How therapists deal with transference?

20 transference is useful in the therapeutic

24. Dr. Billings is a therapist who specializes in psychoanalysis. She focuses on using free association and dream interpretation. 25. You are a humanistic therapist. A potential client is unfamiliar with your school of therapy and asks you to sum it up for him. You tell him the primary tenet of humanistic therapy is that individuals possess self-healing capacities. 26. Dr. Patterson engages in reflective listening with her depressed client. She waits for him to express his feelings and for him to decide what he wants to do about his problems. Dr. Patterson is practicing ________ psychotherapy. client-centered 27. Josie went to a psychoanalyst but found his style too cold and uninvolved. She wanted a therapist with whom she could have more of a relationship. She switched to a Rogerian therapist. The therapeutic setting is now one of warmth and acceptance. 28. Two key assumptions of the ________ approach to therapy are that psychological disorders are learned in exactly the same way as normal behaviors are and that they can be treated by applying the basic principles of learning. behavioral 29. “First, I would like you to get in a comfortable position and begin the breathing techniques which we have been practicing. When you sense that you have arrived at complete relaxation, we will proceed.” This therapist is initiating systematic desensitization. 30. The first step in systematic desensitization is discussing aspects of the feared situation that are most frightening. 31. Frank has been seeing a therapist about his spider phobia. The therapist first asked Frank to describe what it is about spiders that frightens him, and they then put these fears in order from least to most frightening. The therapist then taught Frank muscle relaxation, and finally Frank was exposed to a series of increasingly fearful stimuli. Frank has been seeing a therapist who uses systematic desensitization.

Transference

If you’re just tuning in, we’re in the middle of a sort of series of essays concerning how psychotherapy works. I started with an essay about the importance of the trusting relationship between therapist and client, and followed that up with a sort of overview of four different approaches to therapy technique; the psychodynamic approach, the cognitive-behavioral approach, the family systems approach and the humanistic approach. The plan is to write about each approach in more detail over the next four or so essays. Going in order of first appearance in the history of psychotherapy, we’re due for an essay on psychodynamic psychotherapy, which is, more or less, the descendent of the form of therapy that Sigmund Freud created over a hundred years ago.

Transference

One of the most important concepts associated with the psychodynamic tradition is the idea of transference. Transference is a simple appearing idea that has to do with the way people understand one another and form relationships with one another. As its name suggests, it involves the idea of transferring something from one place to another. What is being transferred in this case is an understanding of a person. Where it is being transferred to is onto another person. When transference is occurring, basically what is happening is that we are trying to understand someone (usually someone we don’t know very well) by making an assumption that they are similar to someone else, and will thus feel and behave in ways that are similar to how that other person would feel and behave.

Transference is a very fundamental process that human beings are constantly doing for better and for worse. Like most fundamental things we can’t help but do, such as being hungry, communicating via body language even when we do not speak, or finding one’s self sexually attracted or repulsed to another, it is not at all dangerous in moderation, but can create problems when done to excess. More to the point, the act of transference, like these other fundamental human processes, reveals and illuminates our motives and our thoughts; thoughts and motives that would otherwise remain hidden away from others and often even from ourselves (especially from ourselves Freud would say). Our acts of transference provide an information rich window into what we are desiring and what we wish to avoid. What we read into other people reveals our secret prejudices and our unfulfilled wishes. What is particularly wonderful about transference information is that it reveals or illuminates motives that people are often themselves unaware of having, or loath to fess up to. Part of Freud’s genius was to recognize not only that transference was something that occurred on a regular basis, but also to realize that the information about personal motives that a person’s transference activity revealed about him or her could be used as a therapeutic tool to promote self-understanding and healing.

Some therapists would disagree with the characterizations I’m about to make, but this is how I see it: transference is something that people do most all the time. It is itself an instance of a more fundamental and general process of perception that all people do which is to read patterns into things that aren’t there in an effort to make sense out of incomplete data.

A Relationship Illusion

Consider the following illustration which, for those of you listening to this via podcast consists of the following things. Three circles are arranged so that they are more or less equidistant. Each circle has a pie-shaped wedge cut out of it so that it looks like a pac-man, or a pie with a piece missing. These circles are oriented so that the missing wedges face each other. That is the visual description of what is in the image, but that is probably not the first thing you see when you look at the image. The first thing you are likely to see is a single triangle. There is no triangle really there, however. There are just three circles with wedges cut out of them. Your eyes see the circles with wedges too, but your brain interprets these three independent things into a single instance of a triangle; in doing so it adds things into the mix that aren’t there so as to organize a familiar pattern.

How is it possible to have such a strong optical illusion of a triangle present in the image when there is no triangle there? Basically, what makes this possible is that people viewing the figure have a lot of prior experience with triangles, and “instinctively” or reflexively read the whole figure of the triangle into existence based on features of the image that suggest features of triangles we’ve known in the past. This processing occurs at an automatic, unconscious and non-verbal level of perception within the brain; you have no choice but to see the triangle, just as you have no choice not to understand the words on this page (or the sounds in your ear). Optical illusions of this type illustrate what the brain is, which is a sort of pattern matching and pattern generating machine. Brains basically find patterns in the world and when things aren’t already in patterns we recognize, we try to fit patterns that are familiar with onto the data we have in an effort to make a familiar pattern appear. This automatic tendency is the basis of optical illusions, and it is also part of the basis of paranoia and a whole lot of interesting psychological phenomena, among them transference.

If seeing the triangle is an example of an optical illusion, transference is a kind of relationship illusion. It occurs easily and effortlessly when we first meet someone and try to form an understanding of who they are based on first impressions. It is an unconscious process, in that it occurs without effort, and does not announce itself. You only know it has happened when the person you thought you had a handle on goes and does something completely unexpected.

Relationship Schemas

It is not easy to get to know another person. When we first meet people what we appreciate about them is their surface. By surface I mean, our first impressions of who they are, and not just how they look (although that is clearly part of it). A person’s depths – for example, how responsible they are, how they treat others, how they carry themselves when under stress – are not immediately visible or knowable. Deeper appreciations of a person’s character are apparent only over time and repeated contacts and opportunities for observing what that person does. In effect we have to explore and witness each part of the people we form relationships with before we can accurately say that we know them well. Though it is undeniably true that trustworthy knowledge about relationships takes time and exploration to develop, it is also true that many people fail to understand this. Older people who have “been around the block” (e.g., who have been burned and hurt by relationship failures) understand, but young and inexperienced people never do, and people in love especially never do.

The reason why it is difficult to get to know someone quickly exposes a deep fact about the limits of human knowledge which is that all human knowledge is fundamentally indirect, based on potentially faulty perception processes, and subject to error. We interpret the world through the lens of our senses; we can’t appreciate it directly. I take this position to be a fundamental truth about the nature of reality. However, people who believe in direct and literal revelation (such as revelation from God) will necessarily see this issue differently, at least as concerns knowledge about God.

Though we cannot know things directly (at least with regard to other people), we can group together things that seem to belong together so as to form a sort of knowledge cluster, or mental map, or (as psychologists call it) a “schema”. Once schemas have formed to organize knowledge about a thing inside someone’s mind, those schemas are used as an aide in understanding and interpreting new information that concerns the things each schema is about. Think of schemas as a sort of reference book that sensory input can be compared against. The brain looks for a match between appearances out in the world (the way someone looks, acts, etc.) , and what is know about the world in the form of schemas. The brain does this because if a match can be found between something new and something old, then all of the stored knowledge inside the schema can be applied to the new situation without having to figure it all out again and again.

Let’s make this all more concrete by giving an example. Suppose you get into a fight with someone you know who has a crew cut and you end up coming to blows. You learn about those blows from the evidence of your senses – you ache, you are bruised and you feel pain! You learn that this person is likely to be violent, and this knowledge about crew cut-guy’s violence potential gets stored in a schema that represents and organizes your knowledge about this person. A week goes by, and there you are minding your own business when you happen to glance up and see a crew cut. Your immediate reaction is to get ready for a fight. This sense of urgency goes away quickly, however, when you realize that this new person is not the person you fought with but rather someone else. In this manner, knowledge taken from your senses is compared against your existing relationship schemas to aid you in quickly appreciating whether you are in danger or not. It’s a good thing you have these relationship schemas to organize your knowledge and trigger an alarm, because otherwise you might have again walked into a punch!

People (by definition) form schemas about all manner of things they know something about, including themselves (which you’ve heard of before, labeled as the ‘self-concept’), other people they know, and how they get along with those people they know. It is exactly these schemas concerning relationships that get transferred from one person onto another in the process of transference. You see that crew cut, and brace for a beating (or get ready to give one). It’s a different person this time wearing that crew cut, but they were initially close enough in appearance for you to mistake one for the other and treat the new person as though he was the old person.

It’s not just crew cuts that can lead us to confuse one person for another, and it’s not just violence that we can respond to. Transference is far more general than this simple example. It’s transference, for example, when you see someone who reminds you of a former lover you no longer see and you get sad for a moment. It’s transference when you fall in love at first sight, because something about that person leads you to believe they are your soul mate. It’s transference when the porn star dresses up as a French maid, or wears pigtails to suggest youth and innocence. It’s transference when you assume that a doctor is competent because she wears a white coat and carries a stethoscope, when the banker’s pin-striped suit leads you to infer wealth and stability, and when the neighbors appear to be richer than they really are because they have a (leased) BMW. It’s a form of transference when a woman who was abused by her father, goes and gets involved romantically with a partner who also abuses her. It’s also transference when a confidence man (or woman) leads you to trust him or her and then steals your money, or when a politician leads you to believe that he or she will act one way, causing you to vote for him or her, and then proceeds to act another way you didn’t expect. We respond to characteristics that aren’t really there, and what is more remarkable is we don’t tend to notice that we’ve done it; we do it automatically and without thinking. The illusion is so seamless it appears to have been out there in the world such that anyone else looking would see the same thing. That’s not the case, however. Transference is really an interpretation and an illusion that is generated inside the brain as the brain tries to organize the world.

