This is an intermediate level course. After completing this course, you will be able to:
This course is based on the most accurate information available to the author at the time of writing. Cognitive psychology and neuroscience findings regarding brain development, structures, and activities continue to shed light on what were once regarded as merely psychoanalytic concepts and processes. As a consequence, new information may emerge that supersedes some explanations in this course.
This course may provoke disturbing feelings in readers due to their own unresolved conflicts, but it also gives them information about processes by which they might resolve these conflicts.
This is a course about transference and countertransference: mental processes that enable us to transfer our conflictual past to the present without even knowing that we are doing so. Sometimes we benefit from this without doing anything further. But most of the time we create havoc in our own lives and in the lives of those with whom we interact.
Certainly, we might think, these two processes do not run the risk of damaging our therapeutic efforts because we are not psychoanalysts. In our work, we focus on behaviors of which clients are quite aware. We restructure thoughts that clients share with us. We help clients process their emotions as they become evident. Furthermore, we deal with our own issues outside of therapy.
This thinking is wrong, however. Transference and countertransference are not conscious phenomena. They occur outside the realm of our consciousness. They take place in session after session without our knowing, whether we are trained to deal with them or not. Equally important, they have the potential either to make our work extremely successful or to diminish – if not wipe away – the good we hope to do.
Hence this course. It focuses on the potential of transference and countertransference to make non-analytic practitioners experts in their fields as they become aware of what is going on beneath the surface of their work. This course grounds readers in clinically supported theory and noteworthy research. It gives them the knowledge and insight necessary for making transference and countertransference work for them. It prepares them to turn the double-edged sword of transference and countertransference into edges of beneficence and positive outcomes.
First, some theoretical overview.
Residing deep within the unconscious mind where there is no time (Freud, 1917), transference and countertransference become activated when similarities between the past and the present arise. Already encoded in well-trodden subcortical neural pathways, material from the unconscious mind is propelled into the conscious mind as we try to deal with the psychological pain we are experiencing. With the “help” of brain activity, we unconsciously re-stage conflict-ridden experiences as if the past were the present. We transfer thoughts and feelings about people in our past to those who resemble them in the present. We assign them roles once played by others. We a take on old roles ourselves. All unconsciously.
Why do we do this? Because we are programmed to assume that if we re-enact conflict, there is a good chance of its being resolved. We will be better off once a new experience replaces our memories of a previous event. For example, as adults, we assign the role of parent to our spouse or therapist. We then sit back and watch, unconsciously confident that they will parent us better than our father or mother did in our childhood.
The problem? They may do this to a great extent, but they inevitably fail to live up to all of our expectations: the ideals we held as little children unable to deal with “shades of gray.” The result? We are unable to replace our pain with a sense of well-being to the level that we so deeply desire.
We are still in pain. We have managed to ignore what theorists and researchers have told us for almost a century: in order to resolve conflict, we must face it squarely, experience and process the pain that it carries, and learn ways of ensuring that it does not happen again. If we do not reckon with the forces that perpetuate our compulsion to simply repeat the past, we only make matters worse. We get hurt once again as we bare our neck to the double-edged sword of transference and countertransference.
Hence, this course:
This is the first course in a three part series, based on the book Transference and Countertransference in Non-Analytic Therapy: Double-Edged Swords, by Judith A. Schaeffer, Ph.D. (Lanham, MD: University Press of America, 2007).
This course was designed for the following four reasons:
First, most contemporary non-analytic graduate programs do not adequately treat the subject of transference and countertransference. Thus many non-analytic clinicians lack the art and skill of identifying and managing the transferential and countertransferential forces responsible for clients’ and therapists’ re-enactment of unresolved conflict. Even if these clinicians suspect transference and countertransference, they find it difficult to diagnose them expeditiously and deal with them effectively.
Second, 21st-century clinicians no longer have the option of open-ended treatment, even for dealing with serious problems, because of managed care’s concerns about cost-effectiveness. Therapists in virtually every theoretical school must achieve positive outcomes more quickly than 20th-century clinicians. They must be able to identify and manage impediments to progress as soon as they arise so that clients finish their work within the sessions they are allotted and/or can afford.
In addition, most managed care companies no longer regard clients acquiring insight and rebuilding their ego as positive outcomes. Instead, practitioners must translate outcomes into observable, measurable correlates and thereby prove that clients have attained perceptible goals. They must acquire new behaviors and reduce, if not eliminate, symptoms. Thus practitioners must define what they do by functions that measure change. They must be aware of all variables that determine – or contribute to determining – whether clients make desired changes. They must know how transference and countertransference impact goal attainment. They must detect, decode, and decisively manage transferred material.
Third, clients and their families, who as consumers expect timely, ethical, and efficacious treatment, belong to a litigious society eager to right wrongs. Though serious mistakes may be rare, unaddressed transferential and countertransferential material can result in errors which clients or their relatives can bring to the attention of grievance boards or lawyers. Should therapists give sexual expression to countertransferential love, for example, an injured partner may hold them responsible for boundary violations. Should clients complete suicide, their families may presume that the professionals who treated them deliberately chose not to address transferential signs of that possibility.Fourth, recent cognitive and neuroscientific research findings undermine the belief that transference and countertransference are just theoretical. They have been detected as phenomena actually instantiated in the brain (Shore, 2003a; Pally, 2001; Gabbard, 2001). It is no longer scientific to deny their existence and thus their ability to affect psychotherapeutic practice.
As if these four reasons were not enough, rare is the client who does not hold unrealistic – though rarely articulated – attitudes that have been formed by past conflictual experiences related to developmental needs.
The first unrealistic attitude is that therapy is a kind of magic. Clients will unconsciously re-enact an early developmental stage in which others will promptly attend to their needs. They will reveal their problems, and their therapist will listen intently and give advice. They will feel better because they will follow that advice. Or they will prove them wrong by not following it.
The second unrealistic attitude is that personal problems arise from the attitudes and behaviors of others, not the client’s own. Clients will feel they are entitled to relive a developmental stage in which they are “the center of the universe” and others must “revolve around” them. Their therapist will help them figure out how to make others act differently. They will not have to change.The third unrealistic attitude is that therapeutic progress should be made sooner rather than later, and preferably with limited effort. As consumers in a fast-paced, highly mechanized world, clients are primed to get what they want quickly as well as effortlessly. No matter how chronic or serious their problems, they expect to find solutions within a short time. If not, they will be dissatisfied.
As a consequence of these unrealistic attitudes, realistic 21st century therapists work quickly and diligently to help their clients accept three age-old, transference-and-countertransference-based realities relevant to successful therapeutic work.
First, effective therapy is primarily interactive (Little, 1951) and relational. It is a highly complex and dynamic “drama” during the course of which clients and therapists weave verbal and non-verbal messages and ask each other to play various roles on the “stage” of their encounter. Therapy is a relationship between two persons with personal and interpersonal histories whose experiences of, expressions of, and use of feelings in the clinical setting become interdependent (Heimann, 1950) as they work toward achieving mutually acceptable goals. Though therapy may have its magical moments, it is by no means magic.
Second, though most problems are personal on one level, they are interpersonal on another, and therefore require solutions that are effective on both levels. Clients must address what they themselves do, and most likely have done repeatedly in the past, even as they identify the contributions of others.
Third, even relatively minor change is neither quick nor effortless. It requires painful honesty, sustained energy, and repeated practice. It demands the hard work without which new relational habits cannot replace old ones and thus the future simply repeats the past.In sum, in order to empower their clients with appropriate motivation, insight, and skills, non-analytic therapists must become experts in dealing with constructs called transference and countertransference and the interpersonal processes that mediate them.
It cannot be emphasized enough that transference and countertransference propel conflictual unconscious material into the dynamics of both analytic and non-analytic therapy. If non-analytically oriented therapists fail to notice these displaced phenomena during their sessions, they are limited in their ability to help their clients move beyond their one-sided accounts of problematic relationships and events outside of therapy. Contrastingly, if therapists identify and decode displaced material that manifests during sessions, their perception of what is going on relationally in therapy can complement and correct clients’ accounts of what goes on outside of therapy.
Then, as therapists sensitively share their insight and invite corroboration or correction, clients can begin to realize that what is transpiring in therapy is similar to the unresolved conflicts at the core of their presenting problems. With this insight, they can begin to resolve their conflicts.
Simultaneously, therapists can realize how, through countertransference, they are also acting out old, conflictual interpersonal issues in their own work with clients. Then they, too, can choose conflict resolution over mindless repetition.
Even a cursory history of the 20th and early 21st centuries reveals transference and countertransference as double-edged swords operating outside of therapy no less than in it. We pour billions of dollars into foreign wars because we unconsciously know that we ourselves have brought pain and suffering to people already victimized by others. We also unknowingly carry countless unresolved conflicts from the past into the present as we engage in profiling, rape, child abuse, hate crimes, human trafficking, wars of ethnic cleansing, and even wars of liberation. We may even unconsciously minimize clergy sexual abuse and its cover-up because we transfer to those involved in them an aura of divinity and macho fatherhood.
Indeed, transference and countertransference are ubiquitous (Brenner, 1976). We have not adequately dealt with layer upon layer of painful, individual and collective memories that unconsciously motivate us to re-stage atrocities. Some were done to us. Some we did to others.In brief, this course is intended to enable non-analytic clinicians to deal with transferred phenomena that can undermine their otherwise excellent collaborative work. It heeds the prophetic words of Marmor (1989): "The future of psychotherapy … lies with the further development of short-term therapeutic techniques" (Marmor, 1989, 259). Without them, regardless of orientation, therapists cannot withstand the pressures of health care reform to reduce therapeutic time. Without them, therapists cannot deal "economically and effectively with the deluge of emotional and behavioral problems" that our disturbed society has spawned (259).
In this course, jargon has been changed into commonly used terms for the sake of readers who are not versed in psychoanalytic language. At the same time, while the impact of cultural diversity on transference and countertransference has been short-changed here because of space limitations, efforts have been made to identify at least some of the unique culturally-based expectancies therapists and clients unconsciously bring to their interactions. Finally, though efforts have been made to place constructs within the context of their original theories, those theories have not been used in their entirety. Rather, select aspects of analytic theories are placed within the context of non-analytic theories without sacrificing the essence of either, again so that readers can more easily interweave new material with the professional knowledge they already possess.
We all engage in transference. It is a pervasive and ubiquitous phenomenon that takes place in many situations in life (Brenner, 1982). We re-experience the past in the present in a way that is inappropriate for the present (Greenson & Wexler, 1969). We misperceive or misinterpret the present in terms of the past.
We unconsciously send “messages” to select persons in our present life that to us they have become indistinguishable from significant others in our past. We unknowingly impose what has taken place in one setting on what is taking place in another, usually because the first event involved unresolved conflict. We unconsciously displace what still warrants our attention because it bothers us.
In this course we focus on just one situation in which transference occurs naturally: psychotherapy. We do so because empirical data support the theory that psychoanalytic and non-psychoanalytic therapists alike deal with transference in their efforts to achieve positive therapeutic outcomes (Gelso & Hayes, 1998). Moreover, within psychotherapy, transference is usually concentrated; it is gathered, pronounced, and intense (Wilson & Weinstein, 1996).
However, it is difficult to define transference in even this restricted setting because, since Freud first used the term in 1907, it has been used inconsistently and ambiguously. There has been no real agreement on its meaning.
Thus we will first explore aspects of transference that have been described in representative literature. Then we will create a theoretical definition that distills the essence of transference from its complexity. Finally we will arrive at an operational definition we can use when dealing with transference in clinical practice.
Freud’s description of transference serves as a prototypical classical definition: Transference is clients’ unconscious displacement of feelings, attitudes, sensations, and thoughts about or toward persons in their’ early life to their therapist. Almost always they do so because of unresolved conflicts related to those early persons (Freud, 1912). This unconscious displacement of phenomena that have been repressed or buried in the unconscious mind serves the purpose of giving clients “new editions of old conflicts” (Freud, 1917, 454).
In other words, transference is the reappearance in the unconscious minds of clients of an early-life event from which they had to dissociate because of its overwhelming emotional impact (Schore, 2003a). Thus, transference is an unconscious movement of conflictual desire and/or belief across space and time from one person in the past to another in the present (Lear, 1993).
As a result, transference creates resistance to facing psychic pain long enough and well enough to resolve the conflict causing the pain (Freud, 1917). Though the conscious mind has been told that past conflicts need to be resolved, the unconscious mind sees transference as a process whereby it can avoid conflict resolution.
Transference can also be thought of as a construct: clients’ displaced, early-life, unresolved conflictual feelings and attitudes that surface in response to experiencing a therapist. Transference is a matter of displaced memories of affective and somatic states related to early-life significant others. It is a matter of memories recalled by clients when they engage in therapy in such a way that they are indistinguishable from events that occurred in the past and outside of therapy. “Transference is … the manifestation of unconscious … memory as it intrudes upon the larger consciousness of self, breaking it up, stunting it, and even at times, taking it over entirely” (Meares et al., 2005, 290).In addition, transference is usually accompanied by negative emotions and/or distressful physical symptoms. This is due to the unresolved conflicts being displaced.
As a form of displacement, transference involves the projection of some aspects of a figure in the client’s past onto the therapist. For example, as clients displace their fear of their critical mother to their therapist, they attribute to their therapist their mother’s habit of criticizing them. “You are like my mother,” the client unconsciously senses, “and like my mother, you will criticize what I do.”
As clients engage in projection, therapists engage in introjection. They unconsciously receive what clients send. “You perceive me as your critical mother and believe I will criticize you,” the therapist senses on an unconscious level.
However, it is important to note that therapists engaging in introjection receive projections without identifying with them or owning them and the feelings connected with them (Stamm, 1995). They “accept” projections without necessarily confirming the perceptions inherent in them (Schafer, 1968).
Rather, confirmation of a projection by a therapist depends primarily on their own countertransference: displacement of their own unresolved conflicts (Westen & Gabbard, 2002). Confirmation depends on “the extent to which the [clients’] projection meshes with aspects of the therapists’ unresolved … conflicts ….” (Meissner, 1996, 43). Some therapists, for example, have not resolved their own conflict over mothers being critical of their children in spite of the fact that they should accept them unconditionally. It is likely that their own mothers were routinely critical and, as a consequence, they hold templates of mothers as critical. Thus they confirm their clients’ projection of them as critical. Consequently, they engage in some form of fault-finding. They routinely bring their clients’ attention to being slightly late, for example.
On the other hand, therapists who have resolved their own conflict over mothers being critical are not likely to confirm a projection of them as critical. They do not find fault with the client who sends them the projection of their being critical. They do not ordinarily call clients’ attention to being slightly late.1
Interestingly, clients who project do not recognize what they project as their own . It feels foreign to them. Something that they dislike seems to be coming at them , but it is not theirs. They therefore sit back and criticize their therapist for what appears to be his or her negative trait or habit, oblivious to the fact that they are actually finding fault with themselves. Hence, though the authors of the DSM-5 do not address transference directly, they do classify projection as a defense mechanism that is “almost invariably maladaptive” (Kupfer et al., 2013, 819; APA 2013).
