Int J Psychoanal (2014) 95:505–523 doi: 10.1111/1745-8315.

12143

Process-orientated psychoanalytic work in initial

interviews and the importance of the opening scene1

Peter Wegner
€ bingen – wegner@t-online.de
Pfalzhaldenweg 16, D-72070 Tu

(Accepted for publication 30 July 2013)

From the very first moment of the initial interview to the end of a long course
of psychoanalysis, the unconscious exchange between analysand and analyst,
and the analysis of the relationship between transference and countertransfer-
ence, are at the heart of psychoanalytic work. Drawing on initial interviews
with a psychosomatically and depressively ill student, a psychoanalytic under-
standing of initial encounters is worked out. The opening scene of the first
interview already condenses the central psychopathology – a clinging to the
primary object because it was never securely experienced as present by the
patient. The author outlines the development of some psychoanalytic theories
concerning the initial interview and demonstrates their specific importance as
background knowledge for the clinical situation in the following domains: the
‘diagnostic position’, the ‘therapeutic position’, the ‘opening scene’, the ‘coun-
tertransference’ and the ‘analyst’s free-floating introspectiveness’.
More recent investigations refer to ‘process qualities’ of the analytic relation-
ship, such as ‘synchronization’ and ‘self-efficacy’. The latter seeks to describe
after how much time between the interview sessions constructive or destructive
inner processes gain ground in the patient and what significance this may have
for the decision about the treatment that follows. All these factors combined
can lead to establishing a differential process-orientated indication that also
takes account of the fact that being confronted with the fear of unconscious
processes of exchange is specific to the psychoanalytic profession.

Keywords: initial interview, scenic information, opening scene, subjective indication,

differential process-orientated indication, countertransference and position of free
floating introspectiveness, ex-centric position, psychoanalysts’ attitude, abstinence

First interview with Mrs E2

When I go to call in the patient from the waiting room, she is standing with her
back to me and discussing something with the secretary. I am surprised and feel
slightly at a loss. In our delayed greeting, our hands miss each other. In the treat-
ment room she does not know where she should sit down.
Then she sits down on the edge of the armchair, holding a bag between us on
her knees. She is casually, rather conventionally dressed and there are signs of

1
Translated by Sophie Leighton. Revised version of presentations to the Hellenic Psycho-Analytical Soci-
ety, Athens, 5 May 2011, the 25th Annual Conference of the European Psychoanalytical Federation,
Paris, 1 April 2012 and the Brazilian Psychoanalytic Society of S~ao Paulo, 1 June 2012.

2
Although she was not yet married at the time of the interview, I refer to her as Mrs E.

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506 P. Wegner
neurodermatitis on her skin. She looks overtired, desperate and extremely serious.
She says she has already had two interviews and has finally been sent to me. My
first thought is that she has felt ‘sent away’ and that coming to me here seems to
denote a failure. I feel uncomfortable and forced to ask questions.

The patient has turned to another person from whom she cannot part. She
is disorientated and withdrawn in the room, barricading herself behind her
bag. I now have to ask questions because she was sent away. Further, into
the interview process, the opening scene is transformed:

She has come because of her “severe neurodermatitis” that began shortly after the
Abitur [German school-leaving examination, which is a university entrance require-
ment]. Her mother was an alcoholic, and she could not get on with her any more.
She was unable to decide on a subject to study and “fell into a deep limbo”. Then
she talked about her father, his family background, his profession and what he
thought about her “physical illness”. She is now 25 years old, and studying German
and cultural studies. Until a few weeks ago she was still living at home because she
was afraid to leave her mother and her sister, who is five years younger, on their
own. Only now has she moved in with her first boyfriend, whom she first got to
know at school.
I say: “The anxiety about separation and the start of the neurodermatitis occur at
the same time.” Mrs E answers in surprise: “That’s true! But even before then I had
the sense of being different from other people. I never went to a disco, never giggled
about boys. I read a lot and only did things with my family.” When I point out how
close her subjects of study are to her father’s profession, she smiles knowingly.
Otherwise she does not know, she says, how to describe her father. Was he strict?
She never dared to criticize him, was always “polite” and so her parents had always
trusted her. Her boyfriend had to spend a very long time winning her over, and “of
course sexuality is a big problem!”

Now I have a patient sitting opposite me, whom I must certainly win
over with questions, but who has something to tell and draws me into her
story with small gestures; her pensiveness and her hesitancy are attractive
qualities. She seems to emerge from a bygone world. Her girlish politeness
obscures her femininity as she sinks back into silence and her speechless
past.
Although even in the first interview Mrs E showed some typical charac-
teristics of psychosomatic patients (e.g. ‘social adaptation’, ‘lack of fanta-
sies’, ‘tendencies to give mechanical answers’, ‘staying at the literal level’,
etc.), she also appeared completely atypical because the interaction
between her and me did not correspond to a “blank relationship” and she
gave no impression of striving for a “no relationship” (Stephanos, 2011,
pp. 19ff.).

I discover some things about various allergies, compulsory diets and expensive
unsuccessful attempts to treat the neurodermatitis and the agonizing itching on
her skin. Finally she says: “My silence is the reason why I could not decide about
having psychotherapy till now. I don’t like talking about myself, without having
any reason to do so.” I say: “Perhaps you find it unbearable to talk about your-

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 Initial interviews 507
self because you don’t understand yourself and your body?” Mrs E smiles, relaxes
a little and says: “The first two colleagues probably didn’t even know how I could
be helped’.

Unconsciously here, not-being-understood, speechlessness and something

new are condensed – the smiling brings a hope into play. Is one possible
reason to talk about herself that someone is listening to her, even when she
is silent and does not understand herself? Consequently does she uncon-
sciously connect any hope that has arisen with her doubts? Is she not to be
sent away after all when she very directly entrusts me with her unconscious
flood of destructive wishes, anxieties and attacks that she has not yet been
able to think, feel and speak about?

