Tag: Transference

What is Working Through?

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Introduction

In psychodynamic psychotherapy, working through is seen as the process of repeating, elaborating, and amplifying interpretations. It is believed that such working through is critical towards the success of therapy.

The concept was introduced by Sigmund Freud in 1914, and assumed ever greater importance in psychoanalysis, in contrast to the immediacy of abreaction.

Interpretation and Resistance

Interpretations are made when the client comes up with some material, be it written, a piece of art, music, or verbal, and are intended to bring the material offered into connection with the unconscious mind. Because of the resistance to accepting the unconscious, interpretations, whether correct or partially incorrect, consciously accepted or rejected, will inevitably require amplifying and extending to other aspects of the client’s life.

In a process Sandor Rado compared to the labour of mourning, the unconscious content must be demonstrated repeatedly in all its various forms and linkages – the process of working through.

Because of the power of resistance, the client’s rational thought and conscious awareness may not be sufficient on their own to overcome the maladjustment, entailing further interpretation and further working through.

Rat Man

Before formulating the concept of working through, in his case study of the Rat Man, Freud wrote of his interpretations:

“It is never the aim of discussions like these to create convictions. They are only intended to bring the repressed complexes into consciousness…and to facilitate the emergence of fresh material from the unconscious. A sense of conviction is only attained after the patient has himself worked over the reclaimed material”.

Transference

The necessity of working through the transference is stressed in almost all forms of psychodynamic therapy, from object relations theory, through the openings offered for working through by transference disruption in self psychology, to the repetitive exploration of the transference in group therapy.

What is Vicarious Traumatisation?

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Introduction

Vicarious trauma (VT) was a term coined by McCann and Pearlman that is used to describe how working with traumatised clients and the effect it has on trauma therapists.

Previously, the phenomenon was referred to as secondary traumatic stress coined by Dr. Charles Figley. The theory behind VT is that the therapist has a profound world change and is permanently altered by the interaction of empathetic bonding with a client. This change is thought to have three conditional requirements: empathic engagement and exposure to graphic and traumatising material, the therapist being exposed to human cruelty, and re-enactment of trauma within the therapy process. This change can produce changes in a therapist’s sense of spirituality, worldview, and self-identity.

VT is still a subject of debate by theorists, with some saying it is based on the concept of countertransference (refer to transference), burnout, and compassion fatigue. McCann and Pearlman argue, however, that there is probably a relationship between these constructs, but VT is unique and distinct.

As time has progressed, the term VT has expanded to more than just indirect trauma experienced by trauma therapists and has come to include many more populations, although the phenomenon is still evolving.

Signs and Symptoms

The symptoms of vicarious trauma align with the symptoms of primary, actual trauma. When helping professionals attempt to connect with their clients/victims emotionally, the symptoms of VT can create emotional disturbance such as feelings of sadness, grief, irritability and mood swings. The signs and symptoms of VT parallel those of direct trauma, although they tend to be less intense. Workers who have personal trauma histories may be more vulnerable to VT, although the research findings on this point are mixed.

Common signs and symptoms include, but are not limited to:

  • Social withdrawal;
  • Mood swings;
  • Aggression;
  • Greater sensitivity to violence;
  • Somatic symptoms;
  • Sleep difficulties;
  • Intrusive imagery;
  • Cynicism;
  • Sexual difficulties;
  • Difficulty managing boundaries with clients; and
  • Core beliefs and resulting difficulty in relationships reflecting problems with security, trust, esteem, intimacy, and control.

Contributing Factors

VT, conceptually based in constructivist self-development theory, arises from an interaction between individuals and their situations. This means that the individual helper’s personal history (including prior traumatic experiences), coping strategies, and support network, among other things, all interact with his or her situation (including work setting, the nature of the work s/he does, the specific clientele served, etc.), to give rise to individual expressions of vicarious trauma. This in turn implies the individual nature of responses or adaptations to VT as well as individual ways of coping with and transforming it. Some have postulated that this traumatisation occurs when one’s view of the world or a feeling of safety is shattered by hearing about the experiences of their clients. This exposure to trauma, however indirectly, can cause an interruption to the daily functioning of the clinician reducing their effectiveness.

Anything that interferes with the helper’s ability to fulfil their responsibility to assist traumatised clients can contribute to vicarious trauma. Many human service workers report that administrative and bureaucratic factors that impediment to their effectiveness influence work satisfaction. Negative aspects of the organisation as a whole, such as reorganisation, downsizing in the name of change management and a lack of resources in the name of lean management, contribute to burned-out workers.