Freud (1912) insisted that transference be regarded as fundamentally unconscious. Though clients may become aware of something calling forth their transference, they are not conscious of the relationship between that present stimulus and a past phenomenon. The transference of feelings about one’s mother to a therapist, for example, seems an occurrence that is taking place now, something that just is.
Transference is an unconscious “meta-language” that carries meaning from client to therapist. As neuroscientist Schore (2003a) explains, the right hemisphere of the client communicates emotional states in nonverbal ways to the right hemisphere of the therapists).2 Therapists receive the message on some instinctual, subliminal level that they have become their clients’ mother figure, for example, and that their clients feel toward them the same way they felt toward their actual mother. Therapists might later recall a gesture or posture of clients that probably served as a stimulus for their awareness, but at the time they were not conscious of that stimulus. Their clients simply and mysteriously sent a message which they simply and mysteriously received.
An unconscious process, transference is no more accessible to clients than other unconscious processes. While they may become distressed by bodily sensations, fantasies, dreams, and other manifestations of transference, clients cannot ordinarily connect their distress with transferred material. As a consequence, they either move on to an issue of which they are conscious, or attribute their distress to a non-displaced, purely here-and-now phenomenon. Clients who transfer to therapists their desire to be mothered by their actual mothers, for example, might experience warm and tender sensations. They might unwittingly assume postures indicative of being held as they project a maternal role onto their therapist. But, if they try to find an explanation, they simply attribute what is going on to their therapist’ maternal ways. Without help, they are not able to access the material they have displaced.
As alluded to earlier, clients do not subject transference to reality testing. They do not use their conscious mind to distinguish facts from fantasy. If their conscious mind does anything, it disregards the transference as an illusion unworthy of further attention.
Thus, transference is a form of unconscious fantasizing that requires conscious reality testing in order for it to do no harm. It requires that the left hemisphere (also called the left brain) be held in abeyance (Herron & Rouslin, 1982).Unfortunately, however, the right brain to right brain communication at the heart of transference by and large excludes activities of the left brain. The transference process involves erroneous perception and extremely simplified cognition that work together to distort reality. One or two similarities are recognized, while many dissimilarities are dismissed. Clients simply fantasize, for example, that their therapist is another person with whom they have had a conflictual relationship. They do not take time to evaluate whether that fantasy matches reality or is a figment of their imagination.3
Indeed, according to its classical definition, transference is merely a repetition of wishes, feelings, fantasies, attitudes, and bodily sensations initially experienced in relation to early-childhood figures and now inappropriately and unconsciously displaced to the therapeutic setting. The client’s transferential experience is something like this: “I want an accepting mother and I do not perceive you as one, therapist. I perceive you as no different from my actual mother. As a consequence, I feel the same negative feelings toward you that I felt toward her.”
In brief, according to the classical definition of transference, the fantasy that begins and sustains transference can be accounted for by similarities between the therapist and an early-life significant other. The client’s here-and-now experience of the therapist and the client’s there-and-then experience of another become temporarily identical (Nunberg, 1951). The past is reconstructed in the present as the client regresses to an early-life stage, notices subtle similarities between the therapist and the early-life figure, and allows those similarities to guide perception. Thus, the therapist becomes a person with whom the client is still conflicted (Freud, 1940).
In other words, the past predetermines the present in that clients cannot help but perceive their revived ideas, feelings, and sensations as simply present realities (Chodorow, 1996). Transference just happens when something in clients’ experience of their therapist, usually of a visual and/or auditory nature, serves as a reminder of a similar past experience recorded in the clients’ memory. “My critical mother had piercing eyes,” the client recalls on an unconscious level, “and so does my therapist. My therapist seems to be my critical mother.”
Thus “transference is its own motivation;” [it is] “a built-in pattern that impels [clients] to engage in a particular type of similarity-judging, memory-priming pattern of behavior” (Levin, 1997, 1141). It is driven by a compulsion that Freud (1912) termed a repetition compulsion.
It takes little for clients to make fantasy-supportive connections. Slight resemblances such as facial hues and features, gestures, tone of voice, or similarity in names become “kernels of truth” (DeLaCour, 1985) that allow clients to re-experience the entire pattern of their relationship with another person who is still significant on an unconscious level. They even sense the setting and atmosphere in which an encounter with the original person occurred (Rioch, 1943).
Originally, Freud (1912) regarded transference as either positive in that its inherent conflict is overshadowed by pleasant feelings, or negative in that it is inundated by disturbing or painful feelings. In the case of positive transference, Freud (1912) believed that clients displace the needs that a past figure did not meet to their therapist and hope that the therapist will meet those needs. A healthy part of the client hopes to create an outcome different from past experience. A healthy part of the client wants the present to be better than the past.
In the case of negative transference, in projecting their negative feelings toward a past figure onto their therapist, clients sustain their fear that their therapist will behave like the past figure. An unhealthy part of the client has a desire to repeat what is known, even if it is harmful, because it is familiar and safe (Stark, 1994). The client is invested in keeping things as they were.
Freud (1912) advised therapists to simply ignore positive transference or to regard it as an asset because it had the potential to help form the therapeutic alliance. In contrast, therapists were to interpret negative transference because it was a liability that, left alone, would weaken or destroy the therapeutic alliance.In time, however, clinicians found that positive transference could also become detrimental. It could encourage a “gentleman’s agreement” (Wolstein, 1996, 507) to keep the therapeutic relationship non-confrontational and thus avoid difficult conflict-resolution work. Hence, even Freudian theorists began to advocate interpreting positive transference if it seemed to interfere with the work that needed to be done. Equally important, they began to note that negative transference could become a positive experience if therapists were able to make their clients aware of their transference and embark upon the hard work of conflict resolution.4
Though a paradigm shift within psychoanalysis has de-emphasized conflict in transferred material (Olds, 1994), the concept of conflict remains central to the classical definition. In simple terms, transferential conflict can be thought of as an incompatibility of conflicting desires “such that satisfaction of one such motive has a negative influence on another” (Westen, 1988, 172). Satisfaction of a sexual wish, for instance, can conflict with the moral values one holds.
Transferential conflict can also be thought of as a matter of a significant difference between what one needs or wishes and what one gets. A child who needs protection from a parent, for example, and is instead neglected, will experience conflict. The child will find it difficult to reconcile his need to be protected with the neglect he experiences, thinking, “Should I not need protection? Or shouldn’t I get the protection that I need?”
Conflict is to be expected even from a neuroscientific perspective because wishes, beliefs, values, and goals are likely to be processed by relatively independent neural circuits. In addition, each hemisphere of the brain forms two independent self-representations or self-images, one stored in the left and one in the right, that are used again and again in new situations. Clients can wish for something that their right brain likes even as their left brain tells them it is illogical to have that wish. Similarly, clients can choose to endure what they experience as harmful even though it is painful. For example, to keep some kind of relationship with a parent, which would be in line with their right brain image of who they are in a family, clients can allow themselves to continue to endure neglect at the hands of that parent, which would be a violation of their left brain image of themselves as rational and therefore not wanting to endure painful neglect.Clients who are engaged in transference attempt to resolve the ensuing conflict, not by dealing with the emotional pain inherent in it, but by repressing their memory of it or blocking it out of consciousness through dissociation. They hope to stop realizing that they have desired a relationship with a neglectful parent, for example, or have been neglected because they kept a relationship with the parent. This repression or dissociation, of course, lays the groundwork for the phenomenon of transference to occur when new, similar circumstances remind clients of their old desires or experiences of not having their needs met. When their therapist has to cancel their appointment because of an avoidable emergency, for example, clients will recall the times they were neglected and thus feel overwhelmingly neglected by the therapist.
The totalistic definition of transference, which is broader than its classical counterpart, was actually formulated early on as Freud’s contemporaries disagreed about whether or not transference should be restricted to displacement of phenomena from the early past. Could it not also be based on clients’ later experiences, they asked, even those occurring in the present outside the therapeutic setting? Could it not be interpersonal in addition to intrapsychic in that the therapist participated in, contributed to, or even instigated its formation? Indeed, if transference were to be a really useful construct during actual therapy, should it not include these experiences and interactions?
Moreover, as early Freudians focused on parental figure links to patterns revealed in the transference, they found it more important to focus on clients’ reactions to their therapists – as representing others in their present life – than to help clients discover the early-life origins of their problems.
Early Freudians also noticed that emphasizing the early-life sources of transferential patterns could strip clients of defenses they still needed for functioning (Bauer & Mills, 1989). They might not be able – at least at the present time – to face the fact that the parent who was more protective of them than the other parent actually failed to do so on a very significant occasion. They might need to defend themselves against that painful realization by engaging in a defense – called reaction formation – that allows them to keep, even embellish, positive aspects of their parent’s image. However, they have the resources to deal with how someone in the present, their therapist, was disappointing them.5
Hence, by the mid-1920s, Rank and Ferenczi (1925) theorized that focusing on displaced material that was impacting the therapist-client relationship – a here-and-now phenomenon – would eventually expose the conflicts the client still needed to resolve, whenever they originated. They seriously questioned whether positive therapeutic outcomes depended solely or even primarily on resolving the early childhood conflicts revealed in the transference.6
Thus for most theorists and therapists, including Freud, the concept of transference eventually acquired a more inclusive meaning that is now its totalistic definition. Transference is the client’s unconscious displacement of attitudes, feelings, sensations, and thoughts from another person in the client’s life – past or present – to the therapist in an attempt to re-enact and resolve conflict.The totalistic definition of transference becomes clearer when contrasted with the classical definition, point by point. (Note that shared elements of the two definitions will not be re-explored here.)
Thus, in the totalistic tradition, transference is an unconscious activity in which both client and therapist engage. The client unconsciously insists that the therapist be an active participant. In fact, the client unconsciously prods, provokes, and coerces; and as a result of this manipulation, the therapist unconsciously participates. The client, who unconsciously desires “role-relationship” with another, demands “role-responsiveness” of her therapist (Sandler, 1976, 44). By engaging in transference, clients “actualize an internal scenario within the therapeutic relationship that results in [the therapist] being drawn into playing a role scripted by [the client’s internal world]” (Westen & Gabbard, 2002, 101).
The totalistic transference emphasizes the therapist’s unconscious participation through a phenomenon called countertransference. Thus it underscores an early observation of Freud himself: “It is a fundamental demand of all transference, underlying all the particular demands, that [the therapist] … should participate in a world endowed with particular meaning” (Freud, 1900, 747). As the client unconsciously attempts to re-animate problematic interpersonal relationships, the therapist unconsciously cooperates. Client and therapist become enmeshed in a complex interaction, “a kind of psychic force field compounded out of intermingled transference and countertransference processes” (Meissner, 1996, 42).
In other words, countertransference is an integral part of a transference relationship. Every transference situation provokes a countertransference situation (Racker, 1968).Freud (1912) alluded to clients’ hope for conflict resolution through transferential reenactment when he wrote of the redemptive potential of transference. Transference is a self-taught attempt on the part of clients to heal themselves, Freud explained. It is motivated by clients’ unconscious healing schema that directs them to try to achieve psychological well-being by processing injurious, conflictual material. The privacy and intimacy of the clinical setting, the unconditional positive regard with which therapists hold clients, and clients’ belief that their therapist will meet their needs, all work together to provide a milieu in which clients’ deepest longings to be loved, accepted, and treated well find expression. Through reenactment, clients unconsciously intend to bring flawed life dramas to wholesome finales. They fantasize that the present will redeem the past: a benevolent person will replace a malevolent one. The new version of an event will repair or heal the original one (Wilson, 1993).7
However, as Freud (1912) also explained, clients cannot heal simply by engaging in transference. Transference in and of itself does not resolve mental conflicts, for healing depends on integration, not unconscious re-enactment, let alone mere repetition. By simply repeating in their unconscious mind events that occurred when they were young, clients do not work within their conscious mind to resolve the conflictual elements of the events. For example, they do not reconcile their wish for an unconditionally accepting mother with their mother’s frequent criticism of them. They do not give up their wish for this kind of a mother. They do not accept the fact that with her limitations, their mother did not fulfill their wish. What is even less adaptive, they do not make plans to fulfill that wish themselves as best they can. Neither do they reduce the scope of the wish so that others can begin to fulfill it. Thus they do not heal.
Indeed, healing depends on clients taking three steps. It is the fruit of their (1) discovering non-integrated parts of themselves that had to be repressed or dissociated from at the time of the original experience, (2) their allowing those parts to develop, and then (3) their integrating them into what becomes a mature, functioning psyche (Rioch, 1943).8 Healing is the result of transforming undeveloped and underdeveloped parts of the psyche into developed, functioning parts.
In contrast, transference is simply a matter of clients hoping that external, arranged, role-dependent interactions with their therapist will be positive enough to erase previous memories. Put bluntly, healing demands hard work. Transference is effortless.
According to the totalistic definition, transference is dynamic rather than static. It is produced by clients as they derive positive or negative meaning from their therapists' seemingly benevolent or malevolent words and actions. Noticing such indicators of attitude as voice quality, degree of energy, level of professionalism, and person-to-person warmth, clients quickly project their feelings and attitudes toward pre- or non-therapeutic persons onto their therapist. Moreover, they make their projections forceful and intense when they encounter a particular therapist who has easily noticeable traits that they associate with their relational conflicts.
Seen in a slightly different light, totalistic transference is dynamic in that it is an organizing activity in which clients unconsciously engage during therapy in response to a number of variables: early-life and later-life memories of others, current experiences with others, and the attitudes, words, and actual behaviors of therapists in the present (Stolorow, 1993). In engaging in transference, clients are imposing the organization of prior perception of experience upon the present and thereby trying to shape here-and-now psychic reality.9 They are attempting to structure and organize experience in such a way that the past can come alive and be re-enacted in the present (Bachant & Adler, 1997). As a consequence, clients’ present-day pain will disappear.
In sum, totalistic transference is not just clients unconsciously reviving old pictures, thoughts, emotions, and sensations and perceiving them as present reality. It is not just, “You seem to be my parent.” Rather, it is “You are my parent. I know so. I say so. Furthermore, you will love me as my parent did not and thus take away my pain. I will no longer be disappointed.” Said simply, in the totalistic tradition, transference is an attempt on the part of clients to replace their memories of others’ past behaviors and thereby replace negative feelings with positive ones.10
Totalistic transference is dynamic in that it incorporates at least two mental activities of therapists. First, therapists unconsciously behave in such a way that they offer clients an opportunity to re-enact past relationships. Therapists’ own characteristics, interpersonal behavioral patterns, and traits make their transferential roles possible in the first place. Indeed, therapists unwittingly inspire the very roles their clients project. It is as if therapists assist clients in writing the scripts that define their roles.
Second, as their countertransference is triggered, therapists with a corresponding unresolved conflict unconsciously transform the roles their clients assign them in subtle, idiosyncratic ways. They shape a transference enactment by responding subjectively to the projections they receive. They give their clients “additional material” with which they can continue to enact their transference. Therapists who indicate that they even slightly disagree with something their clients say, for example, permit their clients to embellish their projection of an earlier critical figure.
