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Transference |
Ceyda Senel Tekin University of Oxford, Certificate Program In Psychodynamic Studies LOOKING FOR TRANSFERENCE Even after a cursory look at the psychoanalysis literature one can conclude that "transference" is one of the most important concepts in psychotherapy. It is the main mechanism through which a patient's past experiences come to life during a therapy session. Transference, defined in a more general sense, is the displacement of patterns of feelings, thoughts and behaviour, originally experienced in relation to significant figures during childhood, onto a person involved in a current relationship. The process involved is largely unconscious. The patient usually does not perceive the various sources of transference attitudes, fantasies, and feelings. Even though parents are usually the original figures from whom such emotional patterns are displaced, it is quite common that siblings, grandparents, teachers, physicians, and childhood heroes are also frequent sources., One can even generalize and say that transference can happen in any relationship where there is an imbalance of power. My interest in transference originated from my initial failure to understand why there was a lot of emphasis in psychoanalysis on a rather trivial looking concept. When I first heard about it, I thought that it was quite natural and obvious that a patient in need of help will not come to a therapy session with a blank mind. For me it was clear that he/she would not in general accept the therapist as just a therapist who is there to help him/her. It is bound to happen that the patient will give a new role to the therapist. The nature of the transference, like the therapist being a positive or negative figure, would then depend on the patient and the complexity of his/her past relationships and experiences. So why was transference so important? This was what I wanted to understand. The first hint of an answer for my question comes from the history of transference. Like many other concepts in psychoanalysis, Sigmund Freud is the discoverer of this phenomenon. Freud's discovery resulted from the noted experience of Breuer, who was seeing a patient, named Anna 0., who as Breuer found out, had intense erotic feelings towards him. This case was known to Freud. He discovered that hysterical female patients tended to fall in love with their physicians, and he first regarded this as a nuisance to the work of psychoanalysis and to the progress of the therapy. But then he made an ingenious conjecture that what was happening was that the patient was re-experiencing feelings that he had had previously towards someone else. Such feelings had given rise to- conflict, had been suppressed and repressed, and found an outlet in the hysterical symptom. In the psychoanalytic setting, they surfaced again. Freud later found that all kinds of earlier conflicts involving hostility, hate, jealousy, rivalry, etc. entered into a relationship with the analyst. Freud discovered that his patient's perception of him during the analysis was distorted and even fabricated in relation to the patient's early feelings toward important figures in his/her own past: mother, father, sisters and brothers. And those infantile feelings were transferred to the analyst unconsciously. According to Freud sexual drives to an important figure in a patient's past life are displaced from the original object to the analyst during a therapy session through transference. In his famous "Five lectures on, Psychoanalysis" [1] Freud said ... I have not told you, Ladies and Gentlemen, of the most important of the observations which confirm our hypothesis of the sexual instinctual forces operating in neuroses. In every psychoanalytic treatment of a neurotic patient the strange phenomenon that is known as 'transference' makes its appearance. The patient, that is to say, directs towards the physician a degree of affectionate feeling (mingled, often enough, with hostility) which is based on no real relation between them and which -as is shown by every detail of its emergence- can only be traced back to old wishful fantasies of the patient's which have become unconscious. " My puzzle about the importance of transference is resolved after realizing that it is the most efficient and natural way through which the past of a patient is reconstructed during a therapy session. This phenomenon of course is largely unconscious. To state it in a complementary way: the patient in the therapy reveals what the problem is by reliving it 'using' the therapist. Quite often in a therapy session, only after this re-experiencing, the patient convinces himself/herself of the powerful existence of his/her memories which hitherto are out of reach of voluntary recall. I have to stress that the usefulness of transference during a therapy session is not, apriori, a trivial point to grasp. As stated above when Freud first encountered and described the phenomenon of transference, he regarded it as an obstacle to therapy. It is also quite possible that he did not want to be emotionally important to his patients. However by (1907) when Jung first visited Freud in Vienna, Freud's views had changed. He asked Jung what he thought of transference and Jung replied " It is the alpha and omega 111 treatment". Freud said, "You have understood". [21] Like many other concepts in psychoanalytic theory, transference is best understood by examples. During my quest to understand this subject I had an experience, in one of my psychotherapy groups, which made transference more understandable to me. Below is an account of what I experienced. I love my mother very much and the feeling is