Contemporary Freudian analysis

1. Introduction

Version followed: the British Psychoanalytical Society's Contemporary Freudian group (historically the "B" or Anna Freud group). This guide uses Joseph and Anne-Marie Sandler's technical frameworks: role-responsiveness (1976), actualisation (1976), the background of safety (1960), and the past unconscious / present unconscious and "second censorship" model (1983, 1984). It also uses the clinical vocabulary of Sandler, Dare & Holder's The Patient and the Analyst (revised edition with A. U. Dreher, 1992), Anna Freud's ego analysis (The Ego and the Mechanisms of Defence, 1936), and the Anna Freud Centre (Hampstead) lineage of developmental lines and "developmental help" (Hurry, 1998). Later Anna Freud Centre work (Fonagy and Target's mentalizing approaches) is a separate modality and is used here only where it informs developmental help. [source: psychoanalysis.org.uk Sandler pages; Karnac/Routledge book pages]

What it is. An intensive, open-ended psychoanalytic treatment. It keeps Freud's structural conflict model (drive/wish, defence, superego, compromise formation) and integrates object relations through Sandler's concept of the representational world: wishes are wishes for particular self–object role relationships, carrying feeling states. [source: psychoanalysis.org.uk/joseph-sandler]

How change happens. The patient's unconscious wishful object relationships are actualised in the analytic relationship. The analyst picks this up partly through their own role-responsiveness. The analyst then interprets it, first in the here-and-now (present unconscious), working with the shame-driven resistances of the "second censorship" before reconstructing the past. As this happens, the patient becomes more tolerant of their infantile wishes and feelings and needs less rigid defence. Insight is consolidated by working through. Where development has been arrested rather than conflicted, the analyst also offers developmental help. [source: psychoanalysis.org.uk/anne-marie-sandler; Sandler & Sandler 1983, 1984] [synthesis: this condensation is mine]

2. Framework

The Contemporary Freudian tradition has no phase manual. The phases below follow the clinical-process chapters of The Patient and the Analyst (clinical situation → treatment alliance → transference/resistance → working through → termination) and standard BPS practice. [synthesis] [uncertain: no session counts are specified in primary sources]

Format. Psychoanalysis is 4–5 sessions/week of about 50 minutes on the couch, open-ended, typically several years. BPS training analyses and training cases run at 5x weekly. Psychoanalytic psychotherapy versions use 1–3x weekly, often face-to-face, and apply the same principles with more emphasis on the alliance and on here-and-now work. [uncertain: frequency is drawn from general knowledge of BPS/BPC standards]

Phase 1 – Consultation/assessment (1–4 sessions).

Goals: understand the presenting conflict, defences, ego strengths and object relations. Assess capacity for an alliance and for reflection on feelings. Distinguish conflict-based pathology from developmental deficit (the Hampstead developmental-lines / diagnostic-profile logic, originally for children). Recommend frequency. [source: freud.org.uk Hampstead page; Edgcumbe 2000] [synthesis: applying the profile logic to adults]
Move on when: there is a shared understanding of why treatment, an agreed frame (times, fees, holidays, missed sessions), and evidence that the patient can use a trial interpretation.

Phase 2 – Opening phase (weeks to months).

Goals: establish the setting and the fundamental rule, and build the treatment alliance (distinct from the transference). Notice early safety-seeking manoeuvres and surface defences. [source: Sandler, Dare & Holder 1992, "treatment alliance" and "clinical situation" chapters]
Move on when: the patient comes regularly, associates with some freedom, and can see that something is happening between patient and analyst. Transference themes become recognisable and repeat.

Phase 3 – Middle phase / transference analysis (bulk of treatment, often years).

Goals: analyse actualisations and role-relationships in the transference. Analyse resistances, the second censorship first. Link present-unconscious fantasies to past-unconscious templates (reconstruction). Work through.
Move on when: core transference patterns have been interpreted in several contexts, the patient increasingly makes their own interpretations, symptoms and character rigidities have loosened, and the patient can self-analyse between sessions. [synthesis]

Phase 4 – Termination (often 3–12 months, date set in advance).