You will recall that the classical definition already implied that therapists provided “kernels of truth” (DeLaCour, 1985) for clients. While consciously performing their roles, therapists also unconsciously contribute other, fragmentary, disguised variables that serve as reminders of persons in clients’ conflictual past. Therapists momentarily use a harsh voice, for instance, and thus give clients the stimulus they needed to notice similarities between therapists and persons outside therapy who verbally abused them.However, the newer totalistic definition goes on to add that clients unconsciously send a message to therapists who have a certain potential that they have already activated that potential. Those who could be critical, for example, are being perceived as such. Therapists then unconsciously introject the message and, if their countertransference permits it, enact the role of a critical person. They might use a slightly disparaging tone of voice or use it to a greater degree than usual.11 Thus, the totalistic definition of transference emphasizes the powerful influence that therapists’ personal, countertransference-based characteristics and behavior have on the content and shape of clients’ transference (Cooper, 1987).
Totalistic transference is displacement of any interpersonal experience in life, not just early-life experience. It adds the later past to the early past and the present to the past as sources of clients’ conflicts (Strachey, 1934, 1969). The totalistic definition of transference also adds what is going on interpersonally outside of sessions to what is transpiring in sessions and what has been going on intrapsychically in the client since infancy.
With Jungian theorists, the totalistic definition of transference has become so broad that it includes archetypal phenomena: universal and transpersonal material common to humanity throughout the ages and therefore able to serve as prototypic interpersonal templates. Universal archetypes trigger transference, and transpersonal archetypal themes form its content. Age-old, worldwide, collective, and transcultural material emerges as the client’s own (Jung, 1966). The archetypes reveal their powerful relevance in generation after generation, culture after culture, and individual after individual (Dieckmann, 1976).
Thus, according to Jungians, transference is both a new experience and an enactment of an old one. It is a here-and-now personal phenomenon based on a then-and-there universal memory. “I am an older sibling in competition with my therapist, my younger sibling,” a client fantasizes, for instance, when being influenced by the universal Sibling Rivalry Archetype.
In order to make complex concepts and processes as simple as possible for non-psychoanalysts, the definition of transference used in the rest of this course is an operationalized one. It is intended to provide a concrete template clinicians can place on transferential phenomena that occur in non-analytic therapy.
Classical countertransference, the mirror of transference, is therapists’ own transference being elicited by clients’ transference (Freud, 1910a). Recall that classical transference refers to clients’ feelings and attitudes toward a significant early-life figure being displaced to the therapist (Freud, 1912).
When defined as a construct, countertransference refers to therapists’ unconscious responses to clients’ feelings and attitudes toward a significant past figure being displaced to the therapists. It is a response triggered by the therapists’ own unresolved conflicts.
In other words, countertransference is therapists’ repressed, early-life, unresolved conflictual feelings and attitudes that surface in response to clients’ displaced conflicts. Countertransference is a fusion of past and present. When old material is transferred to the therapeutic setting, the past becomes the present in the mind of the therapist.When defined as a process, classical countertransference refers to clients’ transferential communication “calling forth” from their therapists’ unconscious minds feelings and attitudes related to their own early-life conflictual experiences. Although there can be some exceptions, ordinarily this “calling forth” depends on two dynamics12.
One is that clients unconsciously send memories of early-life conflictual experiences to their therapists’ unconscious minds, and therapists unconsciously receive them. Neuroscientist Olnick (1969) explains that therapists’ right-brain communication receptors are tuned in to their clients’ right-brain communication expressions. Using visual, auditory, and subliminal signals, clients project onto their unconsciously receptive therapists the traits or habits of persons that helped to create the clients’ early-life conflicts.
The other dynamic on which “calling forth” depends is that therapists already have unconscious memories of their own early-life conflictual experiences that can be “called forth” by clients’ transference. They have conflict-based templates that permit them to transfer presuppositions or presumptions to the therapeutic setting (Herron & Rouslin, 1982). “You are my sibling. You have bullied me and are about to do so now,” a therapist unconsciously thinks about a client who has projected to his therapist subtle traits that characterize the sibling who victimized him in his youth. Thus, countertransference “is determined by the fit between what [the client] projects into the therapist and what preexisting structures are present in the therapist’s intrapsychic world” (Gabbard, 2001, 9).
In the classical tradition, countertransference refers only to those responses that are occasioned by displaced psychic conflicts that clients have transferred from an early-life relationship to the therapeutic relationship and that therapists still have with persons from their early years. The conflicts are triggered by unconscious, right-hemispheric, non-verbal communications of clients and therapists, but they are not based primarily on actual occurrences during therapy sessions. Consequently, they are not justifiable in terms of objective data. They are inappropriate or irrational. Therapists may be annoyed by clients who come late for a session, for example; but if countertransference is not at work, they are not outraged. If, on the other hand, therapists were frequently kept waiting because of the insensitivity of a parent and they are transferring that attribute to their clients, they become outraged.Classical countertransference, like classical transference, is subject to a habit of the unconscious mind called repetition compulsion. Because of repeated projection and introjection, feelings and attitudes in the therapist’s unconscious psyche are easily re-activated. They are not subjected to reality testing but simply serve to make therapists unconsciously re-use old perceptions and re-make old judgments.13
It is generally presumed that therapists introject or unwittingly take in clients’ projections before clients introject therapists’ projections. However, it is more likely that introjection, like projection, is a simultaneous activity of therapists and clients. Or, clients may introject first as therapists provide “kernels of truth” on which clients can base their transference.14These “kernels” may be not only the therapist’s piercing eyes – which are like the client’s mother’s eyes – but also the therapist’s subtle habit of criticizing others that corresponds to her client’s schema of mothers as persons who invariably find something wrong with their child. Indeed, in the classical definition, countertransference is a matter of clients’ transference activating therapists’ unconscious templates of what life and people are like because of therapists’ own early-life unmet needs and unfulfilled wishes.
Countertransference occurs automatically. Then it is itself repressed or dismissed from awareness as soon as it is suspected by the conscious mind. Signs of its presence, called derivatives or manifestations, may be noted by the conscious mind – the therapist may become aware of shuddering in disgust, for example – but countertransference as such takes place within the inaccessible realm of the unconscious mind. That part of the psyche, which is simply called the unconscious, is a “receptive organ” (Freud, 1912, 115) or “delicate receiving apparatus” (Money-Kryle, 1956, 341) that has no choice but to introject what another projects as real or actually occurring. It is unable to use the conscious mind’s reality-testing function to distinguish between fantasies of its own making and objective reality. It fuses past and present, and incorporates one person within another. It distorts perception, impairs insight, and clouds judgment during the therapy session.
Hence a scenario such as this: “I am not this client’s younger sibling,” the conscious mind knows even as the more influential unconscious mind concludes, “I feel like my client’s younger sibling. I am him.”In sum, classical countertransference occurs because of therapists’ conflictual wishes and needs. Therapists who have not resolved their conflict between their wish for their mother’s unconditional love and her real-life withholding of love, for example, tend to experience older, maternal clients as limited in their ability to cherish others, including their therapist. This, in turn, informs the therapists’ attitude and behavior toward these clients. They feel distanced from their clients; they withdraw from them. They minimize their verbal interactions with them. Thus, unless countertransference is detected and processed by the therapist's conscious mind, it is very likely to undermine positive therapeutic outcome. If detected and worked with, however, countertransference can all but assure positive therapeutic outcome. Like transference, it is a double-edged sword.
However complex countertransference already is in its classical sense, it becomes even more so in its totalistic sense. Because of widespread disagreement on how totalistic countertransference should be defined, we will explore just two of its more representative definitions.
At the start, it is important to note that the two definitions under consideration, like most totalistic definitions, presume the following three elements of the classical definition. First, therapists’ countertransference takes the form of emotions, sensations, and cognitions related to their clients. Second, countertransference involves unresolved conflict that has been repressed in therapists’ unconscious mind. Third, besides being dependent on projection and introjection, countertransference is also dependent on identification, a phenomenon wherein clients and therapist actually see parts or aspects of the other person as belonging to themselves.
According to Heimann (1950), totalistic countertransference refers to all attitudes and feelings that therapists experience toward clients, unconscious as well as conscious. It is the total reaction of therapists to their clients in the therapeutic setting. It consists of therapists’ unconscious, unresolved conflicts that are elicited by clients’ transference, as well as therapists’ conscious, justifiable reactions to actual experiences during therapy. It includes reactions to what clients say and do in therapy and to what they report they are going through outside of therapy (Kernberg, 1987).
Thus, the broad definition does not limit countertransference to unconscious, early-life material, to the past, to the subjective, or to fantasy. Rather, it is therapists’ response both to real attributes of clients and to attributes that therapists merely fantasize. A client might indeed be boorish, but a therapist might label him as boorish simply because he resembles a boorish person in the therapist’s past. Likewise, countertransference is a response to present and recent material no less than to early-life material. For example, if therapists are being glorified by interns whom they supervise, they might unconsciously assign similar adulatory roles to their clients. Then, when clients do not admire them, the therapists are greatly disappointed.
In other words, totalistic countertransference, which is subjective in that it arises within the mind of the therapist, may also have an objective component in so far as it is a response to clients’ actual behavior in sessions. It is a product of the present therapeutic relationship as well as the past and present non-therapeutic relationships that both clients and therapists transfer to their therapeutic encounter.
Interesting new research reveals that such a thing is indeed not a rare occurrence. Gazzillo and colleagues (2015), for example, have found that the emotional response of 144 clinicians to clients with any personality disorder was virtually the same. They felt helpless, with the degree of helplessness depending on the level of the client’s overall pathology. Furthermore, clinicians’ response to certain personality disorders was virtually the same. Clients with a histrionic personality disorder, for instance, evoked an overwhelmed and sexualized response in the clinicians. Clients with narcissistic personality disorders evoked a parental and criticized response whereas clients with phobic personality disorders evoked only a parental response.In its broadest sense, totalistic countertransference consists of affect, cognition, and bodily sensations stemming from unmet needs of both therapists and clients. It is occasioned by what clients do to therapists both knowingly and unknowingly. It is sparked both by what therapists bring to sessions independently – what is “set to go” – because of therapists’ previously fashioned conscious and unconscious schemas regarding people and by the professional roles that therapists believe they must play. They may transfer a maternal role to the therapeutic session, for example, when working with a distraught client who strikes them as child-like.15
Totalistic countertransference is a matter of therapists’ experiencing toward clients the feelings and attitudes that therapists originally associated with other persons with whom they still have problematic interactions (Racker, 1968). It is also a matter of therapists’ unconsciously assigning to clients roles peculiar to their own interpersonal experiences and the ways they define themselves in the present. Therapists send messages “asking” their clients to take certain roles that will meet their still-unmet needs and fulfill their still-unfulfilled wishes.
For example therapists who have suffered from dominating fathers tend to assign a dominating role to their clients in the hope that their clients will choose not to dominate. Thus they will meet the therapists’ long-held need for self-determination. Similarly, therapists who see their role as quasi-medical tend to assign patient roles to their clients. They give them a chance to be healed and thus fulfill the therapists’ wish to heal others.
Of course, therapists’ countertransference also creates opportunities for clients’ transference. In behaving in certain ways on their own, therapists create opportunities for clients to relate to them in ways reminiscent of clients’ relationships: early, later, and even contemporary. As recipients of therapists’ behavioral tactics, clients experience their own unresolved conflicts and re-discover aspects of their conflicted selves. Therapists who are somewhat authoritarian, for example, enable clients to return to a student role if that role has remained conflictual for them. In the countertransference, clients find themselves, Sandler (1976) says succinctly.
In addition, in its broadest sense, totalistic countertransference includes transpersonal and transcultural archetypes that emerge as therapists’ own material and get transferred to the therapeutic setting. In fact, according to Jung (1966), archetypes are the major triggers of both transference and countertransference. Therapists might regard themselves as superior to their clients, for example, because of the God and Goddess Archetype. They might classify clients as inferior to them even as therapy begins or do so at the time clients displace their tendency to become a victim from an early-life situation to the therapeutic setting.
Racker (1968) believed that totalistic countertransference depends not only on projection and introjection but on identification: a phenomenon whereby clients and therapists not only project and introject, but actually see parts or aspects of the other person as belonging to themselves. Identification includes (1) projective identification, a mental activity engaged in by one person; and (2) introjective identification, a corresponding mental activity engaged in by another person. (Though both clients and therapists engage in identification, to keep explanations simple, projective identification will be attributed to the client and introjective identification to the therapist.)Klein (1946) first defined projective identification as children’s fantasies of ridding themselves of unwanted feelings by assigning them to someone else. Today, however, most theorists define projective identification as the omnipotent fantasy that we can split off an undesirable part of our personality, put it and the emotions associated with it into another person, and then recover a modified version of what we put into the other person (Grinberg, 1962; Ogden, 1982). Due to the fact that that we unconsciously pressure the person to identify with or own what he or she receives, and that they ordinarily succumb to that pressure, we experience a feeling of oneness with that person (Schafer, 1977).16
Schore (2003a) adds that those engaging in projective identification become dependent on the person into whom the part has been projected. They need the person in order to learn how to deal with the part. They might even need to collaborate with the recipient to manage the part. For instance, clients who have anger management problems first unconsciously put their anger into their therapist. They then unconsciously observe what their therapist does with the anger, noting how the therapist momentarily stops talking, for example, in order to think of how to speak calmly. Interestingly, clients might also unconsciously talk in a very calm way in order to help their therapists regain composure.
In the course of projective identification, clients unconsciously put into their therapists a part of their identity that they are unable or unwilling to admit or own. Concurrently, the therapists participate by unconsciously internalizing that very part of the clients’ identity in a process called introjective identification.
As stated before, clients engaged in projective identification put into their therapists a part of themselves – a feeling, idea, or trait, with its accompanying negative self-definition – that the clients find distressful. They do so for one of two reasons (Hinshelwood, 1999). In the first, the part is related to memories of an experience in which others treated the clients badly, which implied that they were bad persons. In the second, the part is the cause of the clients' treating someone else badly, which also implies that they are bad persons and, on an unconscious level, makes them not want to own what they are doing. It is either, “You are abusing me and therefore distressing me. I must be a bad person;” or “I am treating you badly and cannot stand that in myself. I cannot stand being a bad person.”
When they become recipients of what their clients’ project – sometimes called projective fantasies – therapists identify with their clients and/or with those who have been significantly impacted by their clients. Grayer and Sax (1986) note that in any given session, the therapist usually moves back and forth: identifying first with the client, then with a person who was impacted by the client, then with the client, and so forth.
To begin the rapidly occurring three-step process of projective identification, clients unconsciously put into their therapist an undesirable part of themselves in order to defend themselves against psychic pain (Ogden, 1982). They unconsciously scapegoat: place into their therapist something in them that feels so unbearable that it must be expelled (Heath, 1991). Indeed, they do this so completely that they attribute what they expel no longer to themselves but to their therapist. Abusive clients who are unable to tolerate that trait in themselves, for example, engage in projective identification by perceiving their therapist as abusive. They perceive that their therapist is abusive, while they themselves are not.