Vicarious trauma has also been attributed to the stigmatisation of mental health care among service providers. Stigma leads to an inability to engage in self care and eventually the service provider may reach burnout, and become more likely to experience VT. The research has also begun to show that vicarious trauma is more prominent in those with a prior history of trauma and adversity. Research indicates that a mental health provider’s defence style might pose as a risk factor for VT. Mental health providers with self-sacrificing defence styles have been found to experience increased VT.

Research has demonstrated that females are more likely to develop secondary traumatic stress than males and counsellors not in private practice are more likely to develop secondary traumatic stress. Those with stronger counsellor professional identity (CPI) experience less secondary traumatic stress as well.

Specifically, in emergency medical service (EMS) personnel, previous veteran status increased likelihood of experiencing VT.

While the term “vicarious trauma” has been used interchangeably with “compassion fatigue”, “secondary traumatic stress disorder,” “burnout,” “countertransference,” and “work-related stress,” there are important differences. These include the following:

  • Unlike compassion fatigue, VT is a theory-based construct. This means that observable symptoms can serve as the starting for a process of discovering contributing factors and related signs, symptoms, and adaptations. VT also specifies psychological domains that can be affected, rather than specific symptoms that may arise. This specificity may more accurately guide preventive measures and interventions, and allow for the accurate development of interventions for multiple domains (such as changes in the balance between psychotherapy and other work-related tasks and changes in self-care practices).
  • Countertransference is the psychotherapist’s response to a particular client. VT refers to responses across clients, across time.
  • Unlike burnout, countertransference, and work-related stress, VT is specific to trauma workers. This means that the helper will experience trauma-specific difficulties, such as intrusive imagery, that are not part of burnout or countertransference. The burnout and VT constructs overlap, specifically regarding emotional exhaustion. A worker may experience both VT and burnout, and each has its own remedies. VT and countertransference may also co-occur, intensifying each other.
  • Unlike VT, countertransference can be a very useful tool for psychotherapists, providing them with important information about their clients.
  • Work-related stress is a generic term without a theoretical basis, specific signs and symptoms or contributing factors, or remedies. Burnout and VT can co-exist. Countertransference responses may potentiate VT.
  • Vicarious post-traumatic growth, unlike VT, is not a theory-based construct but rather is based on self-reported signs.
  • Body-centred countertransference.

Mechanism

The posited mechanism for VT is empathy. Different forms of empathy may result in different effects on helpers. Batson and colleagues have conducted research that might inform trauma helpers about ways to manage empathic connection constructively. If helpers identify with their trauma survivor clients and immerse themselves in thinking about what it would be like if these events happened to them, they are likely to experience personal distress, feeling upset, worried, distressed. On the other hand, if helpers instead imagine what the client experienced, they may be more likely to feel compassion and moved to help.

Measurement

Over the years, VT has been measured in a wide variety of ways. VT is a multifaceted construct requiring a multifaceted assessment. More specifically, the aspects of VT that would need to be measured for a complete assessment include self capacities, ego resources, frame of reference (identity, world view, and spirituality), psychological needs, and trauma symptoms. Measuring of some of these elements of VT exist, including the following:

  • Psychological needs, using the Trauma and Attachment Belief Scale.
  • Self capacities, using the Inner Experience Questionnaire and/or the Inventory of Altered Self-Capacities.
  • Trauma symptoms, using the PTSD Checklist, Impact of Events Scale, Impact of Events Scale-Revised, children’s revised Impact of Events Scale (Arabic Version), Trauma Symptom Inventory, Detailed Assessment of Posttraumatic Stress, and/or the World Assumptions Scale.
  • Secondary Traumatic Stress Scale is a 17 item, 5-point Likert scale that distinguishes between PTSD measures by framing the questions as stressors from exposure to clients.
  • The Professional Quality of Life (ProQol) version 5. This assessment has 30 questions on a 5-point Likert scale and measures compassion fatigue and secondary trauma.

Addressing

VT is not the responsibility of clients or systems, although institutions that provide trauma-related services bear a responsibility to create policies and work settings that facilitate staff (and therefore client) well-being. Each trauma worker is responsible for self-care, working reflectively, and engaging in regular, frequent, trauma-informed professional confidential consultation.

