Ferenczi: Mutual Psychoanalysis & the Equivalent Mode

Mutual Psychoanalysis: Sandor Ferenczi, Elisabeth Severn, Clara Thompson and Izette de Forest



Earlier, we have described that one of the main themes in psychoanalysis through the years concerns the connection between relatedness and autonomy (De Wolf 2022). In the same place, we have discussed the central role of Ferenczi.

Sandor Ferenczi by Liesbeth Dullaart

It was Ferenczi who started, in 1913, the Hungarian school in Budapest, next to the Viennese school where Freud was in charge.
• In the Hungarian school, the emphasis was more on the primary mother-child relationship, on the mental process itself, on the meaning of mental shortages and on trauma, than on the oedipal conflict and the inner conflicts between mental representations.
• During WW I, Ferenczi treated many patients with war traumas. That is why trauma enters his thinking.
• At the Hungarian school there was more focus on internalizing than on interpreting.
• The Hungarian school focussed more on counter-transference which made personal analysis more intensive, and through that, more therapeutic than before. The first analysis done by a candidate was supervised by his training-analyst, in order to better understand the counter-transference of the candidate.
Intersubjectivity, mutuality was the central issue within that ‘second road’. It was the Hungarian school that represented, next to the ‘mainstream’ of the Viennese school, the ‘second road’ within psychoanalysis.

We will examine in-depth the discussion c.q. the conflict between Freud and Ferenczi and we will explain why Ferenczi did what he did when treating Severn and Thompson. We will indicate how his concept of mutual psychoanalysis is a direct consequence of his views about the effectiveness of psychoanalytic treatment as described by him and Rank in their book about ‘The development of Psychoanalysis’.

Second Road
Rudnytski (2002) explains how important the period between 1923 and 1933 was for the further development of psychoanalysis. During that period, a number of publications by Breuer, Rank, Ferenczi, and Groddeck appeared in which the essential features were formulated as an alternative to Freud’s dominant topographical model, and later his structural model. This alternative would mainly manifest itself in the ideas of the independents and within relational or interactional psychoanalysis. In their publications, Breuer, Rank, Ferenczi, and Groddeck engaged in discussion with Freud (De Wolf 2022). In 1923, Freud described his structural model of the psyche in The Ego and the Id (1923) and clearly indicated what the main features in psychoanalysis should be. Let’s first explore the context in which Ferenczi’s thinking could develop as an alternative to Freud’s thinking.

Context: Breuer, Rank, Groddeck and Ferenczi

Breuer had a very different view from Freud on the role of sexuality in hysteria. He emphasized the vertical split, in which the patient ‘automatically’ and unconsciously entered into a hypnoid state – a divisional state – during severe hysterical attacks. For Breuer, it was not about intrapsychic wishes, desires, and conflicts, but about external trauma. The severity of the trauma was the cause of dissociation. There was vertical division in order to prevent ego integration, which the patient could not tolerate in view of the severe traumatization.

Breuer was more concerned with reliving the therapeutic relationship and gaining a corrective experience than with interpreting a conflict that lay at the source of the pathology and manifested itself within the treatment relationship. The emphasis was on gratification rather than on frustration. Breuer was more focused on connecting and building an adequate working relationship, or as Winnicott would later call it, creating an adequate holding environment. Resistance and transference are the result of a joint process between the psychoanalyst and the patient. The psychoanalyst is characterized by an attitude of ‘not knowing’ and not by an attitude of ‘knowing’. In the treatment, the patient is encouraged to say what he is thinking about without censorship (free association). The analyst should connect symptoms with events, images, and feelings. He should give words to symptoms.

Rank (1884–1939), the first lay analyst, had a very special place in Freud’s circle, like Ferenczi. He too belonged to the circle of intimates around Freud. In The Trauma of Birth (1924), Rank clearly distances himself from Freud’s view that the Oedipus complex is at the heart of neurotic development. Rank explicitly assumes that the child’s primary relationship is with the primary maternal object. He considers the separation of the mother as the core of the neurotic development; the Oedipus complex is a subsequent psychosexual effect of this. For him and for Ferenczi, there is a clear shift in attention from the oedipal to the preoedipal. He interprets sibling rivalry as preoedipal, that is, as a rivalry between the older child and the newcomer for the attention of the mother object (Rank, 1924).

