Video #3 – “The Transference Begins”

I’ve now uploaded the third installation in my series on psychodynamic psychotherapy, which you can access through the video frame below. This one covers early manifestations of the transference and includes a lot of examples from recent sessions in my practice. It’s a useful counterpart to my earlier post on the subject, fleshing out the ways that an understanding of the transference can shed light on a person’s “outside” relationships and internal dynamics.

Can I ask a favor? I know that everyone dislikes receiving endless email notifications from all the websites we visit, but the number of people who subscribe to my channel has an impact on my standing in the YouTube community and how my channel ranks; if you watch the video and like it, would you mind subscribing? Many thanks.

Joe is the author and the owner of AfterPsychotherapy.com, one of the leading online mental health resources on the internet. Be sure to connect with him on Google+ and Linkedin.

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52 comments

    Hello Dr. Burgo,

    Before I begin, I want to say that I find your website very informative and useful.

    My question is regarding how you approach your client with the very information you speak of. I have been in therapy in the past. I can relate to the first client of whom you speak. I have had a past of making light of past pain. I can relate to your statement that this was a way to distance myself from the pain and from distancing myself from others.

    My therapist brought this up to me, but I was not ready to hear it. I got really mad and soon afterwards, I dropped out of therapy with him (and of course blaimed him). Would there have been a way to soften the blow so to speak?

    It was not until about 2 years later when I was working with another therapist when we began to deal with these issues.

    Thanks for all your work.

    When you say something like this to a client, it’s very easy for him to feel criticized, as if I’m telling him that he’s “doing therapy wrong.” The client I mentioned had that reaction a bit; what I tried to communicate to him was how concerned I was (and I truly was very worried) about those deeply depressed feelings and what had happened to them, whether they might resurface. I think it’s easier for someone to hear what I’m saying if they understand that it comes from a place of concern. Then, you need to address the very critical side of themselves that is always telling them they’re doing something wrong, and is likely to hear many “innocent” things as criticism. But the main thing is to let the person know you’re concerned about him.

    Dr. Burgo,

    Thank you for the video. How fascinating. I am only a short time into psychotherapy and I can already see aspects of myself and my responses in your examples. Although it is very illuminating from an intellectual perspective, would you recommend that people currently in treatment continue to read your blog and watch these videos? Or, alternatively, is there something to be said for ‘not knowing’ about these dynamics between therapist and client? My strongest defense by far is over-thinking and over-analyzing; I guess my concern is the more I know, the less natural I will be and thus the less progress we will make. Just curious what your perspective is on this.

    Thanks,
    Izzy

    Hi Izzy. I think it depends on the kind of therapy you’re in. It may be that your therapist doesn’t work this way, doesn’t address the transference, and so watching the videos won’t be relevant to your therapy. Even if it is, every relationship between client and therapist is different and unique; these are just some examples to give viewers a flavor for the kind of things I might address. What I talk about in my videos will likely by different from what comes up in your therapy.

    I think of my audience for these videos as mostly made up of people who haven’t had psychodynamic psychotherapy and might be curious about it. Based on the comments I receive from visitors to the site, it seems to me that most therapists work in a different way.

    If your therapist does not explain such things as transference and other possible side effects of therapy, they are being irresponsible and unethical. That’s because they have not obtained your informed consent for the approach or techniques they will use. Informed consent requires telling you about risks and side effects, just like with medical procedures or medications. Don’t fall for any malarkey about therapy being somehow too different and special to fully inform clients about it. It is your RIGHT to know.

    This is very interesting. At what point should the therapist communicate this information to the client, and what exactly should he or she say about transference and its “possible side effect”?

    Also, you speak about the RIGHT to know; is this a legal right? An ethical right? Where is this right spelled out or codified? If a therapist fails to do what you say, what are the legal or ethical ramifications?

    The right time is when the client and therapist are setting therapy goals and creating a treatment plan. It should also be discussed whenever the therapist introduces a new technique or method. It’s not informed consent if the client isn’t informed.

    The onus is on the therapist to described ANY possible side effects of therapy, and to be open to hearing about any that the client may bring up.

    Ethically it’s a no-brainer, because how it is OK to do anything to a client WITHOUT their consent? Lack of informed consent opens the door to all kinds of abuses, so the door should stay shut.

