A visitor to the site submitted several questions about transference in response to an earlier post, and I thought they were so interesting and useful, they deserved a lengthy reply — hence today’s post. As a prelude, I’d like to say a few things about how I view the transference, which is different from the way Freud thought about it, and different from the way most lay people understand it today.
Although ideas about transference appear in his work as early as the Studies in Hysteria (1895), it is with the case of Dora (1905) that Freud really begins to think about and articulate his vision of the transference: “What are transferences? They are new editions or facsimiles of the impulses and phantasies 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.”
This is the way most people think of the transference. You are treating me as if I were your father. It is a mis-perception of reality, where the client’s internal unconscious needs, rooted in the past, distort his or her experience of the present. Lay people sometimes use this point of view to invalidate another person’s experience: Stop reacting to me like I’m your mother. I’m not her.
Object relations theorists expanded this view to reflect their understanding of projection and part-objects; but for psychoanalysts nowadays, the transference encompasses an even larger terrain. The relationship between client and therapist, while unique in its own ways, bears a resemblance to other relationships in that similar emotional issues and challenges tend to arise for an individual in all his dealings with other people. For example, if you tend to have have volatile and unstable relationships, with patterns of early idealization giving way to anger, disappointment and devaluation — that is, if you struggle with the issues at the heart of borderline personality disorder — then I assume our working relationship will follow a similar pattern. At first, you’ll see me as the most wonderful therapist in the world; then one day, something I do or say will infuriate you and you’ll turn against me. While modern psychoanalysis views all the emotional transactions between client and therapist as part of the transference, the so-called infantile transference has a special place in our work.
For most of us who struggle with depression, lifelong anxiety or other difficult emotions, these problems took root in childhood, during the earliest years of life, and result from failures of attachment between mother and child. Under optimal conditions, babies pass through a period of helplessness and dependency; as they grow and get what they need from their parents, they eventually become independent, at least to the extent they can stand on their own, look after themselves and find satisfying relationships with other adults. No one is ever completely independent, of course.
When things go awry in early development — that is, when parents are unable to provide what it is needed — the infant instead evolves a set of defenses to escape the awareness of its need and dependency. At one extreme, some people ward off feelings of dependency by merging identities with the loved object and taking possession of it. At the other extreme, some men and women deny their needs entirely and believe themselves completely self-sufficient. There’s a whole spectrum of possibilities in between.
As the infantile transference emerges, the client increasingly turns to the analyst as the source of what he needs, experiencing that relationship, in part, as a revival of his earliest encounter with neediness, but also as a real, present-day relationship involving actual dependency. She brings her characteristic defenses to bear on the growing awareness of that need and it is the job of the analyst to shed light on this process. Over time, the client comes to rely less and less upon those defenses, to accept the reality of his or her need for the analyst’s help, and to tolerate the experience of dependency. Eventually, insight and understanding, along with the experience of the analyst’s care and concern within a healing psychotherapy relationship, provide for the client an emotional experience that approximates what was originally needed. In the process, he or she “grows up,” with certain inevitable limitations and handicaps, and eventually becomes independent.
That is a highly condensed version of what goes on in psychodynamic psychotherapy; I hope it makes sense. So now onto the questions posed by my site visitor:
1. Is it possible for a therapist to intentionally cause transference?
Yes. Under normal conditions, if the therapist is doing her job, the transference gradually evolves on its own. An unscrupulous or narcissistic therapist, however, may behave in seductive ways — by causing the client to feel that he is very special to the therapist, or by trying to elicit his admiration. These acts might be conscious or intentional — as with the predatory therapist — or part of the therapist’s unconscious counter-transference. The narcissistic therapist exploits his clients, feeding off their admiration and need for him. No competent, ethical therapist would ever do anything deliberately to induce a transference reaction or to elicit admiration.
2. Do clients have rights to consent to this?
In theory, yes; but since this process is never announced or articulated — and often happens unconsciously on the therapist’s part — there’s no way to ask for and receive consent. With seductive or narcissistic therapists, their behavior may lay the groundwork for a malpractice lawsuit if it leads to any type of unprofessional contact with their clients.
3. Is it possible for therapists to use their power to meet their own needs?
Absolutely. I gave one example in my first answer. I think many therapists also use their clients’ dependency upon them to avoid their own needs, usually on an unconscious level. Because our clients so often idealize us, it’s also easy to use such idealization as a means to bolster our own defenses, especially those that ward off feelings of shame. I’m not damaged and troubled myself — just look at the way my clients adore me!
4. What does it mean for a therapist to bring his “own stuff” into the room?
It can mean a great many things. In addition to the examples I’ve already given, it could mean that a therapist who has a lot of repressed anger will have a hard time helping his clients to face their own hostility and do things in session to discourage the emergence of angry material. A therapist who can’t accept criticism, who always needs to be right, will find ways to deflect criticism in session and make it about the client, an effort often bolstered by the inherent authority of the therapist’s position. A therapist with an unhappy marriage or few satisfying emotional connections in her “outside” life may come to rely too much upon her clients for a sense of intimacy; under those conditions, a client may unconsciously come to feel that he has to “take care of” his therapist.