As was the case with the triangle illusion, we try to make sense out of the things we are confronted with by matching their appearance to things we’ve known before. We organize things we see so that they fit the things we already know and we fill in the blanks that aren’t there with the rest of the pattern we know from our schemas. We can set ourselves up for problems when we do this, for instance by extending trust or intimacy (sexual or otherwise) to people who haven’t earned it. In this way, we end up harming ourselves some of the time by failing to appreciate dangers that are really present. The positive flip side of this equation is that we can also learn to benefit from transference by learning to accurately recognize novel situations as dangerous because they remind us of past dangers.

Transference As A Therapy Tool

Though transference happens automatically and unconsciously, it is possible to learn to become aware of transference Becoming aware of one’s transferences is a good thing, because it can help you to become a more conscious and proactive person, more in command of your own destiny, rather than a passive, reactive person. Proactive aware people are better able than passive reactive people to influence their lives for the better, and to learn from mistakes so as to not repeat them again and again. They tend to have a better quality of life than passive reactive persons.

There are many ways to become more aware of your own transferences. One way is to write journal or blog entries about what is happening in your life and then to read them over looking for patterns that you have that get you into trouble; areas where your judgment is repeatedly poor and you make the same mistakes over and over (as chronicled some time ago in that bestseller book “Women who love too much”). Another way is to hire a therapist who can help you to become aware of what your transference are. The psychoanalytically oriented school of therapy was the first to identify how becoming aware of transference could serve as a tool for personal growth, and they are still the best trained professionals for helping to accomplish this goal.

If I ask you, “what does therapy look like” and you had never had therapy before, you are likely to describe something like this image: “The therapist is a man with a beard who sits taking notes while the patient lays down on a couch. Neither patient or therapist look at each other. The patient drones on”. This is the classical image of psychoanalysis – quite out of date of course, but still useful for illustration purposes. Did you ever wonder why the therapist and the patient aren’t looking at each other? The reason is that this “no eye contact” arrangement was thought by early therapists to best promote the patient forming a transference relationship with the therapist. The therapist minimizes eye contact, and says nothing about himself and his life outside the therapy room so as to become a blank slate or canvas or screen onto which the patient can project his or her transferences, and the therapist can view these transferences happening, figure out what they are, and help the patient to become aware of what they’re doing. In theory, the patient’s behavior will change as he or she becomes more aware of what he or she is doing. In practice, such insight is often not enough to motivate real change in the patient’s life. It is helpful, but something more is often needed to get the patient to actually behave differently then they have been. The map is not the territory, but some patients and some therapists can mistake the one for the other.

What does this transference-encouraging look like in practice? I’ll give you an example from my own life. While on internship early in my career, I had to participate in my own therapy as a client. I had been reprimanded by a supervisor for being late to a meeting before this therapy process started and was feeling kinda paranoid about being judged unfairly. Very shortly after I started in with my therapist, I found myself feeling that he was judging me too and found myself getting pissed at him. I’m sure he would have picked up on this in short order, but I beat him to it in this instance, telling him, “This therapy relationship is going to work out fine – I hate you already”.

I had the advantage of being educated about transference before the above exchange took place, so my ability to be self-aware about it shouldn’t be taken as the norm. My anger towards my therapist, however, was classic transference. Another typical scenario is for a patient to develop a crush on a therapist or to feel ownership of the therapist’s time (feeling jealous when the therapist is unavailable), or to respond to the therapist as though the therapist was acting like a parent used to act (judgmental, for example, or overly permissive, and getting upset or sensitive when opportunities for slights or limit setting occur.

The aware therapist recognizes over-reactions for transference (generally a safe assumption, but not one to be just assumed), and interprets these back to the patient, ” I don’t think you are a bad person – but you seem to think that is what I think of you. Am I perhaps reminding you of past relationships you’ve been in where you have felt similarly treated?” The occurence of transference then becomes an opportunity for growth of the patient’s self awareness. If you can recognize the patterns you are succeptable to falling into, you aren’t as much at their mercy anymore.

Counter-Transference

It’s not just patients who are vulnerable to transference Therapists routinely (if grudgingly) also form transferences with their patients. This is called counter-transference when this happens, to indicate that it is the therapist’s rather than the patient’s issue and responsibility. A typical counter-transference might occur when a therapist starts feeling angry with a patient who describes doing something that is similar to something that previously harmed (or would harm) the therapist or someone the therapist cares about. A therapist I’m friendly with recently described a situation where a patient was talking about feeling good about not being expected by his elderly parent to take care of that parent. The parent in this case preferred the patient’s brother to provide care, and the patient enjoyed the freedom of being the ‘less responsible child’. The therapist found herself suddenly angry with her patient because she was herself a ‘responsible child’ with an irresponsible brother and she felt herself to be unfairly burdened with elder care responsibilities. It wasn’t exactly fair for her to get pissed at her patient, and she didn’t show it or let the anger feeling interfere with her duties, but she did feel it, and it was there because of counter-transference

Experienced and ethical therapists notice when they are forming counter-transferences and handle them appropriately. This means that they take steps to deal with their own issues so that they do not impose on their work. If they cannot manage their reaction on their own, they seek out their own therapy or supervision situation where they can get help in dealing with it. If they cannot deal with it, they must then stop working with the triggering patient if feasible and possible, recommending another comparable therapist who will not be so affected whenever that is possible. Therapists should strive to never abandon patients, but this doesn’t mean that sometimes everyone isn’t better off with a therapist recusing him or herself from working with a particular patient.

Recognizing counter-transference is as hard as recognizing transference, which is to say, very hard, and even good therapists may take a little while to figure out what is happening. It is ultimately the therapist’s responsibility to figure it out, however.

Conclusion

So that brings us to the end of this essay on transference Transference is a truly amazing process, casting light as it does on hidden thoughts, feelings, wishes and motivations that would otherwise remain hidden and troubling. Freud’s recognition and characterization of transference was brilliant in of itself (although I believe there were writers who recognized the phenomena before he did), but the thing that moves his contribution over the top to genius status was his recognition that transference could be used as a therapy tool. The psychoanalytic therapy he pioneered featured analysis of transference as a central element, and generations of psychoanalytically oriented therapists since his time have continued to recognize the importance and centrality of transference to the work of therapy. Awareness of transference is no cure-all. It is really best suited for problems that are relational in nature (such as anger or depression problems – where transference leads patients towards inappropriate and exaggerated moods and actions). It is not particularly helpful if you are working with a patient who is dealing with a primarily biological problem like schizophrenia or autism, for example. Nevertheless, it is a useful and brilliant tool and technique for most all therapists to know about and use appropriately to the benefit of patients. It is a major contribution of the psychodynamic approach to the universe of psychotherapy techniques.

REVIEW ARTICLE

Erotic transference: a brief review

Transferencia erótica: una breve revisión

Luciano Rassier Isolan

Psychiatrist. MSc student, UFRGS, Porto Alegre, RS

Correspondence

ABSTRACT

Erotic transference is a relatively common process in psychotherapy and psychoanalysis. In spite of its difficult management, when appropriately understood and managed, erotic transference may become a useful tool in the therapeutic process. In this review, we will address the concept of erotic transference, with emphasis on the difficulties faced in the technical management of the process, as well as the use of countertransference and the influence of gender in this situation.

Keywords: Psychoanalysis, psychoanalytic psychotherapy, transference, erotic transference, erotized transference.

RESUMEN

La transferencia erótica es un proceso relativamente común, tanto en la práctica de psicoterapia de orientación analítica como de psicoanálisis. A pesar de, muchas veces, traer dificultades en su manejo, se trata de un fenómeno que, si adecuadamente comprendido y manejado, puede transformarse en una herramienta útil al proceso terapéutico. En este trabajo, será realizada una revisión sobre el concepto de transferencia erótica, resaltándose sus dificultades de manejo técnico, así como el uso de la contratransferencia y la influencia del género en esa situación.

Palabras clave: Psicoanálisis, psicoterapia psicoanalítica, transferencia, transferencia erótica, transferencia erotizada.

INTRODUCTION

The erotic transference consists of a quite common process in the clinical practice of professionals that follow either the analytically-oriented psychotherapy or the psychoanalytical orientation, and it comes up as a topic of great theoretical and practical interest. In fact, as this form of transference is a considerable obstacle, it can be used as a valuable resource for the progress of treatment and understanding of parts of the patient’s personal history and psychic development and functioning.

The goal of the present work is to review the concept of erotic transference, emphasizing the technical difficulties to manage it, as well as to approach the use of counter-transference and the influence of gender in the transference phenomenon.

TRANSFERENCE

The term “transference” as a meaning of resistance was firstly employed by Freud in 1985.1 It was considered an obstacle to the analytical process that prevented the access to residuals of the childhood sexuality that remained linked to “erogenous zones”; in a normal evolution, such links should be already disconnected.

Some years later, in the classic Dora’s case,2 Freud pointed out that the patient does not remember anything that is forgotten or repressed, but act it out, reproducing the repressed not as a recall, but as a repetitive and unconscious action. In the post-scriptum of this work, Freud3 conceptualizes transference saying that transferences “are new editions or facsimiles of the impulses and fantasies which are aroused and made conscious during the progress of the analysis; but they have this peculiarity, which is characteristic for their species, that they replace some earlier person by the person of the physician. To put it another way: a whole series of psychological experiences are revived, not as belonging to the past, but as applying to the person of the physician at the present moment. Some of these transferences have a content which differs from that of their model in no respect whatever except for the substitution. These then – to keep to the same metaphor – are merely new impressions or reprints. Others are more ingeniously constructed; their content has been subjected to a moderating influence – to sublimination, as I call it – and they may even become conscious, by cleverly taking advantage of some real peculiarity in the physician’s person or circumstances and attaching themselves to that. These, then, will no longer be new impressions, but revised editions.” So far, transference had been seen as a clinical phenomenon that could be an obstacle to treatment, later on, however, Freud4 referred to transference for the first time as a therapeutical agent, and observed that transference was not always an obstacle, it could have an important role in the process of understanding patients.

