Understanding Transference
Core Concepts in Psychoanalysis
Book Summary: Transference And Projection: Mirrors to the Self (Core Concepts in Therapy), Chapter 1, 3 & 8
Chapter 1: What is Transference:
Psychotherapy is a fascinating and intimate enterprise that revolves around a special kind of relationship developed between the therapist and the client. This therapeutic relationship has many facets, all important to the effectiveness of therapy. One particularly significant aspect of this relationship is when the client unconsciously reacts to the therapist from patterns established early in life. Transference is the label given to such experiences in the therapeutic endeavour.
Take the following example:
Daniel arrived cold, wet and late for his weekly psychotherapy session, saying his car had broken down. The therapist was sympathetic about his difficulties, especially since it was raining hard, and offered him a hot cup of tea before the start of the session. At the end of the session, Daniel asked her to drive him home, since it was the last session of the day and it was dark and wet outside. She gently refused, saying it would not be appropriate to drive him home, but that he could use her phone to call his partner. In subsequent sessions, Daniel (who had been seeing his therapist weekly for 3 years) expressed considerable hurt and anger that she had not ‘cared enough’ about him to do what he considered this very simple favour. Although he understood the therapeutic process and the importance of boundaries, he felt that she had rigidly considered her own needs over his. it took several sessions to come to the understanding that, for Daniel, this experience was like his relationship with his mother, where as 2 child he had been left alone in the house for long periods of time to cope by himself. When she was present, her needs were large and took priority over his. He felt she had not ‘cared enough’ about his needs for emotional and physical support at a time when he was too young to care for his own.
What is happening here and why is it important to the progress of therapy? In essence, Daniel has experienced a gentle but firm ‘no’ to his request for practical physical assistance as abandonment by his therapist and a signal that she, like others in his life, does not ‘care enougly about his needs. This leads to an exacerbation of his depressive symptoms as he re-experiences the old feelings of being alone and too little to look after himself.
As in many instances of transference, there is a precipitating event in the therapy that is then ‘read’, by the client, through the template of previous relationship experiences. Such templates are organized, internalized schemas that operate at an unconscious level - that is, the client is not aware of the process, even if their attention is drawn to it. Events like the one described above will impede the progress of therapy if they are not processed in ways that can be understood by the client. If Daniel continues to experience his therapist as cold and non-caring about his needs, there will be a rupture in the ‘working alliance’ and the therapy is likely to be stalled.
Transference refers both to the tendency to experience the relationship with the therapist in similar ways to the relationship with early care-givers and to the tendency to structure re-enactments of early disturbing relationships. This was named the ‘repetition compulsion’ by Freud (1912).
Therapeutic movement occurs with interest, objectivity and acceptance:
According to Merton Gill (1982), therapeutic movement results when clients re-experience and express archaic thoughts, feelings and impulses in the presence of the therapist to whom they are now directed, and are able to have that expression met with interest, objectivity and acceptance.
Intellectual understanding not enough:
However, intellectual understanding about those patterns is not enough. Transference means that these early patterns re-emerge and are re-experienced in relation the therapist; this helps the client to grasp at an experiential level just how pervasive they are (Kahn 1997). The experience of a different response to the original archaic feelings than that provided by the early care-giver is also central to the change process (Grant and Crawley 2001).
Transference isn’t pathological:
Transference does not just occur in the therapy relationship. Transference is ubiquitous (Andersen and Berk 1998; Book 1998) - it occurs in marital relationships, with friends, lovers, bosses, doctors and others.
It is not inherently pathological. Rather, it is part of the human process of making meaning that helps humans to predict, understand and make sense of interpersonal events.
It’s not about the process, it’s about the content:
It is more often the content of the transference that is maladaptive in shaping people's interpersonal world than the process of transference itself.
Content vs. Process of Transference:
Process of Transference: This is the general mechanism or psychological process by which emotions and behaviors from past relationships are unconsciously applied to present relationships. The paragraph suggests that the process itself might not be problematic.
Content of Transference: This refers to the specific learned behaviors or ways of relating to others that are transferred. The paragraph argues that it is often the specific content that can be maladaptive.
Example Illustration:
Imagine a child growing up in a family environment where there's a lot of volatility or conflict.
To cope with this environment, the child learns to be compliant (agreeable and obedient) as a way to "keep the peace."
As an adult, this individual may continue to exhibit compliant behavior in relationships, such as with friends or a boss.
