanying ethnic distinction, the patient likely being an ethnic minority.

Two sources of the problem of applying psychoanalysis as a treatment for disenfranchised people bear investigation. The first is the theory itself, and it has already been noted that it will require modification and restandardization that is appropriate to the diversity of potential patients. However, this can be accomplished without being restricted by most of the theoretical nomenclature because such revisions do not alter the basic principles of sexual interest, unconscious motivation, relational desires, defensive styles, and other broad-based psychoanalytic constructs. More fundamental is whether the psychologies of psychoanalysis, namely the delineation of motivations, are deficient in their relevance to patients who are poor.

The second source is the technique of treatment, which is suggested and informed by theoretical preferences, although it is understood that professed orientations often lack congruence with actual practices. The poor person of course has a personality structure that can be conceptualized in metapsychological terms as deftly as one can conceptualize the personality structures of a middle-class or a wealthy person. The added and complicating dimensions are social and political, namely the consequences of poverty that can insidiously facilitate a distance between the poor patient and even the best-intentioned therapist. Most therapists are middle class, so it might be argued that they are too separated from upper-class patients to understand them sufficiently, but that is unlikely. Middle-class people frequently wish for more, and often try to achieve it, so upper-class identification is hampered primarily by a lack of wish fulfillment. In contrast, therapists have no interest in being poor, and despite social conscience, do not seek to identify with the poor. In essence, the poor patient is so unlike the therapist in most instances that regardless of the theoretical frame that influences the analytic technique, the potential for disruptive countertransference is high and prone to override egalitarian and altruistic desires as well. For most analysts, there is at the moment a limit on understanding the influence on a patient of a particular type of social problem, namely being poor. With the aim of alleviating that restriction, let us first examine the problem of theory, and then move on to the countertransference as this affects technique.

Theory All psychoanalytic theories of motivation contain a duality that can be both oppositional and complementary, libido and aggression being the best known examples. Such duality also determines the possibility of categorization of experience and of people into good or bad,

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more or less desirable. This division appears in class structure and, in turn, in the social and personal constructions of the elements of poverty. Inherent to psychoanalytic concepts such as topographical and structural models, separation and connection, and good and bad objects, as well as self and other, is what Kleinians refer to as a schizoid view of reality. This view defines the basic way that people process information into good and bad, acceptable and unacceptable, and desirable and undesirable. It is the legacy of Aristotelian thinking as well as the work of Hegel and other philosophers where logical positivism has significantly influenced psychoanalytic thinking. The suggested context is a dynamic interplay of different psychic forces in which perceptions are organized into categories, thinking evolves from a logical sequence of syllogisms, and knowledge becomes a function of dialectical movements. However, such a way of thinking (categorically) also provides opportunity for biased interactions among individuals.

Organizing perceptions into categories necessitates that preferential categorical organization will occur in which one category will take preference over another. Although categorization is necessary and unavoidable, the relative valuation of the poles, on the other hand, is not. Intriguingly, postmodernism and deconstructionism have currently exerted their influence in psychoanalysis to illustrate just how personal categorical preferences are, without leading to decategorization. Thus, dichotomies such as abstract-concrete, simple-complex, poor-rich, male-female, Black-White, native-foreign all can be a natural progression of an influential philosophy, originally conceptualized as potentially objective and presently transformed to unavoidably subjective. When these distinctions are defined in terms of deficiencies (Mays, 1985), and when conditions, characteristics, and styles that cannot easily be understood and subsumed under the prevalent categories are construed as negative or abnormal, a perversion of the thinking process can be said to take place. We have referred to this as a “polarity” (Herron & Javier, 1996), a dualism that defines the very nature of our political and economic realities. Although certainly not intended as such, it can reflect a prejudicial view of the poor and disenfranchised.