There is a new possibility in the telling, that the listener who may be benign can
hear the patient, invariably for the first time. The move from soma to psyche criti-
cally contains a new beginning. This, under the everyday surface noise of the analy-
sand, may be an unexpected and new position. The patient may know that the
other is listening to them for the first time.
(Sklar, 2011, p. 116)

She says: “I noticed that on the phone you talked about psychoanalysis. Is it true
that psychotherapy addresses current issues while psychoanalysis begins with child-
hood?” I reply that she is worried that I might also send her away and I point out
that we have not yet been able to talk about her childhood, which we would have
time to do though in a second interview. She agrees!

Process-orientated understanding in initial interviews

In the psychoanalytic initial interviews, patients wish to portray their inner
world, an inner world that to some extent is entirely unknown to them.
The interviewer is associated with hope, fear or destruction even before
the first meeting. The process begins with the ‘preliminary phenomena’, for
example, arranging an appointment on the phone (Argelander, 1976). A
patient’s choice of words and voice on the phone can have a lasting positive
or negative influence on the interviewer and, conversely, the analyst’s atti-
tude on the phone can determine whether a productive interview comes
about at all.
This is followed by the first meeting in person, the opening scene, the
patient’s first verbal communication, the psychoanalyst’s first verbal inter-
vention, communications about the life history and case history, the first
interpretation in the stricter sense, agreeing how to proceed and, finally,
arranging a further appointment or saying goodbye conclusively. In this
process, the psychoanalyst’s internal attitude is constantly shifting between
listening, conceptualizing, introspective alertness, taking roles, reacting and
intervening, between past and present, and between a diagnostic and a ther-
apeutic attitude (Wegner, 2008).
For the psychoanalyst the possibility of understanding something about
the patient and the relationship that is just starting is a crucial precondition
for instigating and maintaining a therapeutic relationship, whereby many

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508 P. Wegner

unconscious motivations cannot yet be transformed into the transference

relationship.
Conversely, unless the patient’s helplessness has reached extreme propor-
tions, he will generally only maintain a therapeutic relationship if he feels
adequately understood by the analyst’s attitude and intervention (cf. Sterba,
1934: ‘working alliance’ and the capacity for ‘therapeutic ego-dissociation’).
Whether or not a patient can tolerate inadequate understanding is often a
gauge of his ego capacities. If the analyst manages to listen closely, he will
also detect that the patient has often brought his own ‘diagnosis’ of his
mental or somatic suffering, which is also portrayed through the process of
interaction. It remains the analyst’s task to formulate this as precisely as
possible.
The goal of the interview is to achieve some intersubjective process
descriptions that lead to therapeutically relevant statements (Eckstaedt,
1991). This is also how we can understand some reflections by Danckwardt
and Gattig, who suggest “a special variant of the initial interview” for
obtaining some answers to how the indication of high-frequency psychoana-
lytic treatment can be substantiated:

In addition to the observations on the course of one interview session, observations

on the course of all preliminary interviews should be conducted once or twice a
week. In this way, much dynamic data could be gathered on the basis of a final
reflection, in addition to objective data (e.g. about the manifestations of repetition
compulsion), which would provide an answer to the likely optimum density of the
session sequence.
(1998, p. 44)

The theoretical reflections below attempt to trace in broad terms the

development of a psychoanalytic theory of the initial interview. No direct
link is made with clinical material. The significance of these reflections
instead consists in characterizing them as background knowledge that is
potentially available in the analytic situation and that preconsciously
expands perceptual capacities. Every psychoanalyst will use his own theo-
ries. Something that all psychoanalysts seem to share is that they set aside
their knowledge in favour of free-floating attention in the clinical situation.
As early as 1900, Freud expressed this in inimitable terms: “I found a way
out by renouncing all conscious mental activity so as to grope blindly
among my riddles. Since then I am working perhaps more skilfully than
ever before, but I do not really know what I am doing” (Freud, 1985[1887–
1904], p. 404; letter to Fliess of 11 March 1900).

The diagnostic standpoint

The analyst’s diagnosing standpoint, in the sense of a one-person psychol-
ogy, was long in the foreground in the history of psychoanalysis. It requires
an attitude that should allow an optimum of guileless communications from
the patient, which takes up the patient’s non-neurotic or non-psychotic
parts as far as possible, without any drive-satisfying interactions or gratifi-
cations occurring – an attitude that conforms to the abstinence principle.

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 Initial interviews 509

Freud described this task in An Outline of Psychoanalysis as follows: “The

analytic physician and the patient’s weakened ego, basing themselves on the
real external world, have to band themselves together into a party against
the enemies, the instinctual demands of the id and the conscientious
demands of the super-ego” (1938, p. 173).
Freud himself had no specially formulated interview technique, but made
various comments concerning the first interview, such as: “Anyone who
hopes to learn the noble game of chess from books will soon discover that
only the openings and end-games admit of an exhaustive systematic presen-
tation and that the infinite variety of moves which develop after the open-
ing defy any description” (1913, p. 123). His idea of the trial analysis was
not pursued in any systematic way.
Only Argelander’s more recent ground-breaking works finally point in an
integrative direction. The analyst has three different sources of data avail-
able: (1) objective information, (2) subjective information and (3) scenic or sit-
uational information. He writes: “The reliability of the picture gained of the
personality and its psychic disturbances grows with the integration of the
information from all three sources” (Argelander, 1976, p. 28). In the scenic
information, the experience of the situation with all its emotions and repre-
sentational processes predominates even when the patient is silent. The con-
nection with other data is a secondary act. The criterion for the reliability
of the information is the situational or scenic evidence: “Such information
is practically never capable of being checked by repetition, and it is there-
fore discarded or not mentioned by most interviewers even though it is the
richest in what it discloses regarding the prognosis of the therapeutic pro-
cess” (Argelander, 1976, p. 28). An overview of the international develop-
ment and the theory and practice of the psychoanalytic initial interview is
given for the first time in Initiating Psychoanalysis: Perspectives (Reith
et al., 2011).

