Psychoanalytic Psychology Copyright 2000 by the Educational Publishing Foundation

2000, Vol. 17, No. 4, 706-729 0736-9735/00/S5.00 DOI: 10.1037//0736-9735.17.4.706

The Role of Concordance

and Complementarity in
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Psychoanalytic Treatment

Jeffrey J. Mermelstein, PhD

Binghamton, New York

Heinrich Racker (1968), in his seminal work on countertrans-

ference, highlighted the importance of concordance and
complementarity in the countertransference. The present arti-
cle argues that concordant and complementary identifications
are ubiquitous in the organization of experience and in human
relationships, and that insufficient attention has been given to
the role that these identifications play in the treatment process.
Self psychology and projective identification were critiqued in
relation to how they either avoid recognition of complemen-
tarity or reduce complementarity to concordance. The article
concludes with a reanalysis of the patient-nurse relationship in
Ingmar Bergman's Persona, dynamics that had been previ-
ously described by Otto Kernberg (1975) as projective identi-
fication and critiqued by Robert D. Stolorow and George E.
Atwood (1992).

Jessica Benjamin (1995), in discussing the importance of sameness and

difference in gender development, emphasized that

Jeffrey J. Mermelstein, PhD, independent practice, Binghamton, New York.

I thank Jill Gentile, PhD, John Pagura, CSW, Robert Ruchames, CSW, and
Robert Stolorow, PhD, for their supportive and thoughtful responses to drafts of this
article.
Correspondence concerning this article should be addressed to Jeffrey J. Mer-
melstein, PhD, 84 Main Street, Binghamton, New York 13905.

706
 CONCORDANCE AND COMPLEMENTARITY 707

the implicit assumption in differentiation theory is that acknowledging differ-

ence has a higher value, is a later achievement, and is more difficult than
recognizing likeness. The neglected point is that the difficulty lies in assimilat-
ing difference without repudiating likeness, that is, in straddling the space
between the opposites. It is easy enough to give up one side of a polarity in order
to oscillate toward the other side. What is difficult is to attain a notion of
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difference—being unlike—without giving up a sense of commonality, of being

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"like" (p. 125).

Although I am in total agreement with Benjamin's conclusion re-

garding the interconnectedness of sameness and difference, I do helieve
that psychoanalysts have tended to have more difficulty with difference.
This is evidenced in their avoidance of difference and in their reduction of
difference to sameness. Although I use self psychology as a case example
of the avoidance of difference, and projective identification as an example
of the reduction of difference, I am hopeful that my comments extend
beyond these two approaches.1
The issue of sameness and difference was taken up by Heinrich
Racker (1968) in his seminal work on countertransference. Racker de-
scribed two basic types of countertransference reactions: concordant and
complementary identifications. Racker described concordant identifica-
tions as occurring when there is an identification of the analyst's ego with
the patient's ego that emanates from the analyst's "intention to under-
stand." In contrast, complementary identifications occur when "there
exists also highly important identifications of the analyst's ego with the
patient's internal objects" (p. 134).2 Racker goes on to describe the
complex interplay of these two forms of countertransference including
how one often quickly leads to the other. Racker's notion of a concordant
identification requires a basic similarity or sameness between patient and
analyst. Racker's notion of a complementary identification has more to do
with otherness than with difference per se. Otherness, however, always
involves at least some degree of difference. Throughout this essay, I use
the terms concordance and complementarity to refer to the strengthening
of the self through the use of similarity and difference, respectively.

1
From the onset, I apologize for the necessary generalizations diat I use in my
discussions of both self psychology and projective identification. Schools of thought
and methods of treatment tend to involve significant variation in theory and in practice.
In my critique of sameness and difference, as they are approached within psychoanal-
ysis, I critique a basic self psychological and projective identification methodology,
knowing full well that such standard approaches are theoretical conslructs.
2
Racker references Deutsch's (1926) earlier use of the term complementary
attitude to describe somewhat similar phenomena.
 708 MERMELSTEEN

Although concordance and complementarity use similarity and difference

as their building blocks, concordance and complementarity are not the
equivalent of similarity and difference. The issue is not how similar or
different self and other are, but rather how this essential similarity and
difference is used. For simplicity, I distinguish between concordance and
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complementarity as if they are separate processes. In practice, however,

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concordance and complementarity are often so intertwined that the label-

ing of relational experience as concordant or complementary tends to be
based on the current function of the concordance or complementarity in
the patient's (or analyst's) moment-to-moment subjective experience.
Although Racker was describing countertransferential identifications, con-
cordance and complementarity apply to all relational experience.
Racker's notion of concordant and complementary identifications in
the countertransference, if placed in an intersubjective framework, paral-
lels the concepts of intersubjective conjunction and disjunction (Stolorow
& Atwood, 1992). From an intersubjective perspective, organizing prin-
ciples inform how affective life is structured and experienced. These
organizing principles rely on sameness and difference for the categoriza-
tion and clarification of experience. I believe that there is a prewired
tendency to recognize and organize one's thinking along the lines of
sameness and difference. Neurons fire in an all-or-none manner and thus
operate on the basis of a binary system that fuels the use of dichotomies
in individuals' perceptual and cognitive functioning. These dichotomies
require sameness and difference as their basic unit. New experience is
ultimately compared and organized on the basis of how it is similar to and
different from prior experience. Human beings rely on dichotomies de-
fined by sameness and difference to organize then- experience prior to and
as a precondition for the establishment of meaning. Although complex
composites and integrations of sameness and difference have the potential
to create a unique richness in individuals' perceptual and cognitive
schema, human beings all too often fall back on simpler dichotomous
processing that relies on their most repetitive prereflexive organizing
principles.
When Stolorow and Atwood (1992) described the intersection of two
psychological worlds as either an intersubjective conjunction or an inter-
subjective disjunction, they were following this pattern of comparing and
organizing experience into that which is similar and that which is different.
This approach to intersubjective fields focuses on the coming together of
two subjectivities in the present and tends to categorize the resulting
intersubjective field as either sameness or difference on the basis of the
 CONCORDANCE AND COMPLEMENTARITY 709

dominant affective tone of the intersubjective field at the moment of

intersection. From a broader perspective that includes past and present, the
intersection of two subjectivities is a complex mixture of similarity,
difference, ambiguity, and contradiction. Nevertheless, when patients and
analysts are immersed in a relational process, they often experience the
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relational field as predominantly or perhaps even exclusively conjunctive