The specific qualities of transference were assigned an additional meaning when the concept of “transference neurosis” was introduced.5 This concept emphasized the way how past relationships, which compose the neurosis, affect the patient’s feelings towards the therapist. This concept was later widened, when Freud6 pointed out that “the patient is compelled to repeat repressed contents as something from the present, instead of, as the physician should realize, remember it as something from the past”. The theme of such reproductions, which arise with great and undesirable exactness, is some part of the children’s sexual life and invariably is expressed through transference that takes place between patient and therapist. When one reaches such phase, we can say that the previous neurosis is replaced by a new one, the “transference neurosis.” Repeating the past through transference is a consequence of the “repetition compulsion.” The transference itself is only a fragment of repetition, which is a transference of the forgotten past not only from patient to therapist, but to all the other aspects of the present.

The understanding of transference as a source of unconscious communication was very well developed by Melanie Klein.7 According to her, when the therapeutic relationship is set, the patient recalls feelings, conflicts and defenses he or she experienced in the original situation. Klein understood transference as a reproduction of all primitive objects and objects relations internalized in the patient’s psychology, followed by drives, unconscious fantasies and anxieties.

According to Dewald,8 transference is defined as the displacement to an object from the present moment of all impulses, defenses, attitudes, feelings and responses experienced with the first objects in life . Transference would be a repetition of situations whose origin rely in the past. Greenson9 defines transference as an unconscious process, as a repetition of an object relationship that took place in the past, usually with people who were important for the child’s in his/her first years of life, unconsciously transferred to figures from the present.

Therefore, by analyzing the concept of transference under the light of different authors, it can be defined as a set of unconscious expectations, beliefs and emotional responses that a patient carries to the therapeutic setting. Such responses are not necessarily based on who the therapist is or how he or she really acts, but on the persisting experiences that the patient has during his life with other important figures from the past.

EROTIC TRANSFERENCE

In 1915, Freud10 referred to the “transference love” as a serious difficulty in psychoanalysis as a very frequent situation in which the patient declares love for the doctor. Freud points out that the doctor must recognize that the patient’s falling in love is not to be attributed to the charms of his own person. Freud intends to demonstrate how much the powers of nature are present in the transference phenomenon and also to call the doctor’s attention to what he or she is managing, using the erotic transference to better understand the patient. In this work, Freud classified transference both as positive and negative. The positive transference is then referred to all drives and derivatives related to libido, especially feelings of affection and care, including erotic desires, provided that they have been sublimated under the form of non-sexual love and do not persist as an erotic link. On the other hand, the negative transference concerns the presence of aggressive drives and their derivatives, such as envy, jealous, voracity, destructiveness and intense erotic feelings.

When approaching special types of transference, Sandler11 reported that there are patients who develop erotic transference and refuse to go on with the usual therapeutic treatment, they can reject interpretations that relate current feelings to the past and do not search further explanations for the meaning or cause of symptoms they had complained before. Sessions are used to express their love, gratification in the presence of the beloved, and pledges for having their “love” corresponded. Even though Freud10 acknowledged the resistance of transference, he warned therapists not to confound this reaction with true love, and at the same time he warned them against their attempts to repress patients’ love. He said that “to urge the patient to suppress, renounce or sublimate her instincts the moment she has admitted her erotic transference would be, not an analytic way of dealing with them, but a senseless one. It would be just as though after summoning up a spirit from the underworld by cunning spells, one were to send him down again without having asked him a single question.” This means it would be as disastrous for the patient to have her love fulfilled as suppressed.

Erotic transferences can be manifested in different ways, following both the neurotic and psychotic patterns. Different authors have differentiated several forms of erotic transference. Bolognini12 described four types of erotic transference, with their respective dynamic origins and repercussions in the analytical relationship. The erotised transference would be predominantly based on a psychotic modality. The underlying fantasy in the transference erotisation, which would have a defensive function, would be the fantasy of separation and abandonment, which will be an attempt to restore that state of narcissist fusion with the mother. The erotic transference would be based on a neurotic modality, and loving and affectionate transferences would be clinical manifestations that would correspond to a healthier and ameliorated behavior. For many authors, the erotised transference is typical from borderline patients, very disturbed; in the erotic transference there is an excessive anguish to be loved by the analyst, with manifest and conscious demands of sexual gratification, which are direct, exaggerated and persistent.13,14 It expresses a very primitive mental functioning, in which the object is highly idealized and persecutory. According to Teixeira da Silva,15 apud Blitzen, the erotised transference is a reflex of pre-genital conflicts in which aspects such as intense violence, fragility of the self and lost of the notion “as if” are predominant; the therapist is not “as if” he or she were the father or mother, the therapist is the patient’s father or mother. There is a loss in the capacity of symbolizing, and the intensity of this loss shall represent the level of patient’s regression. In the erotic transferences, the capacity of fantasizing is not lost, and the erotic demands remain in the level of fantasy, the analyst is an object of the patient’s fantasy, different from the erotised fantasies, in which the therapist is a concrete object. Saul16 discusses the role of latent aggressiveness in situations of erotic transference. He points out that this type of transference is associated to real frustrations in relationships that took place in the early years of life, suggesting that hostility and rage triggered by such frustrations could be repeated in the relationship with the therapist. Transference love would be a way of protecting the physician from hostile feelings.

Zimerman17 considers that two risks may follow the installation of erotised transference in the analytical field: one is that when the patient’s demands are not satisfied by the therapist, the patient acts outside the analytical situation, sometimes acquiring some severe traces of malignity. The second possibility is equally malignant, it is when the therapy can end up perverting the transference, including the possibility of the therapist being involved in it.

In the management of erotic transference, one should take into account that new editions of infantile conflicts result from unfulfilled desires that try to be accomplished in the context of the psychoanalytical treatment. It is the therapist’s responsibility to show the reality to the patient, which can be made through a detailed analysis of transference/countertransference feelings of the dyad patient-therapist. When the therapist makes his or her interpretation, putting unconscious emotions into words, he opens the passage to the symbolic. When interpretation makes the unconscious conscious, it allows the libido to be at the self disposal for healthier investments. It puts the patient in contact with reality and not with the fulfillment of a desire, as the patient requires. Moreover, if interpretation is employed correctly, it frequently reduces the desire and resistance inherent to the erotic transference.18 Elaborating the transference love implies elaborating the renouncement and the grief that usually follow the resolution of an oedipal situation. At the same time, the patient must learn that searching for the oedipal object would be a permanent aspect in all his or her love relationships. This does not mean do understand all future love relationships as resulting solely from the oedipal situation, but that the oedipal structure is present and affects the framework of love experiences.

Freud,10 however, pointed out that there is “one class of women with whom this attempt to preserve the erotic transference for the purposes of analytic work without satisfying it will not succeed. These are women of elemental passionateness who tolerate no surrogates.” He goes on saying that “with such people one has the choice between returning their love or else bringing down upon oneself the full enmity of a woman scorned. In neither case can one safeguard the interests of the treatment. One has to withdraw, unsuccessful; and all one can do is to turn the problem over in one’s mind of how it is that a capacity for neurosis is joined with such an intractable need for love.”

For Kernberg,19 the most important technical issues in the management of erotic transfer are: first of all, tolerance with the development of sexual feelings towards the patient, either homosexual or heterosexual, which requires doctors’ internal freedom so that they can use their psychological bisexuality. Then, the importance of systematically analyzing the patient’s defenses against the complete expression of sexual transference, and the risk of becoming invasive through seduction; and finally, the physician’s capacity of analyzing the expression of transference love and his or her reactions to frustration, which will inevitably occur. The therapist’s task would be to avoid talking about his countertransference feelings and integrate the understanding obtained with his or her countertransference with transference interpretations about the patient’s unconscious conflicts.

THE USE OF COUNTERTRANSFERENCE

Initially, countertransference was also treated as an undesirable phenomena of the psychoanalytical treatment, just like transference. Freud20 coined the term countertransference defining it as a phenomenon that arises in the physician “as a result of the patient’s influence on his unconscious feelings.” As in the transference, Freud’s first reaction was to consider it as something inadequate and disturbing that should be avoided. He says, with relation to the doctor, that “we are almost inclined to insist that he shall recognize this counter-transference in himself and overcome it.” Later, Freud21 was already aware of the potential value of countertransference and recommended: The therapist “must turn his own unconscious like a receptive organ towards the transmitting unconscious of the patient … so the doctor’s unconscious is able, from the derivatives of the unconscious which are communicated to him, to reconstruct that unconscious, which has determined the patient’s free associations.”

However, it was after the studies developed by Racker22 and Heimann23 that countertransference became an additional factor in the process of understanding the therapist’s work. Racker22 considered countertransference as a set of therapist’s images, feelings and impulses during the session that could happen in three different ways: a) as an obstacle; b) as a therapeutic instrument; and c) as a “field” in which the patient can really acquire a live experience, different from that he had originally. He also described two types of countertransference reactions: the complementary countertransference, when the analyst takes on the role of the patient’s object; and the concordant countertransference, when the analyst takes on an aspect of the patient’s personality (self, id and superego). Heimann23 describes the countertransference as the set of all physician’s feelings towards the patient. He points out that the therapist can use the emotional responses to the patients’ projections to understand them. For that end, the therapist must be able to keep his/her feelings for himself/herself, instead of discharging them as does the patient.

Erotic transference usually causes some countertransference reactions in the therapist, and examining such reactions is important to understand the patient. Krenberg19 considers it is useful that the therapist is able to tolerate his/her sexual fantasies towards the patient, and must let an imaginary sexual relation happen in the narrative, mentally following the patient’s erotic transference. This will allow him to progressively realize the antilibidinal, antidestructive and rejecting aspects that can be hidden in the patient’s explicit erotic manifestation. According to this author, the analyst that feels himself/herself free to explore, in his/her own mind, the sexual feelings towards the patients will be able to assess the nature of the transference development and, thus, avoid the defensive negation of his own erotic response to the patient. The analyst must, at the same time, be able to examine the transferencial love without acting his countertransference out in what may be configured as a seductive approach.