mutual. In my psychotherapy group there was a woman who, in appearance, looked a lot like my mother. And at the very start of the group sessions, even without any significant interaction, I felt quite close to her and I thought that she had warm feelings towards me and she was close to me [my fantasy associated with my positive transference]. One day she was organizing a party in her house and she invited some people from my group but failed to invite me. I felt very angry, disappointed and rejected. Since I thought /fantasized that she was close to me I did not understand why she acted like that. I never expected that she would not notice me. On the other hand I could not understand why I made a big deal out of this situation because 1, in general would find absolutely normal not to be invited to a party. I then realized that I was transferring my feelings towards my mother to this woman, and had been expecting her to act like my mother. For this reason her failure to invite me to her party gave me a sense of rejection from 'my mother'. Once I realized this I felt very relaxed and comfortable and my anger towards the woman disappeared. This, to me, registers an example of transference and the importance in working with and understanding it in relationships. In the literature one encounters a wide range of definitions of transference. After Freud's initial input, Kleinian school (following M. Klein) put a lot of emphasis on this concept. This school defines the concept to refer to all aspects of the patients communication with the analyst -the totality of the intra-psychic components of the patient's fantasies about the reactions to the analyst. (Langs, 1976) [3]. They describe the analyst as a receptacle into which internal figures and the feelings that surround them are projected (Segal, 1981) [4]. These projections need not only be repressed conflicts and infantile feelings but also more grown up elements. From the 'English School' of psychoanalysis an influential therapist Strachey (1934) [5] widened the concept of transference and suggested that the only effective interpretations in psychoanalytic treatment were transference interpretations. Strachey thought that the therapist becomes a 'fantasy object' for the patient as a result of the, patient's projection of 'primitive interjected Imagoas ' (primitive images of the parents) which were regarded as a significant part of the patient's superego. Many psychoanalysts consider the phenomenon of transference as an old human experience which is inherent to all human relationships. Freud [1] wrote "You must not suppose, more over, that the phenomenon of transference is created by psychoanalytic influence. Transference arises spontaneously in all human relationships just as it does between the patient and the physician. It is everywhere the true vehicle of therapeutic influence and the less its presence is suspected the more powerfully it operates. So psychoanalysis does not create it but merely reveals it to consciousness and gains control of it in order to guide psychical process towards the desired goal" Jacobs [6] gives a nice example of everyday life transference, which I shall summarize below. ,,Mr. K. was very defensive when anyone appeared to be telling him what to do. One day his daughter L. comments that K's tie did not match his shirt. After her comment, which carried no malicious intent to annoy, K becomes extremely angry and says that "How dare you tell me what I should or should not be wearing! You are just like your mother!". L gets agitated from her father's exaggerated response and bursts into tears crying, " You never let me comment on anything! I am not like my mother! You are always treating me like I should be seen and not heard... " What started as an innocent comment turned into a fight between the father and the daughter." Jacob then analyses in detail the elements of transference in this incident. K. had an unpleasant relationship with his wife, ending with a divorce. And L. lived with relatives after her father's imprisonment and mother's separation. In the family that L. lived women were looked down on and their opinions and ideas were not respected. 'In the incident we see that both K. and L. have different agendas in their minds. Both of them transfer their past relationships onto the current situation. Now let us turn our attention to the transference in a therapeutic session. Following Freud, one often distinguishes two types of transference. The first being the "positive transference " in the case that the patient regards the therapist as an ever-loving and all-understanding figure who will heal the wounds of the past. Some experts believe that although a positive relationship and trust between the therapist and the patient is needed for the therapy to be effective, positive transference might be an obstacle to the progress of the therapy. It may not be a positive help to the patient to regard the therapist as an ever-loving parent who will make up for all the incidents of rejection and misunderstanding and pain and loss which have finally forced the patient to seek help. According to Freud transference is present in the patient from the beginning of the treatment and for a while is the most powerful motive in its advance and we see no trace of it and need not bother about it so long as it operates in favour of the joint work of analysis. If it then changes into a resistance we must turn our attention to it and we recognize that it alters its relation to the treatment under two different and contrary conditions: firstly if as an affectionate trend it has become so powerful and betrays signs of its origins in a sexual need so clearly, that it inevitably