Transference and Counter Transference Essay
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Transference and counter transference is one of most important aspects of treatment between patient and practitioner. In a clinical setting we do not always have the opportunity to have consecutive treatments with the same patient and as a result may not be able to acknowledge or notice these occurrences. It is not often that I have the opportunity to see a patient on a regular basis or even twice for that matter. As a result, it is not possible for me to notice or recognize any transference that the patient my have towards me. At times however, I clearly know the impose counter-transference & boundaries issues which patient and I experience.
When my patients are of similar race or age range, I feel a stronger tide towards them. I…show more content…
I was trained by my previous interns to being an active part of the process, and expected that this past internship was going to be the same but it was not. This particular intern was very arrogant, thought she was always right, and looked down upon me. She made her feelings clear to me and I really hated working with her. I noticed she really hated whenever I gave her any suggestions about treatments principle, even when the supervisor would say the same thing she totally would ignore it. The reason she felt this way, I think, was because she was an intern and I am an assistant. There was definitely a superiority complex/power struggle thing going on here. Maybe she felt humiliated by me noticing thing she did not. I certainly did not mean to humiliate her. I think she should understand, me being an assistant, that I am there to help her. It was not uncommon for her to forget things that I might catch on and let her know. That is what I am supposed to be there for isn’t it? In addition to observing, aren’t I supposed to assist? I am not saying that I was more knowledgeable than my intern but I was able to catch some mistakes of hers because I of my position as an intern. I’m sort of an outsider looking in on an interviewer and interviewee. I am able to focus on what both are saying instead just listening to the patient. Because of my suggestions to the intern, I definitely felt resentment from her towards me. It was definitely not a friendly atmosphere or a good
The transference/counter-transference concept is considered an essential part of the analytical process and plays a fundamental part in creating therapeutic change. Clarkson (2003) has identified transference and counter-transference as one of the 5 strands in her model of the therapeutic relationship. Clarkson (2003) defines the transference/counter-transference relationship as the ‘experience of distortion of the working alliance by wishes and fears and experiences from the past transferred onto or into the therapeutic partnership’.
This essay will examine the development of transference and counter-transference as a therapeutic tool with an exploration of the ways in which it can be defined and used in a therapeutic setting. Finally an overview of the way the concept of transference/counter-transference has been received by different schools of therapeutic thought will be briefly discussed. Transference is a defining aspect of psychodynamic therapy but occurs outside the therapy room in every human relationship.
Therapeutically transference can be understood as the client’s repetition of past often child-like patterns of relating to significant others that are brought to the present in relation to the therapist (Jacobs, M, 2004). It can also involve the transference of current ways of relating onto the therapeutic relationship. Freud described transference as the way the client sees and responds to the therapist including the client’s perceptions, responses and provocations towards the therapist (Kahn, M. , 1997).
Transference was originally viewed as a form of resistance and believed to present an obstacle to the therapeutic relationship in which the client sees the therapist as a father, mother, lover etc and not as a professional offering assistance (Jacobs, M. , 2004). Breuer and Anna O perhaps illustrate one of the earliest cases of transference (and counter-transference) and how its lack of acknowledgement resulted in an abrupt termination to the therapeutic process. Classical psychoanalysis views such erotic transference as a form of resistance to the therapeutic process.
Mann (1997) however sees such transferential love as real and as something dynamic with psychic growth emerging from authentic experience. Mann (1997) argues that the emergence of erotic transference signifies the client’s deepest desire for growth and that it is potentially the most powerful and positive quality in the therapeutic relationship. Transference can be positive such as when emotions transferred onto the therapist are not too strong and when they can further the working alliance such as the faith or trust a client places in the therapist.
Negative transference involves intense emotions whether positive (eg. idealisation) or negative (eg. suspicion). However negative transference can still provide useful information about past relationships. Freud originally saw positive transference as useful (except in the case of erotic transference) and viewed the client’s negative feelings towards the therapist as an obstacle. However he later came to realise the significance of the clinical relationship and saw that transference could be used to show the client distortions. The clinical relationship contained the entirety of the client’s distortions.