Teixeira da Silva15 draws attention to the role of the therapist’s own treatment. He says that the “analyst’s ideal didactic analysis would be that in which he/she could analyze with detail his/her pre-oedipal and oedipal aspects and overcome them to develop a natural and true relation with himself/herself. All this would be complementary to practice and theory. This author claims that there is no ideal analysis and that we must understand our work and clinical experience as an endless source of knowledge and development.

GENDER AND EROTIC TRANSFERENCE

There is a growing tendency in the psychoanalytical literature of works considering that transference and countertransference are influenced by the gender and vital cycle of the dyad involved in the analysis. The analyst’s and patient’s sexual identity does not only stimulate but create specific transference and countertransference resistance and difficulties.24 As to the erotic transferences, this is not different. Note, for example, that most of the psychoanalytical case reports involving erotic and erotised transferences is about female patients with male therapists.

Teixeira da Silva,15 points out that both male and female therapists meet difficulties to realize transferences in which they have the role of the opposite sex. This author listed the different characteristics of transference in the therapeutic dyads according to the respective genders. In the male therapist and male patient dyad usually predominates, in the oedipal transference, the situation of an aggressive competition with the father, and, in general, the heterosexual impulses are not realized because they are displaced to external objects. The passive homosexual impulses, when aroused, are sources of great transference and countertransference resistances. In the female therapist and female patient dyad, the arousal of an intense erotisation is more frequent, because the woman regresses more easily to a situation of fusion with the phallic mother, once the therapeutic situation corresponds to the original situation of the girl’s development, in which she must firstly solve her erotic and homosexual development with her mother, then enter the positive oedipal phase, elaborate the oedipus complex and establish her sexual identity. In the male therapist and female patient dyads the erotic transferences – or erotised transference – are more intense. In this situation, the therapist may find difficult to differentiate when the patient projects the rivalry and hostility against the oedipal mother of an anal regression against the frustrating object, that is, against the oedipal mother. In those dyads, when there is a homosexual desire towards the mother, it will be difficult for the therapist to identify it and separate it from the heterosexual desires concerning the father. In the female therapist male patient dyad, there would have an absence of erotised transferences due to the fear of the powerful pre-oedipal mother that generates anguishes of castration that interfere in the development of strong erotic desires for the oedipal mother.

There is a number of other authors that also made important contributions for the understanding of the issue. Lester,25 for example, stressed that the male patient anxiety towards the female therapist as a phallic pre-oedipal powerful and castrating mother can blur and inhibit the expression of sexual feelings towards the therapist as an oedipal mother, which will account for the few cases reporting this situation in the dyad female therapist and male patient. The author also observed that the passivity engendered by regression in the analytic therapy is dystonic to his active male sexual role. Such point of view was not corroborated by Gornick.26 He thought that, for certain male patients, it would be much more difficult to be passive and dependant than expressing sexual feelings, which would make men to defend themselves from such feelings, developing erotic feelings towards the therapist in an attempt to restore the sense of male domination.

Pearson27 points out that the erotic transference is more frequent in women as a form of transference, while men would resist against any form of conscience of an erotic transference. Usually, men would displace their erotic feelings towards the therapist to a woman out of the therapy setting, because recognizing such desires would threaten his sense of autonomy. Person also considers that the erotic transference in women is more frequently a desire for love, whilst in men it is a sexual desire.

CONCLUSION

The management of erotic transference can pose some difficulties, which can be compared to hostile and paranoid transferences, once they can block the therapist’s analytical capacity, at least temporarily.

According to Meurer,28 such situations challenge the therapist’s capacity, demanding a high level of integration with the self, free fluctuating attention and free perceptive sensitivity to be able to detect, acknowledge and interpret what happens in the transference and countertransference. In the erotic transference, the patient is expected to externalize once more his or her intense infantile desire of loving and being loved, and his or her permanent neurotic willingness to fulfill oedipal love frustrations and obtaining unrestricted and exclusive love from the mother-father therapist. A delicate issue is the possibility, and even necessity, of using countertransference to identify the nature of feelings and fantasies present in the transference. Thus, countertransference does not need to arise as an obstacle but as a factor to understanding. As a consequence, the patient’s transference will not be only resistance and drawback, but also a valuable form of communication, which will bring contributions to treatment.

Wallerstein,29 in an analysis of the “Observations on transference love”10 stresses that Freud: 1) Identified the high prevalence of erotic feelings evoked in the psychoanalytic treatment and the “dangers” of such feelings; 2) observed that a small part of patients would develop a form of transference love that would act as very intense resistances and could not be analyzable; and 3) established the main technical foundations to cope with such transferences, as the rule of abstinence and neutrality.

The fact that erotic transference is a common process that can cause technical difficulties when being managed was always stressed in the psychoanalytical literature. Following the basic principles of psychoanalysis postulated by Freud, acknowledging the phenomenon of resistance and adequately using countertransference are necessary conditions for understanding and solving it, which brings precious benefits for the patient’s treatment.

The therapist’s personal treatment is a fundamental instrument, which can make him able to understand his own psychological functioning and the processes that take place in the patient’s mind, as well as the mechanisms that influence the erotic transference and countertransference phenomena. Other required resources can be learning through clinical and theoretical seminars, selected readings and individual supervising.

According to Zimmerman,17 although the patient has an absolute conviction and determination in his game of seduction, in his or her inner deep he is afraid the analyst makes some mistakes, as remaining cold, indifferent and distant from the patient’s appeals and erotic fantasies; getting disturbed and defensively replacing interpretation by criticisms, accusations, moral lessons and apology to good behavior; the patient can even have repressive actions that include the fear of having the treatment interrupted, use of medication or being referred to other professional; and the real possibility of the therapist getting involved in a sexual intimacy, which would characterize a total perversion of transference and of the psychoanalytical process.

The theoretical and technical difficulties in the identification and management of the erotic transference can get worse, when they start to cause ethical and legal problems beyond clinical ones. Bad sexual behavior in the patient-therapist relationship is potentially harmful to the patient and therapist, destructive in relation to the therapeutic work and negative to the profession.

Acknowledgments

I am grateful to Mr. Hamilton Perdigão da Fontoura for his support and advice.

2. Freud S. Fragmentos da análise de um caso de histeria. In: Edição standard brasileira das obras psicológicas completas de Sigmund Freud. Rio de Janeiro: Imago; 1969. v. 7, p. 5-107.

4. Freud S. Notas sobre um caso de neurose obsessiva. In: Edição standard brasileira das obras psicológicas completas de Sigmund Freud. Rio de Janeiro: Imago; 1969. v. 10, p. 159-250.

7. Klein M. Los orígenes de la transferencia. In: Obras completas. Buenos Aires: Paidós-Hormé; 1974. p. 47-77.

9. Greenson R. A transferência. In: A técnica e a prática da psicanálise. Rio de Janeiro: Imago; 1981. p. 167-247.

10. Freud S. Observações sobre o amor transferencial. In: Edição standard brasileira das obras psicológicas completas de Sigmund Freud. Rio de Janeiro: Imago; 1969. v. 12, p. 208-21.

12. Bolognini S. Transference: erotized, erotic, loving, affectionate. Int J Psychoanal. 1994;75:73-86.

13. Blum HP. The concept of erotized transference. J Am Psychoanal Assoc. 1973;21:61-76.

14. Rappaport EA. The management of an erotized transference. Psychoanal Q. 1956;25:515-29.

15. Teixeira da Silva TN. Transferências e contratransferências eróticas. O manejo das mesmas. Rev Bras Psicanal. 1996;30:1205-22.

16. Saul LJ. The erotic transference. Psychoanal Q. 1962;31:54-61.

20. Freud S. As perspectivas futuras da terapêutica psicanalítica. In: Edição standard brasileira das obras psicológicas completas de Sigmund Freud. Rio de Janeiro: Imago; 1969. v. 11, p. 125-36.

21. Freud S. Recomendações aos médicos que exercem psicanálise. In: Edição standard brasileira das obras psicológicas completas de Sigmund Freud. Rio de Janeiro: Imago; 1969. v. 12, p. 149-59.

22. Racker H. Os significados e usos da contratransferência. In: Estudos sobre técnica psicanalítica. Porto Alegre: Artes Médicas; 1982. p. 120-57.

23. Heimann P. Sobre a contratransferência. Rev Psic Soc Psicanal Porto Alegre. 1995;2:171-6.

24. Araujo MS, Bassols AM, Escobar J, Dal Zot J. Sexualidade e prática psicanalítica: identidade de gênero e sua influência no processo psicanalítico. Rev Bras Psicanal. 1996;30:1071-9.

25. Lester EP. The female analyst and the erotized transference. Int J Psychoanal. 1985;66:283-93.

26. Gornick LK. Developing a new narrative: the woman therapist and the male patient. Psychoanal Psychol. 1986;3:299-325.

27. Person ES. The erotic transference in women and in men: differences and consequences. J Am Acad Psychoanal. 1985;13;159-80.

28. Meurer JL. Manejo da transferência e da contratransferência eróticas na formação psicanalítica. Rev Bras Psicanal. 1996;30:1307-12.

Correspondence to
Luciano Rassier Isolan
Rua Ramiro Barcelos, 2171/31
90035-007 – Porto Alegre – RS – Brazil
E-mail: [email protected]

Received on February 14, 2005. Revised on February 18, 2005. Accepted on April 19, 2005.

Final paper presented at the end of the first year of the Specialization Course on Analytically-oriented Psychotherapy, Centro de Estudos Luís Guedes, Universidade Federal do Rio Grande do Sul (CELG/UFRGS), under supervision of Jair Escobar.

What is transference?

Transference is often used to describe a redirection of unconscious feelings from their original object to a new object. For example, feelings which originally occurred towards a parent or spouse could then be transferred to a therapist or counsellor within a therapeutic relationship.

Some types of feelings which can be attributed to transference include:

· Feelings of platonic or familial love

· Negative feelings such as anger or bitterness

· Romantic or sexual attraction

Do we transfer our feelings at other times?

Transference isn’t limited to a therapist/client relationship, however. We can find ourselves repeating certain feelings in any social situation. When we are introduced to a complete stranger, we may find that they remind us of our overbearing mother and have a negative reaction before they have even said hello. Or they may remind us of a close friend and we may treat them as such as a result.