Goals: work through separation and loss in the transference, the return of old symptoms, and idealisation and disappointment of the analyst. Consolidate the internalised analytic function.
End when: the agreed date arrives with the termination reactions analysed, not avoided. [synthesis] [uncertain: no BPS-specific termination protocol found]

3. Guiding principles

The ego as the seat of observation. Anna Freud took the ego as the medium for seeing id and superego. Practically: what you observe is the patient's defences, affects and compromises in the session, so start there. [source: A. Freud 1936, ch. I]
Equidistance. Stand at "a point equidistant from the id, the ego, and the superego". Practically: don't side with the wish, the defence or the conscience. Interpret the conflict between them. [source: A. Freud 1936, ch. III]
Defence before content; surface to depth. Practically: interpret how and why the patient is avoiding something before what they avoid. [source: A. Freud 1936, ch. II]
Second-censorship priority. Practically: work first with resistances that protect the patient from shame, embarrassment and humiliation in the present, and reconstruct later. The Sandlers' rule: "work with the resistances due to the second censorship before anything else". [source: Sandler & Sandler 1983, p. 424, via psychoanalysis.org.uk/anne-marie-sandler]
Present unconscious first, past unconscious later. Practically: interpret the current unconscious fantasy about you before linking it to childhood. Genetic links come once the here-and-now fantasy is felt. [source: Sandler & Sandler 1984, Psychoanalytic Inquiry 4] [uncertain: technical detail]
Transference as actualisation of a wished-for role relationship. Practically: ask "what role is the patient trying to get me into, and what role are they taking?" rather than only "what feeling is displaced onto me?" [source: psychoanalysis.org.uk/joseph-sandler; Sandler 1976]
Free-floating responsiveness alongside free-floating attention. Practically: allow yourself to be partly drawn into roles and use what you notice yourself doing as data. Don't aim for a blank screen. [source: Wikipedia Sandler; psychoanalysis.org.uk/anne-marie-sandler]
Countertransference as a compromise. Your role-response combines the patient's pull with your own tendencies. Practically: before you interpret, separate what is yours. [source: IPA Encyclopedic Dictionary]
The safety principle. People regulate their behaviour to keep a background feeling of safety and well-being, not only to discharge drives or avoid anxiety. Practically: read some resistances as attempts to stay safe, and say so before challenging them. [source: Sandler 1960; Wikipedia Sandler]
Treatment alliance is distinct from transference. Practically: keep tracking the patient's conscious wish to work, and repair it directly when it weakens. [source: Sandler, Dare & Holder 1992]
Tolerance of the infantile self. Practically: help the patient regard childish wishes as understandable rather than shameful. This, rather than eradicating wishes, is what changes. [source: psychoanalysis.org.uk Sandler pages, feeling-state emphasis] [synthesis: the formulation is mine]
Monitor feeling states. Practically: track the level and quality of affect in patient and analyst to judge the level at which the patient is functioning and what is tolerable to interpret. [source: psychoanalysis.org.uk/anne-marie-sandler]
Developmental perspective. Practically: ask whether a difficulty is conflict (interpret it) or arrested development (offer developmental help), and calibrate accordingly. [source: Hurry 1998 book description; freud.org.uk]
Pragmatic, pluralist use of theory. Sandler regarded psychoanalysis as "a body of ideas, rather than a consistent whole". Practically: use the concept that fits the clinical moment, and notice your own implicit theories. [source: Wikipedia Sandler]
Abstinence and neutrality, humanely applied. Practically: don't gratify transference wishes or advise, but stay warm and non-punitive. [uncertain: the general Freudian principle; BPS Contemporary Freudian wording]

4. Complete intervention inventory

The modality has no exercises or homework. Its "interventions" are the analyst's setting, listening and verbal interventions. Example language is illustrative throughout. [source: A. Freud 1936; Sandler, Dare & Holder 1992; Sandler papers as cited]

4.1 Establishing the setting and the fundamental rule

Purpose/when: At the start of treatment, and again when the frame is tested. The setting makes actualisations visible against a stable background. [source: Sandler, Dare & Holder 1992, "clinical situation"]
Steps: (1) Agree fixed times, frequency, fee, holiday and missed-session policy. (2) Explain the couch if used. (3) Invite the patient to say whatever comes to mind, including what feels irrelevant, embarrassing or about you. In A. Freud's phrase, the ego is asked to "be silent and the id is invited to speak". (4) Then keep the frame consistent, and treat deviations (lateness, requests for changes) as material.
Language (illustrative): "The only thing I'll ask is that you try to say what comes to mind, including things that seem unimportant or awkward to say, and things about me or about coming here."
Watch for / working: Early compliance or rebellion around the rule is first data on the transference. It is working when deviations can be talked about rather than just enacted.

