Dealing with Transference
Transference is a phenomenon in psychology characterised by “unconscious redirection of feelings of one person to another” (Wiki Answers, n.d.). It can occur both in everyday life and also in the therapy room. One example of how it can happen is when a person mistrusts another because the other resembles, say, an ex-spouse, in manners, appearance, or demeanour.
In a therapeutic context, transference refers to the way in which the client’s view of and relations with childhood objects (meaning: people) are expressed in current feelings, attitudes, and behaviours in regard to the therapist (Sandler et al, 1980). Analysing this transference has generally been seen as the central feature of psychodynamically oriented techniques (Gill, 1982). Freud initially observed and formulated the notion of transference, understanding its importance for better understanding of the patient’s feelings. It was Jung, however, who noted that within the transference dyad both participants tended to experience a variety of opposites, and that the key to psychological growth was the ability to hold a point of tension with the opposites without abandoning the process. It was this tension, Jung said, which would allow a client to grow and transform (Bauer & Mills, 1989; Wiki Answers, n.d.).
The steps in dealing with transference
The therapist becomes aware of the emotions awakened in her or him by the client. Initially, this is not likely to be a cognitive process, as the therapist reacts to cues in the client that signal something is different. For instance, a client who has been making great progress may come into the rooms looking washed out and sad, or angry or otherwise unhappy. It is a matter for awareness, not reflection, as the therapist tunes into feelings that come up.
- The therapist steps back, disidentifies from the affective reaction and views it more objectively.
- The therapist identifies the client’s affective state.
- The therapist establishes the significance of the client’s message.
- The therapist decides how most effectively to use what has been learned (Basch, 1988).
When there is resistance
Work with transference in the here-and-now of the therapy room includes sensitising clients to the importance of examining their reactions to the therapist, identifying the self-limiting components of these patterns, and developing an increasingly flexible, mature interaction with the therapist. That is the theory. Bauer and Mills (1989) contend, however, that practice is often far from that. They outline various forms of resistance — both on the part of the therapist and on that of the client — that get in the way. Their discussion, artificially separated between client and therapist forms of resistance, follows.
Client resistance to transference analysis is a crucial issue in the psychodynamic psychotherapies where transference is central to the work. Client willingness and ability to examine the client-therapist interaction include some of the following forms of resistance.
Ignoring real-life concerns. The understanding in psychodynamic psychotherapies is that, as stated above, clients will bring the “template” for how they do relationship into the room, and the therapist can work with that in the client-therapist relationship to examine how the client’s life is not working as they wish it would. What can happen is that clients come to believe that the therapist is focusing on the therapeutic relationship to the detriment of the “real-life concerns” the client is bringing. In all cases, the therapist’s most effective stance is one that stimulates the client’s curiosity regarding how they currently function and encourages deeper exploration.
Identifying transference. The therapist’s goal is to bring out latent transferential material into a more open, manifest set of behaviours and statements that can be investigated. This task is made more difficult by clients denying that they are having reactions to the therapist and/or actively discounting the significance of any reactions. Sometimes the only way the therapist can see this is indirectly, as the client discusses, say, the critical, demeaning comments of a punitive parent or authority figure when s/he really is expressing the feeling that the therapist is critical or demeaning. The process of identifying specific behavior patterns fosters therapeutic gains and client autonomy. Over time, with repeated confrontations, it gets easier for the client to accept and address such themes.
Refusal to consider transference as a possibility. Clients often resist exploration and working-through of transference by insisting that their reactions to and interpersonal conflicts with the therapist are based solely on the reality of the therapist: nothing to do with their own intrapsychic issues or past development. End of story. Such a client may insist that all feelings toward the therapist are fully justified by conventional explanations. An inexpressive, withholding character style, for instance, may be rationalised by attributing it to how threatening the therapist, or the therapeutic environment, is. Therapists can work with such resistance in the here-and-now by drawing parallels with historical examples from the client’s life.
Avoidance of responsibility, fear of autonomy. A central feature in therapy can often be the client’s refusal to accept responsibility for how they think and feel, for the conflicts they are facing, and for their role in bringing them about. There is security in neurotic, life-limiting patterns; hence, they are hard to give up (Bauer & Mills, 1989).
In addition to client-centred resistance, there is also resistance engendered by the therapist which contributes to under-analysis of the transference. The sources of this resistance are multiple; it may originate in the countertransference of the therapist, in deficiencies in training, and/or in inadequate supervision experiences of the therapist. Such reactions are likely to stem from unresolved conflicts of the therapist and/or the impact on the therapist of the client-therapist interaction, especially the client’s conflicted interpersonal strategies.