Freud believed transference was a distortion and that by highlighting the client’s distortions he could help them see their distortions in life (Kahn, M. , 1997). Gill and Kohut developed the concept of transference in order to nurture a more effective clinical relationship (Kahn, M. , 1997). Freud thus saw transference as being important in helping the client remember whereas Gill saw it as an opportunity for the client to experience past feelings as well as expectations. For example when past feelings are re-experienced in response to the therapist they will evoke a different response and this is a key therapeutic opportunity (Kahn, M. , 1997).
Freud’s followers came to realise that transference could represent a replay of how a client wished an original relationship experience had been eg. if a client saw their father as aloof and disapproving they may see the therapist that way or as warm and loving creating the father they had wished for. O’Brien and Houston (2007) argue that transference may be about the unfulfilled; an innate need unfulfilled in early life and now sought from in the therapist. Joseph (cited in O’Brien and Houston, 2007) claims that fantasies, impulses, defences and conflicts are all lived out through transference.
He suggests that transference can act as a framework within which the therapeutic situation can be understood elucidating characteristic ways of relating in the present as well as providing clues about the origins of these patterns of relating. Transference is so powerful that it expresses itself regardless of therapist gender and all within therapy significant relationships will eventually be transferred onto the therapist (Kahn, M. , 1997). However due to its subjective nature it is difficult to empirically validate the existence and effects of transference.
However Yi (1998) (cited in Moodley, R. and Palmer, S. , 2006) has researched the effects of race and transference in psychoanalytic literature. Racial differences between therapist and client can be seen to act as a facilitator or a deterrent against the development of transference in the therapeutic relationship. Yi (1998) (cited in Moodley, R. and Palmer, S. , 2006) for example found reactions of white clients to black therapists centred around feelings of superiority, hostility and a paranoid fear of the black therapist’s aggressive power.
A few years after Freud discovered transference he became aware that the therapist encountered similar feelings or experiences towards the client – he termed this counter-transference. Initially it was seen as an obstacle as the therapist was meant to represent the objective observer. However whilst it was believed that counter-transference could be detrimental to therapy it slowly dawned that the process taught the therapist something about the client’s problem about which they had no other means of knowing (Kahn, M. , 1997).
An understanding of counter-transference forms part of the foundation of intersubjective theory. As far back as 1926 Helene Deutsch one of Freud’s proteges described the analyst as being able to experience the object by means of identification and warned that the utilisation and mastery of counter-transference were some of the most important duties of the therapist (Rosenberg, V. , 2006). Heimann (cited in Casement, P. , 1991) emphasises the therapist’s emotional response to the client provides a fundamental tool to therapeutic work as allows access to the client’s unconscious.
Counter-transference has been described as the totality of the therapist’s response to a client including their unconscious participation. Much of the interaction between client and therapist originates in the unconscious of both parties making counter-transference a fundamental instrument for understanding the client’s psyche (Rosenberg, V. , 2006). However it only becomes therapeutic once it enters the therapist’s conscious mind. Kahn (1997) states that counter-transference takes 4 forms: realistic responses, responses to transference, responses to material troubling to the therapist and characteristic responses of the therapist.
Two important concepts within counter-transference are projective identification and role-responsiveness. Projective identification involves a dynamic whereby the client projects an unwanted part of themselves onto the therapist which the therapist then experiences as their own by unconsciously evoking an aspect of themselves capable of identifying with the projected part (Rosenebrg, V. , 2006). Role responsiveness involves the client unconsciously assigning a role to the therapist that the therapist adopts unconsciously such as the nurturing mother.
There is a general move towards accepting that counter-transference provides a crucial source of information about the client. However being able to distinguish what constitutes counter-transference is problematic as a therapist’s response may regard a matter that pertains mostly to them or there may be elements of unconscious communication from the patient. Racker (cited in Kahn, M. , 1997) refers to obstructive and useful counter-transference. Obstructive counter-transference interferes with the therapist’s clarity and empathy.
Kahn (1997) argues that obstructive counter-transference can blind the therapist to important areas of exploration or cause them to focus on areas relating to the therapist’s issue not the client’s. He also states that it can cause the therapist to use clients for vicarious gratification resulting in the client’s conflicts becoming buried further. Counter-transference if obstructive can potentially lead the therapist to elicit subtle cues that greatly influence the client and lead the therapist to make inappropriate interventions.