There are many ways of addressing VT. All involve awareness, balance, and connection. One set of approaches can be grouped together as coping strategies. These include, for example, self-care, rest, escape, and play. A second set of approaches can be grouped as transforming strategies. Transforming strategies aim to help workers create community and find meaning through the work. Within each category, strategies may be applied in one’s personal life and professional life. Organisations that provide trauma services can also play a role in mitigating VT.

Research shows that many simple things increase happiness and this aids to lessen the impact of VT. People who are more socially connected tend to be happier. People who consciously practice gratitude are also shown happier. Creative endeavours that are completely detached with work also increase happiness. Self-care practices like yoga, qigong, and sitting meditation are found to be helpful for those who practice. The Harvard Business Review in a case study regarding to traumatisation stated that it is essential to create an organisational culture in which it is cool to be a social worker or a counsellor, where these professionals are empowered to influence the workplace issues, the strategy of human services in both corporate and care services. Additionally, research indicates clinicians who are exposed to VT are in need of targeted interventions that will boost their resilience. Findings have show interventions such as respite, increasing self efficacy, and having appropriate professional support buffer against the effects of vicarious trauma.

Individuals Found to Experience Vicarious Trauma

Children

Children have been found to experience VT from the traumas experienced by their caregivers and peers. In children the following factors have been found to predict vicarious trauma symptoms:

  • Socioeconomic status.
  • Gender (girls more than boys).
  • Race.
  • Witnessing the trauma directly.
  • Caregiver warmth and hostility.

Foster Parents

Foster parents have been found to experience VT related to the trauma of those they care for. Several studies have found that foster parents experience vicarious trauma, burnout, and compassion fatigue and report that emotional disengagement (a common symptom of VT) is a coping strategy.

Counsellors and Other Mental Health Providers

Counsellors and other mental health professional have been found to experience vicarious trauma when working with veterans and others that have experienced trauma. Some of the factors that predict vicarious trauma severity include:

  • Professional trauma.
  • Level of peer supervision.
  • Social support availability.
  • Emotional coping strategies.
  • Long hours and high caseloads.
  • Population served by the clinician.
  • Defensc mechanisms of the therapist.

American Muslims

After the terrorist attack on the World Trade Centre in the United States, many Muslims were relegated with terrorists and attacks of violence were perpetrated against them. This caused many individuals in this community to experience VT and added to a feeling of worry and being unsafe. Those feeling a stronger sense of religious identity were more likely to experience VT.

What is Negative Transference?

Published on by Andrew Marshall3 Comments

Introduction

Negative transference is the psychoanalytic term for the transference of negative and hostile feelings, rather than positive ones, onto a therapist (or other emotional object).

Refer to Narcissistic Neurosis and Transference Neurosis.

Freud’s Preference

In his pioneering studies of transference phenomena, Freud noted the existence of both positive and negative transferences, while expressing a preference for the former, which he initially saw as a prerequisite for analytic work. Freud considered that “The hostile feelings make their appearance as a rule later than the affectionate ones and behind them”; and more frequently in same-sex than in mixed-sex analytic pairings.

Otto Fenichel pointed out that whereas neurotic aggravations can follow the emergence of a negative transference, so too (paradoxically) can improvements: the patient gets better to spite the therapist for emphasising the patient’s problems.

Later Formulations

Melanie Klein in her disputes with Anna Freud laid much greater emphasis than her opponent on the constructive role to be played by interpreting the negative transference. Jacques Lacan followed her theoretical lead in seeing “the projection of what Melanie Klein calls bad internal objects” as key to “the negative transference that is the initial knot of the analytic drama” – though he himself would face criticism for glossing over the negative transference in training analyses, to keep his analysands in dependence.

W.R.D. Fairbairn was also more interested in the negative than the positive transference, which he saw as a key to the repetition and exposure of unconscious attachments to internalised bad objects. In his wake, object relations theorists have tended to stress the positive results that can emerge from working with the negative transference.

Technical Blocks

  • Fritz Wittels considered the brevity of Wilhelm Stekel’s analyses to be due to his narcissism being unable to endure the emergence of the negative transference.
  • Rollo May saw the flaw in person-centred therapy as a pervasive reluctance to deal with the negative transference.

Literary Analogues

Describing the process of becoming the focus of a paranoid’s hostility, C.P. Snow wrote:

“No one likes being hated: most of us are afraid of it: it jars to the bone when we meet hatred face to face.”