According to Rank, the development of the ego begins with the biologically determined relationship between the mother and the child. In other words, Rank attaches more importance to the dyadic relationship between mother and child than to the triadic relationship between mother, father, and child. Like Ferenczi, he assumes a primary connection at the beginning of development. After this, a phase of differentiation begins as a result of the separation of the primary mother object. This separation is the primary source of fear, and not the fear of castration related to the oedipal constellation.

The main aim of the psychotherapeutic relationship or psychotherapeutic treatment is to learn to cope with the trauma of separation, so that it no longer causes unbearable pain or anxiety. The psychotherapeutic treatment involves connecting and disconnecting, learning to regulate the fear or the emotional pain. The treatment is aimed at ‘affect regulation’. The unity of the self and the other must be restored in such a way that it is possible to separate in order to individualize. The primary repression Rank speaks of is related to the inability to endure separation at birth. This leads to ‘clinging’ behaviour toward the primary maternal object. Development, individuation, and separation are intrinsically linked and fundamentally coloured by fear.

Fear is thus linked to a real trauma and not to fantasies about sexual wishes and desires. Just like Ferenczi, Rank emphasizes the meaning of the external trauma, and tries to minimize the significance of the inner experience. Freud tried to minimize the significance of the trauma in favour of the significance of inner conflicts based on sexual wishes and desires. Fear is connected with differentiation and discernment. For the young child, the primary mother object is not only the first ‘good’ object, but also the first ‘bad’ object because of the separation. The good object provokes love, the bad object hate. According to Rank, there is, therefore, ambivalence. In other words, from the beginning there is a struggle between love and hate, sexuality and aggression, relatedness and autonomy. From the beginning love and hate, sexuality and aggression, relatedness and autonomy are going together. No love without hate, no sexuality without aggression and no relatedness without autonomy. Finding the optimal balance is the most important thing in life

The aim of the psychotherapeutic treatment is to work through the unconscious but conflicting (attachment) relationship with the primary caring (preoedipal) mother object. In the treatment relationship, the earlier separation is repeated in the hope of a better outcome. Groddeck also deals with the ambivalence between mother and child. It involves the relationship with the mother object more than with the father object. Fear is fundamentally bound to the relationship with the mother object, and only secondary to the relationship with the father object. For Rank, the past is of great importance in the sense that the life of the individual is determined by past experiences, but this should not be at the expense of the significance of current events. How the past is repeated in current events should be examined in the treatment: What are the similarities with the past and where do the differences lie?

Ferenczi and Rank (1925) wrote a book on psychoanalytic technique: The Development of Psychoanalysis. In that book, they proposed a more active form of psychoanalysis, thereby distancing themselves from the developments within psychoanalysis that Freud had proposed. They emphasized that psychoanalytic treatment was not about collecting associations or interpretations.
They also distanced themselves from the idea that psychoanalysis should focus on the disappearance of symptoms. What was important was not so much that the symptoms disappeared, but that they did not come back. That is why psychoanalysis should focus on processing the structure of the personality and not primarily on treating the complaint. Rank and Ferenczi emphasized that psychoanalytic treatment should concentrate on gaining a corrective emotional experience in the present, not on applying cognitive clarifying insight aimed at the past. The psychoanalytic setting was important in the process of structural change. The psychoanalyst was much more a new primary (mother) object, trying to initiate a stagnated development, than a strict and expectant/conservative/cautious father figure. The implicit, but mainly explicit, processing of the relationship between the psychoanalyst and the patient became increasingly central. The psychoanalyst had to present him- or herself as a new primary object; he or she was more a developmental than a transferential object.
Rank and Ferenczi wanted to unravel the transference within the setting of the treatment. They developed an alternative to the structural model in the form of a more relational approach. In doing so, they continued on the path taken by Breuer.

Although the unconscious does not correspond to what has been repressed for Freud, it seems that Freud pays more attention to repression than do Ferenczi and Rank (Kramer, 1996). This is related to the fact that Freud places the core of the pathology in the processing of the oedipal conflict, whereas Ferenczi and Rank situate the origin of the pathology in the early relationship with the primary maternal object, that is, more in the dyad than in the triad. In the dyad, there are no mental representations, while in the triad there are.