The way that we deal with the world is shaped by our former experiences. Transference is a product of this theory and, in the confines of a psychoanalytic relationship, can take on a greater significance than at other times.

Why does transference happen in therapy?

In a friendship or romantic relationship, both partners will bring their own personalities, desires and feelings to the partnership. However in a therapeutic relationship, the therapist is putting forward the appearance of a blank slate. They are effectively anonymous, there to reflect the issues and concerns of the client so that they can be better analysed.

Sometimes it is obvious why transference is occurring. If a client is depressed because of a string of bad relationships, they will likely feel validated by a therapist who is providing a sympathetic listening ear. This may lead them to develop romantic feelings towards the therapist and to fantasise about having a closer connection with them.

However, it is important to recognise transference as and when it occurs in order for the feelings to be brought into the open. A qualified therapist will be able to draw attention to these feelings and explore them so that they may be resolved.

Can transference be a good thing?

In our everyday relationships, it can be harmful to associate someone with feelings which are occurring as a result of our unconscious thoughts. To label someone according to our prior experiences prevents us from building an honest relationship with them and gives us a narrow and self-centred view. However, transference in therapy can be very beneficial as it can potentially unlock the answer to issues which have yet to be healed.

If the transferred feelings can be discussed openly and honestly, then new ideas can be pinpointed between the client and therapist. The client will come to realise that their feelings are representations of their inner feelings and are not occurring as a result of their relationship with the therapist. In this way, the relationship can become stronger and the client will feel ready to move on to the next part of their treatment.

Tips for dealing with transference

Work out how helpful/harmful it is

If you think that your feelings are hindering your progress in therapy (ie when they are so strong you feel unable to be honest about them), it’s OK to leave and seek a different therapist. This is especially important if you are attending goal-based treatments such as CBT as you will need to be able to tackle your specified issue with no distractions.

Stay calm

Transference is completely normal. You are not ‘crazy’ for being attracted to your therapist or associating them with your father. The important thing is to bring these feelings to light and discuss them together.

Wait it out

If you are feeling trapped by your thoughts and unable to break free, try to give it time. Once you have openly discussed your feelings with your therapist, they should diminish over time.

Be practical

Your therapist should be able to help you to see the difference between themselves and the original object of your feelings. It could be that it’s just one mannerism which is reminding you of your childhood friend or that your therapist has the same voice as your mother but looks nothing like her. The more differences you can see, the more you will be able to scale down your feelings.

If you’re just tuning in, we’re in the middle of a sort of series of essays concerning how psychotherapy works. I started with an essay about the importance of the trusting relationship between therapist and client, and followed that up with a sort of overview of four different approaches to therapy technique; the psychodynamic approach, the cognitive-behavioral approach, the family systems approach and the humanistic approach. The plan is to write about each approach in more detail over the next four or so essays. Going in order of first appearance in the history of psychotherapy, we’re due for an essay on psychodynamic psychotherapy, which is, more or less, the descendent of the form of therapy that Sigmund Freud created over a hundred years ago.

Transference

One of the most important concepts associated with the psychodynamic tradition is the idea of transference. Transference is a simple appearing idea that has to do with the way people understand one another and form relationships with one another. As its name suggests, it involves the idea of transferring something from one place to another. What is being transferred in this case is an understanding of a person. Where it is being transferred to is onto another person. When transference is occurring, basically what is happening is that we are trying to understand someone (usually someone we don’t know very well) by making an assumption that they are similar to someone else, and will thus feel and behave in ways that are similar to how that other person would feel and behave.

Transference is a very fundamental process that human beings are constantly doing for better and for worse. Like most fundamental things we can’t help but do, such as being hungry, communicating via body language even when we do not speak, or finding one’s self sexually attracted or repulsed to another, it is not at all dangerous in moderation, but can create problems when done to excess. More to the point, the act of transference, like these other fundamental human processes, reveals and illuminates our motives and our thoughts; thoughts and motives that would otherwise remain hidden away from others and often even from ourselves (especially from ourselves Freud would say). Our acts of transference provide an information rich window into what we are desiring and what we wish to avoid. What we read into other people reveals our secret prejudices and our unfulfilled wishes. What is particularly wonderful about transference information is that it reveals or illuminates motives that people are often themselves unaware of having, or loath to fess up to. Part of Freud’s genius was to recognize not only that transference was something that occurred on a regular basis, but also to realize that the information about personal motives that a person’s transference activity revealed about him or her could be used as a therapeutic tool to promote self-understanding and healing.

Some therapists would disagree with the characterizations I’m about to make, but this is how I see it: transference is something that people do most all the time. It is itself an instance of a more fundamental and general process of perception that all people do which is to read patterns into things that aren’t there in an effort to make sense out of incomplete data.

A Relationship Illusion

Consider the following illustration which, for those of you listening to this via podcast consists of the following things. Three circles are arranged so that they are more or less equidistant. Each circle has a pie-shaped wedge cut out of it so that it looks like a pac-man, or a pie with a piece missing. These circles are oriented so that the missing wedges face each other. That is the visual description of what is in the image, but that is probably not the first thing you see when you look at the image. The first thing you are likely to see is a single triangle. There is no triangle really there, however. There are just three circles with wedges cut out of them. Your eyes see the circles with wedges too, but your brain interprets these three independent things into a single instance of a triangle; in doing so it adds things into the mix that aren’t there so as to organize a familiar pattern.

How is it possible to have such a strong optical illusion of a triangle present in the image when there is no triangle there? Basically, what makes this possible is that people viewing the figure have a lot of prior experience with triangles, and “instinctively” or reflexively read the whole figure of the triangle into existence based on features of the image that suggest features of triangles we’ve known in the past. This processing occurs at an automatic, unconscious and non-verbal level of perception within the brain; you have no choice but to see the triangle, just as you have no choice not to understand the words on this page (or the sounds in your ear). Optical illusions of this type illustrate what the brain is, which is a sort of pattern matching and pattern generating machine. Brains basically find patterns in the world and when things aren’t already in patterns we recognize, we try to fit patterns that are familiar with onto the data we have in an effort to make a familiar pattern appear. This automatic tendency is the basis of optical illusions, and it is also part of the basis of paranoia and a whole lot of interesting psychological phenomena, among them transference.

If seeing the triangle is an example of an optical illusion, transference is a kind of relationship illusion. It occurs easily and effortlessly when we first meet someone and try to form an understanding of who they are based on first impressions. It is an unconscious process, in that it occurs without effort, and does not announce itself. You only know it has happened when the person you thought you had a handle on goes and does something completely unexpected.

Relationship Schemas

It is not easy to get to know another person. When we first meet people what we appreciate about them is their surface. By surface I mean, our first impressions of who they are, and not just how they look (although that is clearly part of it). A person’s depths – for example, how responsible they are, how they treat others, how they carry themselves when under stress – are not immediately visible or knowable. Deeper appreciations of a person’s character are apparent only over time and repeated contacts and opportunities for observing what that person does. In effect we have to explore and witness each part of the people we form relationships with before we can accurately say that we know them well. Though it is undeniably true that trustworthy knowledge about relationships takes time and exploration to develop, it is also true that many people fail to understand this. Older people who have “been around the block” (e.g., who have been burned and hurt by relationship failures) understand, but young and inexperienced people never do, and people in love especially never do.

The reason why it is difficult to get to know someone quickly exposes a deep fact about the limits of human knowledge which is that all human knowledge is fundamentally indirect, based on potentially faulty perception processes, and subject to error. We interpret the world through the lens of our senses; we can’t appreciate it directly. I take this position to be a fundamental truth about the nature of reality. However, people who believe in direct and literal revelation (such as revelation from God) will necessarily see this issue differently, at least as concerns knowledge about God.

Though we cannot know things directly (at least with regard to other people), we can group together things that seem to belong together so as to form a sort of knowledge cluster, or mental map, or (as psychologists call it) a “schema”. Once schemas have formed to organize knowledge about a thing inside someone’s mind, those schemas are used as an aide in understanding and interpreting new information that concerns the things each schema is about. Think of schemas as a sort of reference book that sensory input can be compared against. The brain looks for a match between appearances out in the world (the way someone looks, acts, etc.) , and what is know about the world in the form of schemas. The brain does this because if a match can be found between something new and something old, then all of the stored knowledge inside the schema can be applied to the new situation without having to figure it all out again and again.

Let’s make this all more concrete by giving an example. Suppose you get into a fight with someone you know who has a crew cut and you end up coming to blows. You learn about those blows from the evidence of your senses – you ache, you are bruised and you feel pain! You learn that this person is likely to be violent, and this knowledge about crew cut-guy’s violence potential gets stored in a schema that represents and organizes your knowledge about this person. A week goes by, and there you are minding your own business when you happen to glance up and see a crew cut. Your immediate reaction is to get ready for a fight. This sense of urgency goes away quickly, however, when you realize that this new person is not the person you fought with but rather someone else. In this manner, knowledge taken from your senses is compared against your existing relationship schemas to aid you in quickly appreciating whether you are in danger or not. It’s a good thing you have these relationship schemas to organize your knowledge and trigger an alarm, because otherwise you might have again walked into a punch!

People (by definition) form schemas about all manner of things they know something about, including themselves (which you’ve heard of before, labeled as the ‘self-concept’), other people they know, and how they get along with those people they know. It is exactly these schemas concerning relationships that get transferred from one person onto another in the process of transference. You see that crew cut, and brace for a beating (or get ready to give one). It’s a different person this time wearing that crew cut, but they were initially close enough in appearance for you to mistake one for the other and treat the new person as though he was the old person.

