Transference and
Countertransference
TRANSFERENCE
▪ Freud first used the term transference in 1905
▪ He became aware of changes in the patient’s attachment to him, characterised
by the experience of strong positive or negative emotions.
▪ Freud came to see transferences as ‘‘new editions’’ of old impulses and
phantasies aroused during the process of psychoanalysis with the therapist
replacing some earlier person from the patient’s past.
▪ Once the therapist assumed emotional importance and became the target of
transference wishes, the therapist resisted gratifying those wishes. This
frustration was said to give rise to intense affects so that the patient’s conflicts
emerged more clearly and could thus be interpreted by the therapist.
TRANSFERENCE
▪ In the classical Freudian position, the therapist understood the transference as
a repetition of the past - the repetition compulsion.
▪ Repressed early experiences could not be communicated verbally; they are
acted out, that is, they are transferred into compulsively repeated actions.
▪ The patient does not say that he remembers that he used to be defiant and
critical towards his parents’ authority wrote Freud,
. . .instead he behaves in that way to the doctor. . . He does not remember
having been intensely ashamed of certain sexual activities and afraid of their
being found out, but he makes it clear that he is ashamed of the treatment on
which he is now embarked and tries to keep it secret from everybody. . . This is
his way of remembering (1914: 150)
TRANSFERENCE
▪ For the former group of mostly Kleinian clinicians, the transference ‘‘. . . is
not. . . merely a repetition of old attitudes, events and traumas from the past;
it is an externalisation of unconscious phantasy here-and-now’’
(Hinshelwood, 1989: 15)
▪ What is enacted in the here-and-now is an internalised object relationship,
➢For example, we become, in the patient’s experience, a critical other who
humiliates him.
TRANSFERENCE
▪ Many contemporary practitioners of different theoretical persuasions now
understand the transference as a process in which current emotions and parts of
the self are externalised into the relationship with the therapist.
▪ This involves the projection of object relationships infused with
▪ benign, positive feelings and phantasies → the positive transference
▪ more hostile feelings and phantasies → the negative transference
TRANSFERENCE
Zetzel (Current Concepts of Transference, 1955)
Recent developments mainly concern the impact of
▪ an ego-psychological approach
▪ the significance of object relations, both current and infantile, external and internal
▪ the role of aggression in mental life
▪ the repetition compulsion in the transference
➢ Analysis of the infantile oedipal situation in the setting of a genuine transference
neurosisis still considered a primary goal of psycho-analytic procedure
COUNTERTRANSFERENCE
▪ Countertransference - the therapist’s emotional reactions to her patient
▪ Heimann (1950): «All the feelings which the analyst experiences towards his
patient»
▪ In Freud’s time, therapists regarded their emotional reactions to the patient
as manifestations of their own ‘‘blind spots’’.
▪ In 1912, Freud stated that the therapist should behave:
. . .as a surgeon who puts aside all his own feelings, including that of human
sympathy and concentrates his mind on one single purpose, that of
performing the operation as skilfully as possible
COUNTERTRANSFERENCE
▪ Paula Heimann (On Counter-Transference,1950)
«My thesis is that the analyst's emotional response to his patient within the
analytic situation represents one of the most important tools for his work. The
analyst's countertransference is an instrument of research into the patient's
unconscious.»
▪ She favoured the therapist’s emotional response to her patient as a technical
tool, not a hindrance.
▪ A marked shift from seeing countertransference as something that
interferes with technique to viewing such responses by the therapist as a
means of understanding the patient’s unconscious communications.
COUNTERTRANSFERENCE
▪ From Kleinian and many object-relational perspectives
▪ countertransference includes all the therapist’s reactions to the patient
▪ Our task is to understand who we come to represent for the patient and the
internalised object relationships that are activated at any given point in time
whilst simultaneously remaining connected with who we are when divested of
these projections.