Ferenczi and Rank did not always interpret behaviour as a compromise solution in the event of a conflict, but as what it is: a form of behaviour, a way of communicating. The patient was unable to connect feelings to words, so a mental representation did not develop. The behaviour is then not stored in the explicit memory, but in the implicit memory. This is repetition, not memory. Rank and Ferenczi do not focus on gaining insight as a condition for change, but on the further facilitating of development, growth, and revitalization of the relationship.

The danger of Rank’s birth trauma metaphor is that it explains many different and diverse forms of pathology, negating the complexity of development. The father image is replaced by the mother image, the Oedipus complex by the birth trauma, and castration anxiety by separation anxiety (Rudnytsky, 2002). If the birth trauma is taken as a metaphor for attachment and separation, relatedness and autonomy, it can be seen as a creative precursor to modern theories. If the metaphor is taken practically and literally, one misses the mark. The focus is on ‘doing’ more than on ‘thinking’.

• Groddeck made it clear that people only exist within the context of relational involvement. Mother and child denote each other; one is not without the other. The young child is extremely sensitive to what is going on within the mother – that sensitivity takes place primarily at the level of ‘it’ or at the level of unconsciousness, that is, outside the explicit memory and therefore also outside recollection. According to Groddeck, the unconscious is not known. He did not see the unconscious as a dynamic unconscious, but as a nonconsciousness. Here lies another similarity with Ferenczi and a difference with Freud. For Groddeck and Ferenczi, what happens between the young child and the primary maternal object is exemplary of what happens in psychoanalytic treatment.

Freud mainly focused on treating patients with psychoneuroses, while Ferenczi, Rank, Groddeck, and Breuer mainly worked with patients with anxiety neurosis. The latter were therefore more focused on presenting the psychoanalyst as a new empathic, primary (dyadic) object and less as a (triadic) transferential figure. They focused more on the relationship than on the interpretation. Freud and his disciples were more focused on interpreting and reconstructing the past; the significance of the treatment setting was of less importance to them. Gradually, within the mainstream of psychoanalysis, more attention was paid to psychoneuroses and representational disorders, and less to mental process disorders and anxiety neuroses. Within the mainstream of psychoanalysis, it was more and more about reconstruction, while in the ‘second road’ it was more about constructing, creating structures.

This is, in a nutshell, the context in which Ferenczi’s thinking could develop.

Ferenczi (1893–1933) was a controversial figure within the emerging psychoanalytic movement from the beginning. On the one hand, he was very involved with Freud and saw him as a father figure (and that feeling of closeness was mutual) But later on he was disappointed in Freud who was quite abstinent and rational involved. Freud was trying to provoke, by being so abstinent, the inner world of his patients. After his analysis with Freud, Ferenczi went to Groddeck, who was much more warm and empathic, to continue his personal analysis. Ferenczi (see Aron & Harris, 1993) continuously experimented with the nature of the therapeutic relationship, assuming that the relationship itself was curative. He considered countertransference and its investigation to be essential elements of psychoanalytic treatment. He believed the core of the therapeutic relationship, or of the transference-countertransference relationship, was coloured by the real trauma of the patient and the trauma of the psychoanalyst. This trauma had to be relived during the treatment and thus worked through in the presence of an empathic, (maternal) psychoanalyst, who could provide a corrective emotional experience. According to Ferenczi, the psychoanalyst who is abstinent and neutral, and thus lacks compassion and sympathy, will facilitate the re-traumatization of the patient due to an emotionally deficient psychoanalytic process. The ‘living through’ precedes the ‘insight’ and ‘understanding’ – affect takes precedence over cognition. Ferenczi focused on issues such as intersubjectivity, reciprocity, emotionally lived experience, and empathy. The relationship between the caring primary object and the child, and between the patient and the psychoanalyst is the central theme in Ferenczi’s approach. For him, the therapeutic relationship was a layered relationship. The transference relationship and the real relationship are by definition intertwined. Ferenczi stated that the psychoanalyst was not a neutral spectator, but that patient and psychoanalyst participated with each other. He greatly admired Freud, but that did not stop him from acting independently. Ferenczi was concerned with relatedness and autonomy, which was the beginning of what we now call interactional psychoanalysis. In this form of psychoanalysis, intersubjectivity is the starting point. Ferenczi’s famous article: ‘Confusion of Tongues’(1933) presented at the congress in Wiesbaden played an important role in the relation between Freud and Ferenczi