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or disjunctive, ignoring previous and potentially contradictory aspects of

their experience.3 Clinically speaking, Stolorow and Atwood's attempt to
categorize intersubjective fields as conjunctive or disjunctive is diagnos-
tically useful when evaluating the overall tenor of an intersubjective field.
I do find, however, that therapeutic impasses tend to be more tenacious
when there is a complex interweaving of sameness and difference, or in
Stolorow and Atwood's terms, of conjunction and disjunction. For exam-
ple, an intersubjective disjunction can be difficult to recognize and nego-
tiate because it is embedded in an ongoing experience of intersubjective
conjunction, or, to be more precise, the intersubjective field had previously
been organized by both participants in such a way that the conjunction had
been highlighted (figure) and the disjunction had been ignored or denied
(ground). Although the subjective experience of analyst and patient may
point to either conjunction or disjunction, a more contextual approach that
recognizes both the conjunctive and disjunctive aspects of the intersub-
jective field is often required if one is to understand and resolve resilient
therapeutic impasses.
A complementary identification does not necessarily imply a nega-
tive or adversarial position. Freud (1914/1958), in his paper On Narcis-
sism, differentiated between the anaclitic and the narcissistic types of love
objects. The anaclitic love object is chosen on the basis of having one's
needs met by the other (a positive complementary identification). The
narcissistic love object is chosen on the basis of similarity to self (a
concordant identification). Concordant and complementary processes are,
however, helpful in tolerating and negotiating negative affects. With a
concordant identification, experiencing commonality between self and
other strengthens individuals by helping them to feel that they are not the

3
The figure-ground relationship between conjunctive and disjunctive aspects of
the intersubjective field parallels other figure-ground relationships between those
aspects of the intersubjective field that are currently being highlighted (figure) and
those aspects that are being ignored or denied (ground). See Mermelstein (1998) for a
discussion of shifting figure-ground relationships as they occur wilhin the analytic
encounter.
 710 MERMELSTEIN

only ones with a certain affect, idea, or personality trait. With a comple-
mentary identification, the complex interplay between how one experi-
ences self, how one experiences other, how one experiences self-in-
relation-to-other, and how one is experiencing the current interaction with
the other can alter each aspect of the experience. A complementary
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identification has the potential not only to reduce the intensity of one's
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experience, but to change the character of the experience by altering one's

understanding of the source of the experience. Although both concordance
and complementarity can be used defensively, complementarity tends to
more often be experienced and labeled by the other as defensive. Comple-
mentarity often involves pushing off of the other and therefore has more
potential to negatively affect the other. Although both concordance and
complementarity contribute to how intimacy and autonomy are experi-
enced, concordance tends to be experienced as enhancing intimacy
whereas complementarity (including difference) tends to be experienced
as enhancing autonomy. The interconnectedness of sameness and differ-
ence parallels the interconnectedness of intimacy and autonomy. Intimacy
and autonomy, although seemingly disparate processes, each occur against
the background of the other; indeed, each requires the other for its
definition.
Sameness and difference have been used as basic organizing schema
in nonpsychoanalytic empirical research. The entire body of research on
cognitive dissonance (Festinger, 1957) is based on the premise that the
subjective experience of sameness and difference requires an internal
consistency toward which individuals strive. Festinger suggested that the
need for consistency, as measured by sameness and difference, is a central
motivational factor influencing one's perceptions, thoughts, defense mech-
anisms, and choices. Research on the development and use of cognitive
constructs (Kelly, 1955) has also relied on sameness and difference for its
basic building blocks. The Repertory Grid Technique, used to assess
cognitive constructs, organizes the person's object world into threesomes
and then asks how two of them are alike and the other different. Within
psychoanalysis, this test continues to be used by researchers when they are
trying to assess the organization of transference (Soldz, 1993).

Complementarity, Enactments, and the Attribution

of Affective Experience

The issue of how affective experience is unconsciously transferred from

one individual to another remains troublesome and perplexing, touching
 CONCORDANCE AND COMPLEMENTARITY 711

on a wide range of theoretical and technical issues including the issue of

how permeable the membrane is that connects and separates self and other.
Those who believe in projective identification use projective and introjec-
tive processes as a simplified explanatory model that enables them to
identify the origination and purpose of transmissions.
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From an intersubjective perspective, human experience develops and

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continues to exist within intersubjective fields (Atwood & Stolorow, 1984;

Orange, Atwood, & Stolorow, 1997; Stolorow & Atwood, 1992;
Stolorow, Brandchaft, & Atwood, 1987). Subjective experience within an
intersubjective field is contextual and transferable. The intersubjective
alternative to certain clinical aspects of projective identification lies in
their understanding and clinical use of enactments. Enactments concretize
subjective experience into patterns of human conduct (or patterns of
action), which "may include inducing others to act in predetermined ways,
so that a thematic isomorphism is created between the ordering of the
subjective and the interpersonal fields" (Atwood & Stolorow, 1984, p. 91).
Questions having to do with the ownership or origination of affect,
cognition, or any other aspect of experience cannot be easily resolved, and
any answer is, at best, "fallible" (to borrow a term from Orange, 1995).
Within an intersubjective field, all aspects of experience are bilaterally
"transferable" as mediated by the organizing principles of the receiver of
the transfer.
This article argues that many enactments4 seen in psychoanalytic
treatment stem from an inability of the analytic dyad to recognize and
negotiate the complementary cotransference.5 The experience of self,
other, and self-in-relation-to-other are inseparable. Rigid perceptions of
self require rigid perceptions of the other and of self-in-relation-to-other.
It is commonly understood and accepted within psychoanalysis that pa-
tients frequently "position" themselves and others with the purpose of
confirming perceptions of self-in-relation-to-other. This article argues that
this process is ubiquitous and that the analyst's (human) difficulty accept-