    Legally, informed consent is usually included in the laws and regulations regarding therapy in the jurisdiction where the therapist practices. Depending on the particulars, lack of informed consent could lead to lawsuits, damages, loss of license, public censure, etc.

    Just to add, one could also take a consumer protection approach to informed consent. It’s the client’s therapy, they’re paying for it, it’s for *them*, so why shouldn’t they know upfront what the therapist is planning and what the consequences might be?

    For me, the problem is that the transference isn’t a technique and therapists don’t do something in particular to bring into being; it just happens. I see the transference as a major tool for growth; you seem to see it as a big danger and I’m not sure why.

    When I asked you about which ethical guidelines, I meant (and probably should have specified) professional ethics. There’s nothing in my professional ethics that requires me to warn clients of a danger I don’t believe in. That being said, I do make clear in my disclosure statement that I will address the interactions between me and my clients as a way of gaining insight.

    I didn’t say transference is a technique. I said it is a side effect.

    I find it curious that you separate regular everyday ethics (people have a right to know what they’re getting into) from professional ethics. The professionals who draw up those codes of ethics might be fine with withholding info from clients, but are the clients OK with it? Do they even know that it’s happening?

    Also, *you* might think transference is not a danger, but the *client* might see it differently. Actually I don’t think I’ve ever come across a client who said “I’m so glad my therapist never warned me about transference!” but there are many accounts of clients who wish they had known. And there is plenty of literature discussing the risks of transference. It’s a very complex thing and I think most clients would want to know about it in advance.

    Also, I’m not sure how treatment can be properly planned without discussing it. E.g. what if the client has other stressors in their life, e.g. work, school, physical health problems? Don’t they need to be able to consider how therapy side effects might affect these important areas and plan accordingly?

    It seems that we’re speaking two entirely different languages. Our points of view are so entirely different I think there is no basis for further dialog.

    Yikes. This is basically how my conversation about therapeutic practice went with a former psychiatrist. It would be great if we recognized that we spoke “entirely different languages” and that we did not have a basis for helpful dialogue to begin with. Having an informed discussion about psychodynamic psychotherapy beforehand (or even just defined or stated as such) would saved us both a lot of time and me a lot of money. He pushed very had to get me to express my beliefs, and when I finally did, he finally recognized that this process never had the chance to be helpful and agreed we should cease dialogue (or, didn’t like knowing that his lack of proper informing led to much bigger problems we were in no position to deal with.) Discussions at the beginning would also have spared me years of increased fearfulness, suicidality (which I never previously experienced) mistrust (particularly of helping professionals), and isolation the experience induced.

    I think this adds to Margaret’s critique in that transference issues are something that need to be discussed earlier in treatment planning. At the very least, both parties can become aware that they may have different beliefs/expectations about the value inducing transference and therapy based on it, at make decisions in the patient’s best interest (do a different kind of treatment, refer to another clinician, or at least have more proactive/intentional conversations about the extent of their disagreements and what they can do together to make therapy feel safe enough to even have a chance to be helpful without risking serious harm).

    Even a short discussion with you, saying ” I see all the benefits, rather than risks and dangers,” would help me decide that we shouldn’t be working together.

    Transference in psychodynamic psychotherapy is certainly and expected and intended part of dynamic therapy. Many dynamic techniques, like free association and limited disclosure by therapists are intended to quicken transferential responses. As you say, transference is a tool for growth. What I think you mean is transference interpretation and related thinking/reflection/discussion is a tool for growth. Transference interpretation is certainly a psychodynamic technique expected to be used in psychodynamic psychotherapy, so I believe explanation of what transference is and how it used in therapy should definitely be told to potential clients before agreement to begin dynamic psychotherapy.

    Many people who do not expect particularly potential negative transference responses or that they are expected to be shared with therapists are apt to leave psychotherapy early and feeling much worse than before they began, and also disenchanted future psychological help. Many people seeking psychological help do not want an experience that is based on developing and analyzing transference. I don’t see how not explaining transference is beneficial or helpful to clients, and I can certainly see how avoiding its discussion before therapy begins can be potentially harmful.

    Fascinating.