• The primary relationship
Ferenczi emphasized the importance of the mother-child relationship. This relationship is characterized by epistemic trust and unconditional love, or, in other words ‘primary object love’ (Fonagy, 2002). The severely disturbed patients Ferenczi treated were characterized by epistemic distrust, and Ferenczi tried, within his treatments, to move the balance between trust and distrust more towards trust. More than Freud, he put the emphasis on repairing and in offering, in the treatment, a corrective emotional experience. At first, the primary relationship between mother and child is strongly physically coloured. In more actual terms, we can say that Ferenczi discovered the teleological mode (De Wolf 2015, p. 229-249) as characteristic for the early mother-child relationship. Next to that, he viewed trauma as a fracture in the ‘epistemic trust’ (De Wolf 2022 p.123) within the child, which then blocked the development.

• Lived through body
The communication between the child and its primary caring objects is not (yet) verbally mediated, the only available form of communication is through the physical behaviour. The body is in the teleological mode not (yet) a ‘lived-through’ body, not yet occupied with intentions and emotions (Nicolai, 2022). In the teleological mode, only that is true which is accompanied by physical manifestations of behaviour. In order for the ‘not-lived-through body’(the bodily self) to develop toward an ‘lived-through body’(an intentional body or self) there is a long way to go. After biology, psychology comes in. They both have a form of memory: either nonverbally mediated or verbally mediated, the first is about ‘repetition’ the second about ‘working through’. Ferenczi was therefore very focussed on non-verbal signals of trauma. The body is the place where the self and the world meet. Although the self is enmeshed in the world, and connected to it, it does not coincide with it. In order for the child to be able to build up an image of itself, of the world around it and of its being-enmeshed in its world, it must be able to explore, within a safe setting, itself and its surroundings in a tactile way. Thus, there can be room for the evolution of the ‘non-lived’ through to the ‘lived through’ body, and thus, a psychological self can develop from the somatic self. The ‘teleological mode’ will disappear to the background, and through the ‘equivalent’ and the ‘as-if mode’ there will come space for the ‘reflective mode’. In the equivalent mode, inner- and outer world will coalesce, in the as-if mode they are separated, while in the reflective mode, they are distinguished but related, without coalescing (De Wolf 2015 p 229-249). So, we understand that the corrective emotional experience that Ferenczi offered in his treatment, was offered by him from within the teleological mode, in short, not by working through experiences and intentions, but through physically supported behaviour. An example of that, is his well-known ‘kissing technique’. Where Ferenczi discovered the teleological mode Freud discovered the equivalent mode. Freud discovered that his patients believed that their fantasies were realities. That was where he left the theory about seduction behind.

Freud (seated on the left), Ferenczi (seated in the middle)

Ferenczi elaborated upon Freuds seduction theory and did not leave it completely, as Freud himself did. Laplanche (1976) later resumed the seduction theory and upgraded it into a theory about structural seduction. Ferenczi diagnosed the pathology of his patients correctly, but his intervention technique would, today, be seen as unacceptable and scandalous. This does not, by the way, mean that interventions like his kissing technique were sexually coloured. On the contrary, as we will see when we read about the mechanisms Ferenczi used in his article from 1933. To Ferenczi, fantasy has become reality in trauma, and with that, the child has been robbed of its fantasy. To Freud, it was the other way round, the child is, erroneously, seeing its fantasy as reality. What Ferenczi did, in his treatments, was to ‘repeat’ the teleological mode, but, this time, with a different ending. He emphasized more on offering a holding environment, in which there was more space for ‘doing’ than for learning to reflect. He did not do much to facilitate mentalizing in his patients if they were as yet unable to. He represented the ‘good’ parent and with that took the place of the failing primary objects. Good enough parents though, mentalise for their children that, which they cannot do themselves. Parents and, in a way, analysts, as well, ‘add something’. It is about adequately or marked mirroring by the (new) primary object. The caring object must be both sensitive and adequately responsive. Ferenczi was certainly sensitive, but he lacked marking, that is he did not adequately use his own mentalising abilities. In the beginning of the development, there is the teleological mode, which is why Ferenczi emphasized ‘doing’ instead of reflecting. The social biofeedback theory (Fonagy a.o., 2002) was not yet formulated. Because of this, Ferenczi’s thinking stagnated in the equivalent mode, in which fantasy and reality coincide.