Next, clients exert pressure on their therapists to experience themselves and behave in a way congruent with the projective fantasy they have received (Ogden, 1994). Clients stimulate in their therapists intense, unexplained, and ego-dystonic emotions (Maroda, 1995) and thereby cause their therapists to undergo an affective experience commensurate with what they receive. They feel abusive and dislike it (Kernberg, 1987). Moreover, as therapists resonate with what they have received, they internally amplify the emotions connected with it (Schore, 2003a). They become very distressed without understanding why. They find it very difficult to verbally communicate what they are experiencing. They cannot find words to describe what is going on to themselves, let alone another person.Thus projective identification is classified as a form of nonverbal communication. By placing the pain of being abused into their therapist, for example, clients enable their therapist to know by experience how painful it was for them to be abused. This is particularly important to clients when they cannot find the words to express what they have experienced. Consider the following account of a therapy session:
The client denied being sexually abused. In fact, he laughed when he heard the suggestion that others with his symptoms have usually had inappropriate sexual experiences. Yet his therapist experienced a vague, partly comfortable, partly uncomfortable sexual attraction to her client. It was not as if she perceived the client as physically attractive; it was simply an attraction “out there” by itself.
In time, when the therapist disclosed her countertransferential reaction, the client revealed sexual play at the age of five. He enjoyed it, he said, even though he had no other fond memories of the babysitter who introduced him to it.
As she and her client talked about what had occurred when he was a child – experiences that he might be trying to transfer to other females – it became clear to the therapist that what happened to her in therapy was an enactment of her client’s original experience. She realized that though her client said he enjoyed it, in fact he was also conflicted over it. He enjoyed what he later learned he was not supposed to do. When he placed into his therapist his projective fantasy of having a sexual relationship with his therapist, however, he could enjoy the memory of the original experience without having to own it.
Finally, clients engaged in projective identification unconsciously attempt to recover the part they have expelled. They want to get the feel of what their therapist has gone through. They want to know what the expelled part is like, now that the therapist has had to deal with it. They believe that their therapist has actually felt what they themselves could not tolerate; they believe that he or she has not only tolerated it but also dealt with it. As a consequence, the part is less terrifying, and the negative feelings that accompany it are more manageable (Ogden, 1994). In the above vignette, for instance, the client would have fantasized that that his therapist managed the sexual fantasy he had projected even if she had not shared her countertransference.Thus clients engaged in projective identification are able to fantasize that they can safely take back or re-own the traits and feelings related to their original experiences. They have benefited from their therapist’s unconscious modeling. They can now imitate their therapist. They can manage their feeling of being controlled, for example, by rebelling against it, as did their therapist. Or, because they have observed their therapist, now a “control freak,” struggle to abdicate control or control in a benevolent way, they can manage their trait of controlling others.17 The therapist has modulated the negative affect accompanying the projection, allowing the countertransference that it triggered to be acted out, not grossly or completely, but subtly or partially (Schore, 2003a).
This partial and subtle acting out, in turn, proves critical to the client’s implicit learning of a corrective emotional experience. It represents an important opportunity for the client to perceive in real time that although the therapist is affected by the client’s projection – indeed struggles to tolerate its negative affect – he or she ultimately manages to contain it (Pick, 1985).18 It allows the client to enjoy a “safe” interpersonal environment wherein negative emotions can be “metabolized” into something positive (Schore, 2003b).
According to Grinberg (1962), who was among the first to link projective identification with countertransference, projective identification accounts for transference-countertransference enactment and role-responsiveness. Projective identification is a form of pressure exerted by clients to get their therapist to help them process affective experiences that they have not been able to deal with (Schore, 2003a). In that the therapist becomes as much an active participant as the client (Plakun, 1998), projective identification is noticeably interpersonal, rather than being merely intrapsychic, as Melanie Klein (1946) conceived it.19
In the case of introjective identification, therapists experience a feeling state that clients have put into them in an attempt to disown it. For their part, the therapists have identified with their clients’ projective fantasy. They have unconsciously owned it as their own.
Introjective identification can take one of two forms. In the first, called concordant identification, therapists recognize the feeling state belonging to their client as their own and therefore feel like their client. A therapist feels abused, for example, and feels sorry for the client who has been abused by her mother. The client’s subjective reality seems to the therapist to be based in his or her own current reality. Thus concordant introjective identification functions in the course of countertransference to increase therapists’ empathy for their clients..In the second, called complementary identification, the therapist who has identified with a client’s feeling state feels the impact of what the client has done to another person. The therapist experiences what the recipient of the client’s actions has experienced. As a consequence, the therapist empathizes not with her client, but with the person with whom the client has interacted. To use the last example, the therapist experiences the frustration of the mother who resorts to abusing an obstinate child. Thus, this second form of identification, in particular, yields valuable information regarding what clients have contributed to their problems.
Some theorists, such as Blum (1986a), find the broad definition of totalistic countertransference to say so much that it hardly says anything. Consequently, they offer one that is less comprehensive: countertransference is not all feelings and attitudes of therapists toward clients but only those that are unconscious, irrational, and inappropriate because they are displaced; and only those that are conflictual or at least problematic.
If clients actually act badly in the session and therapists are angry, that reaction is called a counter-reaction, not countertransference. If, on the other hand, clients project onto therapists an early-life “picture” of themselves as acting badly – while not actually acting badly in the session – and therapists introject that old “picture,” their angry reaction is termed countertransference. Thus, countertransference is labeled irrational and inappropriate; it defies logic, strictly speaking.20 The present is not the past. One person is not another, however much they resemble each other.
In other words, countertransference is composed of only unconscious responses. They are the imagined or fantasized perceptions of which therapists are unaware.
Furthermore, countertransference involves only conflict-based reactions of therapists. If a therapist has resolved her conflict over expecting her mother to meet her needs and finding her mother instead neglectful, projection – but not countertransference – will occur. The client who resembles a mother might project her own unresolved conflict related to the neglect to the therapist, but the therapist will not feel neglected.
Whether defined classically or totalistically, countertransference can be described in the following ways.
Though signs of countertransference can be obvious – wanting to lash back at mouthy teenagers, for example, is easy to detect manifestations of countertransference are usually subtle. They tend to be disguised or vague feelings, desires, images, gestures, fantasies, associations, bodily sensations, and urges to respond differently from the way one usually does. They might take the form of silence, boredom, fatigue, fragmentary thoughts, and various combinations of these phenomena (Grayer & Sax, 1986). In response to a client who dislikes women, for example, a female therapist might feel chest pains, difficulty speaking, or performance anxiety. Or she may entertain the image of a person she dislikes. She may have a fantasy of being humiliated. She may desire to end the session.
Like transference, countertransference takes a unique form – indeed many unique forms – in every client-therapist relationship. As in the case of transference, it would be more accurate to say there are countertransferences, rather than countertransference. Particular clients remind therapists of other persons, and therapists unconsciously impose idiosyncratic templates on the therapeutic relationship and assign specific roles to their clients. In addition, when clients and therapists represent different ages, ethnic groups, genders, religions, political affiliations, and socio-economic strata, their effect upon each other becomes highly distinctive. Even with the same therapist-client dyad, in no two sessions do countertransference phenomena tend to be identical.
Countertransference, like transference, involves simplified perceptual and cognitive processes. In order to associate a client with a person whom a therapist dislikes, for example, the therapist must dismiss all aspects of both persons except the common element of the trait or behavior the therapist dislikes. Even before that, the therapist must accept the client’s transferential message that the therapist reminds him of a disliked person with whom the therapist has relatively little in common. Perhaps it is his age. Perhaps it is his age and the slightly authoritarian tone of his voice. Perhaps it is his age, his authoritarian tone of voice, and similarity in clothes. But it is not the hundreds of similarities that it should take for one person to be identified with another.
However, at the same time that countertransference demands simplification, it also demands complex fantasizing. After focusing on select data, therapists go on to embellish their fantasies. To use the previous example, they might add to the common element of dislike such “evidence” as physical sensations of being punched in the chest. They might add performance anxiety that reveals itself in confused thought processes, stammering speech, and even an urge to get rid of a client who reminds them of another person they dislike.
Of course, the more therapists acknowledge and deal with material coming from their own unconscious, the less prone they are to fantasizing. None of them, however, can ever complete the work of self-understanding and resolving interpersonal conflict. New clients uncannily call forth deeply repressed, only partially examined conflictual material. As a consequence, while therapists vary in their susceptibility to countertransferential fantasizing, none can completely avoid it (Herron & Rouslin, 1982).
Countertransference is complex in yet another way. It is a convoluted process that not only begins with anxiety-riddled, repressed material, but is itself repressed because of the additional anxiety it induces. It then re-occurs when similar conditions arise, only to be pushed into the unconscious once more.
Freud (1910a) originally regarded countertransference as negative. It was therapists’ undesirable reaction to their clients’ transference. Because it interfered with therapeutic work, it was to be roundly dismissed from the therapeutic process. In time, however, theorists noticed that countertransference was either positive in that it seemed to be conflict-free, or negative in that it contained discernible conflict.
Finally, in the course of developing their totalistic definition, theorists began to regard countertransference as having both negative and positive aspects. On one hand, countertransference ordinarily arouses discomfort – usually anxiety – in the therapist, who must use energy to repress it or dissociate from it. This, in turn, limits insight, clouds thinking, interferes with communication, and leads to misunderstandings that mar treatment.
On the other hand, if detected and decoded, countertransference alerts therapists to what is going on in their relationship with clients (Racker, 1968). It increases therapists’ knowledge of their clients’ personal traits and interpersonal patterns. In fact, some of these traits and patterns may only be accessible through therapists’ countertransference reactions (McDougall, 1978; Cohen, 1952).
In sum, countertransference is a double-edged sword.
Countertransference is governed by an unconscious law of the human psyche to repress what is too anxiety-ridden and painful to handle. It is also governed by what is called the “law of talion”: Respond to every positive transference by positive countertransference and to every negative transference by negative countertransference (Racker, 1972). This happens quickly and automatically, that is, within milliseconds and at levels beneath awareness (Sternberg et al., 1998). It is not a matter of conscious intention.
Consider, for instance, falling asleep, which usually makes therapists feel guilty. At least initially, however, therapists will attribute their dozing off to clients’ being boring: bringing up nonessential material or repeating ad nauseam. Because they are unaware of transferring material themselves, therapists will not realize that they are retaliating in returning negative countertransference for negative transference. It is likely, however, that this is precisely what is happening, in addition to the client’s actually being boring. When accurately decoded, the countertransference will more than likely yield its talionic motivation.Another law of the unconscious mind to which countertransference is subject is the “law of elaboration”: Build on, flush out, and give detail to fantasies. Hence, just as dreams are elaborate to the point of being confusing, even bewildering, countertransference includes therapists’ inclinations to feel and behave fully in accordance with the identifications they are making. In subtle and varied ways, therapists play elaborate roles and perform detailed functions once characteristic of figures in the clients’ or their own past (Bion, 1961).
The good news, however, is that once countertransference is detected and accurately coded, it inaugurates a revelational process. It reveals to therapists how they are influencing the therapeutic process, for better or worse. If they like the elderly because of their sweet grandparents, for example, and convey that message to elderly clients, the latter feel valued and accepted. The therapeutic alliance is quickly and soundly launched. If, on the other hand, therapists dislike the elderly because of their disgruntled grandparents, they are likely to focus on even subtle forms of negativity in their clients. As a consequence, the latter feel devalued and rejected, and the therapeutic alliance becomes fragile at best. Similarly, if therapists continue to associate their elderly clients with their sweet but failing grandparents, they might excuse them from hard work.21
If detected and accurately decoded, however, countertransference gives therapists data about what is going on between them and their clients, as well as about how they and/or their clients are influencing the therapeutic process. Countertransference opens the door to a “slice of life”: the client’s life, the therapist’s life, and the life that client and therapist share in the therapeutic process. It gives therapists a first-hand experience of what feelings and thoughts their clients are unconsciously communicating.
Indeed, the true message of clients is understood primarily in what their communication does to therapists. Far more important than what clients consciously say to therapists are the attitude and affect with which they unwittingly say it, for in these elements lay both the fullness of meaning and the impact of clients’ communication on others. “The way the therapist feels impelled to feel and behave because of the client’s transference may be as important” as what the client says, and perhaps may be more important (Pally, 2001, 91). A client’s “What should I do?” for instance, can inspire a therapist to give advice, help the client think through alternatives, or turn the question back to the client, all depending on whether the therapist’s countertransferential response is one of pity for one without experience being forced to act immediately, confidence in one who desires to become more analytical, or impatience with one who wants to stay dependent. In sum, therapists stand to gain their most significant insight into how they need to plan their work with clients by decoding their own countertransference.
For this reason, Brodbeck (1995) asserts that countertransference, even more than transference, is the central instrument of therapeutic work. Countertransference is “the map guiding the clinician through the hidden shoals of the transference,” write Davies and Frawley (1994, 152). Countertransference is the most valuable instrument of research into the client’s unconscious that the therapist has, concludes Heimann (1950).
The definition of countertransference that will be used in the rest of this course is an operationalized one based on the narrow totalistic definition. It is intended to provide a relatively simple, concrete template to place on a difficult-to-detect phenomenon that occurs during non-analytic therapy.
Countless and varied stimuli trigger transference and countertransference in everyday living. The realms of the unconscious mind wherein transference and countertransference “reside” are multi-structured, multi-layered, and multi-faceted. Unconscious psychological life is no less complex than biological life.
During the course of psychotherapy, however, transference and countertransference are triggered most often by what are called archetypes. One reason for this is that therapy is a highly interpersonal process that draws from its participants primordial, transcultural interactional patterns, such as taking care of infants and children or appealing to powerful others when in danger. Specific cultures may have developed somewhat unique forms of caregiving and turning to powerful others, but all cultures have learned to survive by enacting the Mother and Father Archetypes and the God and Goddess Archetypes, respectively.
A second reason for archetypes triggering transference and countertransference is that therapists and clients hold archetypal beliefs about situations that tend to occur in therapy. “Those in danger of decompensating, for example, must depend on those who know how to protect them,” clients and therapists unconsciously believe. Hence the triggering power of the Father Archetype.
In this section we will first consider the archetypes, the manner in which they trigger transference and countertransference, and the expectations of therapists and clients that make archetypal material difficult to manage. Then we will narrow our focus to the five archetypes that clearly cast therapists and clients in corresponding developmental roles and thereby occasion significant transference and countertransference conflicts that appear and reappear in various culture-influenced forms and intensities during the course of therapy (Dieckman, 1976; Kernberg, 1965).We will also focus on these particular archetypes because they evoke the three major dynamics that are more likely than others to affect the treatment relationship: attachment and intimacy, authority, and sexuality (Westen & Gabbard, 2002). They are more likely than other archetypes to account for the “significant distress or impairment in social, occupational, or other important areas of functioning” (Kupfer et al. 2013, 21) that have been identified by the DSM-5 as indicative of a person’s need for mental health treatment. They are more likely to affect the outcomes toward which both clients and therapists are working.