4.2 Free-floating attention and free-floating responsiveness

Purpose/when: The analyst's continuous listening stance in every session. It picks up the role the patient is pressing you into. [source: Sandler 1976; psychoanalysis.org.uk/anne-marie-sandler]
Steps: (1) Listen without fixing on one theme. (2) Let yourself partly respond to the patient's pull (tone, warmth, irritation, rescuing, lecturing) rather than suppressing every reaction. (3) Notice afterwards what you said or did that was slightly out of character. (4) Ask yourself: "Who am I being for this patient right now, and who are they being?" (5) Separate your own contribution (your habitual tendencies) from the patient's pull. (6) Hold the hypothesis until there is enough material to interpret (4.6).
Language: internal. Write process notes after sessions, marking moments of out-of-character behaviour.
Watch for / working: Over-responsiveness (full enactment) vs. rigid non-responsiveness, which gives no data. It is working when your role-responses predict the material that follows.

4.3 Clarification (preparatory interventions)

Purpose/when: Before interpretation, to bring material into focus: repeated sequences, omissions, shifts of affect. [uncertain: "clarification" as a named step comes mainly from North American ego psychology. Contemporary Freudian writers use it, but a BPS source formalising it is not drawn on here.]
Steps: (1) Pick an observable pattern in this session. (2) Describe it in the patient's own words, without explaining it. (3) Ask whether they recognise it.
Language (illustrative): "Twice now, just as you started on the weekend, you moved on to work."
Watch for / working: It is working if the patient becomes curious. If clarifications pile up into interrogation, the alliance thins.

4.4 Defence (resistance) analysis — Anna Freud's method

Purpose/when: Whenever associations stall, affects are unexpectedly transformed, or content is warded off. In A. Freud's view, resistance is the occasion for ego analysis, not a nuisance. [source: A. Freud 1936, chs. II–III]
Steps: (1) Recognise the specific defence mechanism (e.g. reversal, isolation, turning against the self, identification with the aggressor, projection, denial, intellectualisation). (2) Point out the defensive activity as it occurs, before the defended-against content. (3) Explore what danger it protects against: anxiety, guilt, shame, or loss of safety. (4) Only then, "undo what has been done by the defense" by reaching the warded-off impulse or affect. (5) Trace the defence's history.
Language (illustrative): "When you described her cancelling, you laughed and said it didn't matter. I wonder if the laugh is what helps it not matter."
Watch for / working: Affect that is surprisingly absent or the reverse of what you'd expect (A. Freud's affect-transformation sign). It is working when the defended-against feeling appears, often with anxiety first, and the patient begins noticing the defence themselves.

4.5 Interpreting second-censorship (shame) resistances

Purpose/when: First priority in the session. Use it when the patient hesitates, edits, apologises, or goes vague about present thoughts and feelings, especially about you. [source: Sandler & Sandler 1983, p. 424, via psychoanalysis.org.uk/anne-marie-sandler]
Steps: (1) Notice the moment of censorship (a pause, "nothing", a topic switch). (2) Address the anticipated humiliation or ridicule, not the hidden content. (3) Convey that the thought is acceptable and understandable, so the patient can tolerate it in consciousness. (4) Only after this has eased, go deeper or further back.
Language (illustrative): "Something came to mind and then it seemed you decided it was too silly or embarrassing to say — perhaps you expected I'd think less of you."
Watch for / working: Interpreting "deep" content while shame resistance is active tends to produce compliance or humiliation. It is working when the patient discloses the thought with relief and censors less over time. [synthesis: the failure mode]