Avoidance of here-and-now affect. Bauer and Mills note that therapist “faintheartedness” in discussing manifested transference is responsible for more stagnation in psychodynamic therapy than any other attitude (1989, p115). Looking at their emotions in the here-and-now involves affect-heavy, potentially disturbing interactions for both client and therapist. “Fear” is not too strong a word associated with reasons to avoid it. The reality is that clients, for all their neuroses, sometimes have insightful perceptions of the therapist: a threatening prospect for many therapists to face, especially if they have unresolved intrapsychic or interpersonal conflicts. It is often more comfortable for the therapist to revert to discussion of historical patterns in the client, and some therapists are so knocked by in-the-room affect that they resort to ego regression and acting-out. Some therapists fear that difficult, anxiety-provoking interactions with the client will interfere with the development of the therapeutic alliance; actually, the reverse is true. Without a focus on what gets in the way of client-therapist collaboration, the whole therapeutic process is at the mercy of the client’s maladaptive, self-defeating ways.
Overemphasis on how past conflictual patterns developed. Focus on how maladaptive patterns developed in the client’s past can help the client connect his or her past to the present, giving a sense of continuity and identity. It can also help the client feel secure that, as troubling to him or her as the patterns seem, they can be understood and — hopefully — sorted out. Excursions into the past can be like turning to an old text for a “translation” of what is going on currently. The therapist must remember, however, that the purpose of the therapy is to help the client modify patterns existing in the present, and explorations of the past should be subordinated to that goal.
Constricted therapist activity. Perhaps owing to the history of psychoanalysis in the Freudian era when therapists were meant to be quiet, neutral listeners who did not interfere with the client’s free associations, some therapists may feel uncomfortable with a more dynamic, active role. It is crucial to establish a safe, secure atmosphere and to understand the nature of the transference reactions, but failing to respond adequately to the client out of fear of distorting the transference or badly interpreting client communications does not achieve that safe therapeutic environment. A silent, unresponsive stance to a client may in fact encourage the perception of the therapist as cold and distant no matter what the client’s original transference pre-disposition was.
Difficulty in differentiating transference from non-transference. Even highly neurotic clients have some perceptions about the therapist and the therapy which are realistic, and not based in transference. It is important, therefore, for the therapist to not assume that all reactions to him or her are transferential, and to work to distinguish between those that are and those that are not. A good example here is when the therapist begins the appointment a bit late. Many healthy, not-at-all neurotic people may have a reaction of irritation to this, and the client’s annoyance may stem from a variety of psychic conditions. To put it all down to “transference” may constitute defensiveness on the part of the therapist rather than true discovery of past patterns affecting present relating. Clarifying which client reactions are realistic can deepen the therapeutic alliance and foster client autonomy through affirming their capacity to discern reality.
Presentation of “certainty”. Obviously, the main task of client and therapist is to work together to develop a consensually validated understanding of their relationship. That is not an easy task because there is nowhere that they both can stand which is “outside the relationship” in order to look in on it. Thus, ideas about what is happening in it are best regarded as hypotheses. If the therapist is certain that he or she has the only hold on “reality”, and expresses such views with interventions like, “What you really mean is?”, the client is likely to resist (especially if they are relatively healthy!).
Such a stance interferes with the client’s capacity to understand him or herself from a variety of viewpoints and erodes the client’s ability to self-reflect in a healthy fashion. To assume one has the ultimate meaning or one true “reality” about the client is to disregard the truth that behaviours and statements usually have multiple functions. Beyond that, such an intervention would normally seem to be a dead giveaway of the therapist’s shadow of arrogance! It is far better to suggest that what a client is saying or doing may have implications for the therapy relationship, and/or that “reality” must now be formulated in a more subtle and complex manner than before.
Premature interpretation of projection. More important than deciding transference/non-transference is the opportunity for the client to actively discuss perceptions of the therapist, and for the therapist to work with these perceptions in a non-defensive manner. Although therapist reactions are often determined by the projections onto the therapist of the client’s internal self and/or object representations, the therapist’s interventions do not need to force the client to own these projections at a given stage (it can always happen at a later stage, and sometimes may not occur at all). Forcing the client to relinquish defences prematurely is ill-advised, as these serve an important function in the client’s psychic organisation.
The preferred therapist response is to draw out the client’s feelings and engage in a serious, non-defensive investigation of them. The ability of the therapist to do that conveys some important messages to the client, namely that the therapist: (1) has a solid ego and is not fazed by the client’s projections; (2) has a desire to understand the client’s intra- and interpersonal processes, and (3) is able to tolerate projections of unwanted (intolerable) aspects of the client’s self onto the therapist. This stance communicates trust in the therapeutic process and helps the client to gradually tolerate aspects of him/herself that were denied and projected.
For example, let’s say a client had a very critical, demanding parent. Such a client may internalise that parent voice, becoming perfectionistic and demanding of himself and experiencing resultant depression, low-self-esteem, and even masochistic behaviour. During therapy the client is likely to project this critical parental object onto the therapist, and then respond to the therapist as he used to respond to the parent: with appeasement, clinging, and passive-aggression. Perceiving this, the therapist can help the client discuss how s/he perceives the therapist and how this affects behaviour. The therapist does not disown the client’s projections; rather he or she attempts to understand. Such work detoxifies unacceptable feelings and allows the client to integrate rather than defend against them. When this happens, the therapist is no longer viewed as critical.
An understanding of transference, and client and therapist resistance to it, is clearly a key component of any psychodynamic therapy.