4
Enactment, as the term has come to be generally used, seems to refer to any
undetected unconscious process. Although I focus on the role of complementarity in
the development of certain types of enactments, I do not wish to imply that this is the
exclusive or even principle cause of enactments. Clearly, enactments have multiple
sources and purposes, a discussion of which would go beyond the scope of this article.
5
Throughout this article I am adopting Donna Orange's (1993) term cotrans-
ference to refer to the complex interplay of transference and countertransference,
removing any a priori assumption that the transference develops first and that Ihe
countertransference develops in response to the transference.
 712 MERMELSTEIN

ing the attributions of their patients when these attributions are organized
around complementarity and difference plays a significant role in the
cocreation of enactments. Enactments occur as a continuation of the
patent-analyst struggle to position and reposition one another in each of
their relational matrices. The reciprocal nature of complementary process
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often leads to mutual escalation. When self psychologists suggest that the
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analyst "wear the attribution" (Lichtenberg, Lachmann, & Fosshage, 1992,

1996) ascribed to them by their patients, these self psychologists are
attempting to disengage from unproductive complementary struggles with
their patients.6 Similarly, when object relations analysts attempt to provide
a container for then1 patients' projections (Bion, 1959, 1962), they are
also attempting to provide a therapeutic alternative to escalating
complementarity.
The psychological importance of complementarity lies in the posi-
tive impact that the comparison of self and other can have on self-
cohesion, selfobject functioning, and self-esteem. Complementarity in-
volves an ongoing comparison between self and other that is used to
confirm repetitive perceptions of self, other, and self-in-relation-to-other.
Complementarity includes the need to unconsciously influence others with
the aim of inducing others to corroborate one's relational perspective. To
consciously influence another's behavior would, of course, not have the
same effect. One's awareness that one was consciously attempting to
influence the other would alter the experience. The benefits of comple-
mentarity are threefold: (a) complementarity provides a comparison be-
tween self and other that can be used to augment one's sense of self; (b)
complementarity confirms one's perception of otherness, which is partic-
ularly useful when the other is acting in a manner that threatens one's
relational schema; (c) complementarity provides some degree of psychic
distance, which can be helpful when threatened by engulfment or by the
possibility of losing oneself in a world of sameness.
From an intersubjective perspective, subjective experience is orga-
nized around affect and always exists in a relational context. Insofar as
affects are the central organizers of subjective experience (Jones, 1995;
Socarides & Stolorow, 1984/1985; Spezzano, 1993), the intersubjective
field tends to be defined by the affects that each member experiences in the
presence of and in response to the other. Both of the participants in a

Additionally, when the analyst "wears the attribution," there is the opportunity
of discovering the consequences of the attribution instead of getting bagged down in
competing views of reality.
 CONCORDANCE AND COMPLEMENTARITY 713

relationship are influenced by the affects that the other experiences as well
as the affects that the other avoids experiencing. An important aspect of
complementarity is that the more that one person avoids some aspect of
experience within the intersubjective field, the more that the other is likely
to experience it.7
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Complementary identifications are a strategy for negotiating affec-

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tive experience. When an analyst has difficulty receiving a complementary

identification, it is usually because such a perception attributes affect to the
analyst that the analyst is uncomfortable with, at least in the present
relational context. When affective experience within the patient-analyst
dyad becomes intolerable, the communication process shifts to enact-
ments. At such moments, when the affective relational bond between
patient and analyst is disrupted, there is a loss of selfobject experience for
both the patient and the analyst. The resulting enactment not only serves
to express what cannot be expressed but also serves defensive purposes for
the patient (and I believe, for the analyst as well). Atwood and Stolorow
(1984) described enactments as a pathway to the concretization of expe-
rience. Such concretization serves the function of providing self-cohesion
at critical moments when there is a threat of disruption or fragmentation of
the self.

Self Psychology, Concordance, and the Neglect of Complementarity

Self psychology tends to focus on concordant identifications in the coun-

tertransference to the neglect of complementary identifications (Sands,
1997).8 Self psychology emphasizes the universality and centrality of
selfobject needs and strivings. Selfobject experience is sought to consol-
idate and strengthen the self (Kohut, 1971, 1977, 1984). Sands (1997)
suggested that one's metaphors reflect, define, and circumscribe one's
thinking. The selfobject concept is a metaphor for the profound positive
impact that human beings can have on one another's functioning and sense
of well-being.9 Self psychology does not have an equivalent metaphor for

7
In contrast, when there is concordance, both participants concur in their
willingness to embrace certain aspects of their experience and their need to ward off
other aspects of their experience.
8
I thank Susan Sands for her article, which was the springboard for my thinking
about self psychology, projective identification, and Heinrich Racker's work on
counterttansference.
9
See Mermelstein (2000) for a discussion of the centrality and mutuality of
selfobject experience (and its absence) in the listening process.
 714 MERMELSTEIN

the negative impact that people can have on each other. All too often, self
psychology reduces negative reactions and experience to byproducts of
fragmentation, which fails to recognize the role that complementary in-
teractions and negative affect can play in the acquisition and maintenance
of self-cohesion.
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Twinship or alter-ego experiences during development and as a

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selfobject transference are the purest form of concordant identification.