COUNTERTRANSFERENCE
▪ Kernberg (1965: 49)
The analyst’s conscious and unconscious reactions to the patient in the treatment
situation are reactions
▪ to the patient’s reality as well as to his transference
▪ to the analyst’s own reality needs as well as to his neurotic needs
COUNTERTRANSFERENCE
▪ The patient uses projective identification to dispose of unwanted aspects
of the self into us
▪ It is important not to lose sight of the fact that ‘‘resonance is not the same as
replication’’ (Jacobs, 2001).
▪ Whatever the patient’s projection onto or into us, this will be altered by
our own personal experiences and phantasies. It can therefore never be
the ‘‘same as’’ it is for the patient, but it may give us an approximate
feeling of the patient’s experience that we can employ to further our
understanding of the patient.
COUNTERTRANSFERENCE
▪ When misused, the concept of countertransference gives us licence to
discharge onto the patient our own unresolved conflicts.
▪ When approached thoughtfully and with integrity, our emotional reactions
to the patient are helpful guides to what the patient cannot articulate
verbally.
▪ They provide us with important sources of information about the patient’s
mental state and his needs moment-by-moment.
THE THERAPEUTIC ALLIANCE AND
THE SO-CALLED ‘‘REAL’’ RELATIONSHIP
▪ Greenson & Wexler (1969) - for patients to develop healthy ego functioning
and the capacity for full object relationships, the analytic situation must
offer them the opportunity for experiencing in depth both the realistic and
unrealistic aspects of dealing with the therapist
▪ Both the therapeutic alliance and the transference are important for therapy
THE THERAPEUTIC ALLIANCE AND
THE SO-CALLED ‘‘REAL’’ RELATIONSHIP
▪ Greenson (1967) distinguished three levels of relationship: the transference (and
countertransference) relationship, the therapeutic alliance and the real relationship:
The term ’real’ in the phrase ’real relationship’ may mean realistic, reality oriented, or
undistorted as contrasted to the term ’transference’ which connotes unrealistic,
distorted, and inappropriate. The word real may also refer to genuine, authentic, true
in contrast to artificial, synthetic, or assumed relationship between therapist and
patient. (1967: 217).
➢These different levels of relationship are intimately connected to one another
WHAT IS A TRANSFERENCE INTERPRETATION?
▪ A transference interpretation makes explicit reference to the patient–therapist
relationship and is intended to encourage an exploration of the patient’s
conflicts and internalised object relationships as they manifest themselves in
the therapeutic situation.
WHAT IS A TRANSFERENCE INTERPRETATION?
We infer the transference from different sources:
▪ the patient’s associations
▪ his affect in the room
▪ the wishes and phantasies that are implicit in the patient’s narratives and
dreams
➢ Our own counter-transferential responses
▪ For example, the therapist may be experienced as a ‘‘judgmental other’’ or
as a ‘‘seductive other’’
WHAT IS A TRANSFERENCE INTERPRETATION?
▪ The patient transfers not just actual figures from the past but internal
phantasy figures that have been construed from the interaction between
real experiences and the patient’s own internal reality.
▪ The transference interpretation merely seeks to capture the emotional,
psychic reality of the patient in the grip (control) of a particular phantasy
WHAT IS A TRANSFERENCE INTERPRETATION?
Roth (2001) has described the ‘‘levels of transference interpretation’’:
▪ Interpretations that reflect on links between here-and-now events in the therapy
and events from the patient’s past history;
▪ Interpretations that link events in the patient’s external life to the patient’s
unconscious phantasies about the therapist;
▪ Interpretations that focus on the use of the therapist and the therapeutic situation
to enact unconscious phantasy configurations.
WHAT IS A TRANSFERENCE INTERPRETATION?
▪ Lemma - In my experience making links between the transference and the
current and past external figures in the patient’s life is very helpful so as to
allow the patient to integrate his emotional experience in the transference
with both current and past experience.