Maladaptive Content:
Being compliant made sense in the context of a troubled family, but it might not be the most effective or healthy way to interact in other settings where assertiveness or independence is more appropriate.
Transference produces actions and reactions:
Transference includes the feelings towards the therapist, but also how the client expects to behave and feel and what the client expects from the therapist. For example, the client may expect the therapist to like or love them, to disapprove of them, to understand them, to abuse, manipulate or abandon them. Clients may distort the therapist's behaviour to conform to these expectations. Alternatively, clients may behave towards the therapist in ways that actually produce such reactions.
Transference is largely an unconscious process:
Individuals are unaware that they are projecting past experiences and understandings onto the current situation. There is now considerable research evidence to show that individuals use automatic and unconscious processes when transference is operating.
We are strongly influenced by those closest to us — our patents, teachers, care-givers and siblings. We form unconscious principles to organize all the stimuli.
Because these organizing principles operate outside of awareness, it feels as if we are simply responding to the current situation in a realistic manner.
Therapists are presented with opportunities to ‘re-experience with their lens certain aspects of their presenting past; in which the effects of the past can be reviewed; and through which the effects can be to some extent adapted to the new circumstances of the present and the future’.
Transference create misunderstanding in relationships:
Transference like phenomena create misunderstandings and impasses in therapy, frequently leading to premature termination. This is particularly important when such responses threaten to disrupt the ‘working alliance”.
This alliance is imperative to the progress of any therapeutic endeavour. The development of such a bond is assisted through therapist activity such as empathy, clarification, non-judgementalness and understanding. In some schools of therapy, the relationship itself is seen as an important curative element.
Transference is an intersubjective reality co-constructed by both parties involved:
In the intersubjective schools of thought transference is seen as a process that is contributed to by both therapist and client. The intersubjective reality is ‘co-constructed’ through conscious and unconscious contributions of both parties. The therapist’s job is to assist the client in understanding the reality they have jointly constructed. The client slowly incorporates the therapeutic relationship and this helps them to restructure their internal subjective world. Much of the focus here is on how the client's experience of the relationship is directed by their own psychological organization.
4 ways of Communicating the transference:
The first mode is direct, whereby the client actually tells the therapist how he is experiencing her.
For example:
At the beginning of the session, Jane, a young adult, says that she left the previous session quite disturbed. At the end of the previous session, as she was leaving, Jane said that her therapist had smiled at her and laughed as she said goodbye. Jane said she thought that this meant that her therapist was laughing at her because she was strange, ‘not normal’, and somewhat crazy.
Jane was depressed and disturbed by this all week and felt that her therapist had become very critical of her. As the therapist reflected on what Jane was saying, she could remember smiling at Jane at the end of the previous session, feeling positive about the work together, and possibly chuckling fondly with her as she said goodbye. She had no memory of feeling judgemental towards her.
Jane had a history of being severely bullied and isolated in her early school years & In addition, Jane's father was highly critical of her. These instances of ‘reality-testing’ were important to Jane in helping her to discriminate between people's reactions to het, where she was often hypersensitive.
2. A second mode of communication of transference is symbolic, through stories or descriptions of events in the client's life.
3. The third mode of transference communication is through images such as dreams and fantasies.
4. A fourth mode is that of ‘enactment’, where a client enacts a particular early role relationship with the therapist.
The first clinical example in this chapter with the client Daniel is an illustration of an enactment. Daniel actually enacted the role relationship he had with his mother, by asking the therapist to take care of his physical needs in ways that would be rejected by the therapist. Daniel nudges the therapist into a countertransference enactment where they reciprocally live out his internalized roles (Hirsch 1998). He then re-experiences towards the therapist both his original wish to be taken care of by his mother and his feelings of depression when she does not attend to him in developmentally appropriate ways.
Interpretation of Transference:
The major intervention in working with transference is interpretation or explanation. The purpose of this intervention is to help the client move to greater levels of self-awareness, which, in turn, reduces internal conflict (Natterson 1986) or promotes internal cohesion.
Theoretically correct interpretation may not be therapeutic:
It is important to remember that an interpretation is the offering of an alternative perspective for the client to consider. Thus, the way an interpretation is made by the therapist is now seen to be as important as the content of the interpretation. A theoretically correct interpretation made in an insensitive manner may not be ‘heard’ and thus not be therapeutic. Conversely, an interpretation that may not be theoretically correct or sophisticated can, if offered in an empathic manner, still be productive in inviting the client to explore their perception or experience.