The essential feature of twinship is sameness or likeness. Twinship expe-
riences strengthen the self through the experience of being similar to the
other. Mirroring and idealizing as aspects of development and as selfobject
transferences both involve strengthening through a mixture of concordant
and complementary identifications with a positive affective interchange.
Both involve empowering the other and then acquiring strength through
one's positive connection to the empowered other. Mirroring involves
strengthening through the experience of being affirmed, recognized, or
validated by the empowered other. Idealization involves strengthening
through one's association or merger with the empowered other. Although
mirroring and idealizing selfobject transferences involve complementar-
ity, differences between the analyst and the patient are usually not high-
lighted. Similarly, although empathy is facilitated by an awareness of both
similarity and difference, literature from a self psychological perspective
has tended to use terms such as empathic attunement or resonance, which
focus on concordance while neglecting the potential contribution of com-
plementary process to an empathic understanding of the patient.10
In all fairness to self psychology, I do not doubt that virtually all self
psychologists, when confronted with difference, would strive to be ac-
cepting, indeed mirroring of that difference. In my experience, however,
difference is not foregrounded in self psychological thinking. Self psy-
chologists pay attention to and recognize selfobject experience and self-
object disruption. Indeed, they pride themselves in facilitating an accept-
ing ambiance. Every act of mirroring is a reinforcement of the curative
power of concordance, as is every act of unchallenged idealization or
twinship. Self psychology relies on the strengthening of individuals via the
development, maintenance, and utilization of a selfobject transference. I
am not advocating that self psychologists abandon their use of concor-
dance. I am, however, concerned about the fate of complementarity and

10
A notable exception to this is Fosshage's (1995, 1997) use of an "other-
centered listening perspective" to enhance his empathic understanding of patients.
 CONCORDANCE AND COMPLEMENTARITY 715

difference. Returning to Racker's (1968) work on countertransference

reactions, self psychology's "intention to understand" has contributed to
an almost exclusive emphasis on the analyst's identification with the
patient's ego to the neglect of the analyst's identification with the patient's
internal objects.
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There are, however, a number of currents within self psychology

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aimed at expanding self psychological theory and practice. Although these

developments may not be formulated as a response to the need for more
recognition of difference and complementarity, I believe that they are
responses to clinical observations that are not so different from mine. Wolf
(1976, 1980, 1988) introduced the adversarial selfobject to encompass the
"need to experience the selfobject as a benignly opposing force who
continues to be supportive and responsive while allowing or encouraging
one to be in active opposition and thus confirming an at least partial
autonomy" (1988, p. 55). Despite its introduction and advocacy by Wolf,
a pioneer and leader within self psychology, it has not been widely
accepted. In contrast to an adversarial selfobject, during a complementary
cotransference the analyst is frequently experienced as being far from
benign. Other areas of psychoanalytic exploration include Baeal and
Newman's (1990) interest in integrating self psychology with an object
relations approach to treatment and Fosshage's (1995, 1997) introduction
of an "other-centered" listening perspective in which the analyst attends to
his or her reactions to the patient from the position of other (discussed in
Footnote 10). Such approaches recognize that complementarity can con-
tribute to an empathic understanding of the patient. More generally, the
intersubjectivists' focus on organizing principles and meaning creates the
possibility of exploring the patient's world without preconceiving that the
patient requires a response of "sameness," and thus tends to recognize and
use difference to a greater extent (Atwood & Stolorow, 1984; Orange et
al., 1997; Stolorow & Atwood, 1992; Stolorow et al., 1987). Additionally,
there is growing interest within self psychology in projective identification
(Bacal, 1997; Powell, 1997; Sands, 1995, 1997).

Projective Identification, Complementarity, and Reductionism

In contrast to self psychology, projective identification involves a far more

complex interaction of concordant and complementary identifications with
both positive and negative affect. Current clinical usage of projective
identification has become quite diverse, including contemporary Kleinians
such as Joseph (1989) and more relational analysts such as Bellas (1987,
 716 MERMELSTEIN

1989, 1992, 1995) and Ogden (1979, 1982, 1989, 1994). Although the
metapsychological thinking and clinical techniques vary substantially, the
clinical material presented tends to emphasize similar pivotal moments in
session when the analyst becomes aware of an experience (a feeling, a
fleeting perception, a fantasy, an idea) that catches his or her attention by
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virtue of its intensity or by it not fitting into the analyst's overall experi-
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ence of self, other, or self-in-relation-to-other. These pivotal clinical

moments are often preceded by some period of confusion or agitation prior
to the moment of clarity when the analyst realizes that something impor-
tant has occurred in the cotransference.11 From my perspective, the patient
has stopped using the analyst in a concordant manner as a facilitator of
selfobject experience (mirroring, idealizing, or twinship). In response to
this unrecognized disruption in the selfobject transference, the patient has
activated a (defensive) strategy for reacquiring self-stability through
complementarity, that is, through comparison and interaction with an
other—sometimes an exaggerated, polarized other. The patient strength-
ens him- or herself through positioning the analyst as different and
engaging with the analyst in such a way as to expose and then benefit
psychologically from the analyst's position of difference. The analyst is
often uncomfortable with the position that he or she has been placed in and
with the patient's insistence that the analyst remain in what may be an
exaggerated or polarized position.
It may take the analyst a while to recognize that a shift has occurred.
If the analyst is slow to recognize his or her discomfort, this discomfort
will continue, perhaps even intensify, until the analyst "discovers" that his
or her experience corresponds to the patient's unconscious, disowned
experience. It is this discovery that is the questionable inductive leap of
Kleinian analysts and others who emphasize projective identification.
Ogden (1989) described how, "in projective identification, the projec-
tor—by means of actual interpersonal interactions with the 'recipient'—
unconsciously induces feeling states in the recipient that are congruent
with the 'ejected' feelings" (p. 25). Ogden and others base their clinical
interventions on the assumption that there is a one-to-one congruence or

11
From a self psychological perspective, it is surmised that were more details
provided about the earlier clinical context of the projective identification sequence, it
would be clear that projective identification occurs as a reaction to a disruption in the
analytic relationship that threatens the patient's psychological functioning. Bacal
(1997) and Powell (1997), for example, both pointed out that projective-identification-
type phenomena tend to occur in response to the analyst's withholding of needed
responsiveness.
 CONCORDANCE AND COMPLEMENTARITY 717

symmetry between the analyst's conscious experience and the patient's

unconscious experience. Analysts who use a projective identifications
model rely on this congruence to help the patient to reown the disavowed
or dissociated aspect of his or her experience.12 The affective experience
during this therapeutic exchange is frequently negative, though which of
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the participants experiences this negative affect varies. If the analyst's