    I’d say it’s at least an ethical right. No medical doctor would go into an open-ended, long-term course of treatment with a patient without some very early disclosure of the risks involved in the treatment. Since the induction of anxiety is part and parcel of psychodynamic therapy, by analogy it makes sense that there would be disclosure about such risks as anxiety, dependency, and even the development of love for the therapist.

    Disclosure and discussion by the therapist at the outset might also make those feelings, when they do arise, more manageable in the patient. Forewarned is forearmed.

    What do you think? Helpful or not?

    It’s hard for me to see it that way. I see all the benefits, rather than risks and dangers. As I said it another reply, my disclosure statement mentions that I do address relationship issues between me and my clients; other than that, I’m not sure I could say anything of value, or anything that could truly prepare a client for the transference.

    I have been in successful therapy with a therapist whose practice seems to aligns with that of Dr. Burgo. There is absolutely nothing my therapist could have told me about the process at the beginning of therapy that would have come close to the experience of therapy and it’s impact on the healthy choices I make for my life today. I don’t feel at all like my rights were violated, that I did not give informed consent or that he failed to inform me of the process. I paid my therapist every week to help me learn healthy ways to deal with traumatic childhood sexual abuse and the effect that was having in relationships with others. Knowing what I know today and what hard work it has been, I would do it all over again. And, I’m not finished yet. Engaging in psychotherapy is absolutely the very best thing I have ever done for myself – and what I know today is that there are no words to adequately explain the process. There is no substitute for just surrendering to the process in a safe therapeutic relationship.

    Of course I’m of the same mind. I suppose the tricky part is making sure it actually will be a “safe therapeutic relationship.” That’s the danger I think other site visitors are concerned about.

    Gotta ask before I comment on anything else. Those case examples are not real patients of yours, right? They’re composites or fictional?

    These real, not fictional, clients all came to me through familiarity with my website and understand that I write about my clients from time to time. My disclosure statements informs prospective clients that I will do so. I agree to “anonymize” their material … and if you listen carefully to what I said in the video, there are absolutely NO identifying details of any kind. Whenever there is any risk of a detail revealing anything, I change it. Ages, genders, professions, etc. I’m very careful that only the person him- or herself will know who I’m talking about.

    Really excellent video. Especially accurate for me is your comment at the end about starting to feel somewhat better and not feeling as desperate for help and slipping back into old defenses. That is me to a tee.

    For me, I would describe this as slipping back into the old “postures” that you mention in the beginning…being dismissive of pain, being self-deprecating, not wanting to acknowledge or deal with anything that might feel embarrassing or shameful. Even memories of crying in prior sessions feel shameful and I’d rather forget them when I’m “feeling better.”

    My therapist would call these defenses, too, but he also points out how self-hating this posture is.

    Keep up the great work.

    Hi Joseph

    Thankyou for making transference so relatable. I had always thought of it in the context of a sort of sexual attraction rather than maladaptive ways of relating.

    This might be a little hard for you to do but would you also please consider doing a video on counter transference? Speaking only for myself I think this causes me quite a bit of anxiety in the context of therapy and particularly how to address this within the context of the therapeutic relationship.

    Interesting you should mention countertransference, because I was thinking that after the next video on resistance, I want to do something about the therapist’s feelings for the client as the relationship develops — countertransference in the broader sense, rather than just “unresolved issues” that come up. Give me a few weeks.

    What can I say?! I love this video! I love the other two videos in the series as well. Heck, I’m in love with your whole darn website!

    I’m a 40-something gal who is currently working on a master’s degree in counseling psychology, and is hoping to train (and work) as a psychoanalyst before I die. I’m also actively searching for the fountain of youth. I’ve been in my own analysis for the past 16 months, and – when I don’t hate it – I almost love it. I came across your blog just a week or so ago, and haven’t had time to read everything yet. But what I have read has been immensely helpful to me, as both patient and prospective therapist, in better understanding certain concepts that were/are still a bit fuzzy. Thank you for that. And keep it comin’!

    I will indeed keep it comin’. Although I’m doing these videos for people who might not know what to expect from psychodynamic psychotherapy, I’m glad they’re useful to someone already so familiar with psychoanalytic thinking. Thanks!