The therapeutic standpoint

For the patient, the first interview often represents a first psychoanalytic
self-experience (Schubart, 1989) with decisive importance for the later treat-
ment process. A precondition for the success of this self-experience is an
analyst who encounters his patient’s unconscious conflicts by understanding
and interpreting. The efficacy of a successful trial interpretation as a crite-
rion for the positive indication of psychoanalysis is extremely important.
These are no small demands to ask of the interpreting psychoanalyst, but he
must also be no more than “good enough”, for “we win our analytic match
as a human being and so let the partner be a human being when we miss
the ideal by a hair’s breadth, for absolute omnipotence pre-empts the
other’s autonomy” (Loch, 1965a, p. 22).
But it is critically important for the therapeutic standpoint whether or
not the analyst can take the patient into treatment himself (cf. Bolognini,
2006). In addition to the fundamental attitude of curiosity, empathy,
identification and responsibility, the psychoanalyst must also pay heed to
his situation-specific possibilities in the setting. Along with some other

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510 P. Wegner

factors, this belongs to the ‘subjective indication’ dimension, as theorized

by Dantlgraber. His paper Observations on the subjective indication for
psychoanalysis (2011[1982]) marks a key directional shift in psychoanalytic
interview technique from the so-called ‘analysability of the analysand’ to
an examination of what occurs in the relationship between patient and
analyst that leads to a positive subjective indication for essential psycho-
analytic work. Analysability is not understood in quantitative terms
measured by objective criteria applied to the patient; rather, it is mea-
sured by the analyst’s own subjective possibilities (see Wegner, 2011b, pp.
189–93).

The opening scene

A special importance has been attributed to the actual beginning of the
interview ever since Freud’s time, as with the initial dreams and symptom-
atic actions (Wegner, 1988). Every moment of an analyst–patient relation-
ship can be systematically examined and understood as the expression of an
unconscious communication. The beginning of the interview though has one
distinguishing feature, which is that both participants in what occurs have
still not had any actual experience of each other.
At the very beginning of an interview, patient and analyst move from a
protected situation into an unprotected one. The analyst is also unprotected
insofar as everything new that comes to him has not yet been understood
and it remains unclear whether it can be understood. This ‘destabilization
of the intrapsychic equilibrium’ (Kind, 1986) in both the patient and the
analyst is connected with intense affects. Bion (1987) refers to an ‘emotional
storm’. In previous works I have illustrated a ‘cumulative opening scene’
and analysed it in detail (Wegner, 2006, pp. 31–5; also Danckwardt and
Wegner, 2007, pp. 1122–3).
Specifically in the opening scene, the scenic function of the ego can inter-
vene in an impressively creative way and bring to expression an intractable
unconscious conflict under the influence of a particular current situation. In
general, we refer to the capacity to develop a transference neurosis (cf.
Freud, 1920, p. 18). This situationally adapted capacity of the ego to shape
a scene is felt to be alien to the ego because it simultaneously contains a
regressive tendency and relaxes the habitual ego-structures (cf. Argelander,
2013[1970], pp. 337–41). Argelander emphasizes that the particular current
situation refers to something more than the transference: “Whereas the
transference, as an unconscious process, is constellated from inside to out-
side, the form it assumes in a given situation – the dynamic configuration
assumed by the transference under the condition of the present situation –
is a fresh creation of the ego” (Argelander, 2013[1970], p. 338). He also
emphasizes how tremendously fast the scenic function of the ego can shape
an existing situation and simultaneously portray an “infantile configura-
tion” (Argelander, 2013[1970], p. 339).
Following Argelander’s ideas, I have therefore termed this particular sec-
tion of the first interview the opening scene (Wegner, 1988; Wegner and
Henseler, 1991) by emphasizing two different things:

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 Initial interviews 511

• the unavoidable scenic interaction in the only encounter between

analyst and patient that starts without any prior knowledge of the
other;
• the associated actualization of preverbal areas of the personality, pre-
oedipal conflicts or states that Stone (1961) considered to be actualized
specifically by the analytic situation.
The opening scene is defined as the entirety of the interaction that occurs
between analyst and patient, from the personal greeting up to the outset of
the interview, including the first spoken sentence under the basic conditions
of psychoanalytic treatment that is offered. The ‘entirety of the interaction’
denotes all the verbal and nonverbal actions, all the direct and indirect com-
munications, as well as all the same accompanying conscious, preconscious
and unconscious psychic processes of the analyst and the patient (cf. Weg-
ner, 1988, 2011b). In an empirical investigation, I was able to demonstrate
that the opening scene has significant diagnostic importance and that it is
inadvisable to overlook it, as actually often happens in practice (Wegner,
1988, 2011b), because the speed of the events takes the psychoanalyst by
surprise and impedes perception, so its importance is therefore often under-
estimated.

The countertransference
The opening scene with Mrs E also took shape very quickly. Fully
expecting to greet my patient, I was surprised that she had turned to
someone else and I had to wait for her. I felt slightly at a loss, was dis-
appointed, felt thwarted and, for a few moments, I had the painful sense
of being dependent on Mrs E. When she then turned to me, she was so
confused that our hands missed each other. This was a further disap-
pointment that was at risk of becoming entrenched in me. Was this an
early signal that something would go awry between us? Of course I was
also annoyed about the situation and felt it was in danger of impairing
my possibility of attending to her fully. So had I to compose myself
again on the way into the consulting room in order to regain my appro-
priate attitude and so on. Much later in the course of the interview, I
then connected this part of the opening scene with the being sent away
by the previous interviewers and not being able to separate from the
assumed infantile configuration.
The analyst is not only required to diagnose and to make interventions;
he has to observe himself as part of what occurs in the interaction in the
transference and the countertransference. It should be emphasized that the
analyst does not only react but is also influenced by many factors: his fun-
damental attitude, his individual life and learning history, situation-specific
feelings in anticipating a new patient and subjective investigative and prob-
lem-solving strategies that reduce the flow of information (cf. also Bolog-
nini, 2013). This also includes potential anxieties concerning a new patient,
which are something more than an expression of the patient’s pathology. In
fact, our work is accompanied by:

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512 P. Wegner
anxieties of insecurity, of perceptual conflicts, of aporia, invasion, of the threat
of being confused and of not being able to tolerate one’s incompetence in the face
of the real psychic structure of the analysand. These are anxieties about the loss of
one’s therapeutic omnipotence.
(Danckwardt, 2011a, pp. 121–2)

All these factors on the analyst’s part enter into the opening scene.
After the insight was gained, in historical terms, into how very much the
specific analyst, as part of what happens in the transference and counter-
transference, intentionally or unintentionally influences the course of events,
the concern with countertransference analysis acquired central importance
(cf. Kernberg’s distinction (1965) between the ‘classical approach’ and the
‘totalistic approach’). Heimann (1950, 1960, 1964) accorded an important
status to the countertransference analysis as a diagnostic tool and Rosenfeld
emphasized that: “The most common blockages in the patient–analyst inter-
action relate to the analyst’s early childhood anxieties” (1987, p. 40).
Recently, this discussion led to establishing a process-orientated two-per-
son psychology that describes how: “we deal with a relational system in
which one factor is also the function of the other” (Loch, 1965a, p. 15).
Loch decisively emphasizes the object-relations analytical aspect of the reci-
procity. Statements such as Heimann’s that: “The analyst’s countertransfer-
ence is not only part and parcel of the analytic relationship, but it is the
patient’s creation, it is a part of the patient’s personality” (1950, p. 83) or
Bion’s that: “Analytic interpretations can be seen to be theories held by the
analyst about the models and theories the patient has of the analyst” (1963,
p. 17) are accordingly honed in terms of a two-person psychology.
Whereas previously the analyst was seen as a dependent variable (in rela-
tion to the patient as an independent variable) in the field of investigation,
he is now problematised as an independent variable, independent that is of
the patient’s transference. “The interpretation of transference behaviour
reactive to countertransference is one of these problems”, writes Fliess
(1953, p. 273) and Loch states: “The analyst needs the countertransference
to be able to understand the patient, although he must simultaneously over-
ride it to be able to give the patient an interpretation” (1965a, p. 21). This
gives rise to the supposition that “the dialectic of double negation is an
operating principle of our technique” (ibid., p. 20f.).
This is in fact how a fabric of interacting, reciprocally influencing pro-
cesses is woven between patient and analyst that requires a language (repre-
sentational model; cf. also Bion, 1965) to be described and conceptually
understood, which must always be newly sought; this means, essentially,
that we cannot assume a one-dimensional causality.
The tool of investigation is the analyst alone, and Loch emphasizes: “The
object of investigation and the instrument of research … [belong] in the
same category” (Loch, 1965a, p. 21). He processes signals in two directions:
• One vector represents the conscious communications and their uncon-
scious correlate, where recognizable distortions in the patient’s commu-
nications in the context of the here-and-now (e.g. by transference
aspects) are especially important.

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 Initial interviews 513

• The second vector is directed at the detailed processing that occurs in

the analyst himself. This is what I would call an introspective directed-
ness that relates to conscious and unconscious internal processes.
Even very early in an interview, the number of pieces of information pro-
cessed in the analyst increase to an almost infinite degree. In other words,
he is confronted with a complex problem-solving situation in which he can
only maintain behavioural competence by artificially reducing or ordering
all the data. Otherwise the analyst system would collapse, which often actu-
ally partly occurs, and is itself of strong diagnostic relevance.
It takes some time for an interviewer actually to adapt to a new patient.
Not only the patient but also the analyst must overcome a threshold after
which he can truly listen. This threshold also implies the interviewer’s right
to decide whether he is willing to assume responsibility for a particular
patient. There is considerable evidence that such decisions are made –
more or less consciously – very quickly. Above all, however, this threshold
is set against the onrushing force of the patient’s uncontrolled wishes,
which the analyst can only be ready to process if he has gained an idea of
them and is being given access to unconscious intrapersonal and interper-
sonal conflicts. Most patients know that very well, for after all they are
not only victims of their symptoms but also agents of their own history of
suffering, even if they prefer other explanatory concepts at a conscious
level. Furthermore, this threshold protects the analyst from the fact that
every patient in a specific way is capable of stirring the analyst’s uncon-
scious personality structure or conflictual structure and thus affecting areas
of narcissistic vulnerability. All these problems are often accompanied by
strong affects, especially the analyst’s anxiety about both his and the
patient’s feelings.

The position of free-floating introspectiveness

The analysis of the analyst’s countertransference enables the patient to have
the experience of his ego–self and constitutes the recognition of the sepa-
rateness from the ‘you–object’, as libidinal and aggressive drive demands
and their renunciation become possible to experience (Loch, 2010, pp. 69–
71). This ontogenetic developmental aspect is repeated during the psychoan-
alytic process and embryonically in the first meeting and can, if everything
proceeds well, rectify specific fixations, i.e. allow new experiences through
the analyst’s meaning-attributive interpretations.
The capacity to take up an ex-centric position represents in one sense an
operationalization of the analyst’s introspective activity, as the precondition
for the countertransference in the practising therapeutic sense being brought
to consciousness. Until we are able to perceive countertransference, we can-
not understand or even define it, regardless of whether or not and how it
exists. Attaining the capacity to take up an ex-centric position is based on
an internal mental structure formed by internalizing the oedipal constella-
tion, which “allows objective self-observation with subjective participation.
This means that ‘insight’ and ‘feeling’ can coincide internally, giving the
understanding a sense of internal reality” (Britton, 1989a; 1989b, p. 24).