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discovery of symmetry leads to a "successful" intervention, there is

usually a shift in the relational and affective experience of both of the
participants in the interaction. Although the literature has tended to focus
on the power of the analyst's intervention, patients have often already
succeeded in acquiring some degree of self-cohesion through the use of a
complementary cotransference prior to the analyst's discovery of symme-
try. Indeed, it may be that the patient's bolstering of his or her disrupted
self at the analyst's expense plays a pivotal role in the analyst's discom-
fort, which triggers the analyst's discovered identification and subsequent
intervention.
Stolorow and his colleagues (Stolorow, Atwood, & Brandchaft,
1988; Stolorow, Atwood, & Orange, 1998; Stolorow et al., 1987) have
criticized the theory of projective identification as a unidirectional ap-
proach that emphasizes a drive theory operating on isolated minds. They
have argued that the analyst is presumptuous in imposing his or her
experience onto the patient and that the patient is not in a good position to
critically evaluate the analyst's interpretation of his or her experience, but
instead is being asked to accept the analyst's interpretations on the basis
of the analyst's good intentions, authority, or both (Stolorow et al., 1987).
I am expressing a different concern. I believe that the patient is using
complementarity to facilitate the restoration of self-cohesion and that this
complementarity is agitating to the analyst, who responds by reducing the
complementary cotransference to an unconscious concordant cotransfer-
ence. I am not questioning whether such an approach can have a positive
impact on patients. As with self psychology, I am concerned about the fate
of complementarity and difference. Returning again to the work of Racker
(1968), projective identification often begins with the analyst feeling as if
he or she is being treated as the patient's internal objects (i.e., in a

12
Although Kleinian analysts seem to be quite willing to provide interpretations
based on this discovered identification, other analysts, such as Sands (1997), a self
psychologist, and Ehrenberg (1992), an interpersonalist, choose instead to disclose
observations of their experience in a noninterpretative manner with the aim of fur-
thering the psychoanalytic dialogue.
 718 MERMELSTEIN

complementary manner). Ultimately, however, the assumption that there

exists a one-to-one congruence or symmetry between the analyst's con-
scious experience and the patient's unconscious experience contributes to
interpretations that are based on the analyst's identification with the
patient's ego (i.e., based on concordance).
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Case Illustration: Bergman's Persona

While discussing issues of technique in the treatment of narcissistic

personality disorders, Kernberg (1975) wrote the following:

A recent motion picture by Ingmar Bergman, Persona, illustrates the breakdown

of an immature but basically decent young woman, a nurse, charged with the
care of a psychologically severely ill woman presenting what we would describe
as a typical narcissistic personality. In the face of the cold, unscrupulous
exploitation to which the young nurse is subjected, she gradually breaks down.
She cannot face the fact that the other sick woman returns only hatred for love
and is completely unable to acknowledge any loving or human feeling expressed
toward her. The sick woman seems to be able to live only if and when she can
destroy what is valuable in other persons, although in the process she ends up
destroying herself as a human being. In a dramatic development, the nurse
develops an intense hatred for the sick woman and mistreats her cruelly at one
point. It is as if all the hatred within the sick woman has been transferred into
the helping one, destroying the helping person from the inside, (pp. 245—246)

Stolorow and Atwood's (1992) critique of Kernberg's analysis fo-

cused on Kernberg's inference that the experiences of the nurse were due
to the patient's wish or need to induce such experiences in her. Instead,
focusing on the role of the nurse's own narcissistic vulnerability, Stolorow
and Atwood (1992) wrote the following:

We have found that the assumption that the patient wishes the therapist to feel
impotent or infuriated is much more often than not directly contradicted in our
own work. Such wishes, we suggest, occur only when the patient's disagree-
ments, assertions, and primary wishes to have his own subjective experiences
empathically understood have been consistently unresponded to. (p. 114)

At first glance, Persona appears to be a prototypic scenario depicting

the psychoanalytic situation or, more generally, the dynamics of helping
and being helped. Despite her inexperience, Alma, a 25-year-old attractive
nurse, is asked to care for a well-known, successful actress, Mrs. Vogler,13

13
At the beginning of the movie, the patient is referred to as Mrs. Vogler. Soon
after they move to the summer home, once an intimate attachment has developed
 CONCORDANCE AND COMPLEMENTARITY 719

in her 30s, who has become mute and is in need of 24-hr nursing care.
From the beginning, it is clear that Mrs. Vogler is capable of talking, but
refuses to. While caring for Mrs. Vogler, first in the hospital and then at
her doctor's summer home, an intense relationship develops between
caregiver and care receiver. By the end, the caregiver becomes enraged
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and begins to decompensate, though not necessarily in that order. This

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shift in the caregiver's mental status and the acting out of rage are
probably what led Kernberg to conclude that the patient's inner life had
been transferred to the caregiver. Indeed the translocation of experience
from patient to nurse is profound. From my perspective, one can only
appreciate diis translocation by studying the details of their evolving
relationship. I begin by discussing concordance and complementarity in
the nurse-patient relationship, followed by a discussion of two areas of
translocation: the transfer of ideation (manifest content) and the transfer of
rage, both traveling from patient to nurse.
From the outset, viewers see a wide range of differences between
Mrs. Vogler and Alma, all of which provide the potential for a comple-
mentary relationship. Mrs. Vogler has chosen to become mute. Alma has
a significant need to connect via conversation. Mrs. Vogler is depressed.
Alma is perky. Mrs. Vogler is at a crisis point in her life, the details of
which become clearer toward the end of the movie. Early in the movie,
Alma describes herself as happily engaged, looking forward to getting
married and having children in addition to enjoying her work. Although
Mrs. Vogler has had a breakdown requiring hospitalization, Alma recog-
nizes the strength (willfulness) required to remain mute and is concerned
that Mrs. Vogler is too "strong" for her. There are differences in socio-
economic class and level of success that contribute to Alma feeling
envious of Mrs. Vogler. There is also an age difference, the significance
of which is not explored.
On first meeting, similarity between Alma and Mrs. Vogler is
strikingly absent. Viewers quickly see complementary process in the way
that Mrs. Vogler's silence intensifies Alma's need for conversation. Mrs.
Vogler is afraid of saying something dishonest and has therefore chosen
not to speak. She looks curiously at Alma, who seems to show no such
concerns. One cannot help but wonder whether Alma's chattiness and
openness provide validation to Mrs. Vogler's belief that human discourse