Reality and fantasy
From the beginning, Freud was occupied with the area of tension between ‘fantasy’ and ‘reality’. He realised how difficult it was to discriminate between these two. One can say that Freud wrestled with the distinction between the equivalent and the as-if mode, or with the difference between the teleological and the reflective mode. This same theme, we saw with Ferenczi, but he made, as we saw, a fundamentally different choice in this matter.

Freud chose, in this dilemma, for the fantasy, the inner psychic reality, while Ferenczi was interested in the side of the realistic relationship and the external reality, and therefore, the external world, the ‘doing’. Development and transference then became opposites. From there, Ferenczi developed his ideas about an active form of psychoanalytic treatment. With Ferenczi, it was more about introjection and the curative meaning of the treatment relationship, and less about interpretation and insight. He was more concerned about the building of an inner structure than about re-structuring.

The danger, in Freuds way of working, was that the real relationship with the patient would evaporate in the transference, and the patient would be stuck in the as-if mode, with the risk of developing an avoiding attachment, maximalised autonomy and minimalized relatedness. With Ferenczi, it was exactly the opposite, and the transference could evaporate in the real relationship and the patient get stuck in the equivalent mode. Then, there would rather be the risk of a preoccupied attachment, with minimal autonomy and maximalised connection. With Freud, there was the risk of a psychoanalytic treatment as something, split off from the external reality. With Ferenczi, the risk was more about an analysis where ‘doing’ and repairing is most important, and psychoanalysis takes over life.

The romantic approach
Strenger (1989) introduced the difference between the classic and the romantic approaches within psychoanalysis. According to these last, the individual is perceived as inherently good; limitations are situated in a failing surrounding. This failure does not so much lead to conflicts, but rather to shortages, through which pathology will be situated outside the person. This asks, in treatment, for an empathic attitude of trust and compassion. The analyst offers himself as a new primary object who tries to improve the object relation in order for the treatment relation will work as healing and correcting. ‘Acting’, ‘Behaving’ or ‘Doing’ is perceived as the only form of communication the patient has available, at that moment in time. Doing is not by definition a form of resistance, but sometimes the only possible form of communicating. The treatment is aimed at the development of a coherent and consistent self and at starting a development that is stagnated by a failure of the primary surrounding. With this, the treatment ties in with the external outer world.

Here, it is about what we called earlier ‘the second road’, where intersubjectivity, mutuality and empathy are at the front, and we are far removed from the objective, abstinent and detached psychoanalyst.

In the early 20th century, the difference between representational disorders (mentalized) and process disorders (unmentalized) was not yet known. The difference between anxiety neuroses and psycho neuroses was known, but the consequences of these for the therapeutic practices weren’t yet fully thought out. Ferenczi did not consider behaviour as a formation of compromise, but as a meaningful form of communication. The patient was, as mentioned before, not yet able to connect his emotions to words, so mental representations could not be developed. The analyst should transfer and clarify this meaning to the patient, by means of interpretation, although the perceptiveness for interpretations, with the patients, suffering from a process disorder or an anxiety disorder, was barely there. Nowadays, we would say that the analyst would bring in his own mentalizing ability into the treatment to develop a mentalizing ability in the patient. The concept of mentalizing, and facilitating the mentalizing ability, had not yet found its place in the psychoanalytic world. Because of this, in the treatment of this group of patients, the emphasis was more and more on doing, instead of on reflecting/thinking, with problematic results.

Trauma and neurotic development
Ferenczi stated that, behind the neurotic conflict, there is a real trauma hidden. Real trauma here is a fertile soil for conflict. Conflict pathology presumes development pathology (Ferenczi, 1933). He connected the traumatic roots of the neurosis with what he calls the confusion of tongues: the intermixing of the child’s need for love and tenderness, and the passion of the adult. The world of child and adult are not well matched. Neurosis appear when the adult wrongly interprets the child’s behaviour and considers it in terms of his own grown-up, guilt- and shame-laden passionate sexuality. The neurotic development is caused by the fact that the adult inadequately reads the ‘mental state’ of the young child. Through this, the development of pathology is defined exclusively in terms of trauma, and psychoanalysis becomes a form of psychopathology. The normal and the pathological development are separated, while Freud, on the other hand, wanted to show that the difference between these was gradual. This was one of the reasons that he had taken leave of his trauma theory. He wanted to formulate an all-encompassing theory about the mental functioning of man. His seduction theory presupposed asexuality within the young child, because of which seduction will have no effect, but will only be experienced as traumatic in puberty, because of the -nachträgliche – remembrance of the seductive scene.

