Talking About The Transference
Posted by Dr. Vollmer on October 16, 2013
“I know you are mad at me,” Cleo, fifty-two, says each visit, after being five minutes late. “I don’t feel mad at you, ” I respond, suggesting that her “knowing” is really “assuming” based on previous relationships. “How do you know?” I ask, wondering the basis for her assumption. “I know you hate it when I am late,” she says. “Even if I hate it when you are late, that does not necessarily mean that I am mad at you,” I respond, making the distinction between being annoyed and being mad. “It is interesting that you don’t apologize for being late, but rather you tell me how I feel.” I say, suggesting that it is possible that there have been people in Cleo’s life who have insisted, rather than inquired, about her feelings. These statements, the scratching the head moments, where the work of understanding the transference begins. Freud said this was the “battlefield” and I appreciate that, given that challenging my patient’s assumption is the beginning of a challenge which could be met with anger, despair or curiosity.
This “battlefield” is the work of psychotherapy, that other kinds of psychotherapeutic interventions ignore completely. All of the “T’s,” like CBT (Cognitive-Behavioral Therapy), DBT (Dialectical Behavioral Therapy) and IPT (Interpersonal Psychotherapy), present a technique in which the therapist has no struggle; only the patient does. By contrast, in-depth psychotherapy, posits that the therapeutic relationship is a re-enactment of previous relationships, and as such, it is the substrate in which new ways of being in the world can happen. For this substrate to be effective, both parties need to engage in both a conscious and unconscious interchange of ideas, which is transmitted through word choice, tone, and timing. For the therapist, it is a difficult decision to determine when, what and how to transmit an idea. The struggle in this difficulty is how the caring is communicated, because the time and thought involved in formulating an idea, is the evidence for a strong bond. This alliance is at the heart of therapeutic change. By contrast the “T” therapies, do not promote a strong bond, and in fact, promote the idea that all therapists are completely interchangeable; fungibility is the key to the model, as this means the results can be replicated. There is another T called Transference Focused Therapy (TFT), but even that, takes away the unique dyad, which the psychotherapeutic relationship is based on. Working with the transference is the key to deeper work. I will tell my students, in a way that has religious overtones, as I have no evidence, but I do have years of experience, along with a good hold of the literature, to support the idea. It is possible that what I say is true, but for now, that is far as we can take it.