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514 P. Wegner

It may also be helpful to consider, alongside the analyst’s ‘free-floating

attention’ and ‘free-floating responsiveness’ (Sandler, 1976), one further vec-
tor in the field of investigation and the treatment situation, namely ‘free-
floating introspectiveness’ (Wegner, 2011b), which differs from free-floating
attention through this specific directedness and, furthermore, is in this sense
part of the identification with the psychoanalytic method.
Neyraut (1974, p. 15f.) made an important contribution concerning the
countertransference with the term “precession of the countertransference”.
In my opinion, what Neyraut meant is that the analyst in the analytic pro-
cess, especially when he is protecting the conditions of the setting, carries
out from the very outset for the patient and the analytic situation a spe-
cific preparatory work or, to put it another way, pays a definite tribute,
“namely to be directly, even personally, involved and possibly to shed
light on this involvement” (ibid., p. 15f.). This specific preparatory work
actually precedes the patient’s concrete transference since he may not yet
know that, as he opens up to the psychoanalytic process, he is transferring
particular object-relational patterns on to the analyst. In every case we
must suppose that there is also a transference by the analyst on to the
patient.
Neyraut uses an “extended theory of countertransference … [that] …
encompasses all the analyst’s statements, ideas, feelings, interpretations,
actions or reactions” (ibid., p. 18) and seeks to:

grasp a paradox of the countertransference, which is that while it precedes the

actual analytic situation (training analysis, training, distortions or orthodoxies of
every kind) it also only attains its true dimension when confronted with the internal
demands that arise from the analytic situation itself.
(ibid.)

This paradox could be psychoanalytically explained as “both transference

and countertransference … are known to be motivated forms of behaviour
in that they represent object relationships that are directed or instigated by
drive needs” (Loch, 1965b, p. 41 and 2006, p. 15). However, from the psy-
choanalytic perspective drive needs should be described as an independent
variable (e.g. while the analyst is certain and ready to (counter-) transfer his
own object-relational patterns on to the patient and, wherever possible, to
analyse them). The paradox of the countertransference could be resolved by
referring to parts of the analyst that we describe as independent variables
and that precede the patient’s transference or already exist independently of
a specific transference.
Bejarano (1977, p. 10) drew a distinction between a “general counter-
transference” and a “specific countertransference”, with the latter applying
only to one specific individual patient while the former corresponds to the
analyst’s professionalized introductory attitude. These distinctions also have
a definite relevance in relation to the treatment technique: we can then dis-
tinguish between the psychoanalyst’s attitude that allows him to adopt a
particular functioning towards the patient and the interpretation. The ana-
lyst’s attitude, however, incorporates facets of the part that would belong to

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 Initial interviews 515

the analyst’s observing perspective as an independent variable in the field of

investigation.
This applies especially to so-called early disordered patients, as Bejarano
(1977) worked out that in fact phased interpretations, at least in the sense
of the classical interpreting attitude, are ineffective or indeed even danger-
ous (ibid., p. 1) and should be replaced by the “analyst’s attitude” (ibid., p.
2), i.e. his experiences and feelings in the analytic situation, which is con-
stantly being corrected among other things by analysis of the countertrans-
ference (cf. also Dantlgraber, 1989; Treurniet, 1991). The attitude as an
effective therapeutic factor is mainly invariant towards the patient’s trans-
ference, so belongs to the analyst as an aspect of the independent variables
because the attitude is related to the analyst’s special capacity to let go of
his internal objects (see Loch, 1965b, p. 44). The ability to transcend his
own entanglement in drive-motivated object relationships, i.e. to achieve
separation, is thus for Loch simultaneously:

[the] underlying reason for the abstinence of which the analyst must be capable,
which is only possible if he can be alone without becoming lonely; for solitude,
experienced as abandonment and isolation, is itself a psychopathological phenome-
non that blocks or hinders understanding, let alone the patient’s process of letting
go and becoming free.
(ibid.)

This applies to a special degree for patients with so-called early disorders,
for whom the analyst’s attitude has special therapeutic relevance, and it
should be added that such patients can produce effects in the analyst with
full force even in the first meeting. If the analyst has to deal with object-
relational patterns from the relationship to the primary object, the safe-
guarding of existence (perceptible as catastrophic anxiety about dependency
and object loss) becomes the central focus of the therapeutic work, in con-
trast to the interpretation of the conditions of a particular anxiety (such as
oedipal anxiety about libidinal drive impulses). This applies in a particular
way, however, also for psychosomatic patients who not least through the
works of the Paris School of Psychosomatics have increasingly come into
our awareness (cf. Aisenstein and Rappoport de Aisemberg, 2010). There
are wide-ranging consequences for treatment technique, e.g. when a distinc-
tion is made on this basis between a ‘genuine unconscious’ and a ‘repressed
unconscious’. The somatosis then functions as a setting [mise en sc ene] for
sensory traces, which may have a traumatic quality. Once perceived, how-
ever, they cannot be processed as a drive demand because they are not yet
transformed on a symbolic level. They are directly discharged at the bodily
level (cf. Wegner, 2007, p. 44).

Differential process-orientated indication

We are increasingly being confronted with the question of which indication
for which psychoanalytic treatment is being established by whom. What
does the patient want, what does he need, on what can the patient and ana-
lyst agree, what compromises can we or must we reach and what are our