The solution is not the voiding of duality because it is all too apparent that oppositional forces permeate human nature. Despite the fact that the popularity of relational theories in psychoanalysis has led to devaluation of emotional dualism as a basic motivation.

it has survived in the form of libidinal drives. Variations on this, such as expanding the motivational range to include the four psychologies of drive, ego, object, and the self (Pine, 1990), or insisting that there is one primary motivation be it seeking pleasure or objects, do not alter the oppositional framework in motivation. The fact that complementarity often exists in motivating people also does not negate the basic overdetermination of behavior. Ambivalence is present, and then one acts and feels one way or another … psychic determinism appears to restrict choices as forces are marshaled to fashion a direction. (Herron & Javier, 1996, pp. 612-613) be it seeking pleasure or objects, do not alter the oppositional framework in motivation. The fact that complementarity often exists in motivating people also does not negate the basic overdetermination of behavior. Ambivalence is present,

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and then one acts and feels one way or another … psychic determinism appears to restrict choices as forces are marshaled to fashion a direction. (Herron & Javier, 1996, pp. 612-613)

The history of psychoanalysis can be traced in terms of different emphases in relational patterns, with structural theories striving for separation and relational theories striving for connection (Herron, 1999). Of course, these are broad categorizations that miss some of the complexity involved, but the trends are there. At the same time, all these theories retain a duality, because there is always a struggle involved in attaining the goal, namely a pull in the opposite direction. Klein (1980) took note of this quite some time ago when she described life as a perpetual struggle between love and hate. Even theories dedicated to the primacy of connection (Miller & Stiver, 1997) acknowledge the lure of pathological narcissism (Herron, 1999). Altering the balance and the oppositional tension in human interaction entails “changes in superego formulation and sublimations that will ameliorate oppositional duality, reduce the need for aggressive competitiveness, assuage anxiety, and alter the dominant wish” (Herron & Javier, 1996, p. 620).

Thus, the problem with applying psychoanalytic theories to the treatment of the poor is not the theories themselves but their interpretation, or more precisely, their interpreters, the analysts. In this regard, Russell (1998a, 1998b) refers to the therapist's personal urgency as the main obstacle in the analytic process. One possibility that has been raised to deal with the complications of treating the poor psychoanalytically is the need to shift from structural to relational theories (Altman, 1995), a logic that is in accord with the cultural concerns that were incorporated into the development of interpersonal theories. However, structural theory was aware of cultural influences as well, as suggested notably in Hartmann's (1958) principle of adaptation. Granted the degree and scope of awareness was less than that of the “culturalists”; nevertheless the problem is not primarily variations in social consciousness and emphasis, but limits on understanding the influence of a particular type of social problem, namely being poor. The inevitable existence of polarity serves as food for the basic obstacle, the analyst's countertransference, or failure of the therapist to be in touch with his or her own urgency, resulting in the disruption of the containment function of the therapeutic situation (Russell, 1998a, 1998b).

Countertransference in a Cultural and Economic Context Countertransference was originally thought of as the analyst's transference to the patient's transference, with the assumption that most of the patient's reactions to the analyst are transferential while the analyst's reactions to the patient are not. In essence, from this perspective the patient's reactions are viewed as a distortion of the “real” analyst that is facilitated by the relative anonymity of the analyst, the apparent blank screen on which the patient projects, turning the analyst into mother, father, or some significant person other than the analyst. As analytic technique has developed, the analyst has often been seen as more and more real. This has happened in two ways, namely either the theory espoused an increased mutuality so that the analyst would be deliberately reactive and self-disclosing (Aron, 1996) or the analyst provides a corrective emotional experience (Glickauf-Hughes &

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Wells, 1997) in which the analyst attempts to alter the transference by being different than what the patient expects in the light of his or her behavior toward the analyst. These approaches emphasize the active relationship between the analyst and the patient and are based on the potential insufficiency of the predominance of interpretation and the inevitability of subjectivity that makes neutrality, projective receptivity, and objectivity impossible as absolutes. The description by Renik (1993) of the analyst's irreducible subjectivity makes the latter point extremely well. Such a conception also broadens the concept of countertransference so that it includes the analyst's transference to the patient rather than being limited to a reaction to the patient's transference. Thus, the analyst may have a countertransferential reaction to the patient's appearance or accent or occupation. There will always be countertransference, and increasing mutuality of expression in the therapeutic encounter increases the probability of expression of countertransference. Although it is true that the analyst says something by saying little or nothing, the analyst can usually say more by speaking. Also, although self-disclosing approaches can be used to dispel transference, they slant its expression rather than necessarily remove it. For example, if the patient asked the analyst if he is angry and the analyst replies that he is not, the patient may behave differently toward the analyst. But he may continue to believe the analyst was or is angry. It is relatively easy to tilt the expression of the transference, which is our observable data, but rather hard to dislodge the transference belief, which will then make subtle reappearances as the patient feels it is needed for protection and safety. That is because history is a more frequent and powerful force outside of the analytic hour than in it, and different, empathic, soothing, supportive, or enlightening therapeutic experiences in the session are, at best, ameliorative not curative. Indeed, the main goal of the therapeutic situation is to push for a relative decrease in the patient's feelings of vulnerability (Damos, 1998). As Raphling (1997) noted, patients in analysis have conflicting interests in what they want, and will take, from the analyst, and these include agreement, disagreement, authority, and autonomy. Transferences are altered both through negotiating shared meanings and by contrasting views of the patient's inner life. This is the power of analysis, that in a sense both transference and countertransference get out of the way so that a patient's experience can be influenced by both interaction and interpretation. Raphling states: “The patient brings a potent and influential intrapsychic organization to bear on the analyst, whose responses, in turn, will determine to some extent [italics added] its expression in the analytic setting” (1997, p. 252).

