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‘Actual’ transference manifestations such as anxiety, hypochondria, lethargy, physical disorders, allow the analysts to give meaning to, and define, certain sensations such as drowsiness, boredom, tiredness, discomfort, among others, that emerge during the session. These are minor manifestations, which Cesio termed ‘the occupational disease of the analyst’. He devoted particular attention to the lethargy phenomenon – apparent death – that can sometimes creep over either the analyst or the patient, rarely both, and which has euphemistically been described as ‘sleepiness’. Due to its tragic, incestuous, and sexual aetiology, and because of the neuro-vegetative, cellulo-humoral manifestations that involve somatic or physical disorders both in the analyst and the patient, it certainly constitutes an actual neurosis. Actual neurosis is discovered in the clinical practice that analyses the repressed unconscious and, in particular, the buried primal narcissism and incest. It gains access to consciousness through representations of death and, according to Cesio, through the presentation of the corpse, in the silence, the anxiety, and the lethargy as an end to the parricidal tragedy that is fatally repeated in transference. This is what Cesio calls ‘actual transference’; it has a somatic quality and bears the uncanny hallmark of nightmares and/or destiny realizations. These ‘actual transferences’ can be analysed by means of the construction and the interpretation of the buried contents. Indeed, the concept of burial is essential to the understanding of Cesio’s theoretical position. The hypothesis is that, when the interpretation-construction is made at the right moment, transference love finds its way into consciousness, and a careful analysis of it resolves the transferences by binding its unconscious emotional components. Thus, the actual drama is endowed with the nature of a repetition of infantile experiences with which it is then introduced into time and history. The realization that these memories are a re-living, only now with the analyst, makes it possible to free the libido from these primary, incestuous, tragic fixations, and to channel it, through the meanings it gains, towards a secondary oedipal structure, that can be worked through. The concept of ‘actual transference’ is a contribution to analytic technique because it broadens the therapeutic scope of psychoanalysis on providing the means to treat the so-called ‘actual disorders’ – the new term for actual neuroses – lethargy and the negative therapeutic reaction. The analysis of these ‘actual’ manifestations presents major difficulties because, in order to investigate them, it is necessary to delve into concepts such as death drives, repetition, trauma and transference to the person of the analyst, which arouse strong resistances among analysts but which afford the possibility of broadening the field of psychoanalysis to include actual and somatic manifestations. The latter are frequently only treated with medication, as many analysts are of the opinion that they belong to the field of clinical or psychiatric practice, not of psychoanalysis.
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