Primary object love and confusion
Before the trauma, according to Ferenczi, there was a loving connection between the child and the primary objects, characterized by primary object love, or unconditional love. In this stage there are all kinds of sexually and oedipally coloured behaviour and games. The child imitates the parental objects. It is about imitation and identifying with. The intimacy of the primary objects is not felt at a sexual level, but as tenderness. The primary object though, the parent, interprets what the child feels as tenderness, as sexual desire. Because of their own pathology, shortage or conflicts, certain parents will respond with adult sexual behaviour to the erotic play of the child. They read the inner life of the child fundamentally wrong, hence the expression confusion of tongues. The child is completely powerless against the overwhelming passion of the primary parental object. The confrontation is so brutal and intrusive that it is impossible to integrate it by the young child, because it’s inner structure cannot handle this yet. What rests, for the child, are panic, chaos and identifying with the aggressor. The only way to mentally survive is to identify with the needs of the aggressor, and to adopt his feelings of guilt and shame as its own. The child thinks it is bad, and will behave accordingly. The seduction is denied, the child will be punished for its provoking behaviour (I am bad and deserve punishment), and there is mostly a conspiracy of silence about what has happened. To Ferenczi, the reaction of the environment to the trauma is an essential part of the trauma. If the parent is able to recognize the true nature of the child’s desires, the gap between parent and child may be closed. The parent must be sensitive to what is happening in the inner world of the child, and not be primarily focussed on his own inner world. In order for the development to run a good course, that is in a non-pathological way, the parent must be adequately sensitive and responsive to the needs of the child.

It will be obvious that there is an extremely complex mixture of identifications and introjections, through which a child becomes sensitive to later traumatization and that it hardly has the ability to develop its inner structure in such a way that it can protect itself from further traumatization. After all, through the mechanism of identifying with the aggressor the child prevents itself from recognizing what has happened as traumatic, and thus has to repeat the trauma over and over.

The trauma is connected to a failure of the holding environment the child needs in order to be able to function and develop further, as it is as yet unable to adequately function autonomously. Because of the presence of trauma, within the ego there will be a split between the feelings of tenderness of the child on the one hand, and the prematurely experienced feelings of passion of the perpetrator. This is the phenomenon of the ‘true and false self’ as described by Winnicott. If the surrounding environment of the child has been unable to offer a corrective experience, an adequate holding environment in a psychoanalytic relation or setting becomes a curative factor. Also, the psychoanalyst must realize that offering unconditional attention is, by definition, impossible: there is no such thing as perfection, there will always be failure, within certain perimeters. Here, there appears the concept of the good enough mother, as introduced by Winnicott. The mother is not always there for the child because sometimes she is with the father. Because she is not only the mother of the child but also the lover of the father, her husband. The analyst is not always there for this specific patient, sometimes he is with his other patients and next to that he has his own private life. Here the de-idealisation comes into the picture.

In his ‘Confusion of Tongues’ (1933) and in his posthumously published clinical diary (Dupont 1985) Ferenczi worked out his ideas about the development of trauma and its treatment. To Ferenczi, it is about the treatment of anxiety neuroses or process disorders, in which the relationship is central, while Freud speaks more and more about the treatment of psycho neuroses or representational disorders, in which interpretation is much more central. This may also be seen in terms of attachment theories. Central, with Ferenczi, is more and more the revision of the inner working model both of patients and that of their analysts. Theories about transference and counter-transference, about projective identification and internalisation were already arising and casting their shadows ahead.

Reciprocal or mutual psychoanalysis
According to the psychic model of Ferenczi, the development stagnated because of the failure of the holding environment, or because of the failing of the primary caring objects in their unconditional love. He saw reciprocal openness as an instrument for treatment. Ferenczi considered transference and the resistance configurations in the treatment as a joint construction of both patient and analyst. In which both the pathology of the analyst and that of the patient played a part. This led to his experiments with the mutual analysis, which he described extensively in his diary (Dupont, 1985). He seemed to overlook the fact that the relationship between patient and analyst is principally unbalanced and characterized by dependency of the patient. In short: there are limits to reciprocity.