The question here is to what extent and how the analyst's response to the patient may be influenced by the patient's impoverished status? The psychology of most analysts that has developed long before they met their first disenfranchised patient, and that may well have been reinforced by the homeless panhandler or other encounters on the way to the office, tends to solidify a class dichotomy related to a mode of anxiety regulation commonly used by members of the dominant group. It is as if the presentation of a basic tension becomes essential and, in keeping with a Darwinian philosophy, renders one group's self-definition in opposition to another (Thompson, 1996). Within this view unresolved and unneutralized aggression of the dominant group, or the analyst as authority, is now projected into the world. The content of the introjects and the nature of the repressed material influenced by these

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dynamics become the driving force for, at the least, the control and often the domination of others. The resulting schism, often reflected in just enough distance to still appear politically correct by hiding overt discriminations, makes the development of true empathy and working alliances virtually impossible. At the level of the larger society, the structure of difference pervades even espousals of connectedness, because class distinctions remain as understood necessities that allow primarily tokenism, pity, and condescension. Thus, the poor remain poor and disenfranchised: because poverty is more likely to embrace Blacks, Hispanics, and other minority groups, the members of these groups are often confronted with feelings of repression and alienation. When these feelings resonate with similar feelings at the intrapsychic level, the work of the analysis is exponentially complicated. It would be an unfortunate course of events if at the level of the patient-analyst dyad resistance and the adaptive functions of the ego were defined and interpreted in a way that preserves a basic dichotomy.

Although social programs for the disadvantaged that are derived from the rather overwhelming need to maintain class lines are often prejudicial in both blatant and subtle ways, we take note of that here primarily as background material for countertransference. That is, however, by no means an endorsement of the social system that we believe needs modification if a better standard of living and greater enfranchisement is to take place for more people. At the same time, our immediate concern is the treatment of the underclass by therapists who are also a part of the existing class system and the values this class system represents. There is admittedly a certain degree of error in our categorization of analysts in that there will be exceptions to the countertransferences described, but our experience suggests that one or more of the problems mentioned pertain to most analysts, even to analysts who may have originally come from a minority and disenfranchised group.

The first problem is the Whiteness category to which analysts customarily belong. Frankenberg (1993) described Whiteness as an aspect of American identity that often was not noticed by those who are White, but Leary (1997) comments on the idea of superiority that is tucked away within Whiteness. This category is not restricted to literal skin color, but has become much more of a social construction in which the economic and educational level of the person, regardless of skin, native language, or ethnicity, puts them in the Whiteness class, a relatively affluent group with its own set of values regarding where to live, where to send children to school, and other social and political norms. Of course, Black people or people with native languages other than English can step aside from Whiteness on these grounds, and indeed do so at times, but as therapists these individuals live in the land of Whiteness. The poor do not. They live in the land of relative darkness, no light clearly shining at the end of the tunnel, what can be experienced as an eternal tunnel.

Now it is quite possible that a majority of analysts have had brushes with poverty, as for example with parents who were poor immigrants, or having experienced periods of deprivation themselves. Discrimination against people who are in subgroups of that nature within the Whiteness category definitely occurs, but is customarily something to get past and

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to be avoided in the future. Even the idea of racial solidarity for Black people has its problems when it tries to endure across class lines because the culture of Whiteness has greater economic lure. Yes, you are my brother, you are my sister, we are in the same family, but if you are poor, we are not going to live in the same house, at least not for any length of time.