Copyright © 2014 Institute of Psychoanalysis Int J Psychoanal (2014) 95

516 P. Wegner

criteria for a differential indication? The EPF has set up the Working Party
on Initiating Psychoanalysis to meet this serious challenge. This will be
reported in detail elsewhere (Reith et al., 2010, pp. 57–80; 2011. Two gen-
eral factors for successful interview processes due to the psychoanalyst’s
interpretations have so far been worked out, namely (a) ‘switching the level’,
e.g. from conscious to unconscious, and (b) ‘opening up a meaning space’.
A working group of the German Psychoanalytical Association (E. Gattig,
J. F. Danckwardt, G. Schmidh€ usen and P. Wegner) has also devoted itself to
this subject using a method (as in the ‘free clinical groups’ at the EPF confer-
ences) that goes back to Wolfgang Loch. This method comprises discussing
clinical material in groups on the ‘Prisms effect’ model: like a light ray that
passes through a prism which fans out previously invisible parts and makes
them visible, the group discussion fans out the patient’s previously unnamed,
unconscious components into his individual elements and subtleties.
It emerged from this that in all the clinical case presentations what was
termed the synchronization between analyst and analysand constitutes a cen-
tral phenomenon in treatment technique that can be understood as a “spe-
cific process-quality of the analytic relationship”, which includes the
capacity for agreements on different levels of psychic functioning between
analysand and analyst, in a non-colonizing way (Gattig and Danckwardt,
2009, pp. 317ff). The problem is that, in a colonizing relationship, analysts
behave like conquerors who govern “a conquered country, not according to
the judicial system that they find in force there, but according to their own”
(Freud, 1938, p. 167). That makes a non-traumatic relationship impossible.
Synchronization “involves a psychoanalytic process … that comprises a will-
ingness or at least a maturing capacity … between patient and therapist …
to relinquish an inner subjective ‘transferred’ and ‘countertransferred’ object
and … to abandon resistances and defences constructed against it” (Gattig
and Danckwardt, 2009, p. 317).
One further observable phenomenon could be termed self-efficacy. This
means directing attention to “what continues to operate progressively
between the sessions, e.g. residual session phenomena and beyond that how
much time [between the sessions] … a self-recombining pathological self-
organization [starts in the] patient”.

The resistances and negative therapeutic reactions of the transference–countertrans-

ference dialectics operate in the sessions, while the self-recombining pathological
self-organization operates between the sessions. Freud termed the effects of the self-
recombining, self-organization proliferations [Wucherungen] on the basis of the
phantasies newly formed in the meantime.
(Danckwardt, 2011b, p. 213)

Where little or no self-efficacy emerges in a patient between the sessions,

it can be assumed, for instance, that psychoanalytically orientated psycho-
therapeutic work in the low-frequency setting is not appropriate for the
patient.
One additional factor should in future be submitted to more systematic
examination, namely the psychoanalyst’s anxiety in the psychoanalytic

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 Initial interviews 517

method because these anxieties on the analyst’s part can be assumed to lead
unconsciously to decisions that obstruct the beginning of a psychoanalysis.
Gaddini has already lucidly described a ‘perceptual–regressive’ (in contrast
to the usual ‘perceptual–reactive’) disposition, which generally gains ground
in the initial contact with a new patient:

For the analyst the problem does not mean: “not regressing” at all, but on the con-
trary, being able and in a position to regress without damage, namely to the advan-
tage of the analytic situation … This inner “opening”, the increased freedom of
intrapsychic communication, which involves attaining a degree of liberation from
anxiety … represents one of the fundamental goals that is required by a successful
psychoanalytic training.
(1964, p. 148f.)

Because beginners are thought to struggle particularly with this attitude, a

specific training in psychoanalytic interview technique appears to be indi-
cated.

The second interview with Mrs E

Mrs E breaks the initial silence by asking: “Are you waiting for some-
thing?” After another silence she says: “I’ve been worried about the period
from 0 to 18 years! That feeling of being different only started with pub-
erty. I have no idea how that came about. As a child I was completely nor-
mal, a happy and average child. My parents would confirm that.”
This remarkable beginning of the second interview shows that she tried
to continue working on her own and got into a blind alley. The time until
the next appointment with me must have passed tormentingly slowly for
her, with a great deal of turmoil and increasing confusion (a self-recombin-
ing pathological self-organization or a lack of self-efficacy). But I am to
know nothing about that; quite the opposite, she places projectively into me
the idea that I am longingly ‘waiting’ for ‘something’ from her. In that
mood she sees her past through her parents’ eyes, but she suspects, without
knowing it, that she did not have a happy childhood. Later in the session,
she remembers all kinds of eating disorders, current “terrible dreams” and
sleep problems that she had already had in childhood. Her mother would
then have to sit at her bedside until she fallen asleep. However, she is
mainly concerned with the question of whether she has a physical or a men-
tal illness. But this beginning also shows how close she would like to be to
me. I find this perceptible proximity obscurely frightening, because she
seemed to adapt to me completely.
Finally, we manage to establish that the onset of the neurodermatitis coin-
cides with the beginning of the relationship with her boyfriend and her feeling
of being different with the emergence of sexuality in puberty. The physical
closeness to her boyfriend represents the foundation of the current conflicts.
I have the impression that she does not have any real idea of her sexuality.

She says: “Underneath I’m full of anxiety and turmoil, my body is constantly itch-
ing all over. I can no longer concentrate on anything. Also I’m terribly afraid of

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518 P. Wegner
getting pregnant, although I’ve now been on the pill for years.” I reflect: “You
can’t bear closeness and contact. You feel wounded!” She agrees in amazement.

The course of the second interview yielded some new material and the
patient showed a certain introspective capacity. Although I was unsettled
by her submissive tendency, but it seemed that we had found a synchro-
nized way of talking and feeling.
At the end of the interview, I am sure I want to offer her a psychoana-
lytic treatment and I ask:

“What do you think, how should this continue?” She replies: “Although I have dif-
ficulties deciding as always, I could imagine having psychotherapy. What do you
think about that?” I reply: “I can imagine working with you.”

The third interview with Mrs E

In the period leading up to the third interview, anxieties and resistances are
mobilized in Mrs E. Again she was alone too long, with overwhelming feel-
ings and her inner confusion, in the sense of a pathologically ‘proliferating’
reorganization of the self (Danckwardt, 2011b, p. 212). She seems tense and
strained.

She catches me right off-guard: “I’ve got two questions: how exactly do you work
and what happens in psychoanalysis? Does psychoanalysis deal only with child-
hood? After all, I must solve my many current problems.” I reply: “It seems as if
you’re afraid that your ‘boundaries’ could be ‘damaged’ if you came to me four
times a week on the couch and could not ‘see’ me.” She looks at me disbelievingly
and laughs: “Four times a week?” Then she goes silent and finally says: “You know
how urgently I need your help!”