What is Transference Neurosis?

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Introduction

Transference neurosis is a term that Sigmund Freud introduced in 1914 to describe a new form of the analysand’s infantile neurosis that develops during the psychoanalytic process.

Based on Dora’s case history, Freud suggested that during therapy the creation of new symptoms stops, but new versions of the patient’s fantasies and impulses are generated. He called these newer versions “transferences” and characterised them as the substitution of the analyst for a person from the patient’s past. According to Freud’s description: “a whole series of psychological experiences are revived not as belonging to the past, but as applying to the person of the analyst at the present moment”. When transference neurosis develops, the relationship with the therapist becomes the most important one for the patient, who directs strong infantile feelings and conflicts towards the therapist, e.g. the patient may react as if the analyst is his/her father.

Refer to Narcissistic Neurosis and Negative Transference.

Basic Characteristics

Transference neurosis can be distinguished from other kinds of transference because:

  1. It is very vivid and it rekindles the infantile neurosis.
  2. It is generated by the feelings of frustration that the analysand inevitably experiences during sessions, since the analyst does not fulfil the analysand’s longings.
  3. In transference neurosis the symptoms are not stable, but they are transformed.
  4. Regression and repetition play a key role in the creation of transference neurosis.
  5. Transference neurosis reveals the particular meanings that the analysand has given to current infantile relationships and events, which generate internal conflicts between wishes and particular defences formed to strive against them. These meanings are united and create several transference patterns.

Resolution

Once transference neurosis has developed, it leads to a form of resistance, called “transference resistance”. At this point, the analysis of the transference becomes difficult since new obstacles arise in therapy, e.g. the analysand may insist on fulfilling the infantile wishes that emerged in transference, or may refuse to acknowledge that the current experience is, in fact, a reproduction of a past experience. However, the successful resolution of transference neurosis through interpretation will lead to the lifting of repression and will enable the Ego to solve the infantile conflicts in new ways. Furthermore, it will allow the analysand to recognize that the current relationship with the analyst is based on repetition of childhood experiences, leading to the detachment of the patient from the analyst.

The replacement of the infantile neurosis by transference neurosis and its resolution through interpretation remains the main focus of the classical psychoanalytic therapy. In other types of therapy, either the transference neurosis does not develop at all, or it does not play a central role in the therapy process. Although it is more likely for transference neurosis to develop in psychoanalysis, where the sessions are more frequent, it may also appear during psychotherapy.

What is Transference?

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Introduction

Transference (German: Übertragung) is a phenomenon within psychotherapy in which the feelings a person had about their parents, as one example, are unconsciously redirected or transferred to the present situation.

It usually concerns feelings from a primary relationship during childhood. At times, this transference can be considered inappropriate. Transference was first described by Sigmund Freud, the founder of psychoanalysis, who considered it an important part of psychoanalytic treatment.

Occurrence

It is common for people to transfer feelings about their parents to their partners or children (that is, cross-generational entanglements). Another example of transference would be a person mistrusting somebody who resembles an ex-spouse in manners, voice, or external appearance, or being overly compliant to someone who resembles a childhood friend.

In The Psychology of the Transference, Carl Jung states that within the transference dyad both participants typically experience a variety of opposites, that in love and in psychological growth, the key to success is the ability to endure the tension of the opposites without abandoning the process, and that this tension allows one to grow and to transform.

Only in a personally or socially harmful context can transference be described as a pathological issue. A modern, social-cognitive perspective on transference explains how it can occur in everyday life. When people meet a new person who reminds them of someone else, they unconsciously infer that the new person has traits similar to the person previously known. This perspective has generated a wealth of research that illuminated how people tend to repeat relationship patterns from the past in the present.

High-profile serial killers often transfer unresolved rage toward previous love or hate-objects onto “surrogates”, or individuals resembling or otherwise calling to mind the original object of that hate. It is believed in the instance of Ted Bundy, he repeatedly killed brunette women who reminded him of a previous girlfriend with whom he had become infatuated, but who had ended the relationship, leaving Bundy rejected and pathologically rageful (Bundy, however, denied this as a motivating factor in his crimes). This notwithstanding, Bundy’s behaviour could be considered pathological insofar as he may have had narcissistic or antisocial personality disorder. If so, normal transference mechanisms cannot be held causative of his homicidal behaviour.

