Different feelings brought about by countertransference during a therapy session. Here is a rundown of how countertransference within a therapeutic relationship can manifest itself.
Transferences from therapist’s own childhood unfinished business is put onto the client. For example, the client reminds the therapist of his controlling mother.
Reactive feelings arising from therapist’s own narcissism. Like defiance, being offended, wanting to take revenge, envy, lust, feeling insecure, feeling inferior or superior, etc.
Complementary countertransference: when the therapist encounters the transference of the client, out of which incites the therapist to behave towards / feel towards the client the way the client’s caregiver or significant other would feel.
Identification with client’s significant other (parent, child, spouse, children, boss): in such a way that the therapist cannot empathize with the client.
Projective Identification: Feelings of the patient’s childhood experiences which have been split/dissociated, and projected onto the therapist and simultaneously the therapist feels and acts in a way (e.g. sadistic, critical, judgmental… like his father) that leaves the therapist bewildered.
The consequences unrealized countertransference feelings is that the client is robbed of the empathy he/she needs from the therapeutic sessions, which ultimately renders the therapy unprogressive.
The challenging job of the psychotherapist is to be constantly aware of these feelings and the sources of these transference. Self awareness through self therapy, and workshops and supervision are the only and best way to work through these transferences.
Transference is defined by Kernberg as: the unconscious repetition in the here-and-now of a dominant pathogenic conflict of the past.
In Psychopathology this pathogenic conflict plays out in the individuals’ present style of relating with others. Kernberg explains the origins of this mode of relating to be from the attachment of an individual to his mother at infancy. Early relationships, environment and the psychosocial world affect the neuro-biological make-up of the individual.
The experiences of the past, good and bad, thus get activated in the here-and-now, and affect how the individual perceives current situations and how he/she reacts to this situations. How he/she perceives his/her role is also affected by these early experiences.
Negative affects that do not reflect current reality is seen as pathological. These get reinforced through misunderstandings and reaction to and of the environment. These fixated negative reactions become the character and reflect the personality of the individual.
11:00 Kernberg explains that a combination of past experiences (and these are distorted and play out together in the present, not just one event at a time. Although we all transfer our experience of the past to our present, it becomes noteworthy as a personality disorder when this experience was overwhelming to the person, and becomes distorted.
What is done in psychodynamic treatment?
To resolve the pathological conflicts of the past as they get activated in the present.
14:25 By setting up a “normal” situation in the treatment situation. To sit with the patient face to face, and allowing him/her to say whatever comes to mind without feeling in danger of being judged, and to listen attentively to the patient.
Invite the patient to speak openly, support the patient to feel safe in this interaction.
Therapist exhibits technical neutrality. This interaction activates a transference relationship. The therapist can then help the patient interpret this transference reaction to past experience. This is called transference analysis. The adult mind of the patient can then be supported in integrating his/her past experiences with the present situation, leading to normalization of affect in the present.
Significance to psychotherapy…
Paying attention to transference situation, or what we can understand as the relational events that occur between therapist and client in the therapeutic setting in the here-and-now is very important to working with clients because it works directly with the personality of the patient. This is usually the armor that stands in the way of the psychotherapeutic work. Kernberg’s lecture featured here is detailed, and he explains how relationship experiences of an individual in infancy has a role in the wiring of the brain. He also explains how with psychotherapy that works with transference, his/her affect incongruence can be “mentalized”, and integrated within the patient.
Borderline Personality Disorder Case Illustration
46:00 Kernberg cites a case study of a patient with borderline personality disorder.
22 years old female, suicidal attempts, overdose of medications and street drugs, frequent hospitalization. 3 previous therapies, unsuccessful. sexual promiscuity, antisocial and manipulative behavior, violent affect storms, attacking people emotionally.
Treatment started haltingly due to multiple suicidal attempts. Kernberg describes how he experienced her behavior towards him, which were violent and un-compromising. Kernberg explains how he reacted to her firmly, and in my opinion, authentically. He specified what he could tolerate and what he did not. He however kept focussed on the transference without trying to fix or analyze or advice.
The behavior towards the therapist in this case is what Kernberg describes as the transference. It is how the patient has learnt to behave towards others in a relationship.
What we can take from this, is that patients who have had severe trauma as children do play out their pathological relationships with the therapist. It is up to the therapist to be aware of this patterns of relation of the patient. Sticking to the focus of the transference, and reacting authentically (if you are angry, say so, if you do not accept the abuse, say so, and set limits while being firm and sympathetic).
Kernberg also says that therapist have to look at the treatment in the long term, and although we may be impatient to see change in the patient, we have to be patient.
Important points to protect the frame of treatment
* safety of the therapist.
* use common sense.
* be patient in the long run. session takes months and years.
* analysis of what is going on is essential.
* tolerance of transference analysis is variable.
Significance of transference in Gestalt Therapy
Gestalt therapists do not use the term transference. This is because of the traditional link this word has to traditional psychoanalysis that Kernberg speaks about. But the concept of using the interaction of the here-and-now is very much Gestalt therapy. Dialogical Gestalt therapist work with what we call the intersubjective or the in-between. This in-between is the transference.Gestalt Therapist who adopt the strict theory of the method, work with the following processes that is also present in transference analysis:
* working in here-and-now,
* attention to the dialogue between therapist and client.
* non-judgmental (we call this phenomenological) listening to the client, allowing the client to his freedom of speech.
* active listening to the client.
* reflecting back to the client how his/her behavior or way of interaction affects the therapist.
* supporting the client to understand his current way of relating to his/her past (often pathologic) experiences.
* allowing the patient to integrate this phenomena of his/her past into the present.
The dawn of Gestalt therapy was initiated by psychoanalysts like Wilhelm Reich’s “Character Analysis“ and Sándor Ferenczi. The writings of these men, have already addressed the issue of working with transference as a means of working through character.
Kernberg, O. (2016). 29 Otto Kernberg. Youtube.com. Accessed on 05/2017. https://youtu.be/-H9qZBIfjHM
Clarkin, J. F., Yeomans, F. E., & Kernberg, O. F. (2007). Psychotherapy for borderline personality: Focusing on object relations. American Psychiatric Pub.
Doering, S., Hörz, S., Rentrop, M., Fischer-Kern, M., Schuster, P., Benecke, C., … & Buchheim, P. (2010). Transference-focused psychotherapy v. treatment by community psychotherapists for borderline personality disorder: randomised controlled trial. The British Journal of Psychiatry, 196(5), 389-395.
Yeomans, F. E., Levy, K. N., & Caligor, E. (2013). Transference-focused psychotherapy. Psychotherapy, 50(3), 449.