Jung (1966) held that universal themes, collective beliefs, transcultural images, and primitive interpersonal scripts known as archetypes frequently attract the attention of the unconscious mind wherein they reside. They even become structural elements of the human psyche. As such, they demand to be used as patterns for life’s interactions. Thus, they prompt therapists and clients to resonate with them, even enact them, in the therapeutic setting. Because of their empathy, “therapist[s] become in certain respects mother, father, sibling, child, and lover of the [client]” (Schafer, 1959, 354) as more than one archetype is activated during therapy sessions.
However, the exact nature of the transference and countertransference depends on the client’s and therapist’s cultures, with culture being defined broadly to include ethnicity, age, socio-economic class, political affiliation, gender, sexual identity, religion, and other demographic characteristics. Being a mother in a Latino culture wherein the maternal role is central to family life, for example, is different from being so in a British, upper-class culture wherein some maternal functions are performed by nannies. Similarly, sibling rivalry in a Korean culture defined by a gender and age hierarchy, as well as by the influence and interference of in-laws, is different from its expression in a single-parent, Anglo-American family culture that is characterized by individual responsibility even among young children. Thus, important lenses through which therapists must observe archetype-based transference include the interwoven and ever-evolving cultures with which the client identifies.
Put succinctly, ethnocultural transference is a core variable in therapeutic work. The sociocultural histories of both client and therapist influence therapeutic dynamics (Comas-Diaz and Jacobsen, 1991). Individual narratives and interpersonal therapeutic dynamics are without doubt shaped by their respective cultural groups. As a consequence, listening to clients’ narratives must include listening “to what lies beneath these meanings, how and in which context they were formed, … and the anxiety that is [experienced by] both the client and the therapist,” (Tummula-Narra, 2015, 283).
At the same time, however, therapists must continually note long-lasting similarities among cultural identifications and be wary of a client’s manipulation of culture as a defense mechanism. “All Latinos are late,” for example, may not be so much a valid excuse on the part of a client as an attempt to limit interaction with the therapist because of fear triggered by the God and Goddess Archetypes.
In other words, it is extremely important that therapists be wary of their own unconscious bias against cultures other than their own. Should they see them as inferior, for example, they may not hold high expectations of certain clients. Or they may unconsciously pathologize certain clients or stereotype them or regard them as too entrenched in their ways to change.Unfortunately, space limitations do not permit detailed exploration of the impact cultural phenomena might have on transference and countertransference. Periodically, however, in the following sections culture-relevant questions will be asked. which the reader is invited to consider more thoroughly.
Jung’s (1966) Mother Archetype is by and large the most relevant to therapy because, like the prototypic mother-child relationship, therapy involves repeated, intimate contact between two persons through conscious and unconscious channels of communication (Tower, 1956). Therapy easily becomes an opportunity for clients to find, once more, the vanished mother figure (Ferenczi, 1909). It is an opportunity to enjoy again the mother-infant quasi-union of the first months of life (Greenacre, 1954). Similarly, therapy easily becomes an opportunity for therapists to play the maternal roles of creating and nourishing new psychic life.
When two people are all alone for an extended period of time, as they are in the therapeutic setting, they cannot help but concentrate on each other’s feelings and attitudes (Greenacre, 1954). Therapists closely attend to their clients, as did clients’ mother figures. Clients experience understanding, non-judgmental professionals (Macalpine, 1959) who make no emotional counter-demands (Greenacre, 1954) and thus afford them another experience of original, early-life pleasure.
Indeed, regardless of gender, most therapists come across in the typical therapeutic setting as having a maternal-nursing attitude toward a suffering patient-child (Greenacre, 1954). Even when therapists fail to gratify their clients, they replicate clients’ early experience of mother: a combination of gratification and deprivation (Greenson & Wexler, 1969).
Thus, therapy gives clients a perfect chance to recreate their infantile life in the transference (Bollas, 1983). Seeing their therapist as a mother, clients can unconsciously displace their experiences with their original caregiver (Tower, 1956). They can expect that their therapist will satisfy all needs and repair all injuries (Horowitz et al., 1984). If only they please their therapist – usually in combination with making themselves appear needy and giving themselves negative attributes – they can induce their therapist’s care (Goldin, 1985).
For a client, the Mother Archetype is tantamount to secure attachment and uncomplicated intimacy: being loved unconditionally. It corresponds to the client’s – indeed any person’s – need to be valued, if only by one person. It permits the infant to discover his or her personal capacity “to light up the mother’s face,” an experience that becomes the “fundamental basis of self-image and self-esteem” (Casement, 1991, 93).
At a fundamental, unconscious level, clients become like infants. They hold non-verbal expectations of symbolic bodily contact, of being held, fed, and kept warm and dry. They believe that their therapist will give them continual, empathic attention. They believe that their therapist will respond to both obvious and subtle indications of what they need.
At an even deeper unconscious level, clients, like infants, entertain fantasies of returning to the mother-infant symbiotic state wherein they are no longer separate individuals (Benedek, 1953). They fantasize a psychological, pseudo-biological merger in which they enjoy undivided attention.
Concurrently, the Mother Archetype promotes in therapists complementary parental, care-giving attitudes and behaviors. On the positive side, these variables are key to establishing a nurturing, interdependent environment supportive of the therapeutic alliance.
However, on the negative side, these variables can become problematic, especially in the case of clients who have pronounced depression, anxiety, dependency issues, and phobias (Gazzillo et al., 2015). Clients’ journey to independence rightfully includes an experience of dependence on their therapist, but this dependence must foster healthy independence from the therapist. It must be transitional and temporary, not permanent.
Unfortunately, this is a fact that therapists who consciously attempt to maintain rapport during the working alliance can forget. They can unconsciously habituate dependence. They can unconsciously try to make clients who are dependent and want to be cared for regard them as primary change-agents (Chused & Raphling, 1992). In subtle and sundry ways, therapists can cross over the line of objectivity and neutrality. They can make the mistake of assuring clients that they are not only profoundly interested in them and their needs but also intent on meeting those needs rather than helping clients assume that responsibility themselves (Plakun, 1998).
Another danger inherent in the Mother Archetype is how clients’ expectations of being mothered compares with therapists’ actual performance. Therapists inevitably “mother” imperfectly; they do not – indeed cannot – fully compensate for clients’ early experiences of deprivation. Thus, therapy can become an occasion of powerful transferential conflicts within the client, and between client and therapist, as parental functions promoted by the Mother Archetype supersede key attitudinal and behavioral variables needed to sustain goal-attainment.
Gabbard (1996) exposes yet another danger. Clients with cogent needs to be mothered may also have a strong urge to defend against the therapist-client merger they covet. They may then withdraw and become resistive. They may even try to seduce their therapist, for a sexualized relationship may be preferable to the threat of a merger.
But even if seduction attempts do not occur, positive outcome depends on how successfully therapists balance clients’ need to be “held close” and their need to be “held separate.” Therapists must give clients “space” in which to find, on their own terms and in their own time, the person who nourishes them psychologically. They must allow clients their self-sufficiency and autonomy. They must even allow clients to pursue a narcissistic desire to have “omnipotent” control of caregivers, or at least to oppose them as they strive for self-sufficiency, and still experience the caregivers’ unconditional acceptance and positive regard.
Therapists who unconsciously hold the belief that they are and should be benevolent and self-giving and that clients should be able to use them to obtain whatever they need are especially vulnerable to acting out the Mother Archetype. In the beginning, their belief appears benign, even beneficial. It assures therapists that they can be unconditionally empathic and totally available to their clients.
In time, however, this belief proves malevolent. Therapists grow weary. As their own need for self-care mounts, they cannot sustain the posture of being used by their clients. Furthermore, like all other human beings, therapists have an instinctual sadistic trait against which they cannot endlessly defend (Pick, 1997). It is only a matter of time before they rebel against a system – in spite of having set it up themselves – whereby clients can make endless use of them. They might even become emotionally abusive of their clients, albeit in extremely subtle ways.
In a similar way, it is only a matter of time before the seemingly positive enmeshment engendered by the Mother Archetype becomes negative. Therapists who are eager to help clients make progress, for example, begin innocently: they use an educational intervention. By overusing this intervention ever so slightly, however, they unwittingly give clients a two-fold message: because therapists know considerably more than their clients, they can bring about change; their clients cannot. In time, these therapists actually begin to do the work that clients should be doing, which permits their clients to become passive.
Clients who do not do the homework that they agree to do, for example, stimulate positive countertransference as they assume the role of needy students and their therapists project the need to be a knowledgeable “teacher.” Then, if their countertransference remains positive, therapists who have introjected the role of “teacher” unconsciously transform that role into primary doer or main participant. In the end, as clients become proficient in non-participation, therapists experience disturbing countertransferential anxiety, which, in turn, gives rise to negative transference and the likelihood of treatment failure.
Thus, because of the Mother Archetype’s profound influence on the unconscious minds of both client and therapist, therapists must maintain a delicate balance. They must allow clients control over what they do along with how and when they do it, but they must also require that they take primary responsibility for their own personal growth and development.
Equally important, therapists must be neither insistent upon preserving closeness with their clients nor determined to maintain separateness from them. Therapists must be neither silently detached nor intrusive. They must remember that their client’s need to feel secure in therapy because they are being “held” by their therapist is figurative. They might experience themselves as a “child” within an adult, but they are not a biological child (Casement, 1991).
At the same time, however, therapists must keep in mind that a carefully selected intervention, such as reflective listening, can give the client a sense of being held physically that is more real than if “a real holding … had taken place.” (Winnicott, 1988, 61). Conveying understanding through language can seem to clients as if their therapist were “holding [them] in the past, that is, at the time [they] needed to be held, the time when love meant physical care and adaptation” (Winnicott, 1988, 62).To summarize, in therapy, no less than in actual life, the Mother Archetype engenders clients’ developmental needs and therapists’ empathic responses even as it generates personal and interpersonal conflict. In the hands of therapists who provide security by “holding” their clients even as they allow them to “move freely,” the Mother Archetype can facilitate significant therapeutic progress.
The Father Archetype also influences the therapeutic process. It speaks to another essential element of human development in early life: morality and its foundation in authority. The father represents the conscience, that psychological phenomenon that facilitates doing what is right and good for others, even if it is personally difficult (Nunberg, 1951), in order to preserve and protect life. Thus, the Father Archetype speaks to the human instinct to sacrifice oneself for the good of the species. It encourages one to protect and defend life even at the cost of one’s own life. [Would a fundamentalist Islamic or Christian culture have a special impact in the case of the Father Archetype?]
Freud once said that the death of a man’s father is the most important event in his life (Reik, 1937). It could hardly be otherwise for both men and women when that protector and defender of life departs, never to return.
Clients easily displace conflictual material from their biological father to their therapist because a major, if not the major, reason for coming to a therapist is to protect or restore their intrapersonal and interpersonal life. This is true regardless of the therapist’s gender.
Equally natural is the therapists’ assumption of the paternal roles that clients assign them. Regardless of gender, therapists want nothing more than to preserve or renew psychological life. This is especially true when they work with clients with avoidant personality disorders and phobias (Colli et al., 2014; Gazzillo et al., 2015).
Transferential conflicts arise from the Father Archetype, however, because although the preservation and protection of life is a matter of changing oneself, clients tend to not want to make personal change. Rather, they want either to change others or to have their therapist change life for them. They do not want therapists to use their authority, which is bestowed on them by the very same clients, to hold them responsible for personal change. Effective therapists, however, help clients realize that it is they who must change, even to the point of sacrificing what is dearest to them. Hence, conflicts inherent in the Father Archetype develop within clients as well as between clients and their therapists.
In that most therapists choose their profession because of a deep-seated “savior” complex (Little, 1951; Cohen, 1952), the Father Archetype appeals to therapists. They unconsciously believe that they are meant to save both themselves and others. In fact, by introjecting Father Archetypal transference, they can save themselves by saving their clients. As a consequence, they find it appealing to set a treatment framework, suggest a treatment plan, and impose certain expectations on their clients whereby they establish an authority-based relationship with their clients (Westen & Gabbard, 1998).
Therapists who unconsciously believe themselves to be omnipotent and innately powerful authority figures are especially vulnerable to the Father Archetype. They easily adopt a corollary belief: they are absolutely necessary for clients’ progress. Clients need to be rescued, healed, and protected, and they are rescuers, healers, and protectors par excellence.
Therapists who fail to recognize this related belief can even harbor unconscious prohibitions against their clients’ getting well. It is mental illness, after all, that makes the therapist’s presence a necessity.
Danger then arises for at least two reasons. First, although most clients want to get better on a conscious level, on an unconscious level many want to remain ill. Their symptoms enable them to feel connected with early, omnipotent caregivers. [Clients] “want to hold onto [an] imagined perfect, or at least powerful, [person] from their past. They … color the therapist with free-floating transference feelings. [They] fight to see the therapist as omnipotent rather than face the disappointment of seeing the real therapist.” (Alpert, 1992, 147).Second, therapists are especially vulnerable to reparative functions, and clients become persons to whom therapists wish to make amends (Little, 1951; Pick, 1997). Indeed, repressed desires to rescue and perform reparative functions are the very basis of countertransference in the therapeutic setting (Volkan, 1995). When therapists hear about – indeed share – their clients’ pain, they want to restore them to a pain-free emotional life. If clients let themselves be restored, all is well. If not, therapists become increasingly anxious, which, in turn, increases their desire to heal. And the vicious cycle begins again.22
Particularly vulnerable to the negative side of the Father Archetype are therapists who have had a depressed mother. Unless they have done considerable personal work, their depressed mother, be she alive or deceased, continues to induce rescue and reparative fantasies. If she has also operated in a punitive motivational paradigm, she continues to provoke guilt. In turn, her therapists/children want to assuage their guilt or to have grounds to deny it (Racker, 1972).
While on the surface this need would seem to be positive or at least harmless, it inevitably becomes harmful for several reasons. First, reparative needs are susceptible to becoming reparative impulses, which, in turn, are susceptible to the repetition compulsion (Little, 1951). As therapists unconsciously keep clients impaired because they want to make them well again and again, therapy becomes a travesty.
Second, therapists’ reparative needs cause them to unconsciously identify with clients’ unconscious prohibitions against getting better that stem from their primitive aggressive instincts. Thus, as clients express their early aggressive tendencies by thwarting therapists’ efforts, therapists unwittingly exploit clients’ sickness for what it does for them (Little, 1951).Third, therapists’ reparative needs impede clients’ growth away from being victims to whom reparation is due to being survivors who choose to renounce victimhood and assume responsibility for their own welfare. Victimhood may be painful, but self-pity and the attention of others are powerful reinforcers of remaining a victim.
Based on an eventual, developmentally appropriate need for autonomy, Jung’s (1966) God and Goddess Archetypes promote the twin fantasies of omnipotent control and self-sufficiency (Klein, 1957). [What might be the impact of therapists belonging to a majority culture and their clients belonging to a minority culture? Of white privilege in the case of an African-American client? Of gender in a patriarchal institution?] They nurture the authority-based illusions of being smart enough to outwit “the gods” and powerful enough to rectify wrongs by punishing and rewarding others. 23
Gabbard (1996) believes that the God and Goddess Archetypes are especially influential in therapy because of clients’ feelings of inferiority and their belief in their therapist’s superiority. Especially for clients with depressed/depleted narcissistic disorders and paranoia (Gazzillo et al., 2015), therapists’ ability to use therapeutic interventions can serve as a painful reminder of others’ superior creative powers and their own inferiority (Epstein, 1977). In fact, envy is aroused in some clients principally by their therapist’s interpretative ability, Melanie Klein (1957) writes. Ironically, while therapists want to increase clients’ insight by interpreting, actually doing so can be a therapeutic mistake.24
He was an attractive but needy client who had just been jilted in love. However, he was also seducing a vulnerable married woman who had little experience with men.