4.6 Interpreting the actualised role relationship (role-responsiveness in use)

Purpose/when: When you recognise you have been drawn into a role (4.2) and the pattern is repeating. This is the central Contemporary Freudian transference intervention. [source: Sandler 1976; IPA Encyclopedic Dictionary; psychoanalysis.org.uk]
Steps: (1) Identify the wished-for (or feared) relationship: self-role, object-role, and the feeling state. (2) Check your own contribution (4.2 step 5). (3) Step out of the role. Don't continue the enactment, and don't abruptly reverse it. (4) Describe the interaction neutrally, including your part where useful. (5) Interpret the wish or safety the relationship provides ("identity of perception" with a wished-for relationship). (6) Leave the genetic link until later (4.9).
Language (illustrative): "I notice I've been giving you a lot of advice today, which isn't usual for us. I think something in how we've been together has invited me to take charge — perhaps there's a wish for me to be someone who decides for you, so you don't have to risk wanting something."
Watch for / working: Self-disclosure of countertransference that burdens the patient [synthesis]. Interpretations that blame the patient for "making" you act. It is working when the patient recognises the pattern elsewhere and the enactment loosens.

4.7 Here-and-now transference interpretation (present unconscious)

Purpose/when: When current unconscious fantasies about the analyst, or displaced versions of them, are close to the surface. [source: Sandler & Sandler 1983, 1984; psychoanalysis.org.uk/anne-marie-sandler, "here-and-now"]
Steps: (1) Listen for references to others (boss, partner) that may be displacements of feelings about you. (2) Choose the version closest to consciousness. (3) Interpret the current fantasy about you, including the defence against it. (4) Hold off on "because of your mother" links until the here-and-now fantasy is felt.
Language (illustrative): "You're describing a doctor who listens but doesn't really care. I wonder if some of that is how I feel to you this week, after I changed Tuesday's time."
Watch for / working: Forced "you mean me" interpretations produce compliance or irritation. It is working when the patient brings feelings about you directly.

4.8 Interpreting transference of defence

Purpose/when: When the patient's ways of avoiding you repeat old defensive patterns (detachment, ingratiation, compliance). [source: A. Freud 1936, ch. II]
Steps: (1) Treat the defence as a historical solution, not deception. A. Freud warns that we do patients "a great injustice" if we call such defences camouflage. (2) Shift attention from the id content to the ego's way of coping. (3) Explore when this way of coping first became necessary.
Language (illustrative): "You're very careful to agree with me. I suspect that being agreeable was once a way of staying safe with someone."
Watch for / working: Accusatory tone. It is working when the patient becomes curious about the pattern rather than ashamed of it.

4.9 Reconstruction / genetic interpretation (past unconscious)

Purpose/when: Later, once here-and-now fantasies are recognised. It links current templates to childhood. [source: Sandler & Sandler 1983, reconstructions made "later"]
Steps: (1) Gather repeated transference and current-life patterns. (2) Offer a tentative construction of the childhood situation and the child's way of understanding it. (3) Frame it as a hypothesis about a template, not a recovered fact. The past unconscious is inferred, not directly remembered. (4) Return to how the template operates now.
Language (illustrative): "It may be that as a small boy, the only way to keep your father close was to need nothing from him — and something like that still happens here."
Watch for / working: Intellectual agreement without affect, and reconstructions offered too early. It is working when memories, dreams or feelings emerge that fit or correct the construction.

4.10 Dream interpretation

Purpose/when: When the patient brings dreams. They give access to wishes (id) and to the censor's defensive measures (ego). [source: A. Freud 1936, ch. II]
Steps: (1) Ask for associations to elements rather than translating symbols. A. Freud cautions that symbol translation alone yields no deeper understanding of the person. (2) Note the day residue and its link to the session or analyst. (3) Interpret the defensive work (disguise, reversal) as well as the wish. (4) Connect to the current transference.
Language (illustrative): "What comes to mind about the locked door? … You dreamed this the night after we talked about the break."
Watch for / working: Dreams brought compliantly to please you, which is a transference in itself. It is working when the patient associates freely and dream themes shift over time.