Interpretation of Transference needs to be focused on client’s experience:
Scharff and Scharff (1998) suggest that the best interpretations are short and in an understandable form. When something more complex needs to be said, it is best presented in smaller segments over time. They also argue that sensitive therapists offer interpretations with tact, focusing on the client's experience; this is particularly helpful with clients who are paranoid or distrustful. For example, ‘it seems that you feel worried that I will judge you’ helps the client to focus on his experience of the therapist and allows him to feel the therapist has some understanding of his inner world.
Chapter 3: Early development: Work of Freud
Freud’s complicated life:
To go back to the origins of the understanding of transference we need to consider Vienna a hundred years ago. Freud is often described as one of the handful of people whose thought profoundly impacted the intellectual and cultural life of the twentieth century. Such a description can easily, however, conceal both the central concerns of Freud's work and the realities of his life - a life that was far from easy.
Freud's early family life was complicated and his adult life was not without conflict. Freud was, and still is, both revered and reviled. Intellectually, Freud was a product of the scientific and medical culture of the late nineteenth century, as well as of the patriarchal culture of Europe of that era.
Initial discovery:
Freud first encountered the pattern of relationship between doctor and patient from his older colleague Breuer that he later came to call transference in 1883. His understanding of transference evolved over time, from initially seeing it as an obstruction to the treatment process to seeing it as an essential component of psychoanalysis.
Universal need to love and be loved:
A footnote in Freud’s 1912 paper, ‘The dynamics of transference’ provides an evocative starting point. Freud described the unique combination of circumstances that came to determine the way an individual experiences and expresses the universal need to love and be loved. This template about love, formed out of early life experiences, determines the way in which all subsequent relationships are approached, especially significant relationships.
Individual goes through life asking of every relationship, ‘will this be a source of love for me?’ For some, the template leads to new experiences, new relationships, being approached positively in the expectation of a loving response. For others, the template leads to the opposite, the expectation of earlier disappointments or hurts being repeated yet again.
Connection to Drive theory:
Freud, still imbued with the biological and scientific ambience of his profession and time, saw this need to be loved as a biologically based drive or force — the libido — that was never fully satisfied and was therefore always seeking new outlets (classical Freudian perspectives usually considered as being underpinned by ‘drive theory’). Thus from the beginning Freud saw transference not as product of the analytic situation, but as a natural part of life.
Repetition Compulsion:
The way the libido found expression in adult life could either be in a relatively mature way, to a certain extent under the person's conscious control, or in a more immature of neurotic way, where the patterns of past difficulties or disappointments were constantly being repeated without any conscious understanding of why this was happening. Here we encounter another key component in Freud's understanding of mental life, ‘repetition compulsion’. This term describes the pattern whereby people endlessly repeat patterns of behaviour that were difficult or distressing in earlier life.
Understanding alone did not lead to change:
For Freud, it was not in the end sufficient if he helped his patients recover earlier memories of their life that had been assigned to the unconscious. Understanding alone did not lead to change.
Transference seen as progress instead of obstacle:
His approach to the transference then changed: no longer was transference an obstacle, an interruption, to the real work of psychoanalysis. Instead, it became the vehicle through which the work was achieved. The clearest illustration of the template acquired in childhood, the template which kept neurotic symptoms in place in the present, was the way in which the template shaped the present relationship between analyst and patient. Thus interpretation of the transference - seeking to understand how the way in which the patient experienced and related to the analyst in the present was shaped by earlier life experiences - moved into the center of the therapeutic method in Freud's work.
Distort or Be neutral?
As his understanding of the importance of transference developed, Freud grappled with the question as to how the transference could be encouraged in the psychoanalytic process. From this emerged the belief that the analyst should seek to avoid any gratification of the client's needs or wishes; and the idea was strengthened of the analyst being a neutral ‘blank screen’ onto which transference feelings could be projected.
This ideal of the ‘neutral’ analyst, which in Freud's own practice seems ’ to have meant the analyst ‘keeping a respectful distance so that patients can find their own way, without having the analyst's ideas imposed upon them’ (Kahn 1997: 8), appears to have led to the impression that the analyst is unresponsive. This is, however, perhaps more how some analysts have interpreted Freud's ideas for themselves.