We discuss all the necessary questions about the setting, my holiday

arrangements, the level of the fee, my rules about absence and so on and
finally we agree on a four-sessions weekly psychoanalysis. A few months
after the beginning of the treatment, the patient asks for a fifth session
because she finds the weekend break intolerably long, which we then main-
tain until the end of the treatment.

The wish for closeness and the fear of non-separateness

The opening scene of the first interview condenses a key element of the psy-
chopathology, namely the non-separateness from the primary object, in
which she could not experience herself and which contained the appearance
of a total reciprocal contamination, which she also feared as a deadly dan-
ger. At the same time, physical symptoms determined the whole analysis,
simultaneously bringing to expression the lack of any connection or under-
standing between her and her body. For a long time, the patient maintained
the impression that she could experience introspectively. The language used
in this served to bypass her inner catastrophe of speechlessness. That could

Int J Psychoanal (2014) 95 Copyright © 2014 Institute of Psychoanalysis

 Initial interviews 519

barely operate because I accepted the function of a non-separated object in

the transference.

She says: “It’s about your body, your functioning and your wishes. I only have the
idea of ‘two in one’. I’m ‘two in one’. Alone I don’t exist because without you
everything is missing. ”

This statement helped me to understand that, beyond the complication of

our sexual difference, ‘I’ and ‘my body’ had to survive intact so that the
patient could experience herself in a vital and significant way. To this
belonged all the merely imaginable perceptions, feelings and thoughts in the
countertransference, which Mrs E could take in ‘through her skin’, first as
unseparated from me and later as her own. I not only had to ‘win’ her and
‘wait’ for her, I had to care for her, tolerate, hate and love her and think
and speak for her.
In the third interview ‘she wanted me’, without wanting me, but without
me she would be ‘nothing’: “You know how urgently I need your help!”
The process by which a relationship emerged and developed, the perception
of our bodily natures and the invention of our shared language, enabled
conditions to emerge for the development of her ego–self, “that … is first
and foremost a body–ego” (Freud, 1923, p. 27) and the toleration of sepa-
rateness without loneliness, in the sense of an approach to the ‘depressive
position’.

The return of the beginning to the separateness of the end:

The ‘psychoanalytic position’

From the very first moment of the initial interview to the end of a long course of
psychoanalysis the unconscious exchange between analysand and analyst, and the
analysis of the relationship between transference and countertransference, lie at the
heart of the psychoanalytical work.
(Wegner, 2000, p. 811)

Over many years Mrs E emphasized: “After every session I’m overwhelmed
by uncertainty as to whether I’ll ever see you again”. Every break was a
threat to her and plunged her into despair. Sometimes I found this annihila-
tion or non-existence of growing trust intolerable. Every session seemed like
a first interview. At the conclusion of the treatment, Mrs E had attained
the capacity to tolerate love and hatred simultaneously and thus an appre-
ciative independence that she had not previously experienced. Clinical mate-
rial from the final stage of her analysis impressively shows how the initial
themes returned to the foreground and what inner development was thereby
possible for Mrs E (cf. Wegner, 2013).
Without the analyst’s self-analytic capacity, every interview tends to be
threatened with failure. The fact that the free-floating introspective analyst
himself becomes the actual diagnostic instrument here underlines the com-
plexity and paradox of psychoanalytic working in unconscious relational
events from the outset. The persistence in the diagnostic position contains

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520 P. Wegner

risks, above all for potentially bringing about an agreement concerning

treatment and the following treatment process. If I do not know myself
whether I am able and willing to begin a treatment with a specific patient,
how can a patient get involved in a psychoanalytic process? Admittedly, the
analyst is better protected because he can experience himself as more sepa-
rate from the patient, but simultaneously the unconscious communication
with the patient is restricted and the patient will experience himself rather
as the object of an invasive and intrusive alien ‘power’. The success of an
unconscious communication in transference and countertransference and
their continual dissolution by interpretations simultaneously seems to be the
decisive factor for the successful course of a psychoanalytic treatment.
Establishing a positive indication for psychoanalysis therefore means more
acutely that the interviewer himself must ascertain: “I can imagine a psycho-
analytic treatment with this patient!” We thereby take up a ‘psychoanalytic
position’ that is fundamentally different from all other psychotherapeutic
procedures.