4.11 Affect and feeling-state interventions

Purpose/when: When feelings are transformed, absent or flooding. It helps to judge the patient's level of functioning and what they can tolerate. [source: A. Freud 1936, ch. III, affect defence; psychoanalysis.org.uk/anne-marie-sandler, feeling states]
Steps: (1) Name the feeling state present now (yours and the patient's). (2) Note discrepancies between content and affect. (3) Calibrate. If affect is overwhelming, name it and contain it before interpreting. If it is absent, interpret the defence against it (4.4).
Language (illustrative): "You're telling me about the diagnosis very calmly, and I find myself feeling quite shaken."
Watch for / working: Reliance on countertransference without checking it. It is working when affect becomes more modulated and more available.

4.12 Interpreting safety-seeking

Purpose/when: When behaviour that looks resistant serves to keep a background feeling of safety: rituals, controlling the session, sameness, avoiding change. [source: Sandler 1960; Wikipedia Sandler, safety as resistance]
Steps: (1) Identify what the behaviour secures (familiarity, control, feeling held). (2) Acknowledge the safety it gives before naming its cost. (3) Explore what loss of safety the patient fears if it changes.
Language (illustrative): "Starting each session with the week's news seems to give you a solid footing before anything uncertain can happen here."
Watch for / working: Challenging safety operations head-on increases them. It is working when the patient tolerates small unpredictability in the session.

4.13 Working through

Purpose/when: After an insight has been gained, so it is repeated and extended across contexts until it changes functioning. [source: Sandler, Dare & Holder 1992, "working through" chapter]
Steps: (1) Expect the same resistance to return after insight. (2) Re-interpret the same pattern as it appears in new material (relationships, dreams, transference, history). (3) Point out the patient's own increasing ability to recognise it. (4) Tolerate repetition. Don't treat it as failure.
Language (illustrative): "Here it is again, the same move we've seen with your sister and with me — this time with your new manager."
Watch for / working: Impatience or reproach. It is working when time between enactment and recognition shortens.

4.14 Treatment alliance interventions

Purpose/when: When the patient's conscious collaboration weakens (missed sessions, doubt about treatment), or in the opening phase. [source: Sandler, Dare & Holder 1992, "treatment alliance" chapter]
Steps: (1) Separate the alliance (the patient's adult wish to understand) from the transference. (2) Address the alliance explicitly: what the patient wants from treatment and what makes it hard. (3) Then interpret the transference meaning of the wobble.
Language (illustrative): "Part of you wants to keep coming to understand this, and part of you feels it's pointless — let's look at both."
Watch for / working: Over-reliance on the alliance to suppress negative transference. It is working when the patient returns to collaborating with the negative feelings still voiced.

4.15 Developmental help (Anna Freud Centre tradition)

Purpose/when: When deficits rather than conflicts dominate: poor affect regulation, weak self–object differentiation, limited capacity to reflect on states of mind. Developed for children, and applied to adults with care. [source: Hurry 1998 (book description); Edgcumbe 2000; freud.org.uk] [synthesis: adult application]
Steps: (1) Assess (developmental-lines logic) which capacities are lacking. (2) Prioritise naming and differentiating feelings, linking feelings to events, and distinguishing the patient's mind from yours. (3) Use simpler, here-and-now, affect-focused interventions. Postpone conflict and genetic interpretations. (4) Return to interpretive work as the capacities develop.
Language (illustrative): "I think when I was quiet just now it felt as if I'd gone — not just quiet, but gone. Can we look at what that was like?"
Watch for / working: Drift into supportive therapy with no exploration. It is working when the patient can reflect on their own and others' minds and later tolerate conflict interpretation. [uncertain: detailed adult-technique steps are my synthesis; primary texts are child-focused]

4.16 Termination work

Purpose/when: Final phase. [synthesis] [uncertain]
Steps: (1) Agree a date well in advance. (2) Interpret the return of symptoms and old transferences as reactions to the ending. (3) Work through idealisation, disappointment, gratitude and anger toward you. (4) Review together what the patient can now do for themselves.
Language (illustrative): "Since we set the date, your old sleeplessness has come back. Perhaps that's a way of showing me you're not ready for me to go."
Watch for / working: Premature flight, or extending the date to avoid loss. It is working when the patient mourns rather than denies the ending.