Sigmund Freud held that transference plays a large role in male homosexuality. In The Ego and the Id, he claimed that eroticism between males can be an outcome of a “[psychically] non-economic” hostility, which is unconsciously subverted into love and sexual attraction.

Transference and Counter-Transference during Psychotherapy

In a therapy context, transference refers to redirection of a patient’s feelings for a significant person to the therapist. Transference is often manifested as an erotic attraction towards a therapist, but can be seen in many other forms such as rage, hatred, mistrust, parentification, extreme dependence, or even placing the therapist in a god-like or guru status. When Freud initially encountered transference in his therapy with patients, he thought he was encountering patient resistance, as he recognised the phenomenon when a patient refused to participate in a session of free association. But what he learned was that the analysis of the transference was actually the work that needed to be done: “the transference, which, whether affectionate or hostile, seemed in every case to constitute the greatest threat to the treatment, becomes its best tool”. The focus in psychodynamic psychotherapy is, in large part, the therapist and patient recognising the transference relationship and exploring the relationship’s meaning. Since the transference between patient and therapist happens on an unconscious level, psychodynamic therapists who are largely concerned with a patient’s unconscious material use the transference to reveal unresolved conflicts patients have with childhood figures.

Countertransference is defined as redirection of a therapist’s feelings toward a patient, or more generally, as a therapist’s emotional entanglement with a patient. A therapist’s attunement to their own countertransference is nearly as critical as understanding the transference. Not only does this help therapists regulate their emotions in the therapeutic relationship, but it also gives therapists valuable insight into what patients are attempting to elicit in them. For example, a therapist who is sexually attracted to a patient must understand the countertransference aspect (if any) of the attraction, and look at how the patient might be eliciting this attraction. Once any countertransference aspect has been identified, the therapist can ask the patient what his or her feelings are toward the therapist, and can explore how those feelings relate to unconscious motivations, desires, or fears.

Another contrasting perspective on transference and countertransference is offered in classical Adlerian psychotherapy. Rather than using the patient’s transference strategically in therapy, the positive or negative transference is diplomatically pointed out and explained as an obstacle to cooperation and improvement. For the therapist, any signs of countertransference would suggest that his or her own personal training analysis needs to be continued to overcome these tendencies. Andrea Celenza noted in 2010 that “the use of the analyst’s countertransference remains a point of controversy”.

What is Splitting (Psychology)?

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Introduction

Splitting (also called black-and-white thinking or all-or-nothing thinking) is the failure in a person’s thinking to bring together the dichotomy of both positive and negative qualities of the self and others into a cohesive, realistic whole.

It is a common defence mechanism. The individual tends to think in extremes (i.e. an individual’s actions and motivations are all good or all bad with no middle ground).

Splitting was first described by Ronald Fairbairn in his formulation of object relations theory; it begins as the inability of the infant to combine the fulfilling aspects of the parents (the good object) and their unresponsive aspects (the unsatisfying object) into the same individuals, instead seeing the good and bad as separate. In psychoanalytic theory this functions as a defence mechanism.

Refer to Emotional Conflict and Psychological Projection.

Relationships

Splitting creates instability in relationships because one person can be viewed as either personified virtue or personified vice at different times, depending on whether they gratify the subject’s needs or frustrate them. This, along with similar oscillations in the experience and appraisal of the self, leads to chaotic and unstable relationship patterns, identity diffusion, and mood swings. The therapeutic process can be greatly impeded by these oscillations, because the therapist too can come to be seen as all good or all bad. To attempt to overcome the negative effects on treatment outcome, constant interpretations by the therapist are needed.

Splitting contributes to unstable relationships and intense emotional experiences. Splitting is common during adolescence, but is regarded as transient. Splitting has been noted especially with persons diagnosed with borderline personality disorder. Treatment strategies have been developed for individuals and groups based on dialectical behaviour therapy, and for couples. There are also self-help books on related topics such as mindfulness and emotional regulation that claim to be helpful for individuals who struggle with the consequences of splitting.

Borderline Personality Disorder

Refer to Borderline Personality Disorder.

Splitting is a relatively common defence mechanism for people with borderline personality disorder. One of the DSM IV-TR criteria for this disorder is a description of splitting: “a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation”. In psychoanalytic theory, people with borderline personality disorder are not able to integrate the good and bad images of both self and others, resulting in a bad representation which dominates the good representation.