    I’m only moderately familiar with psychoanalytic thinking, but every little bit of information I can find on the subject helps to organize and solidify what I do know. It certainly makes the most sense to me from a theoretical standpoint. It’s when I try to see it all from a patient’s point of view that it gets confusing. I lie there on the couch trying to say and do what comes naturally, all the while thinking things like “What is Dr. L. doing?” I wonder what she sees and what she’s trying to show me. I even find myself filing away certain ways of saying or doing things for my own future use as a therapist. It’s as if I’m trying to be in two or three places at once, which is sometimes quite an overwhelming and disorienting feeling. Is this a normal reaction?

    Thanks again, Dr. Burgo.

    I don’t know if it’s “normal”, but I think telling Dr. L about all those thoughts would ALSO be a part of free association.

    I’m only moderately fmialiar with psychoanalytic thinking, but every little bit of information I can find on the subject helps to organize and solidify what I do know. It certainly makes the most sense to me from a theoretical standpoint. It’s when I try to see it all from a patient’s point of view that it gets confusing. I lie there on the couch trying to say and do what comes naturally, all the while thinking things like What is Dr. L. doing? I wonder what she sees and what she’s trying to show me. I even find myself filing away certain ways of saying or doing things for my own future use as a therapist. It’s as if I’m trying to be in two or three places at once, which is sometimes quite an overwhelming and disorienting feeling. Is this a normal reaction?Thanks again, Dr. Burgo.

    Yes, I think it’s a normal reaction. This will settle down over time. But you should tell Dr. L all about it!

    What can I say?! I love this video! I love the other two videos in the seiers as well. Heck, I’m in love with your whole darn website!I’m a 40-something gal who is currently working on a master’s degree in counseling psychology, and is hoping to train (and work) as a psychoanalyst before I die. I’m also actively searching for the fountain of youth. I’ve been in my own analysis for the past 16 months, and when I don’t hate it I almost love it. I came across your blog just a week or so ago, and haven’t had time to read everything yet. But what I have read has been immensely helpful to me, as both patient and prospective therapist, in better understanding certain concepts that were/are still a bit fuzzy. Thank you for that. And keep it comin’!

    Thanks for the look in at the kinds of problems that people present to you in your practice.

    It does feel as if what you’re calling “transference” is the “transfer” of how folks relate in the outside world to the inside-the-four-walls of the therapy office. As opposed to, say, a patient allegedly relating to the therapist in a way that has nothing to do with the therapist, but instead with some “transferred” past relationship. Only the example of the patient who emailed you and criticized you was presenting about the therapy with you specifically. All the others were “transferring” how they dealt with the world to how they dealt with you. Even the patient who found her therapy with you failing in some way, and then quit, didn’t seem to be focused on you, but on the dependency issues of therapy in general.

    It makes sense that patients would “transfer” in this way, no? We all do, all the time. Even therapists “transfer” their past experiences with patients to their present ones with newer or other patients. Not countransferentially specifically to the therapy, but to the experience. It’s almost impossible to do what Bion talked about as therapy “without memory or desire.” Not that I’m sure that’s a desirable way to do psychotherapy in the first place.

    Interesting video. Thanks for it.

    Hi joseph,
    I’m not sure if this is the correct place to post my comment, or if it’s appropriate for your site at all…
    I’v just started psychodynamic therapy and had felt that it was ‘useful'(much more than this), in fact had decided that I would have benefited from therapy, of some sort from an early age. However just prior to my last therapy session I watched a very disturbing film, ‘The Wall, Or Psychoanalysis Put To The Test For Autism’, by Sophie Robert. I then had a panic attack in session, my therapist was great, and i look forward to hearing her thoughts on the film, just wondered what you and/or fellow readers of ‘After Psychotherapy’ think about this film?

    Personally i’m now caught up in the whole pseudoscience vs therapy / medication vs therapy / behaviourism vs therapy debate, (psychotherapy is wining, just) i’m trying to educate myself but so many conflicting opinions, studies, papers etc.

    Regardless, thank you for all the time and effort you have put into this site.

    thanks,
    hal

    I tried to paste a link directly to the film, but turned into a massive list of numbers, letters etc. So hear is a link to an article from which you can navigate to the film. Also it can be difficult to find the film, i think because the film makers are being sued. I also found it on @ http://www.daily motion
    http://www.guardian.co.uk/commentisfree/2012/apr/16/autism-psychoanalysis-lacanian

    I watched about ten minutes of this film and turned it off. For me, Lacanian analysis represents all the worst aspects of psychoanalysis and though I spent many months reading and attempting (mostly unsuccessfully) to understand what Lacan was trying to say, I took away literally nothing of clinical use.