5. Handling problems

Stuck analysis (repetitive, "dead" sessions). Assume an unrecognised actualisation is running: you and the patient are living out a role relationship that feels like nothing happening. Review your process notes for out-of-character behaviour (4.2), name the interaction (4.6), and check for unnoticed second-censorship resistance (4.5). [source: Sandler 1976 logic] [synthesis: application to impasse] Consult a colleague or seek supervision. [synthesis]
Resistance. Treat it as ego activity to be understood (4.4), interpreting shame-based resistances first (4.5) and safety-seeking second (4.12). Never treat it as opposition to overcome. [source: A. Freud 1936; Sandler & Sandler 1983]
Overwhelm / regression. Reduce depth. Interpret the here-and-now, name affects, and postpone reconstruction. Consider lower frequency or a sitting position if the couch increases disorganisation. Support the alliance (4.14) and developmental help (4.15). [synthesis] Kernberg notes that the therapeutic vs. resistant value of regression is still disputed across schools. [source: Kernberg 1993 abstract] [uncertain]
Non-adherence to the frame (lateness, missed sessions, unpaid fees, contact outside). Hold the frame consistently (fees for missed sessions as agreed), then interpret the meaning, i.e. which relationship is being actualised. Avoid both punitive enforcement and quiet accommodation; either completes the enactment. [synthesis]
Acting out. Interpret it as remembering-in-action of what can't yet be put into words. Link it to the transference, especially around breaks. A. Freud notes acting in the transference means "the bounds of analysis have already been overstepped", so set limits when safety is at stake. [source: A. Freud 1936, ch. II; Sandler, Dare & Holder 1992, "acting out" chapter]
Negative therapeutic reaction (getting worse after progress). Consider unconscious guilt, envy of the analyst's help, or the threat that improvement poses to a safety-giving tie to an internal object. Interpret what being better would cost. [source: Sandler, Dare & Holder 1992 chapter title] [synthesis: specific formulations]
Ruptures / countertransference enactments you have taken part in. Acknowledge your part without lengthy self-disclosure. Treat the enactment as information about the actualised relationship and interpret it (4.6), since Sandler sees role-responses as compromises with your own tendencies. [source: IPA Encyclopedic Dictionary] [synthesis: repair steps]
Intellectualised compliance (the patient "agrees" with every interpretation). Interpret the agreement itself as transference of defence (4.8), and the second-censorship fear of being an unsatisfactory patient (4.5). [synthesis]
Patients pulling you into multiple conflicting roles (e.g. rescuer and persecutor within one session). Map each role relationship separately and interpret the shift between them as the patient's solution to a conflict. [source: BPC/Tavistock seminar description, multiple roles] [synthesis: response]
Deficit presenting as resistance. If interpretation produces confusion rather than defence, switch to developmental help (4.15). [synthesis]
Breaks and holidays. Anticipate them and interpret reactions before and after, because they reliably mobilise safety and abandonment themes. [synthesis]
Risk (suicidality, self-harm, psychosis). Not addressed in the sources. Temporarily step outside neutrality, assess risk directly, involve medical colleagues, and later analyse the meaning of the step. [synthesis] [uncertain]

Sources

Sources:

Books and papers cited (further reading, not drawn on in full):

Freud, A. (1936). The Ego and the Mechanisms of Defence.
Sandler, J. (1960). The background of safety. IJP 41.
Sandler, J. (1976). Countertransference and role-responsiveness. Int. Rev. Psycho-Anal. 3.
Sandler, J. & Sandler, A.-M. (1983). The 'second censorship', the 'three box model' and some technical implications. IJP 64.
Sandler, J. & Sandler, A.-M. (1984). The past unconscious, the present unconscious, and interpretation of the transference. Psychoanal. Inquiry 4.
Sandler, J., Dare, C., Holder, A. & Dreher, A. U. (1992). The Patient and the Analyst (2nd ed.).
Hurry, A. (Ed.) (1998). Psychoanalysis and Developmental Therapy.
Edgcumbe, R. (2000). Anna Freud: A View of Development, Disturbance and Therapeutic Techniques.

← Previous · I-006Modern conflict theory Next · I-008 →Psychoanalytic and insight-oriented psychotherapy