Narcissistic Personality Disorder

Refer to Narcissistic Personality Disorder.

People matching the diagnostic criteria for narcissistic personality disorder also use splitting as a central defence mechanism. Most often narcissists do this as an attempt to stabilise their sense of self-positivity in order to preserve their self-esteem, by perceiving themselves as purely upright or admirable and others who do not conform to their will or values as purely wicked or contemptible.

The cognitive habit of splitting also implies the use of other related defence mechanisms, namely idealisation and devaluation, which are preventive attitudes or reactions to narcissistic rage and narcissistic injury.

Depression

In depression, exaggerated all-or-nothing thinking can form a self-reinforcing cycle: these thoughts might be called emotional amplifiers because, as they go around and around, they become more intense. Typical all-or-nothing thoughts:

  • My efforts are either a success or they are an abject failure.
  • Other people are either all good or all bad.
  • I am either all good or all bad.
  • If you’re not with us, you’re against us.

Janet, Bleuler and Freud

Refer to Pierre Janet, Eugen Bleuler, and Sigmund Freud.

Splitting of consciousness (“normal self” vs. “secondary self”) was first described by Pierre Janet in De l’automatisme psychologique (1889). His ideas were extended by Bleuler (who in 1908 coined the word schizofrenia from the Ancient Greek skhízō [σχῐ́ζω, “to split”] and phrḗn [φρήν, “mind”]) and Freud to explain the splitting (German: Spaltung) of consciousness – not (with Janet) as the product of innate weakness, but as the result of inner conflict. With the development of the idea of repression, splitting moved to the background of Freud’s thought for some years, being largely reserved for cases of double personality. However, his late work saw a renewed interest in how it was “possible for the ego to avoid a rupture… by effecting a cleavage or division of itself”, a theme which was extended in his Outline of Psycho-Analysis (1940a [1938]) beyond fetishism to the neurotic in general.

His daughter Anna Freud explored how, in healthy childhood development, a splitting of loving and aggressive instincts could be avoided.

Melanie Klein

Refer to Melanie Klein.

There was, however, from early on, another use of the term “splitting” in Freud, referring rather to resolving ambivalence “by splitting the contradictory feelings so that one person is only loved, another one only hated … the good mother and the wicked stepmother in fairy tales”. Or, with opposing feelings of love and hate, perhaps “the two opposites should have been split apart and one of them, usually the hatred, has been repressed”. Such splitting was closely linked to the defence of “isolation … The division of objects into congenial and uncongenial ones … making ‘disconnections’.”

It was the latter sense of the term that was predominantly adopted and exploited by Melanie Klein. After Freud, “the most important contribution has come from Melanie Klein, whose work enlightens the idea of ‘splitting of the object’ (Objektspaltung) (in terms of ‘good/bad’ objects)”. In her object relations theory, Klein argues that “the earliest experiences of the infant are split between wholly good ones with ‘good’ objects and wholly bad experiences with ‘bad’ objects”, as children struggle to integrate the two primary drives, love and hate, into constructive social interaction. An important step in childhood development is the gradual depolarization of these two drives.

At what Klein called the paranoid-schizoid position, there is a stark separation of the things the child loves (good, gratifying objects) and the things the child hates (bad, frustrating objects), “because everything is polarised into extremes of love and hate, just like what the baby seems to experience and young children are still very close to.” Klein refers to the good breast and the bad breast as split mental entities, resulting from the way “these primitive states tend to deconstruct objects into ‘good’ and ‘bad’ bits (called ‘part-objects’)”. The child sees the breasts as opposite in nature at different times, although they actually are the same, belonging to the same mother. As the child learns that people and objects can be good and bad at the same time, he or she progresses to the next phase, the depressive position, which “entails a steady, though painful, approximation towards the reality of oneself and others”: integrating the splits and “being able to balance [them] out … are tasks that continue into early childhood and indeed are never completely finished.”

However, Kleinians also utilize Freud’s first conception of splitting, to explain the way “In a related process of splitting, the person divides his own self. This is called ‘splitting of the ego’.” Indeed, Klein herself maintained that “the ego is incapable of splitting the object—internal or external—without a corresponding splitting taking place within the ego”. Arguably at least, by this point “the idea of splitting does not carry the same meaning for Freud and for Klein”: for the former, “the ego finds itself ‘passively’ split, as it were. For Klein and the post-Kleinians, on the other hand, splitting is an ‘active’ defence mechanism”. As a result, by the close of the century “four kinds of splitting can be clearly identified, among many other possibilities” for post-Kleinians: “a coherent split in the object, a coherent split in the ego, a fragmentation of the object, and a fragmentation of the ego.”