▪ Reconstructive interpretations (that link present behaviour to the past) offer
an opportunity to ally ourselves with the patient’s ego. They invite the
patient to join us in thinking about him in a way that allows for more
distance from the intensity of the patient’s feelings.
WHAT IS A TRANSFERENCE INTERPRETATION?
▪ When we make a transference interpretation
▪ we are neither interpreting the past nor the present – we are interpreting the
past in the present
▪ In therapy we do not work with a still-life picture of the patient but with an ever
changing, interactive system.
▪ Our analysis of a patient’s historical past is coincident with, and is influenced
by the context of remembering.
▪ We are active contributors to the context in which remembering takes place,
and hence to the shaping of the memories that the patient recounts.
THE QUALITY OF
THE
TRANSFERENCE
The Positive Transference
▪ A positive transference assists the therapeutic work as the patient’s
positive attachment to us allows for greater ease of communication and
fosters engagement with the process.
▪ An idealising transference can become a resistance to treatment.
The Erotic and Sexualised Transference
▪ Freud (1915b) demolished the boundary between transference love and real love,
arguing that the difference between the two was a matter of degree rather than
kind.
▪ Normal love shares many of the unrealistic aspects of transference love.
▪ Like transference love, it has infantile prototypes, it is repetitive and idealising.
▪ Freud proposed that when erotic feelings emerge in the therapeutic relationship,
they represent an attempt to disrupt the therapeutic work by recruiting the
therapist into being the patient’s lover.
The Erotic and Sexualised Transference
▪ Absence of any loving and/or erotic feelings would in fact be unusual and
may indicate the operation of resistance as if the patient cannot tolerate
within himself the emergence of such feelings.
▪ The emergence of erotic feelings in the therapeutic relationship can be
more problematic, and when it is, then it is usually referred to as the
eroticised transference.
▪ as the patient becomes insistent on the gratification of his erotic feelings and
fantasies
The Erotic and Sexualised Transference
▪ The critical question is how we intervene when erotic feelings arise
▪ In a general sense, we need to be receptive to any feelings that the patient
experiences towards us, including erotic ones
▪ Given that such feelings are also frequently associated with shame or fear,
we help the patient if we can approach this exploration without judgement
or anxiety on our part
The Erotic and Sexualised Transference
A few aspects of working with erotic feelings:
▪ Notice the emergence of erotic feelings
▪ Think about whether the erotic feelings have an infantile quality
▪ Think about whether the patient is sexualising the relationship
▪ Think about whether the type of relationship that the patient strives to establish is a
defence against the erotic.
▪ Think about how erotic feelings are being used in the transference
The Negative Transference
▪ The therapeutic relationship will also need to stand the test of the patient’s
hostility or his mistrust. These feelings are not always expressed at the outset.
▪ Some patients may find it very threatening to own such feelings in themselves
and/or to express them.
▪ Consequently, they may be displaced onto other relationships in the patient’s life
so as to protect the therapeutic relationship.
▪ The patient will, for example, report arguments or conflicts with a partner or boss safely
keeping their anger ‘‘out there’’ rather than in the relationship with us.
▪ Most of the time, negative feelings are more readily voiced when the patient trusts
that we can tolerate their expression without retaliating or trying to minimise their
significance.
The Negative Transference
▪ Interpretation of the negative transference is a risky intervention since it brings
into focus the patient’s hostile feelings and phantasies.
▪ Once exposed, such negative feelings may leave the patient fearing our retaliation.
▪ It is often preferable to interpret the negative transference in the context of an
established therapeutic relationship in which the patient has felt supported and has
had experience of relating to a helpful therapist.
The Challenges Of Working In The Transference
▪ When patients are encouraged to work directly with transference reactions,
conflictual issues are identified and the patient’s anxiety is heightened.
▪ The patient may perceive our behaviour as critical, attacking or intrusive.
▪ In these situations, we may find it difficult to be experienced as the bad,
persecuting object.
The Challenges Of Working In The Transference
The transference interpretation overemphasises the significance of the therapist to the patient.