When the woman finally decided to end their emotional affair, the man was furious, and his fury extended to plotting revenge against her. He would reveal the affair to her husband, he decided, and would hear of no reality testing that his therapist attempted to use.
His therapist wondered whether she should stand back and simply reflect her client’s feelings or share her countertransferential anger. After all, she reasoned, she had the right to expose his malice as well as the responsibility to defend his “victim.”She chose the latter, only to find her client resort to terminating his therapy. He could not – he would not – entertain thoughts of personal responsibility for harm he might do to others. He perceived himself as a god above reproach. He wanted to believe that he had the right to punish others without examining his role in failed relationships. He wanted to establish his personal omniscience and omnipotence.
In hindsight, the therapist realized that it would have been better for her to continue to make intrapersonal diagnostic use of her client’s transference rather than her own countertransference. She needed to learn gradually why the client was resentful of suggestions that he focus on his personal responsibility. Once those reasons were addressed, the client might have been able to renounce his defensiveness and take personal responsibility for his actions. The client may never have assumed that responsibility, but premature termination eliminated even the possibility of that outcome. Instead, the God and Goddess Archetypes set the stage for an unsuccessful outcome in spite of a well-intentioned intervention. The therapist needed to address her own goddess issues: her assuming that she had power over her client power and her right to take control in this particular instance.
The therapist also needs to make use of a counterintuitive finding. Ironically, clients’ unconscious insistence on failing in therapy is “inspired” by the God and Goddess Archetypes. It is actually a control issue (Schafer, 1997). If clients are not successful, they continue to suffer, but they thereby outwit and punish their therapist. Their authority, which is covert, is amazingly potent (Grinberg, 1997).
Clients who experience failure of the parental holding environment are especially inclined to embrace the God and Goddess Archetypes. Because they have had to sustain and nourish themselves, they instinctively adopt the position that they are omnipotently self-sufficient (Modell, 1980). They even believe that they must parent their therapist, much as they once did their parents. The more ill the clients, the more powerful are their transferential role reversals due to their original parents making them into virtual parents (Searles, 1975).Paradoxically, clients’ fears of being personally omnipotent are also embedded in the God and Goddess Archetypes. Clients fear the unending power and authority which that state conveys and, even more so, their not being able to find well-modulated support: an equal or at least a powerful companion-other (Stein, 1993). [How might the Filipino culture, with the emphasis it puts on debts of gratitude to elders, confound this issue?] At the same time, clients fear domination and absolute control by their equal because they interpret great power with great enslavement. They regard having such a companion as risking exploitation, even annihilation (Modell, 1980).25
For their part, therapists who hold the unconscious belief that they are superior to others because of their education, experience, and professional success are especially vulnerable to enacting the God and Goddess Archetypes. They assume that they are gifted. They are remarkably skillful in their perception, analytic and synthesis abilities, instinct, and ability to deal effectively with affect. Some even believe they are magical.
Then, because these therapists actually have a certain amount of a priori knowledge due to their experience and education, they succumb to fantasies of having innate power and authority (Bion, 1967). When, in addition, clients transfer to therapists their culturally-based reverence and awe for professionals called “doctor,” the therapists are tempted to believe that they actually are superior human beings, superior to their clients and, perhaps, superior to people in general (Cohen, 1952). Unsuspected and unacknowledged in the unconscious, this countertransferential force becomes “larger than life.” It becomes a “recipe” for ultimate therapeutic failure: therapists assume authority-figure roles and relegate their clients to subject-figure roles.
These assignments become doubly dangerous in that the God and Goddess Archetypes also “inspire” fantasies of ideals with which therapists unconsciously identify (Racker, 1972). They begin to treat a challenge to their ideas and interpretations as unwelcome interference. They let humiliation by clients, particularly blatant shame projected by clients with borderline or narcissistic personality disorders, plunge them into deep depression. They allow poor evaluations by clients to increase their fear that these same clients will disclose their “incompetence.” They automatically blame treatment failures on clients.
These therapists then adopt the belief that therapeutic failures cannot and will not be tolerated. Although they do not consciously deny that mistakes are part of being human, they unconsciously regard them as reasons to defend themselves against what would otherwise be wholesome feedback. Thus, they fail to learn the lessons that therapeutic mistakes teach. In the end, they sharply increase the probability of future failures.Unfortunately, in response to countertransferential fears of failure and of owning mistakes, many clients persist in developing negative therapeutic reactions and treatment-destructive resistances. They even begin to hate their therapists (Blum, 1997), which, in turn, makes therapists with omnipotent self-beliefs move from frustration and confusion to dislike, even hatred, both of themselves and their clients. They may even wish to attack or annihilate the clients they hate and, finding this unacceptable, project it onto their clients. When clients, especially adolescents, receive this projective identification, the worst proves true. They engage in self-destructive behaviors or activities dangerous to others (Ogden, 1994), both of which undermine therapeutic work.
The therapist thought that he liked his adolescent client in spite of the terrific challenges she was providing. Besides not going to school, she was running away from home and using drugs. The therapist reflected often on how he thought that he really listened to his client; in fact, he listened and listened and listened. He responded empathically; he seldom challenged her, and when he did so, he was most respectful and gentle. Yet his client continued her self-destructive behavior.
“Am I really able to like this client?” the therapist began to wonder. “I want to so badly that perhaps I am fooling myself. Maybe that is why my client periodically refers to parents who can hardly stand her.”
Finally, the therapist had to admit that the time and energy that he was spending on helping someone change who apparently would not change might be leading to more negative countertransference than he liked to admit. He decided to share that thought, hoping that doing so would help his client.
“I find your behavior so frustrating,” he said to his client. “No matter what we plan and what you say you will do, you hardly ever do it. Maybe my negativity is something you sense. Maybe you won’t change because you sense that I don’t like what you are doing and therefore don’t like you.”
The client listened attentively but said nothing. At the end of the session, however, she made reference to no one really wanting her, not even her parents. Listening intently and respectfully, the therapist simply held his client’s pain. And he held it in subsequent sessions until, when it finally lost its grip on his client, she no longer had to act it out.
As this vignette reveals, therapists’ unwitting denial of unpleasant truths about themselves and thus their enactment of the God and Goddess Archetypes can weaken, if not destroy, the therapeutic and working alliances. It is only when therapists recognize, indeed humbly acknowledge, their negative countertransference that the truth of the therapeutic relationship can serve as an invitation to clients to deal with similar truths.
Another way in which therapists unwittingly enact the God and Goddess Archetypes is by engaging in manic interpretive activity as a way of controlling depressive anxiety related to feelings of clinical impotence (Epstein, 1977). But manic activity only makes matters worse. Therapists’ assuming direction and control of the therapeutic process is often positive early in therapy, but it soon becomes negative for at least two reasons.First, clients are actually ambivalent both about the therapeutic bond (Fox, 1998) and about the power and authority that they presume their therapists possess. They both love and hate their therapists; they both idealize them and depreciate them (Olinick, 1996). They both want to receive their therapist’s attention and destroy his or her position and authority (Freud, 1915). They desire to surrender to their therapist’s authority – even turn over self-responsibility – but still stay in control. If clients actually surrender, sooner or later they rebel and demand that the all-benevolent, all-powerful therapist return their power. It is not to include their responsibility, however. In that way, they can do what they want without facing consequences. They can be assured that their therapist will set things right. Indeed, writes Schafer (1997), clients’ refusal to take responsibility for their life ranks well above their use of self-abnegation to solicit reassurance.26
Second, therapists’ assumption of direction and control becomes negative because it implies their right to respond negatively when therapeutic success is minimal or absent. It allows them to justify their urge to express anger in ways that feel good at the time: to covertly punish their clients, to get subtle revenge, to engage in imperceptible pay-back. It even justifies their hating their clients. In time, however, this persistent countertransferential maltreatment is registered and experienced by their clients. It then becomes a significant factor in therapeutic stalemates and failures (Blum, 1997).27
Another way in which therapists enact God and Goddess Archetypes is by rationalizing their rigidity and always having to be right. They become rigidly self-righteous about what they do and how they do it and reclassify clients who object to what is happening in their treatment as simply uncooperative.
Finally, some therapists enact God and Goddess Archetypes by unconsciously believing that they can use any available therapeutic measure, even sexual involvement with clients, to ensure therapeutic success (Searles, 1975).
It is no wonder, then, that therapists’ fantasies of omnipotence are a chief obstacle to effective therapy (Bion, 1967). Undiagnosed or misdiagnosed God and Goddess Archetypal phenomena are exceedingly dangerous.
Jung’s (1966) Sibling Rivalry Archetype promotes expectations of getting one’s way, winning over competitors, and placating others if victory is not within reach. [How might clients who are immigrants and therapists who are natural citizens be affected by the Sibling Rivalry Archetype?] Though therapists may first appear to be parents, as they reveal their shortcomings, they soon become “mere siblings” competing for some obscure prize or preferred place in a larger, relational world. This often happens when clients begin to find out that therapists have other clients, especially if they have histrionic or psychopathic traits (Ferenczi, 1909; Gazzillo et al., 2015).
The Sibling Rivalry Archetype evokes clients’ need for space that protects them from being impinged upon by the environment. That space is composed of both non-persons and persons, including the therapist.28
The Sibling Rivalry Archetype challenges therapists to become aware of their need to assume that they are necessarily the focus of their client’s internal world. It challenges therapists to provide both time and opportunities for clients to discover the value of their therapist gradually.
Therapists who unconsciously believe that they deserve to be liked, even loved, for all the good they do are especially vulnerable to enacting the Sibling Rivalry Archetype. This belief lies along a continuum of therapists’ expecting simple gratitude for services rendered, to demanding that clients complete their therapy successfully, to expecting that clients actually meet their therapists’ needs.
The Sibling Rivalry Archetype challenges therapists to let clients “use” them temporarily and for therapeutic reasons but not develop the habit of taking advantage of them.
This can be a difficult balancing act because therapists who feel used for more than a short time begin to feel abused. Even if they are not hostile, clients who are demanding can soon cause their therapists to dislike them. Even non-demanding clients who share their pervasive negative feelings with their therapists are asking that the latter absorb that negative affectivity – a term used repeatedly in the DSM-5 (Kupfer, 2013) – session after session. Consequently, therapists can begin to resent their clients. Then they may experience a need to retaliate.
Relying heavily on getting gratitude from clients is particularly dangerous for therapists. In their efforts to work hard and long to deserve gratitude, therapists do not always take the time to develop outside relationships. In fact, to the extent that therapists feel loved and appreciated in their work, they can fall into the insidious trap of devaluing extra-therapeutic relationships. Because they meet their attachment and intimacy needs in their work, they unconsciously conclude that they do not have to meet them outside of their work.
Therapists may then rely on clients to comfort and renew them. They may even expect clients to meet their intimacy needs. They may act out their sexual arousal by unconsciously encouraging erotic feelings in clients for their own gratification. They may ask for unnecessary details of clients’ sexual fantasies (Gabbard, 1996).
Similarly, therapists may unconsciously encourage clients’ erotic fantasies about them, only to become cold and aloof in response to clients’ longings. They may insist that clients focus on problems brought in from outside and thus give clients the message that sexual feelings are unacceptable, even disgusting. Given transference, this may, unfortunately, mirror clients’ own feelings.
Clients who detect their therapist’s aloofness will tend to experience a form of negative attachment, even victimization. Caught in the transference-countertransference cycle, they may actually wish to prolong this victimization and avoid responsibility for behaviors that may correlate with past abuse. They may not want to face the fact that in some cases and to some extent their own immature thinking and irresponsible behavior contribute to ongoing victimization (Schafer, 1997).29
In other cases, clients who feel abused by their therapists will identify with them and become persecutors themselves. They may unconsciously imitate them in abusing others. Or they may engage in manic or aggressive activity. Or they may become depressed enough to attempt suicide. (Racker, 1972).30
If they are unable to detect the self-hatred of depressed or physically ill clients, therapists may make the mistake of sending “messages” to clients demanding that they become well. Some clients will rebel by resisting or even terminating therapy (Ogden, 1994). Others will comply, at least outwardly and for the time being. None, however, will satisfactorily address issues stemming from the Sibling Rivalry Archetype.
A similar Sibling Rivalry Archetypal issue is clients’ insistence on progress in therapy. They desire and expect success much too early in the therapeutic process. Shafer (1997) explains that if clients are consistently and quickly successful, they may be dealing with relatively superficial material rather than holding themselves responsible for making difficult personal changes. Conflicts then arise for therapists who want to support clients’ efforts to be successful and yet need to challenge them to work on truly important issues.
In sum, the Sibling Rivalry Archetype challenges therapists to manage their clients’ and their own competition for dominance in therapy. They must learn to collaborate rather than compete. They must assume responsibility for themselves rather than for each other.
The Animus and Anima Archetypes hold expectations of completion, the strengths of one gender being added to the other. The animus, an archetype within the female psyche, is “the deposit … of all men’s ancestral experiences of woman” (Jung, 1966, 209). The anima, a comparable archetype within the male psyche, is a detailed outline of women’s ancestral experiences of men. Men are compensated by a feminine element, as women are compensated by a masculine element as both genders search for wholeness, completeness, and unity. Both men and women achieve strength and power through attachment to what they are not (Jung, 1966).
The animus brings with him the paternal: the logical and the cognitive, especially the ability to discriminate. The anima brings with her the maternal: the relational and the emotional, especially the connectedness so needed in interpersonal relations (Jung, 1966).
The Anima and Animus Archetypes play out in therapy in clients and therapists expecting each other to compensate for what they do not have themselves. Rather than work to develop their own capacities, therapists and clients expect the other to do so for them.
If transference and countertransference become fully operative, the animus, partial as he is to argument, can best be seen at work in women in disputes wherein both client and therapist “know” that they are right. They have an unshakable feeling of rightness and righteousness. “Men can argue in a very womanish way, too, when they are anima-possessed and have thus been transformed into the animus of their own anima” (Jung, 1966, 153).
With women, be they therapists or clients, the argument soon becomes a matter of personal vanity and touchiness rather than content. With men, be they therapists or clients, the argument soon becomes a matter of power, be it truth or justice or some other “ism.” Their dialogue becomes marked by misapplied truisms, cliches, platitudes, opinionated views, insinuations, misconstructions, and misinterpretations. Nothing is important except proving one’s point, with the result that the therapeutic alliance is seriously weakened, even destroyed. [What might be the impact of American political affiliations, especially in an election year?]
Granted that most therapists manage the animus well enough to resist falling into an obvious argument, they can be righteous and judgmental in their interpretations. They can be set on having the last word. They can be less than open to clients’ rejection of their ideas. Their clients, in turn, may need to reject whatever their therapist says for the sake of being right.
