Transference, Regression, Working Through and Countertransference
Transference (T) is the key ingredient that makes a therapy psycho-analytic. In the broad, non-technical sense we can define transference as the phenomenon by which patterns of behaviour, responses and underlying feelings which have been developed in early childhood as reactions to significant persons are inappropriately repeated, displaced, that is, transferred to any person in the present. In this sense all human relationships contain transference elements.
In a narrower sense, we talk about transference when the old patterns appear in relation to the therapist and the therapeutic situation itself. To put it differently in this sense transference is the patient's perception of and attitude toward his therapist and the therapy produced by unconscious displacement of his perceptions of and attitudes towards his parents, siblings and others in his early childhood. Thus, the psychotherapist comes to represent the characteristics the patient used to see in the most important persons in his life. Often the feelings that are transferred on to the therapist have been repressed, that is to say, have never been consciously experienced, let alone expressed, in relation to the originally significant person.
When Freud first discovered the phenomenon by which the patient inappropriately 'transfers' something from his early experiences on to the analyst, he considered it an impediment. Only some years later did he realize that such 'false connections' could be used most effectively to help the patient to unravel his neurosis. Today we are interested in the phenomenon of transference because of its diagnostic value as well as its therapeutic use. Through a process of compulsive repetition it reveals in the here-and-now the unresolved and most crucial conflictual patterns which are still active in the patient's current life. If the therapist can bring the patient to make his own transference reactions conscious, express and acknowledge them and experience their links with his current and past relationships, then transference becomes the most powerful healing tool.
Transference is particularly prominent when the patient is in a regressed state. (40) Regression is an unconscious defensive process by which the patient reverts to a previous level of functioning, usually to a certain infantile or juvenile stage. Often one can read this former age by observing the patient's behaviour, way of speaking and non-verbal signals. Sometimes the regressed patient stops communicating verbally and gives all the signs of a distressed baby at a pre-verbal stage in the first year of life. Other patients understand exactly the meaning of the strange question: "How old do you think you are now?" and can answer it without hesitation.
This unconscious escape into one's past might serve to avoid something dreaded in the present or in the immediate future. Some patients are able to regress regularly towards the end of each session as a reaction to the fear of being abandoned. They exhibit signs of helplessness as if trying to make the therapist feel guilty for keeping to the time boundaries. In this sense one could also say that regression is a way of communicating to the therapist what is expected of her. Regression can occur, of course, outside the therapeutic situation as well. A toddler separated from his mother may show a return to babyish behaviour.
Many psychoanalysts advocate and foster the so-called therapeutic regression as the best way of reaching the level of the early damage in order to start the healing process from there. This healing process requires "holding" the patient for a while as well as (41) working through the transference.
The expression "working through the transference" emphasizes that it is via the transference that the analytic or psychodynamic process unfolds and brings about positive changes. In contrast, the traditional phrases "working in the transference", or simply "working through", seem to imply that the psychoanalytic process takes a long time. Moreover, the preposition "in" suggests to me that we are sitting in midst of transference phenomena with no reference to reality.
Working through the transference entails that:
the therapist observes and monitors the patient's defensive pattern in the here-and-now vis-ŕ-vis the boundaries and the therapist (DT);
she helps the patient to focus on these patterns, to experience and express fully the underlying feelings and emotions (XT);
she helps the patient to link them with the same emotions, patterns of defensive behaviour and responses in his past and current relationships (DAX/TCP);
she helps the patient to change those maladaptive patterns in the here-and-now as well as out there (D/TC).
Immediately after the successful confrontation, the disruption of the neurotic defences, and the appearance of the "healing anger", positive feelings (+XT) surface in the here-and-now; the current (DAX/C) and past (DAX/P) conflicts are linked with the one in the here-and-now (DAX/T). These so-called TCP-links are repeated many times and in many variations in the subsequent course of the therapy.
In the session not only the patient experiences feelings, emotions, impulses and their fluctuations, but also the therapist. They can be subsumed partly or entirely under the concept of (42) countertransference. The definition varies according to authors. The broadest one says that all the feelings and emotions stirred up in the therapist within the therapeutic situation are countertransference. Such definition is neither helpful nor accurate. After all the therapist might, for instance, be upset about something that happened before the session and which has nothing to do with the patient or the therapeutic situation. According to a narrower definition, all feelings the therapist experiences towards the patient are countertransference. The problem with this definition is that it does not distinguish between feelings that are reality-based and others that are not. For instance, if the patient irritates the therapist with his subtle insolence, the therapist's experience of irritation is a straightforward human reaction based on real provocation. If the therapist feels a wave of anger against the patient or feels tense in his presence without obvious reason, then the explanation is in the therapist's unconscious. She might be unconsciously responding to the patient as if he was someone from her own past (e.g. her father, brother). In this case her anger is plain transference and not countertransference. She should do everything to work through her own problem either on her own or with the help of a supervisor or another therapist. Finally, the other possibility is that the therapist's anger is her response to the patient's transference. In this case we can talk of countertransference in the narrow sense of the word. Countertransference can, in fact, be defined as the response of the therapist's unconscious to the patient's transference.
When without any apparent reason the therapist starts feeling uneasy in the session, dissatisfied with herself, depressed, stuck or unsure of herself and/or she catches herself preaching or intellectualising, she has to ask herself whether transference or countertransference feelings on her part are in operation. It often happens that the therapist becomes aware of her countertransference feelings only after the session.
Countertransference feelings are an important tool the therapist can and must use. Through them she can understand better what the patient does in close relationships and what patterns of interaction are likely to develop.