between Mrs. Vogler and Alma, Mrs. Vogler is referred to by her first name, Elisabeth.
For simplicity, I refer to her as Mrs. Vogler through this discussion.
 720 MERMELSTEIN

is superficial and dishonest. More generally, Mrs. Vogler's seeming in-

difference to others (including Alma) fuels Alma's connection to her,
much the way that distancers are frequently pursued by those who claim
to be pursuing closeness. Mrs. Vogler has become mute to distance herself
from the world. Alma, in contrast, does not permit long silences or much
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distance.
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On the surface, it appears that Alma is the caregiver and Mrs. Vogler
the patient. It soon becomes apparent that there is a significant amount of
role confusion and role reversal in their relationship. Although their
relationship appears to depict a psychoanalytic relationship, Mrs. Vogler's
refusal to talk leaves her unsuitable for psychoanalysis as it is generally
practiced. Indeed, Mrs. Vogler's refusal to talk contributes to Alma
becoming the analytic patient. From the beginning of their relationship,
Alma does all of the talking. As their relationship develops, Alma begins
pouring her soul out to Mrs. Vogler who, although not verbally respond-
ing, is clearly listening attentively. From my perspective, Alma has
developed a selfobject transference, primarily idealizing with mirroring
and twinship features. Alma's idealization of Mrs. Vogler is evident in her
repetitive portrayal of Mrs. Vogler as a creative, educated person who is
worldly and experienced. Early in their relationship, Alma says, "I have a
tremendous admiration for artists." Later, Alma tells Mrs. Vogler, "I ought
to be like you." The mirroring aspect of Alma's selfobject transference is
apparent in Alma's appreciation of Mrs. Vogler's attentiveness and re-
sponsiveness toward her. Alma tells her, "It's strange, isn't it? No one has
ever bothered to listen to me like you do now. You're the only person who
has ever listened to me. . . . It feels so warm and nice." The twinship
aspect of Alma's selfobject transference is expressed when Alma tells
Mrs. Vogler about her experience of seeing one of her films, going home,
looking in the mirror and thinking, " . . . we are alike. You are much
prettier, but somehow we are alike. I think I could change myself to be
you." Alma's last sentence suggests that the twinship is not identical and
foreshadows the changes that are yet to occur. At the height of Alma's
selfobject transference, Alma reveals to Mrs. Vogler an evocative story of
infidelity, intense sexual pleasure, and the pain of a subsequent pregnancy
and abortion. Then, during the following morning, Alma reads a letter
written by Mrs. Vogler to her doctor, and the selfobject transference is
shattered:

Alma is taking care of me, spoiling me. I think she is quite fond of me even a
tiny bit in love in a charming way. Besides, it's really funny studying her.
Sometimes she cries over past sins, an orgy with strangers and then an abortion.
 CONCORDANCE AND COMPLEMENTARITY 721

Alma is grievously wounded, and her relationship with Mrs. Vogler

begins to unravel.

The Translocation of Ideation

Alma talks at great length about an infidelity and subsequent abortion. It

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is then revealed that Mrs. Vogler's life was apparently going well until she
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became pregnant. We learn of Mrs. Vogler's frantic but failed attempts to

abort a child who would be born deformed and the role that this crisis
played in her breakdown. Was Alma speaking for Mrs. Vogler, and if so,
how did this occur? Although it is tempting to dismiss this profound
concordance as coincidence or to generalize that these issues are important
for all women, this kind of telepathic knowing and translocation of
ideation is not beyond the reach of unconscious communication and
should not be so quickly dismissed. It is unfortunate that it is not known
what Mrs. Vogler was thinking prior to and during Alma's revelations
about her infidelity and abortion. Did Mrs. Vogler somehow invite Alma
to discuss her infidelity and abortion?
From my vantage point, I experienced a heightened intimacy and
mutual attunement during the day leading up to Alma's revelations about
her infidelity and abortion. During this time, I experienced Mrs. Vogler as
being more attentive than she had been before, so much so, that when Mrs.
Vogler speaks to Alma for the first time and then later that night comes
into Alma's room, her move toward Alma seems to be a natural outgrowth
of their developing closeness. Viewers are then informed (by Mrs. Vogler)
that Alma imagined both events (and as the film develops, this appears to
be the case). I believe that the intensification in the responsiveness and
intimacy that was occurring throughout the day contributed to Alma going
further in revealing herself than she had consciously planned. More
specifically, I believe that Alma's expressiveness was at least partially
guided by Mrs. Vogler's responsiveness. From my perspective, Mrs.
Vogler did not project ideation into Alma, but instead Mrs. Vogler was
responsive to ideation within Alma and facilitated its expression. Never-
theless, the question remains of what purpose the expression of Alma's
infidelity and abortion served for both Alma and for Mrs. Vogler.
Alma's relational position and dynamics parallel those of patients in
psychoanalysis. There is likely to be as much disagreement about why
Alma has chosen to tell Mrs. Vogler the story of her infidelity and abortion
as there is in understanding why any patient chooses to reveal him- or
herself in psychoanalysis. From my perspective, Alma, like all analytic
patients, needs to tell her story. She needs, however, to tell her story in the
 722 MERMELSTEIN