    I have not worked with autistic children but I have worked with adults who present with what is referred to as Asperger’s Syndrome, and with autistic-like symptoms. It always surprises me that few people — including people in the UK! — are unfamiliar with the work of Frances Tustin. I find her invaluable for an understanding of autistic defenses. She doesn’t “blame” the mother; she sees autistic shell and confusional defenses as a response to a catastrophic and premature awareness of separation from the mother, which can come about for various reasons but not because the mother is “bad”. Successful analytic work with these people involves empathically entering into the terror at the heart of their experience — the terror of disintegration, the feeling that their bodies are damaged and full of wounds, the absolute panic when they come out of the shells in which they live.

    I don’t write about this much because whenever I do, the Asperger’s people come after me.

    What happens when therapy ends abruptly in the thick of transference, in your experience? Do you think clients can move on with another therapist and feel as safe and potentially experience transference with them? Just wondering if you’ve ever had clients come from a heavily transference-laden therapeutic situation where they ultimately felt uncomfortable and put out (not expolited), say, by extreme fee hikes. You may (correctly) guess this is my situation. I found it so scary and at the same time enlightening to be in therapy, but I just don’t know if I can go through all that again with someone else. How well do transference wounds heal when never fully addressed to completion? Sorry if not articulate….I feel sad and I am on my second glass of wine ( a lot for me

    I think the client who has gone through what you’ve been through may eventually be able to trust another therapist, but it will take a long time. If I understand what you’re describing, it sounds as if your therapist has traumatized you with those “extreme fee hikes” — as I’ve said before, I regard those as unethical. If and when you decide to give it another try, I’m sure it will take quite some time before you’ll fee safe. I’ve had clients come to me after bad therapy experiences and they naturally have a very hard time settling in.

    I know that seems logical to you but I’ve never known a therapist who warned clients that they might be damaged by transferential feelings. Every relationship that involves a degree of need (i.e., every close or intimate human relationship) makes you vulnerable to hurt. It’s just the reality of what it means to be human and vulnerable.

    Customary action does not make an ethical standard.

    Was my previous post “hostile, irrelevant to the post or overly rambling?”

    Really excellent video. Especially aaccrute for me is your comment at the end about starting to feel somewhat better and not feeling as desperate for help and slipping back into old defenses. That is me to a tee.For me, I would describe this as slipping back into the old postures that you mention in the beginning being dismissive of pain, being self-deprecating, not wanting to acknowledge or deal with anything that might feel embarrassing or shameful. Even memories of crying in prior sessions feel shameful and I’d rather forget them when I’m feeling better. My therapist would call these defenses, too, but he also points out how self-hating this posture is.Keep up the great work.

    Hi Dr. Burgo, I was just wondering if you ever got around to the next video on resistance. I’ve been on the edge of moving into the stage for awhile I think and am curious about your thoughts and examples on the subject.

    I’ve been so caught up with finishing my book that I had to put videos aside for a bit. I’m currently proofing galleys and the book will come out in October; I’m hoping to return to my videos within the next few weeks. Thanks for asking!

    I have been in analysis 4 days/week x 4 years. We’ve accomplished a great deal – stopped several addictive behaviors (smoking pot/cigarettes, pills, ETOH) and am now working on weight reduction and healthy living. My question is this – my transference is a combination of erotic/maternal/infantile and is very, very strong. We work in the transference and have a very good relationship. How can I possibly every say good-bye to this wonderful woman who is helping me save my life. How can I ever NOT see her? I am internalizing her well, but, how in the world will I be able to do without the daily face-to-face?
    Thanks, love your blog!
    Pam

    Hi Pam,

    All I can say is that a time will come when you’ll feel differently. The way you feel now means you’re not ready to leave, that you still have a lot of work to do. No doubt it will still be difficult to leave when you do, but at some point, you’ll feel ready to go it alone.

    That is what my doc says. I’ll understand it when I get there. Plenty of tears between now and then, I’ll have faith and stay the course. Thank you. Pam

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