Finally Kahn (1997) argues that it can cause the therapist to adopt a role into which the client’s transference casts us (role-responsiveness). Whilst there are evident dangers if counter-transference is left unchecked, when the therapist is aware of the cause of counter-transference then it can closely resemble empathy and be used for therapeutic growth. Racker (cited in Kahn, M. , 1997) describes this kind of useful counter-transference as feelings that the therapist can employ to the client’s advantage by considering them until they become empathic insights.
Remaining aware is a difficult task and supervision and self analysis are strongly recommended so the counter-transference becomes beneficial and not detrimental to the therapeutic relationship. It is essential that the therapist monitors their own internal mental processes and questions their own responses with regards to the client (O’Brien, M. and Houston, G. , 2007). Other counselling approaches are becoming increasingly aware of the importance of acknowledging transference/counter-transference as a therapeutic concept. The failure to recognise and work with transference is a common reason for unsuccessful treatment (O’Brien, M. and Houston, G. , 2007).
Although transference as a concept is not indexed by cognitive, emotional or behaviour therapies (Clarkson, P. , 2003) Grant and Crawley (2002) (cited in Jacobs, M. , 2004) have acknowledged that transference is synonymous to the notion of schemas in cognitive behavioural therapy. Jung separated transference into personal and archetypal and saw transference as an attempt by patients to form psychological rapport with the therapist as was understood as providing a means of releasing psychic energy (Clarke, L, 1988).
Some existential and psychosynthesis practitioners do not recognise transference as a term and a client’s feelings, behaviours, fantasies etc will not be interpreted or recognised as transference (Clarkson, P. , 2003). However phenomenological therapists accept transference but believe the psychoanalysts have interpreted it in a limited manner. Many client-centred therapists see transference as fiction. Levant and Schlein (1984) (cited in Clarkson, P. , 2003) have asserted that the therapist invents and maintains transference to protect themselves from the consequences of their own behaviour.
However Carl Rogers acknowledged the existence of transference in both analytic and non-directive therapy. Some transactional analysts actively work with transference (eg. Moiso 1985 cited in Clarkson, P. , 2003) whilst others acknowledge it but do not work with it (eg. Goulding and Goulding 1978 cited in Clarkson, P. , 2003). Clarkson (2003) however states that more and more practitioners are increasingly becoming aware of the benefits of accepting and working with transference (and counter-transference) as a valid therapeutic tool.
The way transference and counter-transference have been used in therapy has undergone dramatic changes in the history of psychoanalysis in particular and therapy at large. There has been a move away from the analysis of resistance and defences used by the Freudians to a more humanistic approach that encompasses acceptance, empathy and mirroring as advocated by the object relations theorists (O’Brien, M. and Houston, G. , 2007). Despite the negative views expressed towards it in general the majority of therapeutic schools acknowledge the importance of transference and counter-transference as a means of promoting therapeutic change.
Transference and counter-transference has been viewed as a joint creation (Mann) that is summed up by Ogden (cited in Mann, D. , 1997) ‘There is no such thing as an analysand apart from the relationship with the analyst and no such thing as an analyst apart from the relationship with the analysand’.
- Casement, P. (1991) Learning from the Patient, The Guildford Press, New York
- Clarke, L. , (1988) ‘Transference by any other name’, British Journal of Psychotherapy, Vol. 5 (2)
- Clarkson, P. (2003) The therapeutic relationship (2nd ed), Whurr Publishers, London
- Jacobs, M. (2004) Psychodynamic counselling in action, Sage Publications, London
- Kahn, M. (1997) Between therapist and client: the new relationship, Henry Holt and Company, New York
- Mann, D. (1997) Psychotherapy: an erotic relationship, Routledge, East sussex
- Moodley, R. and Palmer, S. (2006) Race, Culture and Psychotherapy, Routledge, East Sussex
- O’Brien, M. and Houston, G. (2007) Integrative Therapy, Sage Publications, London
- Rosenberg, V. , (2006) ‘Countertransference: whose feelings? ’, British Journal of Psychotherapy, Vol. 22 (4)
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