right relational setting. A prerequisite for the telling of this story is the
development of a selfobject transference or, more generally, the develop-
ment of safety and the experience of having an attentive listener, prefer-
ably one who is not part of your life and will not pass judgments on your
story or use it against you. Alma has developed such a selfobject trans-
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ference with Mrs. Vogler and is thriving within it. Alma is conflicted about
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the intense pleasure that she experienced during her infidelity. She has
significant pain attached to her pregnancy and resulting abortion. As Alma
weeps, she is physically held and consoled by Mrs. Vogler. They continue
talking until morning. Alma subsequently experiences Mrs. Vogler speak-
ing for the first time and then entering her room after she went to bed,
events Mrs. Vogler later denies. Alma has clearly become more vulnerable
in her relationship with Mrs. Vogler. If Alma did imagine these events, she
may have done so in response to heightened anxiety about her relationship
with Mrs. Vogler and her wish for assurance from Mrs. Vogler about their
attachment.
Less is known about Mrs. Vogler's dynamics because of her mute-
ness. What is known is revealed through her nonverbal behavior, through
the letter that Alma opened, and through her history as it is eventually
presented. In her letter, she reveals that she has been studying Alma. She
refers to Alma as engaging in an orgy with strangers, perhaps "accurate,"
but clearly judgmental and harsh. Mrs. Vogler sees herself as fundamen-
tally different from Alma. Mrs. Vogler uses her perceptions of Alma as a
springboard to feel better about herself and to confirm her isolation.
The basic relational problem is that whereas Alma is benefiting from
the concordance in their relationship, Mrs. Vogler is benefiting from the
complementarity. Alma has organized her subjective experience of her
relationship with Mrs. Vogler so as to highlight their similarity and
resonance, and minimize their differences. Mrs. Vogler, however, has
organized her experience of their relationship in such a way that their
differences are highlighted. The concordance that Alma had experienced
prior to her reading of Mrs. Vogler's letter is shattered when it is revealed
that Mrs. Vogler has been harboring critical judgments of her. The rupture
in their relationship is irreparable. What becomes apparent is that Alma
and Mrs. Vogler were having two different relationships. Although, it is
generally true that participants in a relationship can only experience the
relationship from their own subjectivity, there is usually some common
ground, some overlap in subjectivities, even during times of conflict,
which facilitates the reparation of relational disruptions. Alma and Mrs.
Vogler appear to have diametrically opposed perceptions of what is going
 CONCORDANCE AND COMPLEMENTARITY 723

on in their relationship. I believe that this experience of polarized oppo-

sition is a function of the concordance and complementarity. Alma's need
for a self-selfobject connection with Mrs. Vogler intensifies her need to
focus almost exclusively on sameness and the emotional attunement
between them. Although she previously had a number of perceptions of
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difference, her need for a concordant selfobject transference renders these

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differences inconsequential. In contrast, Mrs. Vogler presses for comple-

mentarity, which includes distancing herself from Alma while focusing on
their differences. More generally, Mrs. Vogler has distanced herself from
the world. Muteness as a symptom symbolizes and facilitates her relational
positioning. Such a distancing, which clearly developed well before her
muteness, relies on and gathers support from complementarity and a sense
of difference.

The Translocation of Rage

The translocation of rage from Mrs. Vogler to Alma is more difficult to

track. To begin with, viewers are not provided with much data about Mrs.
Vogler's anger and rage prior to her current crisis. In her present state, one
can surmise that her muteness contains within it elements of unexpressed
rage. Thus, when Alma becomes enraged, one might conclude that Mrs.
Vogler's rage was projected into Alma. If one tracks the details of how
Alma came to be enraged, one sees Mrs. Vogler colluding with Alma's
developing perception that Mrs. Vogler is genuinely interested in her,
indeed is just like her. Had Mrs. Vogler not colluded with this developing
concordant cotransference, Alma may have been better equipped to handle
the complementary cotransference. Mrs. Vogler set Alma up by colluding
with Alma's need for and illusion of concordance, which facilitated the
development of a selfobject transference. Mrs. Vogler then burst Alma's
bubble. One can conjecture that this was a passive aggressive expression
of Mrs. Vogler's rage.
The incident that shattered their relationship occurs when Alma
reads Mrs. Vogler's letter. Considering that Mrs. Vogler had been mute
and that Alma has a strong curiosity about Mrs. Vogler, including a wish
to know what Mrs. Vogler thinks about her, one has to wonder why Mrs.
Vogler chose to include comments contemptuous of Alma in an unsealed
letter that she then gives to Alma to deliver to the post office. Imagine if
an analyst who keeps his or her personal life entirely private were to give
an analysand with a strong transference an unsealed letter to mail. Would
it not be considered a hostile act if the letter included hurtful comments
about the analysand? Although data are lacking on Mrs. Vogler's subjec-
 724 MERMELSTEIN

live experience leading up to the writing and nonsealing of her letter, one
can still conjecture that Mrs. Vogler had a wish to provoke Alma into a
fragmented, rageful state. What would be the psychological purpose of
this act?
Recognizing that Mrs. Vogler has a complementary relationship
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with Alma, three hypotheses come to mind. One possibility is that Mrs.
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Vogler was inducing anger in Alma in order to confirm her view of the
world as a hostile, dangerous place in which people cannot be trusted. A
second possibility is that Mrs. Vogler is likely to feel more accepting of
her own anger in the presence of someone who seems to be out of control
with theirs. Both of these possibilities include Mrs. Vogler bringing out
the worst in Alma and then benefiting from her use of Alma as "other." In
the first possibility, Alma is being used to confirm Mrs. Vogler's view of
the world and to confirm the choices that Mrs. Vogler is making in relation
to the world. In the second possibility, Ahna is being used as a point of
comparison to help Mrs. Vogler to feel better about herself. It should be
noted that whereas the expression of Alma's rage is occurring in tandem
with Alma's fragmentation, Alma's rage does not seem to have as dele-
terious an impact on Mrs. Vogler. From my perspective, the relational
dynamic is that there has been a shift toward bilaterally experienced
complementarity. For Alma, who had previously been experiencing con-
cordance, this shift includes the loss of selfobject experience and self-
cohesion. For Mrs. Vogler, the relationship had already shifted to comple-
mentarity or perhaps had been primarily complementary from the outset.
Mrs. Vogler derives self-cohesion through the complementary cotransfer-
ence, and for her the intensification of the complementary cotransference
is not as abrupt, nor does it involve as great a loss.
A third possibility is that Mrs. Vogler is inducing anger in Alma in
order to create psychological distance in response to Alma's expression of
dependency and warmth. In this regard, it is interesting that Mrs. Vogler
appeared so emotionally available during the previous day and that she
begins her comments about Alma in the letter with the remark, "Alma is
taking care of me, spoiling me." She then proceeds to criticize the same
events that the evening before she had responded to so empathically. One
cannot help but wonder whether Mrs. Vogler is pushing Alma away in
response to her own need for intimacy and her subsequent reactions to that
need. I am aware that on this point I am joining Kernberg in his (Kleinian)
perception that Mrs. Vogler is threatened by and needs to spoil that which
is experienced as good.
 CONCORDANCE AND COMPLEMENTARITY 725