Thus, the culture of the analyst's office is the culture of Whiteness, regardless of how one apparently “rainbows” the room. Now, it has been noted that patient-analyst similarities can obscure understanding, and that differences between analyst and patient can be informative for the patient (Raphling, 1997), but these types of reciprocations and distinctions operate from a shared cultural base. Thus, as a starting point for the analyst, it is necessary to acknowledge the challenge to identification or a severe limit in identifying with the poor patient's plight. This is the case because the patient's life situation is usually out of the analyst's experiential base, in contrast to feelings of anxiety or depression, which may be shown. Indeed, it is not expected by the analyst as a personal possibility. It is not unusual for the patient to be blamed for his or her plight because, after all, the analyst has avoided it and believes, at least implicitly, that it can be avoided by following the rules of Whiteness —including proper discipline, arduous work, education, consistency, clear goals, and capacity for delaying gratification. Only then, through following such rules, will one be bound to have at least a moderate degree of success.

Consider, for instance, the case of a 34-year-old, single divorcee who decided to seek treatment to deal with her mother's eminent death of a slow and debilitating cancerous condition. She had a long work history at a bank, which was in the process of becoming increasingly technology-driven at all levels of banking. Equipped only with a high school education and no additional computer training, she felt she had no opportunity to advance within the banking industry or to find another job that could provide enough income to cover her bills. When not dealing with the impact of her mother's death and the profound sadness and anger associated with the loss, the sessions were characterized by what sounded like continuous complaints about her numerous misfortunes at work and her failed attempts to establish a meaningful relationship with a man. She lived, until recently, in a four floor walk-up in a poor section of the Bronx that was in need of multiple and continuous repairs. Her cat, which was her only sure companion, was old and required frequent medical attention, further draining her already limited financial resources. She felt trapped at all levels and would often break down into uncontrollable sobbing when the feelings of loneliness, isolation, hopelessness, and entrapment would emerge in the course of the session. Her condition was made even more complicated by multiple and serious medical complications affecting her health, including a cancerous condition, which kept her always worried about the next flare-up. The financial burden associated with the medical bills not covered by her HMO certainly complicated her economic condition further. There was a sense of heavy and unshakable burden in this woman who, nevertheless, took the step to search for some kind of solution to her dilemma by seeking psychological treatment. There was also a sense of pride in her demeanor and she always managed to present herself well and with a touch of elegance.

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Some of the feelings that the therapist had to confront were his belief that the patient's previous choices had placed her in her current precarious financial position. Although that was clearly true, she was confronting a severe financial challenge that a person who came from a more economically privileged family background would not have had to have faced in the same way. She had only herself to rely on to face these challenges and in spite of all this, she came to treatment not in search of a concrete response to her pain, but in search of an understanding of how she continued to contribute to her condition. She began to make changes accordingly. For a while the therapist had to struggle with an acute feeling that the patient had a strong sadomasochistic component in her behavior as she had a history of relationships that were abusive, rejecting or dissatisfying and her general life experience was one of limited joy. Being aware of this, however, she decided to take the step to break up with her live-in boyfriend and confront her own loneliness, rather than remain connected with someone so dysfunctional and emotionally draining. She desperately started to look for relationships that she felt might add possibilities to her experience. She became involved with a lawyer, but it became clear that the mark of her life of deprivation and her shame about not being able to invite him to her apartment eventually became obstacles to the continuation of the relationship. However, she saw the brief involvement as her ability to be able to seek potentially more rewarding relationships. She has refused to return to the previous relationship in spite of his constant plea to resume the relationship and despite the fact that she has confronted severe feelings of depression and isolation. Similarly, the patient was able to find another and much better apartment to move to in her attempt to change her life condition.