It’s not just crew cuts that can lead us to confuse one person for another, and it’s not just violence that we can respond to. Transference is far more general than this simple example. It’s transference, for example, when you see someone who reminds you of a former lover you no longer see and you get sad for a moment. It’s transference when you fall in love at first sight, because something about that person leads you to believe they are your soul mate. It’s transference when the porn star dresses up as a French maid, or wears pigtails to suggest youth and innocence. It’s transference when you assume that a doctor is competent because she wears a white coat and carries a stethoscope, when the banker’s pin-striped suit leads you to infer wealth and stability, and when the neighbors appear to be richer than they really are because they have a (leased) BMW. It’s a form of transference when a woman who was abused by her father, goes and gets involved romantically with a partner who also abuses her. It’s also transference when a confidence man (or woman) leads you to trust him or her and then steals your money, or when a politician leads you to believe that he or she will act one way, causing you to vote for him or her, and then proceeds to act another way you didn’t expect. We respond to characteristics that aren’t really there, and what is more remarkable is we don’t tend to notice that we’ve done it; we do it automatically and without thinking. The illusion is so seamless it appears to have been out there in the world such that anyone else looking would see the same thing. That’s not the case, however. Transference is really an interpretation and an illusion that is generated inside the brain as the brain tries to organize the world.

As was the case with the triangle illusion, we try to make sense out of the things we are confronted with by matching their appearance to things we’ve known before. We organize things we see so that they fit the things we already know and we fill in the blanks that aren’t there with the rest of the pattern we know from our schemas. We can set ourselves up for problems when we do this, for instance by extending trust or intimacy (sexual or otherwise) to people who haven’t earned it. In this way, we end up harming ourselves some of the time by failing to appreciate dangers that are really present. The positive flip side of this equation is that we can also learn to benefit from transference by learning to accurately recognize novel situations as dangerous because they remind us of past dangers.

Transference As A Therapy Tool

Though transference happens automatically and unconsciously, it is possible to learn to become aware of transference Becoming aware of one’s transferences is a good thing, because it can help you to become a more conscious and proactive person, more in command of your own destiny, rather than a passive, reactive person. Proactive aware people are better able than passive reactive people to influence their lives for the better, and to learn from mistakes so as to not repeat them again and again. They tend to have a better quality of life than passive reactive persons.

There are many ways to become more aware of your own transferences. One way is to write journal or blog entries about what is happening in your life and then to read them over looking for patterns that you have that get you into trouble; areas where your judgment is repeatedly poor and you make the same mistakes over and over (as chronicled some time ago in that bestseller book “Women who love too much”). Another way is to hire a therapist who can help you to become aware of what your transference are. The psychoanalytically oriented school of therapy was the first to identify how becoming aware of transference could serve as a tool for personal growth, and they are still the best trained professionals for helping to accomplish this goal.

If I ask you, “what does therapy look like” and you had never had therapy before, you are likely to describe something like this image: “The therapist is a man with a beard who sits taking notes while the patient lays down on a couch. Neither patient or therapist look at each other. The patient drones on”. This is the classical image of psychoanalysis – quite out of date of course, but still useful for illustration purposes. Did you ever wonder why the therapist and the patient aren’t looking at each other? The reason is that this “no eye contact” arrangement was thought by early therapists to best promote the patient forming a transference relationship with the therapist. The therapist minimizes eye contact, and says nothing about himself and his life outside the therapy room so as to become a blank slate or canvas or screen onto which the patient can project his or her transferences, and the therapist can view these transferences happening, figure out what they are, and help the patient to become aware of what they’re doing. In theory, the patient’s behavior will change as he or she becomes more aware of what he or she is doing. In practice, such insight is often not enough to motivate real change in the patient’s life. It is helpful, but something more is often needed to get the patient to actually behave differently then they have been. The map is not the territory, but some patients and some therapists can mistake the one for the other.

What does this transference-encouraging look like in practice? I’ll give you an example from my own life. While on internship early in my career, I had to participate in my own therapy as a client. I had been reprimanded by a supervisor for being late to a meeting before this therapy process started and was feeling kinda paranoid about being judged unfairly. Very shortly after I started in with my therapist, I found myself feeling that he was judging me too and found myself getting pissed at him. I’m sure he would have picked up on this in short order, but I beat him to it in this instance, telling him, “This therapy relationship is going to work out fine – I hate you already”.

I had the advantage of being educated about transference before the above exchange took place, so my ability to be self-aware about it shouldn’t be taken as the norm. My anger towards my therapist, however, was classic transference. Another typical scenario is for a patient to develop a crush on a therapist or to feel ownership of the therapist’s time (feeling jealous when the therapist is unavailable), or to respond to the therapist as though the therapist was acting like a parent used to act (judgmental, for example, or overly permissive, and getting upset or sensitive when opportunities for slights or limit setting occur.

The aware therapist recognizes over-reactions for transference (generally a safe assumption, but not one to be just assumed), and interprets these back to the patient, ” I don’t think you are a bad person – but you seem to think that is what I think of you. Am I perhaps reminding you of past relationships you’ve been in where you have felt similarly treated?” The occurence of transference then becomes an opportunity for growth of the patient’s self awareness. If you can recognize the patterns you are succeptable to falling into, you aren’t as much at their mercy anymore.

Counter-Transference

It’s not just patients who are vulnerable to transference Therapists routinely (if grudgingly) also form transferences with their patients. This is called counter-transference when this happens, to indicate that it is the therapist’s rather than the patient’s issue and responsibility. A typical counter-transference might occur when a therapist starts feeling angry with a patient who describes doing something that is similar to something that previously harmed (or would harm) the therapist or someone the therapist cares about. A therapist I’m friendly with recently described a situation where a patient was talking about feeling good about not being expected by his elderly parent to take care of that parent. The parent in this case preferred the patient’s brother to provide care, and the patient enjoyed the freedom of being the ‘less responsible child’. The therapist found herself suddenly angry with her patient because she was herself a ‘responsible child’ with an irresponsible brother and she felt herself to be unfairly burdened with elder care responsibilities. It wasn’t exactly fair for her to get pissed at her patient, and she didn’t show it or let the anger feeling interfere with her duties, but she did feel it, and it was there because of counter-transference

Experienced and ethical therapists notice when they are forming counter-transferences and handle them appropriately. This means that they take steps to deal with their own issues so that they do not impose on their work. If they cannot manage their reaction on their own, they seek out their own therapy or supervision situation where they can get help in dealing with it. If they cannot deal with it, they must then stop working with the triggering patient if feasible and possible, recommending another comparable therapist who will not be so affected whenever that is possible. Therapists should strive to never abandon patients, but this doesn’t mean that sometimes everyone isn’t better off with a therapist recusing him or herself from working with a particular patient.

Recognizing counter-transference is as hard as recognizing transference, which is to say, very hard, and even good therapists may take a little while to figure out what is happening. It is ultimately the therapist’s responsibility to figure it out, however.

Conclusion

So that brings us to the end of this essay on transference Transference is a truly amazing process, casting light as it does on hidden thoughts, feelings, wishes and motivations that would otherwise remain hidden and troubling. Freud’s recognition and characterization of transference was brilliant in of itself (although I believe there were writers who recognized the phenomena before he did), but the thing that moves his contribution over the top to genius status was his recognition that transference could be used as a therapy tool. The psychoanalytic therapy he pioneered featured analysis of transference as a central element, and generations of psychoanalytically oriented therapists since his time have continued to recognize the importance and centrality of transference to the work of therapy. Awareness of transference is no cure-all. It is really best suited for problems that are relational in nature (such as anger or depression problems – where transference leads patients towards inappropriate and exaggerated moods and actions). It is not particularly helpful if you are working with a patient who is dealing with a primarily biological problem like schizophrenia or autism, for example. Nevertheless, it is a useful and brilliant tool and technique for most all therapists to know about and use appropriately to the benefit of patients. It is a major contribution of the psychodynamic approach to the universe of psychotherapy techniques.

You may be feeling overwhelmed by the number of new terms, theories, and practices you are learning. With all of the clinical information, you are consuming it can be easy to gloss over the concepts of transference and countertransference.

You know it makes sense that as a clinician you may be triggered by a client or you remind the client of someone they know. You may feel it’s common sense and it will be easy to identify in the clinical setting. However, transference and countertransference can be the areas that cause the most significant issues for you as a clinician. Here is why these concepts are a big deal and what you need to know.

What is transference?

To define transference, start by thinking about the word transfer. When you transfer something, you move it from one place to another. The transference definition in psychology is when a client redirects their feelings from a significant other or person in their life to the clinician.

Think of it as the client projecting their feelings onto you as they would another person in their life. In most cases, the client experiences unconscious transference and is unaware that they are doing it. The client’s feelings transfer onto you and may be positive or negative. Transference in therapy is normal. Expect to experience transference in counseling and discuss any concerns you have with your supervisor.

Transference examples:

  • The client places unrealistic demands on you.
  • A client admires you and tells you how much you remind them of their best friend.
  • A client displaces anger onto you during a session when talking about his abusive parent.

Why is transference a big deal?

Transference has benefits in the counseling session. The client can relax and be real during the session allowing themselves to experience growth. As a clinician, you can utilize the transference as a tool to help the client gain insight into their strength to handle situations outside of the session. You can help your client to see their reality of the event they are dealing with.

Just as it can benefit the process, negative transference can hinder your client’s growth. If you become activated during transference and react negatively or defensively, it can stop the growth process. For example, if the client speaks to you in anger as they would to their partner and you personalize it, then you may miss an opportunity to help your client. Transference is a powerful way to improve your client’s ability change their behavior and gain insight.

What is countertransference?

Countertransference is when you as the clinician transfer your feelings onto your client. Often clinicians don’t realize when this happens. The countertransference definition can be thought of as the clinician’s response to a client’s transference.

Countertransference is an excellent reminder that clinicians are human beings with feelings and emotions. During a session, a client may open up and bear their souls causing a strong emotional reaction. The experience of the clinician during the session can affect the outcome. Clients can remind you of someone you know currently or in the past. As a clinician, you need to be aware of countertransference at all times.

Countertransference examples:

  • A clinician offers advice versus listening to the client’s experience.
  • A clinician inappropriately discloses personal experiences during the session.
  • A clinician doesn’t have boundaries with a client.

Why is countertransference a big deal?

Countertransference can occur in many different ways and have adverse effects. It is a big deal when a clinician brings in their outside experiences and they lose their perspective which can lead to a reaction that hurts the client. Countertransference is common and can happen regardless of your years of clinical experience.