Summary and Conclusions

The focus of this article is on the ubiquity of sameness and difference as

the basic building blocks of human experience and on the powerful role
that complex mixtures of concordance and complementarity play in
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human relationships. In conclusion, I wish to emphasize the following

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points.
1. All experience is embedded in relational matrices. The very
embeddedness of experience within a relational matrix requires similarity
and difference. To embed is to relate, which requires comparison. The
basic units of comparison are similarity and difference. All relational
experience has concordant and complementary dimensions that are built
from these essential similarities and differences.
2. Complementarity is so basic, so complex, and so variable that to
try to understand it inevitably leads to generalizations that reduce its
richness. Complementarity exists in many forms. There are innumerable
ways that self and other can be different and many ways to use that
difference. Concordance and sameness are much simpler. Everyone knows
sameness. It is familiar and feels safe (unless it threatens one's sense of
individuality or specialness). In contrast, people are threatened by differ-
ence, especially if it violates their core organizing principles.
3. The essence of complementarity is that when two individuals
relate to one another, there is mutual impact with both individuals orga-
nizing their view of self against the background of how they view other
and self-in-relation-to-other. Although self and other are internal repre-
sentations, they correlate with how individuals experience themselves and
others in the world. The behavior of others can threaten one's organization
of experience. Projective identification type enactments often occur when
an "other" does not cooperate with one's internal world. When one's
relational perspective is not capable of assimilating new experience or of
accommodating to it, one response is to unconsciously attempt to induce
others to act in ways that confirm one's internal world, thus removing the
experience of dissonance.
4. When Atwood and Stolorow (1984) described psychoanalysis "as
a science of the intersubjective, focused on the interplay between the
differently organized subjective worlds of the observer and the observed"
(p. 41), they were creating space for complex forms of experiencing and
interrelating with the other. Complementarity is an essential aspect of how
subjectivities fit together.
5. Concordance relies on similarity as its basic building block.
 726 MERMELSTEIN

During reciprocal concordant identification, both participants are acting

with a common goal. Concordance is a win-win situation in which both
parties benefit from the resonance of similarity (unless one or both of the
participants are threatened by the similarity or the concordance).
6. Complementarity is not the equivalent of difference. Complemen-
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tarity relies on difference as a basic building block in its organization of

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experience. Complementarity is the psychological use of difference to

accomplish important psychological goals. These goals involve the inter-
play of object and selfobject usage. Although complementary relation-
ships may be win-win, in which case both parties benefit from how their
way of being complements the other, complementarity is often not a
win-win situation. During complementary interactions, each of the par-
ticipants is motivated by his or her separate agenda, and these agendas
more often than not do not fit together well. In particular, complementarity
becomes problematic when the perceptions and organizing schema of both
participants are diametrically opposed, reciprocally threatening the other's
functioning, and cannot be easily reconciled. The more important the
relationship and the more that the relationship is based on similarity and
resonance, the more threatening the dissimilarity and dissonance.
7. On what basis can one attribute one's subjective experience to the
psychology of the other instead of to one's own? Under what circum-
stances is an individual likely to believe that a feeling (or thought, or
selfstate) has its origin in someone else? In my experience, people are
more likely to attribute that their feeling is being induced by the other
when (a) they define the feeling as "not me"; (b) when they are uncom-
fortable with that feeling; and (c) when something is going on between
them and the person that they are interacting with that has left them
unsettled and ready to attribute the origin of a feeling, especially an
unwanted feeling, to the other.
8. What makes complementarity so difficult for analysts is their wish
to remain in a concordant position. The problem in the relationship
between Alma and Mrs. Vogler in Persona is that Alma had developed
and wished to maintain a (concordant) selfobject transference that was in
direct conflict with Mrs. Vogler's complementary stance toward her.
9. Concordance and complementarity do not usually appear in a
singular fashion, which makes their recognition and management more
difficult. As Benjamin pointed out in the section I quoted at the beginning
of this article, "the neglected point is that the difficulty lies in assimilating
difference without repudiating likeness." In Persona, there was a polar-
ization between the concordant and complementary relational positions of
 CONCORDANCE AND COMPLEMENTARITY 727

the two protagonists, which placed the characters in total opposition to one
another and led to an impasse, indeed a hopelessness between them. In the
psychoanalytic encounter, patient and analyst may have the immediate
experience of being polarized, one needing concordance, the other using
complementarity. A closer examination of the history of the cotransfer-
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ence usually reveals that patient and analyst have each used concordant
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and complementary identifications, though perhaps not during this phase

of their relationship.
10. The experience of self, other, and self-in-relation-to-other always
involves complex mixtures of sameness and difference, although on the
basis of the emotional tenor of the relationship, sameness or difference
may dominate to such an extreme that the entire cotransference may
appear to be exclusively concordant or complementary. This reductionism
of subjective experience to concordance or complementarity can play an
important role in therapeutic impasses. Ultimately, however, therapeutic
progress is served by a recognition of both sameness and difference—and
the ability to have one without sacrificing the other.

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