The anima can also disrupt therapy if transference and countertransference are not detected and managed. She can bring with her hypersensitivity, sentimentality, compulsive touchiness, and self-pity. Thus she can make both therapists and clients highly alert to each other’s shortcomings and reluctant to explore their own contribution to difficult relations. Wanting to maintain an exaggeratedly positive self-image, clients and therapists can consciously collaborate yet unconsciously resist honest interpersonal evaluation. They can become very offended at the implication of personal weakness. They can abort fruitful evaluation by retaliating in passive-aggressive ways. [What might be the impact of some Asian cultures that regard shame as totally unacceptable?]
If, on the other hand, client and therapist identify and work with the anima, she can become for them a source of life-giving energy. With her help, they can learn to accept in themselves and each other a partly positive, partly negative self-image. Thus they can enjoy elemental, feminine dynamism (Ulanov, 1984).
In light of the potential of the archetypes to wreak havoc in interpersonal relationships, it is crucial that therapists from cultures that differ from their clients discover ways in which specific archetypes might be impacting their clinical work. They must begin by detecting transference and countertransference phenomena (Mishne, 2003). By doing so, they will be in a position to help their clients “become aware of, review, and alter obsolete conclusions that determine their contemporary approaches to their lives” (Renik, 1990, 199).
They will also be able to collaborate with clients to resolve the personal, interpersonal, and cultural conflicts that lie beneath various human needs and lead to unending aggression. They will not deny those needs, for they are universal and integral to psychological functioning, but will consider new, more appropriate ways of meeting them.
Note 1. Some theorists, like Meissner (1996), hold that “projection … creates pressure in the interpersonal interaction to draw the other member of that interaction to fulfill the expectations and inherent demands of the projection.” I prefer to make a distinction between projection and projective identification, wherein the latter – but not the former – creates the pressure. See the next section for a more detailed explanation. (Go back)
Note 2. See the book Transference and Countertransference in Non-Analytic Therapy: Double-Edged Swords, by Judith A. Schaeffer, Ph.D. (Lanham, MD: University Press of America, 2007) on which this course is based for a more thorough explanation derived from recent neuroscientific and cognitive research. (Go back)
Note 3. For their part, therapists are to identify the conflictual wishes, urges, and fears originating in a very early time that energize clients to perceive something in the present. They are then to help clients subject these phenomena to reality testing (Freud, 1912). (Go back)
Note 4. In addition, clinical experience led Freudian theorists to regard transference as a blend of positive and negative elements. Sooner or later, transference that appears to be positive reveals its conflictual basis. Clients might perceive their therapist as a protective father, for example, but eventually notice that he does not or cannot protect them from all pain. By contrast, transference that appears to be negative eventually shows its positive aspects. In particular, if clients can be helped to express their negative transferential emotions and can experience their therapist as non-retaliatory as he or she draws attention to the transference, they discover the positive affect under the negative transference. Hatred of the therapist who falls short in providing protection, for example, usually cloaks longing for and love of the parent who was projected onto the therapist. (Go back)
Note 5. They also noticed that conflictual material was at least implied in issues that brought clients into therapy. Moreover, tensions and conflicts that occur during therapy were strikingly similar to those occurring outside of it, making therapy a virtual “slice of life.” It was a slice of a particular client’s life abetted by a particular therapist. (Go back)
Note 6. Influenced by this thinking, many late-20th century theorists put major emphasis on here-and-now transference enactments during therapy (Kernberg, 1987; Binder, 1996). They advise therapists to interpret what is happening in the session at hand (Danvanloo, 1978; Malan, 1976b; Sifneos, 1979; Luborsky, 1984; Strupp & Binder, 1984). They hold that, although therapists can obtain information about clients’ interpersonal history, they do not have to include that data in their interpretations (Malan, 1976a). Their first priority is to help clients understand that although their problems probably began in early child-parent experiences, they need to address the current situation rather than its past origins. Indeed, many contemporary clinicians who think of transference in a totalistic sense prefer not to make distinctions between past and present conflictual material. They see it as virtually impossible to tease apart the past from present. Are clients angry simply because their therapist is criticizing them? Or are they angrier than usual because they experience that criticism as similar to that of their teachers, adding injury to injury, so to speak? Asking clients may be helpful, for those who are particularly insightful may have vague suspicions, but clients’ powerful emotions are likely to obstruct clear associations. (Go back)
Note 7. Searles (1975) has given another explanation for clients’ transferential re-enactment: clients are unconsciously attempting to contribute to their therapists’ own emotional growth, integration, and maturation. Clients are giving their therapists an opportunity to resolve their own conflicts. Instinctively realizing that their own growth and integration depend heavily on that of significant others, clients surmise that unless significant others become mature, their own maturity will be unstable. At the same time, clients unconsciously want others to change so that they do not have to make dreaded personal changes themselves. They have identified with their long-lived immature emotional states and dysfunctional relational patterns to the extent that changing themselves feels like losing themselves. In addition, clients want to be mature without suffering the pain of personal change. The solution? Becoming mature by relating to a therapist who has become mature in the course of resolving the conflicts that they, as clients, have introduced into the therapeutic setting. Of course, this works no more than clients’ attempts to heal themselves. (Go back)
Note 8. Transference-based healing attempts miscarry in the end because they do not involve any real integrative processing (Ferenczi, 1909). Rather than requiring clients to subject distortions to rational scrutiny and, as a consequence, change the nature of similar present relationships, transference allows them to enact past relationships with all their distorted attributions and illusions (Freud, 1940). For example, clients may enact a parent-child relationship with their therapist, attributing to themselves neediness and inability to care for themselves and to their therapist resourcefulness and willingness to meet their needs. They do not subject these illusions to reality testing. They fail to take into consideration their own potential for self-nurturance or their therapists’ perceiving them not as dependent children but as resourceful adults. As a consequence, the clients cannot integrate a capability for self-nurturance into their psyche. They retain an unrealistic need for others’ nurturance and remain conflicted over others’ refusal to meet that need, leaving their present relationships no healthier than their past.
Thus, therapists must help clients “determine where … self-images and [interpersonal] patterns came from, how they may have been adaptive at the time they were initiated, and whether they are still adaptive or are self-defeating and maladaptive and therefore need to be changed” (Bollas, 1987, 3). Through effective therapy, clients will see what they are doing to avoid pain – indeed they will run smack into the pain – and finally, by dealing with it, will discover from experience that they can face it, even embrace it, and survive. Thus, identifying and dealing with transference becomes the primary means by which clients reduce, if not completely eliminate, their unique, historical, and potential psychic pain (Lear, 1993). (Go back)
Note 9. From a cognitive standpoint, transference can reveal itself anywhere along a continuum from simple or fragmentary thoughts to elaborate schema or scripts that organize and give meaning to repressed experience. “This particular therapist resembles another person with whom I should have felt good,” clients might unconsciously “think.” Alternately, clients might use “Buxom, smiling women are mother figures who will make up for the nurturing I never got” as a schema whereby they classify each individual with those features as maternal. (Go back)
Note 10. In general, totalistic transference makes use of a more powerful form of projection called projective identification, which is explored in the next section. (Go back)
Note 11. This activity will become clearer as projective identification and introjective identification are explored in the next section. (Go back)
Note 12. “Transference and countertransference sometimes occur without a transference/countertransference interaction” (Meissner, 1996, 307). However, the view of countertransference as inherently interactive has become increasingly operative (Gabbard, 1994). (Go back)
Note 13. Therapists unconsciously introject what is given them: “messages” about roles, functions, self-definitions, and traits. Because these “messages” are given repeatedly, therapists “hear” them, “read” them, and take them to heart on an emotional, non-cognitive, non-verbal level without being conscious of what they are doing. In other words, introjection is ever present as a companion to projection. (Go back)
Note 14. There is an element of reality in that those being given a projection have some of the objectionable attribute or at least the potential to act in the objectionable way (Searles, 1975). (Go back)
Note 15. For instance, therapists might experience frustration as a result of their “good client” template when clients say little or nothing even though they came on time. However, therapists are also being influenced by their clients’ unconscious need to punish them for exacting promptness from them, as did their parents, no matter the cost to them. Clients’ actual present behavior is a manifestation of clients’ transference as well as the countertransferential communication that they have received from therapists. (Go back)
Note 16. These terms are defined differently in various theoretical schools, making it impossible to offer definitions acceptable to everyone. What is important, however, is for therapists to be aware of powerful forms of identification that inaugurate transference and countertransference. As a consequence of these forms of identification, therapists unwittingly act and react toward their clients in negative ways they would not consciously choose. (Go back)
Note 17. But the traits are not the same as they were originally because the recipients have contained and managed them in their own unique ways without even being aware of them. Under most circumstances, the recipients have lived with the undesirable traits without having “allowed” them to damage other aspects of the self (Little, 1957) or the self as a whole. Ironically, if the traits were not totally ego-dystonic to recipients, in some way the recipients may have even enjoyed them. Controlling people who need control, for example, can feel pleasant to those who control.
When the recipients are criticized for the traits, however, they find what has happened problematic. To the extent that there is a “kernel of truth” in recipients’ having at least some aspects of the unwanted traits, they become defensive. They are caught between becoming aware of painful feelings related to the unwanted traits and denying them. (Go back)
Note 18. If the therapist cannot tolerate the projective fantasy, however, she confirms the client’s belief that his feelings are indeed unbearable and unmanageable. The client then feels even worse. Instead of having his need to hope being met, the client experiences hopelessness and despair (Bion, 1967). (Go back)
Note 19. Therapists must remember that it is not only clients who engage in projective identification. They do so themselves, unconsciously of course. For instance, they project their fantasy of omnipotence, which is easily transferred from an earlier narcissistic period of development; assign their clients the role of patients healed at the hands of their therapists; and then pressure their clients to be “cured.” Thus therapists must own and process their projective identifications no less than help their clients to do so. (Go back)
Note 20. Winnicott (1965) regards the fact that therapists bring their own unresolved conflicts to bear upon the therapy situation as unrealistic, even abnormal. It is both abnormal and unrealistic, for example, to desire to be exacting with an older woman client simply because she is like women teachers who were exacting with the therapist in the past. What would be normal and realistic, by contrast, would be the same therapist’s urge to hold the older woman client strictly accountable for being prompt for her sessions, as the therapist does all clients. The client’s promptness ensures income each week, additional income from the next client, and the therapist’s sense of accomplishment, all of which reflect the therapist’s work ethic and personality. (Go back)
Note 21. Keeping a positive alliance is not as benign as it may seem. (Go back)
Note 22. These therapists consciously conclude that failing with a client is much more than a personal problem (Sharpe, 1930). It means that clients will not get better, and therapists will be failures. (Go back)
Note 23. Bringing gifts, asking for advice, and being careful not to disappoint one’s therapist are likely to be other signs of the God and Goddess Archetypes. (Go back)
Note 24. It is not unusual for clients to harbor a deep, passive wish to defeat the therapists that they love when they realize that therapists are much more resourceful and insightful than they are. “You are so great, my fate lies in your hands; do your best and I shall yet defeat you” (Stein, 1981), clients unwittingly warn as envy surfaces. Like envious persons in everyday life, clients try to defeat envied others rather than acquire the skills they possess. (Go back)
Note 25. The actual abuse that certain clients suffered presents special difficulties, for within the psychic structure of many victims lies a figure who is, paradoxically, both a protector and a persecutor image (Kalsched, 1996). (Go back)
Note 26. Conflicts arise in therapy as therapists attempt to determine how and when to interpret clients’ refusal to take responsibility for their lives and their therapy. Working most obviously within the God and Goddess Archetype, therapists must balance their need to be ultimately responsible for the therapeutic process with their clients’ need to decide whether or not they will take responsibility for their own lives, including their therapeutic “life.” (Go back)
Note 27. Blum (1997) believes that transference hate can become an even greater problem than transference love because it reaches even deeper into clients’ and therapists’ psyches than does their loving: it threatens their fundamental self-esteem. Nevertheless, transference hate and countertransference hate are easily repressed or denied because they seem contrary to the therapeutic alliance. “Clients should not hate their attentive, resourceful therapists, and therapists should not hate their needy, vulnerable clients,” cultural and psychotherapeutic traditions hold. If hate is present, it must be denied, according to conventional wisdom. Then, like other denied and repressed emotions, hate intensifies on an unconscious level even as it is minimized or rationalized on a conscious level. As a result, hate can be unwittingly enacted by clients, and even by therapists. In turn, enactments of hate, such as holding a grudge, are powerfully reinforced by resultant experiences of self-enhancing power and enjoyable vindication.
Hate tends to be strong when intimacy fears surface. However desperately clients want to be in a close, loving relationship, few have learned to tolerate the stress of that intimacy. When it surfaces and therapists do not draw attention to it – let alone help clients to deal fully with it – clients often resort to such hate-based maneuvers as significantly reducing the efficiency of their therapist. They induce guilt in their therapists, especially those who need to be needed, by acting-out and thereby destroying any concrete plan to improve (Herron & Rouslin, 1982). (Go back)
Note 28. These therapists acknowledge that they may be used, as older siblings may be rightfully used by younger siblings, but they maintain that they must not be abused. They are not ultimately responsible for their “siblings;” unlike their parents, they can walk away if things get too bad. (Go back)
Note 29. Therapists must resolve the thorny conflict of accepting their clients as they are while challenging them to grow in maturity and responsibility. Therapists must come to a satisfactory balance between respecting clients’ perspectives and questioning the inevitable distortions they harbor, especially in the area of immature interpersonal relationships (Handley, 1995). (Go back)
Note 30. Perhaps nothing causes greater transferential conflict than suicidal desires of clients and the anti-suicide stance of therapists, for the possibility of clients committing suicide reminds therapists many times over of losses they had to accept in their families of origin. Hence, therapists experience conflict over holding and containing their clients’ suicidal desires and wanting to eradicate them at all costs and as soon as possible. In turn, therapists’ inability to resolve these conflicts satisfactorily can easily result in significant loss of rapport or even loss of the therapeutic alliance. (Go back)
Alpert, M. C. (1992). Accelerated empathic therapy: A new short-term dynamic psychotherapy. International Journal of Short-Term Psychotherapy, 7, 133-156.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th edition). Washington, DC: Author.
Bachant, J., & Adler, D. (1997). Transference: Co-constructed or brought to the interaction? Journal of the American Psychoanalytic Association, 45, 1097-1120.
Balint, M. (1968). The basic fault: Therapeutic aspects of regression. London: Tavistock Pub.
Bauer, B. P., & Mills, J.A. (1989). Use of transference in the here and now. Patient and therapist resistance. Psychotherapy, 26, 112-119.
Benedek, T. (1953). Dynamics of the countertransference. Bulletin of the Menninger Clinic, 17, 201-208.
Binder, J. L. (1996). Research finding on short-term psychodynamic therapy techniques. In F. Flack (Ed.), The Hatherleigh guide to psychotherapy (pp. 79-97). NY: Hatherleigh Press.
Bion, W. R. (1961). Experiences in groups. London: Tavistock.