Otto Kernberg

Refer to Otto Kernberg.

In the developmental model of Otto Kernberg, the overcoming of splitting is also an important developmental task. The child has to learn to integrate feelings of love and hate. Kernberg distinguishes three different stages in the development of a child with respect to splitting:

  • The child does not experience the self and the object, nor the good and the bad as different entities.
  • Good and bad are viewed as different. Because the boundaries between the self and the other are not stable yet, the other as a person is viewed as either all good or all bad, depending on their actions. This also means that thinking about another person as bad implies that the self is bad as well, so it’s better to think about the caregiver as a good person, so the self is viewed as good too. “Bringing together extremely opposite loving and hateful images of the self and of significant others would trigger unbearable anxiety and guilt.”
  • Splitting – “the division of external objects into ‘all good’ or ‘all bad'” – begins to be resolved when the self and the other can be seen as possessing both good and bad qualities. Having hateful thoughts about the other does not mean that the self is all hateful and does not mean that the other person is all hateful either.

If a person fails to accomplish this developmental task satisfactorily, borderline pathology can emerge. “In the borderline personality organization”, Kernberg found ‘dissociated ego states that result from the use of “splitting” defences’. His therapeutic work then aimed at “the analysis of the repeated and oscillating projections of unwanted self and object representations onto the therapist” so as to produce “something more durable, complex and encompassing than the initial, split-off and polarized state of affairs”.

Horizontal and Vertical

Heinz Kohut has emphasized in his self psychology the distinction between horizontal and vertical forms of splitting. Traditional psychoanalysis saw repression as forming a horizontal barrier between different levels of the mind – so that for example an unpleasant truth might be accepted superficially but denied in a deeper part of the psyche. Kohut contrasted with this vertical fractures of the mind into two parts with incompatible attitudes separated by mutual disavowal.

Transference

Refer to Transference.

It has been suggested that interpretation of the transference “becomes effective through a sort of splitting of the ego into a reasonable, judging portion and an experiencing portion, the former recognizing the latter as not appropriate in the present and as coming from the past”. Clearly, “in this sense, splitting, so far from being a pathological phenomenon, is a manifestation of self-awareness”. Nevertheless, “it remains to be investigated how this desirable ‘splitting of the ego’ and ‘self-observation’ are to be differentiated from the pathological cleavage … directed at preserving isolations”.

What is Countertransference?

Published on by Andrew Marshall9 Comments

Introduction

Countertransference is defined as redirection of a psychotherapist‘s feelings toward a client – or, more generally, as a therapist’s emotional entanglement with a client.

Refer to Transference and Body-Centred Countertransference.

Early Formulations

The phenomenon of countertransference (German: Gegenübertragung) was first defined publicly by Sigmund Freud in 1910 (The Future Prospects of Psycho-Analytic Therapy) as being “a result of the patient’s influence on [the physician’s] unconscious feelings”; although Freud had been aware of it privately for some time, writing to Carl Jung for example in 1909 of the need “to dominate ‘counter-transference’, which is after all a permanent problem for us”. Freud stated that since an analyst is a human himself he can easily let his emotions into the client. Because Freud saw the countertransference as a purely personal problem for the analyst, he rarely referred to it publicly, and did so almost invariably in terms of a “warning against any countertransference lying in wait” for the analyst, who “must recognize this countertransference in himself and master it”. However, analysis of Freud’s letters shows that he was intrigued by countertransference and did not see it as purely a problem.

The potential danger of the analyst’s countertransference – “In such cases, the patient represents for the analyst an object of the past on to whom past feelings and wishes are projected” – became widely accepted in psychodynamic circles, both within and without the psychoanalytic mainstream. Thus, for example, Jung warned against “cases of counter-transference when the analyst really cannot let go of the patient…both fall into the same dark hole of unconsciousness”. Similarly Eric Berne stressed that “Countertransference means that not only does the analyst play a role in the patient’s script, but she plays a part in his…the result is the ‘chaotic situation’ which analysts speak of”. Lacan acknowledged of the analyst’s “countertransference…if he is re-animated the game will proceed without anyone knowing who is leading”.

