The countertransference hatred (feelings of malice and aversion) that suicidal patients arouse in the psychotherapist is a major obstacle in treatment; its management through full awareness and selfrestraint is essential for successful results. The therapist's repression, turning against himself, reaction formation, projection, distortion, and denial of countertransference hatred increase the danger of suicide. Such antitherapeutic stances, their recognition, and the related potential for constructive or destructive action are the subject of this paper. Components of Countertransference HateCountertransference hate, like all hate, is a mixture of aversion and malice. The aversive component is the one fundamentally most dangerous to the patient and is often not clearly distinguished from the sadistic (malicious) as¬ pects of countertransference hate. Sometimes the aver¬ sion is experienced more consciously while the malice is muted; this will give rise to a sense of inner fear and fore-

Empathy is usually regarded as an irreducible inborn capacity, operative from birth, for knowing the inner experience of another person without necessarily perceiving cues from that person about his thoughts or feelings. Merging of the type characteristic of early infant-mother symbiosis has often been considered the origin and basic component of empathy. However, merging is an illusory experience which cannot function as an active mechanism in the perceptual process, and the psychological structures needed for certain kinds of empathy do not commence development until eighteen months of age. The mechanism of empathy has also been ascribed to vaguely defined variants of identification. This is not a settled issue, but the idea is not compatible with a recent rigorous effort to define identification. The author offers a different theory of empathy, according to which empathy is a capacity that evolves with neuropsychological maturation and interpersonal interactions in the course of individual development. Empathy depends on sensory perception of behavioral cues from the object about his inner state. The empathizer compares these behavioral cues with one or more kinds of referent in this own mind which could be expressed by similar behavior. He then infers that the inner experience of the object qualitatively matches that associated with his referent. Limitations in the accuracy and scope of empathy are threefold: patients may limit or distort the expression of behavioral cues about their state of mind; referents available in the mind of the empathizer may be inadequate; and the inferential process is inherently uncertain. As a result, knowledge of another person's thoughts and feelings which can be acquired through empathy is limited. The theoretical understanding of empathy offered in this paper implies ways for improving empathic accuracy, especially by means of applying two or more kinds of referents to the same set of perceived cues.

The concept of the sustaining fantasy and the Sustaining Fantasy Questionnaire (SFQ), an instrument for its measurement, is introduced. Sustaining fantasies represent characteristic ways to ameliorate intense negative affect or to restore self-esteem. The responses of 134 psychiatric inpatients were used to construct ten scales. The SFQ and MMPI were then administered to 125 nonpatients. Psychiatric inpatients had higher scores than normals on fantasies of death, withdrawal, restitution, suffering, God, and closeness. Fantasies of power and revenge, admiration of self, competition and aesthetics did not differentiate between groups. SFQ scales correlated significantly with MMPI scales and demographic characteristics as well with staff ratings of the inpatients.

In our view helplessness is a primal, often intolerable feeling. It underlies and intensifies other feelings that are also hard to bear. Both analyst and patients face helplessness, and both resort to defenses, often intensely, in order to avoid it. The intensity of this battle can merit calling it a war. The analyst's war is conducted using distancing, anger, blaming and disparaging as well as by intellectualizing the patient's struggles. Patients then find themselves abandoned and helplessly alone. We analysts, of course, want not to fall into the trap of war, and we try to free ourselves from waging it. A major way we accomplish this is through continuously working, often with the help of analysis and self-analysis, to increase our capacity to maintain our emotional stability in the face of these intensities. We learn to find new forms of awareness, beyond words and ideas. It requires a new understanding of what is threatening to us, which fosters a deeper capacity to empathize with the patient. This helps us to find the psychic, physical and emotional space within ourselves in which to hold our helplessness and other profound affective experiences. In this way we become an increasingly steady resource for our patients as well as for ourselves.

This article attempts to apply a theory of aggression as motivation to overcome obstacles to the understanding of phobic states and their formation. The role of aggression in the genesis of phobic conditions is discussed, and the traditional analytic view of aggression as instinctual drive is contrasted with a motivational approach. The motivational view offers the advantage of a clearer understanding of the stimulus contexts, representational connections, and both real and imaginary object connections that are lacking in the more traditional understanding of aggression as a biological drive.