Bion, W. R. (1967). Notes on memory and desires. Psychoanalytic Forum, 2, 272-273 and 279-280.
Blum, H. P. (1986a). Countertransference and the theory of technique: Discussion. Journal of the American Psychoanalytic Association, 34, 309-328.
Blum, H. P. (1997). Clinical and developmental dimensions of hate. Journal of the American Psychoanalytic Association, 45(2), 359-375.
Bollas, C. (1983). Expressive use of the countertransference. Contemporary Psychoanalysis, 19, 1-34.
Bollas, C. (19887). The shadow of the object: Psychoanalysis of the unthought known. London: Free Association Books.
Brenner, C. (1976). Psychoanalytic technique and psychic conflict. NY: International Universities Press.
Brenner, C. (1982). The mind in conflict. New York: International University Press.
Brodbeck, H. (1995). The psychoanalyst as participant and observer in the psychoanalytic process: Some thoughts on countertransference from a constructionist perspective. Psychoanalysis and Contemporary Thought, 18, 531-558.
Casement, P. (1991). Learning from the patient. New York: The Guilford Press.
Chodorow, N. (1996). Reflections on the authority of the past in psychoanalytic thinking. Psychoanalytic Quarterly, 65, 32-51.
Chused, J. (1992). The patient’s perception of the analyst: The hidden transference. Psychoanalytic Quarterly, 61, 161-184.
Chused J., & Raphling, C. (1992). The analyst’s mistakes. Journal of the American Psychoanalytic Association, 40, 137-149.
Cohen, M. B. (1952). Countertransference and anxiety. Psychiatry, 15, 231-243.
Colli, A., Tanzilli, Al, Dimaggio, G., & Lingiardi, V. (2014). Patient personality and therapist response: An empirical investigation. The American Journal of Psychiatry, 171, 102-108.
Comas-Diaz, K., & Jacobsen, F (1991). Ethnocultural transference and countertransference in the therapeutic dyad. American Journal of Orthopsychiatry, 61.
Cooper, A. M. (1987). Changes in psychoanalytical ideas: Transference interpretation. Journal of the American Psychoanalytical Association, 35, 77-98.
Davanloo, H. (1978). Principles and techniques of short-term dynamic psychotherapy. New York: Spectrum. 392-402.
Davanloo, H. (1990). Unlocking the unconscious. Chichester, England: Wiley.
Davies, J. M., & Frawley, M. G. (1994). Treating the adult survivor of childhood sexual abuse: A Psychoanalytic perspective. New York: Basic Books.
DeLaCour, E. P. (1985). Aspects of transference interpretation. Smith College Studies in Social Work, 56, 1-14.
Dieckmann, H. (1976). Transference and countertransference: Results of a Berlin research group. Journal of Analytical Psychology, 21, 25-36.
Epstein, L. (1977). The therapeutic function of hate in the countertransference. Contemporary Psychoanalysis, 13, 442-461.
Ferenczi, S. (1909). Sex in psychoanalysis. New York: Basic Books.
Fox, R. (1998). The “unobjectionable” positive countertransference. Journal of the American Psychoanalytic Association, 46, 1067-1087.
Freud, S. (1900). The interpretation of dreams. Standard Edition, 5. London: Hogarth Press.
Freud, S. (1912). The dynamics of transference. Standard Edition, 12: 99-108. London: Hogarth Press.
Freud, S. (1915). Observations on transference-love. Standard Edition, 12: 157-171. London: Hogarth Press.
Freud, S. (1917). Introductory lectures on psychoanalysis. Standard Edition, 16: 317-326.
Freud, S. (1940). An outline of psychoanalysis. Standard Edition, 23: 139-207. London: Hogarth Press.
Gabbard, G. O. (1994). Sexual excitement and countertransference love in the analyst. Journal of the American Psychoanalytic Association, 42, 1083-1106.
Gabbard, G. O. (1996). Therapeutic approaches to erotic transference. In F. Flack (Ed.), The Hatherleigh guide to psychotherapy (pp. 231-247). New York: Hatherleigh Press.
Gabbard, G. O. (2001) What can neuroscience teach us about transference? Canadian Journal of Psychoanalysis, 9 (1), 1-18.
Gazzillo, F., Lingiardi, V., et al.. (2015). Clinicians’ emotional responses and Psychodynamic Diagnostic Manual adult personality disorders: A clinically relevant empirical investigation. Psychotherapy, 52, 238-246.
Gelso, C. J., & Hayes, J. A. (1998). The psychotherapy relationship. New York: John Wiley & Sons, Inc.
Goldin, V. (1985). Problems of techniques. In A. J. Horner (Ed.), Treating the oedipal patient in brief psychotherapy (pp. 55-85). Northvale, NJ: Jason Aronson, Inc.
Grayer, E. D., & Sax, P. R. (1986). A model for the diagnostic and therapeutic use of countertransference. Clinical Social Work Journal, 14, 295-309.
Greenacre, P. (1954). The role of transference: Practical considerations in relation to psychoanalytic therapy. Journal of the American Psychoanalytic Association, 2, 671-684.
Greenson, R. R., & Wexler, M. (1969). The nontransference relationship in the psychoanalytic situation. International Journal of Psycho-Analysis, 50, 27-38.
Grinberg, L. (1997). Is the transference fear by the psychoanalyst? International Journal Psycho-Analysis, 78, 1-14.
Grindberg, L. (1962). On a specific aspect of countertransference due to the patients’ projective identification. International Journal of Psycho-Analysis, 43, 436-440.
Handley, N. (1995). The concept of transference: A critique. British Journal of Psychotherapy, 12(1), 49-59.
Heath, S. (1991). Dealing with the therapist’s vulnerability to depression. Northvale, NJ: Jason Aronson.
Heimann, P. (1950). On countertransference. International Journal of Psycho-Analysis, 31, 81-84.
Heimann, P. (1960). Countertransference. British Journal of Medical Psychology, 33, 9-15.
Herron, W. G., & Rouslin, S. (1982). Issues in psychotherapy. Washington, DC: Orgin.
Hinshelwood, R. (1999). Countertransference. International Journal of Psycho-Analysis, 80, 797-818.
Horowitz, M., Marmar, C., Krupnick, J. Wilner, N., Kaltreider, N., & Wallerstein, R. (1984). Personality styles and brief psychotherapy. New York: Basic Books.
Jung, C. G. (1966). The archetypes and the collective unconscious. Collected works (Vol. 9, Pt. 1). Princeton, NJ: Bollingen.
Kalsched, D. (1996). The inner world of trauma: Archetypal defenses of the personal spirit. New York: Routledge.
Kernberg, O. F. (1987). An ego psychology-object relations theory approach to the transference. Psychoanalytic Quarterly, 56, 97-221.
Kernberg, O. W. (1975). Borderline conditions and pathological narcissism. New York: Jason Aronson.
Klein, M. (1946). Notes on some schizoid mechanisms. International Journal of Psycho-Analysis, 27, 99-110.
Klein, M. (1957). Envy and gratitude. London: Tavistock.
Kupfer, D. J. et al. (2013). Diagnostic and statistical manual of mental disorders: Fifth Edition. Washington, D.C.: American Psychiatric Publishing.
Lasky, R. (1990). Catastrophic illness and the analyst's emotional reactions to it. International Journal of Psycho-Analysis, 71, 455-473.
Lear, J. (1993). An interpretation of transference. International Journal of Psycho-Analysis, 74, 739-755.
Levin, F. (1997). Integrating some mind and brain views of transference: The phenomena. Journal of the American Psychoanalytic Association, 45, 1121-1151.
Little, M. (1951). Countertransference and the patient's response to it. International Journal of Psycho-Analysis, 32, 32-40.
Little, M. (1957). ‘R’–The analyst’s total response to his patient’s needs. International Journal of Psycho-Analysis, 38, 240-254.
Luborsky, L. (1984). Principles of psychoanalytic psychotherapy: A manual for supportive-expressive treatment. New York: Basic Books.
Macalpine, I. (1959). The development of the transference. Psychoanalytic Quarterly, 19, 501-539.
Malan, D. H. (1976a). The frontier of brief psychotherapy. New York: Plenum Press.
Marmor, J. (1989). The future of dynamic psychotherapy. International Journal of Short-Term Psychotherapy, 4(4), 259-284.
Maroda, K. (1995). Projective identification and countertransference interventions: Since feeling is first. Psychoanalytic Review, 82(2), 229-247.
Meares, R., Stevenson, J., & Comerford, A. (2005). Distinct pattern of P3a event and related in borderline personality disorders. NeuroReport, 16, 289-293.
Meissner, W. (1996). The therapeutic alliance. New Haven, CN: Yale University Press.
Mishne, J. (2003). Multiculturalism and the therapeutic process. New York: Guilford.
Modell, A. H. (1980). Affects and their non-communication. International Journal of Psycho-Analysis, 61, 259-267.
Money-Kyrle, R. (1956). Normal counter-transference and some of its deviations. In D. Meltzer & E. O’Shaughnessey (Eds.), The collected papers of Roger Money-Kyrle (pp. 330-342). Strathtay, Perthshire: Clunie Press.
Nunberg, H. (1951). Transference and reality. International Journal of Psycho-Analysis, 32, 1-9. O’Crowley, A. M. (1999). The analysis of the transference: Interpretation and changes in psychotherapy. Dissertation Abstracts International: Section B: the Sciences & Engineering, 60(4-B), 1866.
Ogden, T. H. (1982). Projective identification and psychotherapeutic technique. New York: Jason Aronson.
Ogden, T. H. (1994). The concept of interpretive action. Psychoanalytic Quarterly, 63 (2), 219-245.
Olds, D. D. (1994). Connectionism and psychoanalysis. Journal of the American Psychoanalytic Association, 42, 581-612.
Olinick, S. (1996). An aspect of transference: The struggle to become an analysand. Journal of the American Psychoanalytic Association, 44 (2), 475-489.
Olnick, S. (1969). On empathy and regression in the service of the other. British Journal of Medical Psychology, 42, 41-49.
Pally, R. (2001). A primary role for nonverbal communication in psychoanalysis. Psychoanalytic Inquiry, 21, 71-94.
Pick, I. B. (1997). Working through in the countertransference. In R. Schafer (Ed.), The contemporary Kleinians of London (pp. 348-367). Madison, CN: International University Press.
Plakun, E. M. (1998). Enactments and the treatment of abuse survivors. Harvard Review of Psychiatry (5), 6, 318-325.
Racker, H. (1968). Transference and countertransference. New York: International Universities Press.
Racker, H. (1972). The meanings and uses of countertransference. Psychoanalytic Quarterly, 41, 487-506.
Rank, O., & Ferenczi, S. (1925). The development of psychoanalysis (C. Newton, Trans.). New York: Nervous and Mental Diseases Publishing Company.
Reik, T. (1937). Surprise and the psychoanalyst. New York: E.P. Dutton.
Renik, O. (1990). The concept of a transference neurosis and psychoanalytic methodology. International Journal of Psycho-Analysis, 71, 197-204.
Rioch, J. M. (1943). The transference phenomenon in psychoanalytic therapy. Psychiatry, 6, 147-156.
Sandler, J. (1976). Countertransference and role responsiveness. International Review of Psychoanalysis, 3, 43-47.
Schafer, R. (1959). Generative empathy in the treatment situation. Psychoanalytic Quarterly, 28, 342-373.
Schafer, R. (1968). Aspects of internalization. New York: International Universities Press.
Schafer, R. (1977). The interpretation of transference and the conditions for loving. Journal of the American Psychoanalytic Association, 25, 335-362.
Schafer, R. (1997). Vicissitudes of remembering in the countertransference: Fervent failure, colonization and remembering otherwise. International Journal of Psycho-Analysis, 78, 1151-1163.
Schore, A. N. (2003a). Affect dysregulation and disorders of the self. New York: W.W. Norton & Company.
Schore, A. N. (2003b). Affect regulation and the repair of the self. New York: W.W. Norton & Company.
Searles, H. (1975). The patient as therapist to his analyst/Nontransference. In P. Giovacchini (Ed.), Tactics and techniques in psychoanalytic therapy: Countertransference (Vol. II, pp. 95-151). New York: Jason Aronson.
Sharpe, E. (1930). The technique of psychoanalysis. International Journal of Psycho-Analysis, 2, 361-386.
Sifneos, P. E. (1979). Short term dynamic psychotherapy: Evaluation and technique (2nd ed.). New York: Plenum Press.
Stark, M. (1994). Primer on working with resistance. New York: Jason Aronson.
Stein, M. (1981). The unobjectionable part of the transference. Journal of the American Psychoanalytic Association, 29, 869-891.
Stein, G. S. (1993). A transference psychosis. Journal of Clinical Psychoanalysis, 2, 345-262.
Stein, R. (1974). Incest and human love. Baltimore: Penguin.
Sternberg, W. F., Bailin, D., Grant, M., & Gracely, R.H. (1998). Competition alters the perception of noxious stimuli in male and female athletes. Pain, 76, 231-238.
Stolorow, R. D. (1993). An intersubjective view of the therapeutic process. Bulletin of Menninger Clinic, 57, 450-457.
Strachey, J. (1934, 1969). The nature of the therapeutic action of psychoanalysis. International Journal of Psycho-Analysis, 50, 275-291.
Strupp, H. H., & Binder, J. L. (1984). Psychotherapy in a new key: A guide to time-limited dynamic psychotherapy. New York: Basic Books.
Strupp, H.H. & Hadley, S.W., & Gomes-Schwartz, R. (1977). Psychotherapy for better or worse: An analysis of the problem of negative effects. New York: Jason Aronson.
Tower, L. E. (1956). Countertransference. Journal of the American Psychoanalytic Association, 4, 224-255.
Tummula-Narra, P. (2015). Cultural competence as a core emphasis of psychanalytic psychotherapy. Psychoanalytic Psychology, 32, 275-292.
Ulanov, A. (1984). Transference/countertransference: A Jungian perspective. In M. Stein (Ed.), Jungian analysis (pp. 68-86). Evanston, IL: Northwestern University Press.
Volkan, V. (1995) Six steps in the treatment of borderline personality organization. Northvale, NJ: Jason Aronson, Inc.
Westen, D., & Gabbard, G. O. (2002). Developments in cognitive neuroscience: II. Implications for theories of transference. The Journal of the Psychoanalytic Association, 50, 99-134.
Westen, D. (1998). The scientific legacy of Sigmund Freud: Toward a psychodynamically informed psychological science. Psychological Bulletin, 124, 333-371.
Wilson, A. (1993). Hierarchical concepts in psychoanalysis. In A. Wilson & J. Gedo (Eds.), Hierarchical concepts in psychoanalysis: Theory, research, and clinical practice (pp. 311-324). NY: Guilford Press.
Wilson, A., & Weinstein, L. (1996). The transference and the zone of proximal development. Journal of the American Psychoanalytic Association, 44, 167-200.
Winnicott, D. W. (1965). The maturational processes and the facilitating environment. New York: International Universities Press.
Winnicott, D. W. (1988). Human nature. London: Free Association Press.
Wolstein, B. (1996). The analysis of transference as an interpersonal process. American Journal of Psychotherapy, 50, 499-509.
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