▪ a transference interpretation does not in itself overemphasise the significance of the
therapist in the patient’s life; it merely acknowledges the fact that the therapist
invariably becomes an important figure in the patient’s life because the intimacy
recreated in psychotherapy elicits intense feelings and phantasies
By focusing on the patient’s negative feelings towards the therapist (i.e. the negative
transference), this will somehow preclude a positive experience that will disconfirm the
patient’s pathogenic assumptions in relationships.
The Challenges Of Working In The Transference
▪ A focus on the transference can divert attention away from the present, conscious
concerns of the patient, which also need to be addressed.
It is important to firstly acknowledge what has happened and only then to
elaborate the potential transference implications of the story if we consider that
the patient will be helped by this.
▪ Working in the transference encourages regression that is damaging for the more
severely disturbed patient.
The Challenges Of Working In The Transference
▪ Making a transference interpretation is a powerful intervention that needs to
be carefully evaluated.
▪ A well-timed and accurate transference interpretation can be very helpful in
bringing to the fore core patterns of relationships that assist the patient
towards change.
The Challenges Of Working In The Transference
▪ Transference dynamics are live and more immediate and hence verifiable in the here-
and-now than the patient’s report of past experiences or relationships outside of the
therapy.
▪ The transference interpretation allows the therapist to make use of the emotional
immediacy of the therapeutic relationship to counter intellectual resistances.
▪ The transference interpretation facilitates an increase in interpersonal intimacy by
allowing the therapist to demonstrate attunement to the patient’s current experience.
The Challenges Of Working In The Transference
▪ The transference interpretation allows the therapist to address the patient’s defences
against intimacy as they emerge in the therapeutic relationship and so contributes to a
strengthening of the alliance.
▪ Through a transference interpretation the therapist models a way of handling negative
perceptions.
The Aims of Working in the Transference
▪ To help the patient recognise and own denied/spit-off aspects of the self.
▪ This allows for a more integrated experience of the self, characterised by
greater autonomy and flexibility.
▪ To help the patient become aware of the discrepancy between how he perceives the
therapist/other people and how they actually are.
▪ This involves helping the patient understand how perception is coloured by
internal states of mind and how this, in turn, gives rise to particular
affective experiences and thus shapes behaviour. Insight into these
distorting influences helps the patient separate old relationships from the
new ones and is the starting point for the development of new models of
relationships.
The Aims of Working in the Transference
▪ To help modify the force of the ‘‘bad’’ internal object. This requires an exploration
of the patient’s bad or persecutory internal objects and the associated matrix of
anxieties and defences, with the aim of helping the patient internalise a more
benign experience of the other.
▪ The overall aim is to establish a link between internal and external figures by helping
the patient appreciate the dialectical nature of internal and external reality.
▪ In practice, we build up to a full interpretation that eventually describes to the
patient ‘‘What is going on and we explain why we think it is going on’’
(Riesenberg-Malcom, 1986: 75).
Working With Countertransference
▪ Like the transference, the major part of countertransference is unconscious.
▪ Our countertransference is the response to the patient’s projective identification.
Working With Countertransference
Most contemporary analysts would agree that at times the patient actualises an
internal scenario within the analytic relationship that results in the analyst’s
being drawn into playing a role scripted by the patient’s internal world. The
exact dimensions of this role, however, will be coloured by the analyst’s own
subjectivity and goodness of fit between the patient’s projected contents and the
analyst’s internal representational world (Gabbard, 1995: 481–2).
Working With Countertransference
The process of interpretation when we have become identified with, and have
acted on a projective identification involves identifying the following
• What has been projected.
• What defensive purpose the projection serves, that is, what feeling or state of
mind or part of the self is the patient wishing to rid himself of and why.
• Whether we have contributed to an enactment, that is, whether instead of
thinking about what is happening in the therapeutic relationship we are pushed
into some kind of action.