provokes an internal opposition to itself and secondly; if it consists of hostile instead of affectionate impulses. On positive transference Freud [3] wrote "The patient who ought to want nothing else but to find a way out of his distressing conflicts, develops a spatial interest in the person of the doctor. Everything connected with the doctor seems to be more important to him than his own affairs and to be diverting him from his illness... If the doctor has opportunity to talk the patient's relatives he learns to his satisfaction that the relatives say; "He is enthusiastic about you. He trusts you blindly. Everything you say is like a revelation to him ". We can see that it is a very powerful situation. As alluded above the second logical possibility is coined as the "negative transference" which consists of the patients projecting of hostile feelings, rejection and negative attitudes, which the patient may bring to bear on the analyst. In contrast to the positive one negative transference is very important and it needs to be resolved and dispelled by the therapist continually detecting the patients hostility and negative behaviour. The therapist should draw attention to these behaviours and try to trace their origin; the past experiences possibly that took place in his/her childhood. Klein [7] argues that working through envious and destructive feelings in the therapy is a necessary prerequisite for any integration of the personality. It is through the analysis of the negative transference that this come about,and is something which again involves exploration of early destructive feelings. An example [8] of negative transference can be inferred from the following conversation between a therapist and a patient. "The girl was 22 years old and she had made suicidal attempts, and she was verbally fluent. She was telling some of her difficulties in relationship with others when she suddenly broke off. "Can't you say something? " she asked. "I' m doing all the talking, and you are just sitting there and listening. I can't bear your silence." Patient: If you don't talk I don't know what you are thinking of me. Therapist: What do you imagine that I might be thinking? P: I think you might be finding me boring, or that you are criticizing me. T: It sounds to me as if you approach people with negative assumptions; as if you never expect people to find you interesting and likeable. If we look at the history of this patient; this girl has lost her mother when she was very young, and had never managed to get on with her father. She had not had enough love in childhood to acquire any sense of being lovable or even likeable. In such a case, the patient's developing, changing relationship with the therapist will be a crucial factor in helping her" Up to now we have followed Freud's classification of transference as positive and negative. Anna Freud (1936) [9) had a different perspective and she proposed a different categorization according to the complexity of process. She distinguished between "transference of libidinal impulses" and " transference of defense". In the former, instinctual wish attached to infantile objects are projected towards the analyst. In the second one the defenses against the infantile wishes are repeated in the current therapeutic relationship. Finally let me summarize and discuss what I have considered in this essay. I have defined transference both in everyday life and in the context of therapy. The details of the mechanism is rather intricate and during a therapy session, the dynamics of transference depend on many different parameters. Longer-term psychodynamic therapy and counseling provide more opportunity for transference to develop and to be useful. Then the resolution of transference is possible after the patient starts to understand what is going on during the therapy; namely the occurrence of transference. Gradually the patients, during a therapy, learn that expressing their strong feelings like love, hate etc. do not bring about any harm. They realize that the therapist is not devastated or shocked by their strongest feelings and these helps them construct better relationships in 'real life'. Before I conclude, I should mention that more recently there has been some challenges to the (rather canonical) interpretation of transference as a repetition the past experiences in a current (therapeutic) relationship. Cooper (1987) [10] comments " The transference is a new experience rather than enactment of an old one. The purpose of transference interpretation is to bring to consciousness all aspects of this new experience including its colourings from the past". REFERENCES 1. Freud, S, (1910) "Five lectures on psychoanalysis" Pelican books (1962). 2. Freud, S, (1911-1913) "The complete works of S. Freud ", Volume XII, "The case of Schreber, papers and technique and other works London, Hogarth Press. 3. Langs, R. (1976) "The therapeutic interaction ", Vol 11. New York: Jason Aronson. 4. Segal, H. (1981) "The work of Hanna Segal", New York: Jason Aronson 5. Strachey, J. (1934). "The nature of the therapeutic action of psychoanalysis International Journal of Psycho-analysis. 6. Jacobs, M, (1999) "Psychodynamic counseling in action", London Sage Publication Ltd. 7. Klein, M (1948). "Contributions to psychoanalysis." London, Hogarth Press. 8. As quoted in (1987) "The politics of psychoanalysis, Introduction to Freud and Post- Freudian Theory." Stephan Frosh, Macmillan education Ltd. 9. Freud, A, (1936) "The Ego and the Mechanisms of Defense", London: Hogarth Press. 10. Cooper (1987) 'The Transference neurosis: a concept ready for retirement." Psychoanalytic Enquiry. |
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