To Ferenczi, it is not just about the analyst offering himself as a new primary object, doing better that the earlier primary objects, an object to be idealised, but also as an object that will certainly fail, within certain perimeters. In his own terms: the analyst must, figuratively, be ‘murdered’, or de-idealised by his patient. Idealising, and de-idealising must go hand in hand, because otherwise the patient will never be able to function autonomously. Ferenczi is not only focused on relatedness and intimacy, but also on failure, autonomy and internalising. It is about positive and negative transference, about gratification and frustration, about match and mismatch, and reparation, or, in the words of Bowlby: about attachment, separation and internalisation.

Izette de Forest

Ferenczi’s controversial ideas ended up in the development of a mutual form of psychoanalytic treatment. In that frame especially the treatment of Elizabeth Severn, Clara Thompson and Izette de Forest have become well-known. Therefore, in the rest of this lecture we will elaborate on the mutual psychoanalysis as Ferenczi shaped it.
It is remarkable how, until very recently, the meaning of Ferenczi has been treated with a conspiracy of silence within the psychoanalytic mainstream. This can be compared to the processes Ferenczi describes in his ‘Confusion of Tongues’.

We will therefore clarify the conflict between Freud and Ferenczi using what Ferenczi describes as determining for the development of trauma in his famous article from 1933. The behaviour of Severn, Thompson and De Forest, as well as that of Ferenczi himself, was seen as a form of acting out, and therefor as malicious, while in fact it was the only possible form of communication available in the treatment of seriously traumatized patients whose analysts could rightfully be called wounded healers. As were many in their generation.

Elizabeth Severn
Elizabeth Severn was not only one of the most controversial patients of Ferenczi, she also, according to Rachman (2018) contributed independently to psychoanalysis with, among others, her book ‘The discovery of the Self, A Study in Psychoanalytical Cure’. Her ideas about empathy, the analysis of counter transference, self-disclosure and intersubjectivity are decidedly progressive, and make of her a pioneer of the relational psychoanalysis. Rachman describes in his book about Elisabeth Severn, who has also been called ‘the evil genius of psychoanalysis’, how Mason, reading Ferenczi’s clinical diary, discovered that the patient called RN in the diary, was in fact E. Severn. He also describes how K. Eissler managed to track her down and interview her. From this interview Severn does not, by the way, emerge as a seriously disturbed woman. The deep regression in the treatment of both Severn and Thompson may be understood in terms of the sexual trauma which had taken place in both these women’s lives.
Severn and Ferenczi developed the mutual analysis as a treatment form for trauma, in which unconditional motherly love came to be central. They started their experiment when the treatment of Severn stagnated because of problems in Ferenczi’s counter-transference, which negatively influenced the treatment of Severn. Their way of working went further as an intensive form of self disclosure and an exchange of roles, as was also the case in the treatments of Clara Thompson and Izette de Forest. Ferenczi lay on the couch with Severn and no longer let her pay. He then encountered his own unprocessed relationship with his terrorizing mother, which had been important in his feelings of counter-transference when working with Severn. The treatment of Severn focussed, in that same period, on working through the relationship with her abusive father.

Elisabeth Severn

Through Margareth Severn, Severn’s daughter, the letters of Ferenczi concerning Ferenczi’s analysis ended up in the Freud Archives. Both Ferenczi and Severn got ‘the silent treatment’ from the psychoanalytic world, a treatment more often seen in this world concerning analysts-colleagues with opinions that are different. Ferenczi’s intention was to offer a corrective emotional experience through offering unconditional love (non-eroticizing love), through which the damage Severn had suffered because of the sexual trauma, could be repaired. Through this, he thought, re-traumatization might be prevented. So, mutual analysis was, to Ferenczi, a clinical experiment, in which he tried to replace the incest trauma by the internalisation of an empathic instead of an abusive father. As Ferenczi described in his ‘Confusion of Tongues’, the incest trauma will lead to a victim losing his/her voice in the confrontation with the trauma. Severn would once more lose her voice when she tried to defend Ferenczi’s treatment against the psychoanalytic world, in which she failed and which led to re-traumatization. In the interview with Eissler, Severn succeeded in working through her own ‘Confusion of Tongues’, and to give words/voice to both her own treatment by Ferenczi, as her inner problems, her cure and her later way of functioning. Severn was severely abused by her father, and her mother refused to protect her from her father’s abusive behaviour. It is easy to see the Alien Self come into existence, when the primary objects respond from their own adult passions, and cannot adequately read the developmentally coloured desires of the small child. Shortly after her marriage, Severn was divorced, which was also extremely traumatizing to her, she was separated from her daughter who, in her turn, was abused by her grandfather. The analysis with Ferenczi found itself in a deadlock because of the negative countertransference by Ferenczi. It was Severn who was sensitive to this and suggested to Ferenczi to mutually analyse each other. This helped him to see his own negative countertransference and made him better able to analyse Severn and thereby to help her.