Freud himself seems to have been much more responsive and interactive with his patients than later stereotypes of the psychoanalyst would suggest (Appignanesi and Forrester 2000). Within the mainstream of classical Freudian psychoanalysis, there occurred a marked shift towards a more structured and impersonal process, to the extent that Freud has been criticized for ‘being too real, too much himself with his patients.
Chapter 8: Guidelines for use of Transference:
To use transference in this specific way requires training and detailed clinical supervision. However, transference is an ubiquitous phenomenon that is present in all relationships. In the following, some guidelines for the use of transference is discussed, which can be used by someone who doesn’t have a specific training.
If therapists are to make constructive use of the transference, they need to have their own understanding or rationale — their own sketch map of how focusing on the transference can be a source of change for the client. Such a picture is built up over the course of a therapist's career, continually being refined in the reflexive process between, on the one hand, reading and understanding of theory and, on the other hand, increased clinical experience.
1. As a hypothesis, not as a fact:
The possibilities are endless, which means, as we discuss below — that any understanding of the transference elements of the client-therapist relationship should always be held tentatively, as a hypothesis to be confirmed or disconfirmed, rather than as an unassailable fact.
2. Transference holds distorted element with persistence:
As postmodernism is making increasingly clear, perception is always subjective and in that sense contains elements of distortion. What is different about the distortion involved in the transference aspects of a relationship is the persistence with which the distorted view is held.
3. Transference cannot be seen simply as a ‘quality’ within the client
Although transference is usually seen to involve an element of distortion, it is also always connected in some way, however approximately, to the therapist's responses and reactions to the client. This suggests that transference cannot be seen simply as a ‘quality’ within the client, which can be observed independently of the therapist's presence and behaviour.
4. Contamination in Transference
This, in turn, challenges the traditional assumption that the therapist needs to be ‘neutral’, in the sense of being unresponsive to the client, so as not to ‘contaminate’ the transference; such neutrality is itself a behaviour which the client will unconsciously assimilate. The notion of distortion is often questioned today because of its implication that there is a ‘real reality’ that only the therapist knows about. Gill (1982) suggests replacing the idea of distortion with the notion of situations as being open to multiple interpretations, including events in the therapeutic relationship; each interpretation needs to be explored afresh by therapist and client.
Responding to transference:
1. Listening as a cure:
The starting point is that the therapist will always need to be listening in a particular way to the client. Listening to the content and the affective quality of what the client is saying, but also listening for hints, buried in what is being communicated, about the particular transference or projection that might be present in the way in which the client is relating to the therapist at this point in time, The hints are sometimes obvious, but are usually more subtle.
2. Offering alternative interpretation rather than being authoritarian:
In dealing with transference and projection, we are in the realm of subjective experience of the unconscious, of the symbolic. This can raise a dilemma for the therapist. The client is often initially unsure about or resistant to understanding their experience or behaviour in transferential or projective terms; the therapist needs to be sufficiently confident in presenting this as a possibility that it is likely to be considered by the client.
Yet, on the other hand, the therapist must avoid the trap of being dogmatic, of being ‘the one who knows the truth’ about the client's experience. The word ‘interpretation’ sometimes can appear to assume a rather magical or mysterious quality for some therapists; the very ward ‘interpretation’ can at times sound rather authoritarian. It is perhaps helpful to think of ‘making an interpretation’ as simply ‘putting a different possibility’ to the client — an alternative interpretation of behaviour or experience, not necessarily a correct interpretation. An interpretation of the transference should be an ‘invitation’ to explore another way of looking at experience.
Conclusion:
Getting our understanding of the transference or a projection correct in theoretical terms is perhaps less important than the manner in which we use our awareness of the transference to explore the client's experience. What matters is what the client experiences in the relationship with the therapist as the transference is explored: does the client feel that their subjective experience is understood before an explanation is given for it?
Thoughts after 8 months:
It seems that understanding the transference mechanism is helpful to an extent, but it doesn't suffice to know this and be aware of it during conversations. I showed interest, accepted other person’s thoughts, tried asking reflective questions without judgement. However it didn’t help. Conversation went downhill until it hit the bottom.
Later after some reflection, it seems to be group regression.
“groups can regress to more primitive forms of functioning. In a regressed state, the group may unconsciously seek to maintain a shared emotional state, like sadness, as a defense against more complex feelings like ambivalence or guilt.“
I couldn’t maintain the same level of fictitious sadness. One person interrupted me, told me that he is getting bored. This isn’t interesting and I’m not really telling the Truth.
Ouch!