Translations of summary
Prozess-orientierte psychoanalytische Arbeit in Erstinterviews und die Bedeutung der
Anfangsszene. Von der Anfangsszene des Erstinterviews bis zur Beendigung eines langen psychoanalyt-
ischen Prozesses steht der unbewusste Austausch zwischen Analysand und Analytiker, die Analyse der
€
Ubertragungs-
Gegen€ ubertragungsbeziehung, im Zentrum der psychoanalytischen Arbeit. Anhand von Erstinterviews
mit einer psychosomatisch und depressiv erkrankten Studentin werden Bereiche psychoanalytischen
Verst€andnisses initialer Begegnungen herausgearbeitet. Bereits in der Anfangsszene des Erstinterviews
verdichtet sich die zentrale Psychopathologie, ein Festklammern am Prim€arobjekt, weil es von der Pat-
ientin nie sicher als anwesend erlebt wurde. Der Autor beschreibt die Entwicklung einiger psychoanalyti-
scher Theorien u €ber das Erstgespr€ach und demonstriert deren spezifische Bedeutung als
Hintergrundwissen f€ ur die klinische Situation: die »diagnostische Position«, die »therapeutische Posi-
tion«, die »Anfangsszene«, die »Gegen€ ubertragung« und die »gleichschwebende Introspektionsbereits-
chaft des Analytikers«.
Neuere Untersuchungen verweisen auf »Prozessqualit€aten« der analytischen Beziehung, wie die »Syn-
chronisierung« und die »Selbstwirksamkeit«. Letztere versucht zu beschreiben, nach wie viel Zeit zwis-
chen den Interviewsitzungen im Patienten konstruktive oder destruktive innere Prozesse Platz greifen
und welche Bedeutung dies f€ ur die Entscheidung u €ber die nachfolgende Behandlung hat. Alle Faktoren
zusammen k€ onnen zu einer differenziellen prozessorientierten Indikationsstellung f€
uhren, die außerdem
ber€ucksichtigt, dass es berufsspezifisch f€ur den Psychoanalytiker ist, mit der Angst vor unbewussten
Austauschprozessen konfrontiert zu sein.
Trabajo psicoanalıtico orientado al proceso en la primera entrevista y la importancia de la esce-
na de apertura. Desde el primer momento de la entrevista inicial hasta el final de un largo recorrido en
psicoanalisis, el intercambio inconsciente entre analizado y analista y el analisis de la relaci on entre
transferencia y contratransferencia, estan en el coraz on del trabajo psicoanalıtico. Partiendo de las entre-
vistas iniciales con un estudiante que presenta una problematica psicosomatica y depresiva, se elabora
una comprensi on psicoanalıtica de los encuentros iniciales. La escena de apertura de la primera entrevi-
sta condensa ya la psicopatologıa central – un aferrarse al objeto primario ya que nunca fue vivida su
presencia con seguridad por el paciente. El autor esboza el desarrollo de algunas teorıas psicoanalıticas
sobre las entrevistas iniciales y demuestra su importancia especıfica como un conocimiento de fondo de
on clınica en los siguientes ambitos: la ‘posici
la situaci on diagnostica’, la ‘posici
on terapeutica’, la ‘escena
de apertura’, la ‘contratransferencia’ y la ‘atenci on libremente introspectiva del analista’.
Las m as recientes investigaciones se refieren a las ‘cualidades del proceso’ de la relaci on analıtica, tales
como ‘sincronizaci on’ y ‘auto-eficacia’. Esta ultima trata de describir cuanto tiempo despues de las pri-
meras entrevistas un proceso interno constructivo o destructivo se asienta en el paciente y que significa-
do esto puede tener sobre la decisi on del tratamiento que sigue. Todos estos factores combinados
pueden llevar a establecer un proceso diferencial en la indicaci on orientada al proceso que tenga en cuen-

Int J Psychoanal (2014) 95 Copyright © 2014 Institute of Psychoanalysis

 Initial interviews 521
ta el hecho de confrontarse con los temores de los intercambios inconscientes especıficos de la profesi
on
psicoanalıtica.
L’orientation du travail psychanalytique vers le processus au cours des premiers entretiens et
l’importance de la sce ne inaugurale. Des les tout premiers instants de l’entretien preliminaire jusqu’a la
fin d’une cure analytique au long cours, l’echange inconscient entre l’analysant et l’analyste, de m^eme que
l’analyse de la relation entre transfert et contre-transfert, constituent le cœur m^eme du travail analytique.
L’auteur de cet article oriente sa reflexion vers la comprehension analytique des premiers entretiens a partir
des entretiens preliminaires qu’il a conduits avec un etudiant atteint de troubles psychosomatiques et depres-
sifs. La scene inaugurale du premier entretien condense le principal aspect de la psychopathologie – un
agrippement  a l’objet primaire dont la presence n’avait jamais ete solidement eprouvee par le patient.
L’auteur donne un apercßu de certaines des theories psychanalytiques relatives au premier entretien et montre
l’importance specifique qu’elles rev^etent eu egard aux differentes composantes de la situation clinique qu’elles
permettent d’eclairer: la « position diagnostique », la « position therapeutique », la « scene d’ouverture », le
« contre-transfert » et l’« introspection librement flottante de l’analyste ».
Des recherches plus recentes se referent aux « qualites du processus » definissant la relation analytique,
telles que la « synchronisation » et l’« auto-efficacite ». Ces recherches tendent a mettre en regard le laps
de temps entre les entretiens preliminaires avec la mise en œuvre chez le patient des processus construc-
tifs et destructifs internes et leur impact eventuel sur la decision a venir concernant le traitement. Tous
ces facteurs combines peuvent conduire a poser une indication axee sur le processus et qui tient compte
en m^eme temps de la specificite de notre profession qui nous confronte a la crainte face aux processus
d’echange inconscients.
Lavoro psicoanalitco fondato sul processo (process –oriented) nel primo colloquio: l’importan-
za della scena iniziale. Dal primissimo momento del colloquio iniziale fino alla fine di una lunga anal-
isi, lo scambio inconscio fra analista e analizzando e l’analisi del rapporto di transfert e controtransfert
costituiscono l’essenza del lavoro psicoanalitico. L’autore si propone di formulare, sulla base del materi-
ale tratto dai primi incontri con uno studente con disturbi psicosomatici e depressivi, una concettualizz-
azione psiconalitica degli incontri iniziali. La scena iniziale del primo incontro racchiude gia in se la
psicopatologia centrale: una dipendenza morbosa dall’oggetto primario, a causa del fatto che questo non
e mai stato percepito come presente e affidable dal paziente.
L’autore delinea vari concetti psicoanalitici riguardanti il primo colloquio, come la ‘posizione diagnosti-
ca’, la ‘posizione terapeutica’, la ‘scena iniziale’ il ‘controtransfert’ e ‘l’introspezione fluttuante dell’anali-
sta’, dimostrando la loro rilevanza nella prassi clinica.
Studi pi u recenti si sono occupati invece di variabili del processo nel rapporto analitico, come per esem-
pio la ‘sincronizzazione’ e l’ ‘efficacia del se’. Quest’ultima variabile riguarda l’osservazione del com-
portamento psichico del paziente fra un incontro e l’altro, e, in particolare i tempi e la qualita dei
processi interni (costruttivi o distruttivi) che si attivano nel paziente. Questo tipo di informazione e rilev-
ante nell’orientamento del trattamento che segue. Tutti questi fattori messi insieme consentono valutazi-
oni specifiche per ogni sogetto, fondate sull’analisi del processo. L’attenzione al processo consente
inoltre di tenere conto del fatto che il confrontarsi con la paura degli scambi inconsci e parte inerente
della professione psicoanalitica.

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