In this sense, the term includes unconscious reactions to a patient that are determined by the psychoanalyst’s own life history and unconscious content; it was later expanded to include unconscious hostile and/or erotic feelings toward a patient that interfere with objectivity and limit the therapist’s effectiveness. For example, a therapist might have a strong desire for a client to get good grades in university because the client reminds her of her children at that stage in life, and the anxieties that the therapist experienced during that time. Even in its most benign form, such an attitude could lead at best to “a ‘countertransference cure’…achieved through compliance and a ‘false self’ suppression of the patient’s more difficult feelings”.

Another example would be a therapist who did not receive enough attention from her father perceiving her client as being too distant and resenting him for it. In essence, this describes the transference of the treater to the patient, which is referred to as the “narrow perspective”.

Middle Years

As the 20th century progressed, however, other, more positive views of countertransference began to emerge, approaching a definition of countertransference as the entire body of feelings that the therapist has toward the patient. Jung explored the importance of the therapist’s reaction to the patient through the image of the wounded physician: “it is his own hurt that gives the measure of his power to heal”. Heinrich Racker emphasised the threat that “the repression of countertransference…is prolonged in the mythology of the analytic situation”. Paula Heimann highlighted how the “analyst’s countertransference is not only part and parcel of the analytic relationship, but it is the patient’s creation, it is part of the patient’s personality”. As a result, “counter-transference was thus reversed from being an interference to becoming a potential source of vital confirmation”. The change of fortune “was highly controversial. Melanie Klein disapproved on the grounds that poorly analysed psycho-analysts could excuse their own emotional difficulties” thereby; but among her younger followers “the trend within the Kleinian group was to take seriously the new view of counter-transference” – Hanna Segal warning in typically pragmatic fashion however that “Countertransference can be the best of servants but is the most awful of masters”.

Late Twentieth-Century Paradigm

By the last third of the century, a growing consensus appeared on the importance of “a distinction between ‘personal countertransference’ (which has to do with the therapist) and ‘diagnostic response’ – that indicates something about the patient…diagnostic countertransference”. A new belief had come into being that “countertransference can be of such enormous clinical usefulness….You have to distinguish between what your reactions to the patient are telling you about his psychology and what they are merely expressing about your own”. A distinction between “neurotic countertransference” (or “illusory countertransference”) and “countertransference proper” had come (despite a wide range of terminological variation) to transcend individual schools. The main exception is that for “most psychoanalysts who follow Lacan’s teaching…counter-transference is not simply one form of resistance, it is the ultimate resistance of the analyst”.

The contemporary understanding of countertransference is thus generally to regard countertransference as a “jointly created” phenomenon between the treater and the patient. The patient pressures the treater through transference into playing a role congruent with the patient’s internal world. However, the specific dimensions of that role are coloured by treater’s own personality. Countertransference can be a therapeutic tool when examined by the treater to sort out who is doing what, and the meaning behind those interpersonal roles (The differentiation of the object’s interpersonal world between self and other). Nothing in the new understanding alters of course the need for continuing awareness of the dangers in the narrow perspective – of “serious risks of unresolved countertransference difficulties being acted out within what is meant to be a therapeutic relationship”; but “from that point on, transference and counter-transference were looked upon as an inseparable couple…’total situation'”.

Twenty-First-Century Developments

Further developments in the current century might be said to be the increased recognition that “Most countertransference reactions are a blend of the two aspects”, personal and diagnostic, which require careful disentanglement in their interaction; and the possibility that nowadays psychodynamic counsellors use countertransference much more than transference – “another interesting shift in perspective over the years”. One explanation of the latter point might be that because “in object relations therapy…the relationship is so central, ‘countertransference’ reactions are considered key in helping the therapist to understand the transference”, something appearing in “the post-Kleinian perspective…[as] Indivisible transferencecountertransference”.

Body-Centred Countertransference

Psychologists at NUI Galway and University College Dublin have recently begun to measure body-centred countertransference in female trauma therapists using their recently developed “Egan and Carr Body Centred Countertransference Scale”, a sixteen symptom measure. High levels of body-centred countertransference have since been found in both Irish female trauma therapists and clinical psychologists. This phenomenon is also known as “somatic countertransference” or “embodied countertransference” and links to mirror neurons and automatic somatic empathy for others due to the actions of these neurons have been hypothesised.