There are preconceived notions about poverty that are very difficult to reconsider when faced with a poor person as a patient. The contextual approach suggested by Stolorow (Orange, Atwood, & Stolorow, 1997) is particularly useful in this regard. This is not a psychological theory or school of psychoanalysis, but rather a way to understand the patient regardless of the analyst's theoretical preference. The intersubjectivity that is a hallmark of contextualism puts the analyst in a position of reflecting on personal feelings and actions that are happening in and as a result of the interaction with the patient. In working with poor patients the countertransference needs to be defined broadly, that is, it is the analyst's transferential reaction to his or her idea of a poor person which, in turn, will be further influenced by the patient's transference manifestations. Of course, given the initial conceptual countertransference, it is likely that the analyst will interpret transference so that it is congruent with the analyst's original expectations, thereby compounding the distortion. This was, indeed, the danger with the patient just briefly described as well. The full texture of the patient's psychological pain only emerged when the therapist suspended all his preconceptions of what this patient was all about and the therapy situation turned into a containment of safety.

The starting point in understanding the poor person is the same as it is with other patients about whom one is likely to have preconceived stereotyped notions. These notions can be a function of the analyst's understanding of analytic theory, for example poverty as a function of

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an ego deficit, and of the analyst's personal history, for example, of viewing poor people as dangerous. However, neither the theory nor the personal history has to be used in a prejudicial manner. This type of countertransference has been well documented with regard to gender (Chodorow, 1994) and race (Javier, 1990; Javier & Herron, 1992; Leary, 1997), but analysts are both more willing and more likely to work with people of different genders and ethnicities than with the poor because of the class difference and its accompanying economic limitations which keep the patients who live in poverty out of the analyst's usual practice.

Working Through Transference and Countertransference Challenges Leary (1997) has suggested a model for understanding race that is useful as well for poverty. Poverty is a reality that needs to be acknowledged by both analyst and patient. Poverty is also shaped culturally and personally, so poverty can best be conceptualized as contextual and as a social reality. The analyst has the opportunity to recognize that each patient will intra-psychically make their own meaning for their poverty and will experience poverty as a fact, and that these meanings are unlikely to match the analyst's, but are available for exploration. Possible attitudes by analysts are to feel sorry for the patient and in turn to emphasize the social reality of poverty to the exclusion of personal responsibility, or to reverse the process and blame the patient while excusing the society. Disdain, hostility, and rage are also possible feelings based on the analyst's fear of poverty and its connection with danger to the law and order of society. Because we are discussing therapeutic encounters, the analyst is also faced with a fear of rev aling an offending attitude, as well as the possibility that the patient will be reactive and manipulative on the basis of the patient's transference to the analyst's social class and status. There may also be successful or unsuccessful attempts to identify with the patient based on past personal experiences with poverty, or other identifications that express the analyst's desire to rebel against society in some way. For example, we have often found that student therapists in our university-based Psychological Services Center consider the patients to be overcharged, although the fees are normally low as part of sliding scale structure to facilitate the treatment of the poor and disadvantaged. Nevertheless, student therapists are resistant to collecting fees without being aware that they may be manipulated by the patient.

These are just some of the countertransferences that are brought to the treatment of the poor. A question that has to precede these issues is. Why do it, especially given the ease with which it can be avoided? The answer lies in the needs of the people, which are often increased by the stresses inherent to poverty. Social conscience, as well as personal commitment, makes serving those who need us an integral part of the job. At the same time it is a job, meaning a living has to be earned, so one cannot continually give therapy away and have the practice survive. So let us assume a balance, that all therapists devote some time to treating the poor. On that basis we can move to how best to do it, and the biggest need in that regard is the resolution of countertransference.

This is not so easily accomplished because we are dealing with a particularly powerful set of feelings that, in the main, represent a fear of the poor: that in fact, by alleviating their psychic

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misery we will open the door to the disappearance of our own power. As they become psychically empowered through the possibilities of therapy we may fear that we will become them, a middle class that has expanded to the point that it is not any longer in the middle because there are no people below us. It is as though the potential envy or gratitude of the less fortunate is needed to keep the more powerful intact and emotionally alive. The lure of what Freud termed the “narcissism of minor differences” (1918/1957, p. 199) has a long history in which people have been kept in place to the point that societies are never without the poor. Political and social activism that really does something about disadvantages is of course called for, but even if every therapist does not do that, every therapist can try to treat the poor.