A crucial area to be aware of is erotic countertransference which is when the clinician experiences attraction, love, or sexual feelings towards a client. With strict ethical and legal guidelines, relationships with clients are prohibited. If you experience a strong reaction to a client, then you need to seek supervision for your countertransference.

Your awareness of transference and countertransference is crucial in your growth as a clinician. Remember that these occurrences are normal and don’t be afraid to seek supervision when they happen. Don’t jeopardize your career as a clinician because of your pride. Your openness to accept feedback and guidance from a seasoned clinician can help you sharpen your skills in this area as well as prevent you from harming your client.

Dr. Kristie Overstreet is a clinical sexologist, certified sex therapist, licensed professional clinical counselor, author, speaker, and consultant. She holds a Ph.D. in Clinical Sexology, Master of Arts in Professional Counseling, and a Bachelor of Science in Biology. She is a licensed counselor in California, Florida, Georgia, and Louisiana. She is also a Certified Sex Therapist and Certified Addiction Professional. She has over 12 years of clinical experience specializing in sex therapy, transgender healthcare, relationships, and helping counselors build their private practice. She is president of Therapy Department, a private practice that provides counseling, training, speaking, and consulting services across the United States. For more information about Dr. Kristie’s work visit www.KristieOverstreet.com.

What Do Transference and Counter Transference Mean?

Transference and Counter Transference are not the easiest of concepts to understand and many new coaches find these difficult.

The term transference originates from Psychodynamic Therapy where it is defined as a client’s unconscious conflicts that can cause problems in everyday life. It is where the individual transfers feelings and attitudes from a person or situation in the past on to a person or situation in the present and where the process is likely to be, at least to some degree, inappropriate to the present. Although the concept is originally a therapeutic one, it is also used to understand what can happen in any type of relationship whether personal or professional such as that experienced in the coaching relationship.

The feelings that your client experiences in relation to you as his or her coach or to a colleague or manager is what is referred to as transference. That is where the individual transfer feelings based on feelings experienced with influential people and early life experiences onto you as the coach or perhaps another person that s/he is involved with. Depending on that relationship a client may either form a positive or negative transference. For example, if someone had difficulties with their parents or some other influential person such as a Head Teacher, they transfer (without their conscious knowledge) these feelings. Supposing a father was very authoritarian which the individual found a difficult experience to be on the receiving end of; s/he might transfer those difficult feelings onto anyone s/he perceives as being in a position of power. For example, managers, the Police or you as a coach. It is irrelevant whether that individual has power or not, as it is all about unconscious processes and perceptions the client has.

The example above is what could be termed a negative transference. However, if the individual had a wonderful mother who was supportive and kind it is possible the client may see you as such. Such a client may be wonderful to work with because they have made a positive transference of these qualities on to you.

Transference is seen as being a general phenomena and for those who believe in its existence is one that is acted out by everyone and often contributes to the decisions we make about those we chose as friends and partners as well as towards those we may not like without that person doing anything other being him or herself.

A positive transference is one where the client experienced positive feelings towards an individual based on the person in their past and a negative transference is just the opposite. If they have negative feelings then it is these that the person transfers onto the individual.

Additionally, if your client responds to you in a particular way you may find yourself responding back to the way s/he is treating you. In this case the term Counter Transference is used to describe the unconscious feelings you may experience towards your coaching client based on the way the client is acting towards you. Again this could either be a positive or negative Counter Transference.

Therefore as a coach the concepts of Transference and Counter Transference are ones that we need to keep in mind.

Some examples of transference could include where your client may have had painful experiences and finds trusting people difficult and is therefore is mistrustful of you and what you can offer being challenging to work with. Alternatively, perhaps your client is anxious about rejection and is keen to seek your approval at all times.

An example of counter transference could be where you are seeing the client who finds it hard to trust people as above. It may take a session or two but you start to see a pattern in their behaviour and realize that you find yourself feeling under pressure to placate and reassure your client over and above the way that you would normally feel or behave towards your other clients.

One big clue that you may be experiencing a counter transference is where you find yourself experiencing feelings and/or acting outside of your normal pattern of behaviour towards a coaching client.

Transference and counter transference is something that is best addressed in your coaching supervision. You and your coaching supervisor can explore this in relation to your work with you client and how these concepts may be acted out in your coaching. By doing this you can then go on to consider how such concepts are affecting your work with the client and what, if anything, you need to do to ensure a healthy and productive relationship is maintained between you and your client.

For example, you might not be aware that you have allowed your boundaries to slip – say in relation to how much time you offer one client over and above that which you would normally see as being part of a coaching contract. Alternatively, you may come to realize that you are much harsher with one particular client compared to the way you are with others. Forming a positive Counter Transference can have a downside as although you may like your client you might find yourself allowing colluding with the individual not encouraging your client to face challenges where it would be helpful for him or her to do so.

Transference and counter transference may seem like difficult concepts but they can be a useful tool that can be used in the coaching process.

Transference

Transference describes a situation where the feelings, desires, and expectations of one person are redirected and applied to another person. Most commonly, transference refers to a therapeutic setting, where a person in therapy may apply certain feelings or emotions toward the therapist.

What Is Transference?

Transference is a psychology term used to describe a phenomenon in which an individual redirects emotions and feelings, often unconsciously, from one person to another. This process may occur in therapy, when a person receiving treatment applies feelings toward—or expectations of—another person onto the therapist and then begins to interact with the therapist as if the therapist were the other individual. Often, the patterns seen in transference will be representative of a relationship from childhood.

The concept of transference was first described by psychoanalyst Sigmund Freud in his 1895 book Studies on Hysteria, where he noted the deep, intense, and often unconscious feelings that sometimes developed within the therapeutic relationships he established with those he was treating.

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Transference is a common occurrence among humans, and it may often occur in therapy, but it does not necessarily imply a mental health condition. Transference can also occur in various situations outside of therapy and may form the basis for certain relationship patterns in everyday life.

Types of Transference

Some of the more common types of transference include:

  • Paternal transference, when an individual looks at another person as a father or an idealized father figure. The person may be viewed as powerful, wise, and authoritative, and an individual may expect protection and sound advice from this person.
  • Maternal transference occurs when an individual treats another person as a mother or idealized mother figure. This person is often viewed as loving and influential, and nurture and comfort is often expected from them.
  • Sibling transference can occur when parental relationships are lacking or when they break down. Unlike parental transference, this type of transference is generally not represented by leader/follower behavior, but by peer or team-based interactions.
  • Non-familial transference can be seen when individuals treat others according to an idealized version of what they are expected to be rather than who they actually are. Stereotypes can form in this manner. For example, priests may be expected to be holy in everything they do, while policemen may be expected to uphold the law at all times, and doctors may be expected to cure any ailment.
  • Sexualized transference, sometimes categorized as either erotic or eroticized transference, may occur when a person in therapy develops a sexual attraction to their therapist. While erotic transference often refers to sexual thoughts an individual identifies as unrealistic and can be a positive type of transference, eroticized transference is a consuming attraction toward the therapist that can be detrimental to the therapeutic relationship and the client’s progress.

Sometimes, transference is seen in everyday situations, such as when:

  • A person is easily annoyed by a classmate who looks a bit like their often-irritating younger sibling.
  • A young person treats a much older female coworker with tenderness because she brings back memories of that person’s now-deceased mother.
  • An individual begins to mistrust a romantic partner simply because a previous partner cheated.

Transference may be positive or negative. Both types can benefit therapy in different ways. Positive transference can lead the person in therapy to view the therapist as kind, concerned, or otherwise helpful. Negative transference might cause a person in therapy to direct angry or painful feelings toward the therapist, but the therapist may still be able to use these emotions to help the person achieve greater understanding.

Transference in Therapy

A person’s social relationships and mental health may be affected by transference, as transference can lead to harmful patterns of thinking and behavior. The primary concern is generally the fact that, in the case of transference, an individual is not seeking to establish a relationship with a real person, but with someone onto whom they have projected feelings and emotions.

When transference occurs in a therapeutic setting, a therapist may be able to better understand an individual by gaining knowledge of the projected feelings and, through this new understanding, help the person in therapy achieve results and recovery. By understanding how transference is occurring, a mental health professional may be better able to understand both a person’s condition and/or aspects of the person’s early life that affect them in the present.

Transference may often occur between a therapist and a person in therapy. For example, the therapist may be viewed as an all-knowing guru, an ideal lover, the master of a person’s fate, a fierce opponent, and so on. Proponents of psychoanalysis believe that transference is a therapeutic tool crucial in understanding an individual’s unconscious or repressed feelings. Healing is believed to be more likely to occur once these underlying issues are effectively exposed and addressed.

A therapist might also educate a person in treatment on the identification of various situations in which transference may be taking place. Techniques such as journaling can allow a person in therapy to identify possible patterns in both thought and behavior, through the review and comparison of past entries. When examples of problematic transference become more recognizable, a person in therapy may be able to explore why the transference occurs and help prevent its recurrence.

One type of therapy known as transference-focused therapy (TFP) harnesses the transference that occurs in therapy to help individuals gain insight into their own behavior and thought patterns. It is most commonly used to treat borderline personality (BPD).

Last Updated: 09-25-2019

What is Transference?

Originated by psychoanalyst Sigmund Freud, transference is the experience of a person’s expectations, feelings, and desires unconsciously transferring and being applied to another person. Often this term refers to a person’s experience in therapy, wherein the person who is in a therapy session begins redirecting certain unresolved conflicts and emotions toward the therapist. While it may be surprising, this experience is a normal part of therapy, and it can happen both on the part of a person seeking treatment, as well as on the part of the therapist.

The process of transference happens unconsciously from one person to another. In therapy, it happens when a person receiving treatment applies emotions and expectations toward a therapist. When it occurs, a person may start to interact with their therapist as if he or she is the individual in their past experiences. Generally, it takes shape when recounting certain childhood relationships. This is a common experience and does not necessarily mean anything is wrong. Even so, understanding the common types of transference can be beneficial to spotting it when it occurs.