Clara Thompson and Izette de Forest
Both Clara Thompson and Izette de Forest belonged, with Elisabeth Severn, to the Budapest school where Balint was the successor of Ferenczi. Thompson and De Forest were both, just like Severn, seriously traumatized in their early childhood, which was why ‘doing’ had the focus more than ‘feeling’ or reflecting. Thompson and De Forest were the ones who championed Ferenczi’s intellectual legacy in the United States. Thompson, moreover, was one of the determining figures within the relational psychoanalysis. It was De Forest with whom Ferenczi shared his difficult relationship with Freud. She in her turn would do the same later with Fromm. In essence, the problem between Ferenczi and Freud was about the fact that Ferenczi did not feel seen by Freud, in the sense that Ferenczi felt that, with Freud, it was mainly about the theory of psychoanalysis, and not about the person the patient was. With Ferenczi, it was primarily about the person and only secondly about the theory. From the beginning, with Ferenczi reciprocity in the treatment was central. With Freud, Ferenczi missed warmth, empathy and reciprocity. De Forest described Ferenczi as personal and very involved, without a professional façade.

Clara Thompson

Both Thompson and De Forest stated, reflecting upon their treatment with Ferenczi, that they experienced the offering of a non-eroticizing form of analytic love, as a healing power in their treatment. Thompson, more than Severn and De Forest, looks critically at her treatment by Ferenczi. Shapiro (1993) explains this by the fact that the treatment had to be ended early because of the illness and subsequent dying of Ferenczi. Both were, just like Severn, working as analysts. Clara Thompson told everyone who wanted to hear that she could, whenever she wanted, sit on Ferenczi’s lap and was allowed to kiss him. Ferenczi allowed this, not from any sexual motive but from the idea that, in the frame of the treatment, a form of unconditional analytical love should be offered. He saw the ‘kissing’ as a materialisation of the creation of a repairing holding environment. With that, the analyst participates in the trauma of the patient. To Ferenczi, it was about offering a therapy that was repairing through the offering of a non-sexual but emphatically involved father. Thompsons behaviour may be explained as a misinterpretation of Ferenczi’s behaviour, as the acting-out of a sexually coloured transference. But closer to the reality of her mental functioning might be the explanation that this was the only form of communicating that was available to her at that moment. Because of the incest trauma, her mental development was stagnated, therefore she was functioning, in those aspects that were related to the trauma, in the teleological mode, which goes together with physical behaviour. Physical interaction is necessary in order to feel that the other, the analyst, cares about you. The difference between ‘Father’ and the analyst, who may resemble father in certain ways, has then disappeared. The analyst, at that moment, is the father. The above, to Ferenczi, also meant that he was greatly in favour of personal analysis, not just like, in the beginning, with Freud to experience a psychoanalytic process and how that feels. But especially to let the psychoanalyst get to know his own countertransference and to confront it and work it through.

It is certain that Ferenczi has enriched psychoanalytic thinking with the meaning of concepts such as empathy, unconditional love and attention, the primary relation, reciprocity, the curative effect of a corrective experience within the psychoanalytic relationship. In this, later meaningful analysts such as Kohut and Winnicott cast their shadows. Ferenczi’s views on the development of trauma and pathology, and especially developmental pathology, are very important today. His emphasis on ‘doing’ and acting within the teleological mode would, today, be seen as unsuitable and even abusive. Pitfalls here are the evaporation of the transference in the real relationship, the disappearance of the sexuality in the non-erotic primary love, and the stagnation in the equivalent mode. Our challenge within the psychoanalytic way of thinking is to come to an integration of both Freud and Ferenczi’s positions, in which Fonagy’s concept of mentalizing could be helpful.


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