Acknowledging the reality of discrimination against the poor has to be a part of the process. At the same time, poverty can be used intrapsychically and interpersonally for security and defensive ends. The impact of the cultural concept is interwoven with the psychic process. The therapeutic encounter has to have a fluidity that allows more forces into the process and reduces the isolation of the dyad. The therapist has to be open to what the poor person thinks about the better-off therapist, as the therapist of one color has to be open with the patient of another color. However, in the interaction, what about all the possible distorted attitudes the therapist is bringing to the process? How can the therapist be a productive force rather than an obstacle? One way that has been suggested to get past these attitudes is to shift cultural identities. We suspect this shift can only be partially accomplished through concealment and has the potential for subtle enactments because Whiteness will retain its appeal. A second possibility is to be more disclosing, to respond to the patient's thoughts about our differences and to acknowledge his or her potential for discrepancies and misunderstandings. This leaves the therapist vulnerable, however, to the patient creating exaggerated transferences that are not solely linked to projections, as well as providing the patient with the need to conceal what is now known to be distasteful, or to provoke based on known annoyances for the therapist. Disclosure has to be a discretionary process that is as open to error as nondisclosure. Thus, once recognizing the countertransference, there is no set way to make use of it, just individual possibilities. The concept of empathic failures, and their repair, remains a hopeful possibility, as do the awareness of asymmetric mutuality, relative neutrality, and the use of healthy narcissism.

The idea of healthy narcissism is being motivated to act in such a way that satisfies the self, which in operating as a therapist means trying to do an effective job. That satisfaction is focused on the interaction with the patient and includes empathy as a basic ingredient. Tuch (1997) has pointed out that empathy facilitates the provision for self-object needs, points out directions of interaction that can heal narcissistic injuries, and provides a medium for appreciation. The poor have clearly suffered from self-object failures and live with these failures, as well as with empathic failures in that many people continually do not appreciate how they feel. The analyst's ability to remedy either self-object failures or empathic ones is going to be particularly limited with poor patients because each failure has powerful external controls that are beyond the analyst's reach. For example, self-object failures that come as a

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result of social inequality will not be eliminated by therapy, although adaptation can be improved. Then, Tuch notes: “One important source of empathic failure is the analyst's tendency to rely too heavily upon his or her own experience in order to understand patients” (1997, p. 266). Given the class discrepancies that involve experiential discrepancies, empathy through personal experience has to be limited. This point is further illustrated by Basch's comments that sometimes “a patient's appearance, viewpoints, lifestyle … are so foreign that one feels less … interested in the person and more in the grip of ʻstranger anxietyʼ” (1988, p. 168).

Tuch offers a way out of the misunderstanding issue by redefining empathy as “the methods by which one comes to know how and why others feel as they do” (1997, p. 263). There are a variety of methods available to achieve such empathy, including affect, theory, insight, and fantasy, but personal experience is not required. It does require the need for the therapist to keep his or her personal urgencies under conscious control to allow for the patient's narrative to evolve unencumbered (Russell, 1998a, 1998b). Context does have to be understood so that the place of affect, style, and action in the person's life can be comprehended and interpreted. Subjectivity comes into play in the therapist's willingness to develop such an empathy when faced with “stranger anxiety.”

Concluding Thoughts What is being sought after is a type of optimal responsiveness. In terms of countertransference, this responsiveness will be both personal because of its inevitable subjectivity and impersonal in being object directed in a deliberate effort to understand how the patient feels regardless of the therapist's feelings, which are recognized by the therapist. Thus, Basch comments on the need for the analyst “to separate himself sufficiently from his feelings and emotions” (1983, p. 119), while still allowing himself or herself to experience the feelings of the other.

Our approach is to integrate countertransference by acknowledging it first ourselves and, if appropriate, to the patient. With the patient we start with the meaning of what may be alleged about therapies, as a disparity, a dislike, a disinterest in the patient, but couple this with a willingness to admit such possibilities and see how they fit with the patient's experiences. We note that we are products and makers of the culture, as are our patients, and that such influences merit consideration in the analytic work. We also accept the probability that these cultural differences, our Whiteness and ethnicity, and the patient's otherness will at times create empathic failures that are resistive to repair. We are going to be operating from a certain distance that will work only for some patients and, as Tuch (1997) points out, some patients want to avoid being understood, so the task can be increased even when our empathy might seem to be on the increase. As for all patients, our task remains discovery of patients' basic psychic struggles and the uncertainties of their origins and facilitating the alleviation of psychic pain. Because of who we are, the work is, in many ways, made more difficult, but it is also because of who we are that we have a need to undertake the work with all who may need it.

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