  • Paternal transference. This form of transference occurs when a person views another person as a father figure. This takes shape as the belief that another person is in a position of power, has authority, and can give sound advice and protection.
  • Maternal transference. Similar to the paternal example, in this instance, an individual treats another person as an idealized mother figure. They likely view this person as caring and expect them to be nurturing and comforting.
  • Sibling transference. Often this can be experienced when parental relationships are not super strong and take shape as more peer-based interactions rather than a leader/follower relationship.
  • Non-familial transference. This form of transference takes shape when a person treats others as idealized versions of what they are expected to be rather than their authentic selves.

How Transference Impacts Therapy

In therapy, transference is an important concept to pay close attention to, as it can result in potentially damaging types of thinking and behaviors. These thoughts and behaviors can impact a person’s ability to experience a positive outcome.

One of the biggest issues occurs for a person who establishes a relationship with a therapist — but who is merely a projection of their feelings and emotions toward someone else — will not be able to develop a more authentic and sustaining relationship with their therapist.

Some believe transference signifies a deeper issue or some kind of unfinished business in your life. When you experience a strong reaction to something the therapist says or does, therefore, it may help hint at that deeper issue. In these instances, a therapist can take time to better understand a person’s projected feelings and help identify the cause of the experienced feelings.

Recognizing Transference in the Moment

Fortunately, there are also some ways to identify and normalize these types of attachments with your therapist. Start by recognizing that developing a close attachment with your therapist through the transference of your emotions happens all the time. Because many therapists are interested in relational issues, they are able to openly discuss why the projections might be occurring. If you are made uncomfortable by your feelings, you can simply detail them to your therapist, and they’ll help address the situation.

When projected feelings of transference start to seep into your therapy session, try to actively separate feelings for your therapist from the figure from whom you’re transferring emotions. You can make a list of the ways your therapist is different than your template to help distinguish the two, while taking time to clear your mind before a session begins. If you feel your emotions will greatly impact your ability to receive a positive outcome, it is always possible to seek out support from another therapist and practice.

Reverse Transference

In a therapy setting, countertransference occurs when a therapist begins to project his or her own unresolved conflicts onto their clients. While transference between a client and a therapist is a well-known possibility, it is important for a therapist to be able to identify countertransference when it happens and try to remain neutral. This form of transference takes shape in the following common ways:

  • Subjective
    In this instance, a therapist’s own unresolved issues causes him or her to project unresolved conflicts onto their clients.
  • Objective
    Here, a therapist’s reaction to a clients’ anxiety or emotions result in them using those feelings in the therapeutic relationship.
  • Positive
    Possibly damaging to the therapeutic relationship, this results in the therapist over-supporting or trying to befriend the client.
  • Negative
    This occurs when a therapist acts out against uncomfortable feelings negatively by being overly critical and rejecting the client.

While therapists generally try to avoid feelings of countertransference during sessions with clients, it can have some positive benefits. One study, for instance, found that in certain instances of positive countertransference, it can help strengthen the bond between a therapist and client, and eventually, lead to positive outcomes and improvements for the client.

Better Understand Yourself

Transference and countertransference are relationship issues, albeit the relationship with your therapist, and — although they can be uncomfortable experiences — they provide you an opportunity to better understand your thoughts, feelings, fantasies, and relationships.

Additionally, by arming yourself with the knowledge to identify and address transference and countertransference in a therapeutic setting, you are better equipped to tackle any potential negative impacts. When you explore the reasons behind transference, you can help understand why it occurs and how to prevent its recurrence in the future.

Understanding Transference In Psychology

By Nadia Khan

Updated December 18, 2018

Reviewer Whitney White, MS. CMHC, NCC., LPC

Understanding transference in psychology can be a difficult concept to grasp. In psychology, transference is described as a situation that occurs when an individual’s emotions and expectations toward one person are unconsciously redirected toward another person.

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Sigmund Freud first developed the concept of transference in his book Studies on Hysteria (1895). In his book, he described the intensity of the feelings that developed during his own experiences in therapy with patients. Freud explained patient to therapist transference occurring unconsciously where the patient transfers his or her emotions toward the therapist he or she is seeking treatment with.

Freud asserted that transference is often related to unresolved issues occurring in the patient’s past. Freud found that transference can be destructive or helpful during therapy depending on how the patient and therapist interact. The patient often unconsciously continues the behavior even if it is pointed out to them.

Since Freud, there have been other ways of describing transference. In The Psychotherapy Relationship, author Gelso defines transference as “the client’s experience of the therapist that is shaped by his or her psychological structures and past, and involves displacement onto the therapist, of feelings, attitudes, and behaviors belonging rightfully in earlier significant relationships.” Both definitions agree that transference involves experiences from an individual’s past. As described above, transference most often occurs in therapy situations, but there are other types.

Other Types of Transference

Non-familial transference occurs when individuals treat others according to what they have idealized the person to be instead of who they are. This can happen with any individual who fulfills a role in the person’s life. For example, the individual may treat a teacher or doctor as only their role is the factor for which the base their opinion on.

Maternal transference occurs when an individual treats another person the same way they would expect their mother or a maternal figure to be. If they have had a positive relationship with their mother, they may reach out to the individual for comfort and love. However, if the individual experienced a negative relationship with their mother, they may have deep feelings of rejection and lack of comfort and nurturing.

Paternal transference is much like maternal transference except when the individual looks at another person in a fatherly role. The individual may expect more of an authority figure or someone who takes on a protective or powerful role. Negative transference like maternal could bring about strong feelings of rejection, and feelings of being inadequate as a person.

Sibling transference is unlike maternal or paternal. In this case, it does not take on a leader and follower role. It occurs in more of a peer or colleague situation.

Patient-Therapist Transference

Transference also includes the patient’s expectations about how he or she will behave and feel and what his or her expectations are from the therapist. The patient’s expectations may include love, disapproval, and an entire range of emotions. The client may even expect to experience abuse or abandonment from the therapist. Clients might even subconsciously behave in a way that produces the reactions they are expecting from the therapist.

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It is important to realize that transference is not an exact distortion or a repetition of the past. It is the client’s interpretation of interactions with the therapist.

For instance, a patient develops romantic feelings toward the therapist. Then the therapist does not return those feelings and reinforces the acceptable boundaries between patient and therapist. When the patient expected the therapist to return those feelings and they weren’t, the patient again experienced the same feelings of hurt, abandonment, or anger experienced in other past relationships. If the patient never comes to understand what is happening, little or no progress toward dealing with the transference will be made.

Whether the transference is positive or negative, it can be beneficial to therapy in different ways. Positive transference may lead the patient to view the therapist as kind, caring and personally concerned about his or her well-being. Negative transference may cause the patient to re-direct anger, sadness, and other negative feelings toward the therapist.

However, the therapist may be able can help the patient use these projected emotions to create an understanding of why the transference is occurring. Once the patient has a greater understanding of the transference, the patient can begin dealing with the issues causing the transference and begin the healing process. Freud used transference as a tool crucial to understanding the patient’s subconscious or repressed feelings.

Communicating Transference

There are several ways clients communicate the transference that is happening toward their therapist. The first method is when the patient communicates their feelings directly with the therapist. In this case, the patient realizes what is occurring.

The second method of transference is symbolic. The patient may communicate transference through his or her experiences or stories. The stories or experiences can resemble his or her perception of the relationship with the therapist. The patient may or may not realize transference is occurring.

The third method of transference occurs through communication of dreams and fantasies experienced by the client. The patient may have dreams or fantasies about the therapist, where the therapist is present, or about the current relationship with the therapist. The patient may or may not realize transference is occurring.

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The fourth method is enactment, where the patient takes on a particular role with the therapist. For instance, a patient may take on the role of a child treating the therapist as though he or she is his or her mother. The patient may expect the therapist to fulfill all maternal needs that were not fulfilled as a child. In this case, the patient usually does not realize transference is occurring.

Issues Regarding Transference

Several serious issues can occur during transference. The patient’s mental health and relationships are affected and can be helped or harmed by transference. The major concern is that the patient is not seeking to build a relationship with an actual person. In reality, the patient is seeking a relationship with another individual who they have projected feelings and emotions toward.

Dealing with Transference

Dealing with transference in therapy involves more than just talking about events and feelings in the patient’s past or current experiences. It is also a lived experience, where the therapist helps the patient reach the core transference issues within the therapy. Change can only come about through the patient’s re-experiencing and understand these processes.

Major techniques in dealing with transference involve intervention to work on interpreting occurrences and developing explanations for the transference. Interpretation helps the patient understand the meaning of the transference that is occurring. Interpretations occur about many of the life issues of a client, but primarily address unconscious and conflicted aspects.

It is important to understand the definition of interpretation in therapy. In therapy, interpretation offers an alternative perspective to what is being perceived. The way the therapist interprets it is as important as the content of the interpretation. Even if a correct interpretation is made but conveyed in the wrong way, it may not be therapeutic to the patient at all.

To deal with transference, the patient must be made aware of what is occurring. The therapist needs to work to help the patient identify occurrences causing the transference. The therapist may recommend techniques such as the patient keeping a journal. This will help the patient identify triggering occurrences causing the transference. Through identifying such occurrences, reoccurrences of transference can be minimized.

A therapist might also educate a patient in treatment on the identification of various situations in which transference may be taking place. This process usually requires repetition of events and interpretations of those events over an extended period. This leads to an understanding followed by a transformation of the patient’s issues are worked through. Working through the transference requires exploring and then resolving issues the patient has.

This might include current relationships, work, a family of origin and the transference. In therapy, this process of applying what is learned in therapy to other situations is referred to as generalization.

The therapist might suggest techniques such as journaling. Journaling can allow a person in therapy to identify possible patterns in both thought and behavior, through the review and comparison of past entries. When examples of problematic transference become more recognizable, a person in therapy may be able to explore reasons why the transference occurs and help prevent its recurrence.

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Freud, S. ( 1958) Psycho-analytic notes upon an autobiographical account of a case of paranoia (Dementia Paranoias), in J. Strachey (ed.)The Standard Edition of the Complete Psychological Works of Sigmund Freud, Vol. 12. London: Hogarth.

Gelso, C.J. and Hayes, J.A. (1998) The Psychotherapy Relationship. New York: Wiley.

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