There are some differences between how the therapeutic relationship is con- LO8 ceptualized by classical analysis and contemporary relational analysis. The classical analyst stands outside the relationship, comments on it, and offers insight-producing interpretations. In contemporary relational psychoanalysis, the therapist does not strive for an objective stance. Contemporary psychodynamic therapists focus as much on here-and-now transference as on earlier reenactment. By bringing the past into the present relationship, a new understanding of the past can unfold (Wolitzky, 2011a). Contemporary psychodynamic therapists view their emotional communication with clients as a useful way to gain information and create connection. Analytic therapy focuses on feelings, perceptions, and action that are happening in the moment in the therapy sessions (Luborsky et al., 2011; McWilliams, 2014; Wolitzky, 2011a, 2011b). The therapeutic relationship is central to increasing client self-awareness, self-understanding, and exploration (Barber, Muran, McCarthy, & Keefe, 2013). Current findings of interpersonal neurobiology lend strong support for the effectiveness of the psychoanalytic relationship when treating clients who have suffered interpersonal trauma and neglect (Schore, 2014).
Transference and countertransference are central to understanding psychodynamic therapy. A significant aspect of the therapeutic relationship is manifested through transference reactions. transference is the client’s unconscious shifting to the analyst of feelings, attitudes, and fantasies (both positive and negative) that are reactions to significant others in the client’s past. Transference involves the unconscious repetition of the past in the present. “It reflects the deep patterning of old experiences in relationships as they emerge in current life” (Luborsky et al., 2011, p. 47). A client often has a mixture of positive and negative feelings and reactions to a therapist. When these feelings become conscious and are transferred to the therapist, clients can understand and resolve past “unfinished business.” As therapy progresses, childhood feelings and conflicts begin to surface from the depths of the unconscious, and clients regress emotionally. Transference takes place when clients resurrect these early intense conflicts relating to love, sexuality, hostility, anxiety, and resentment; bring them into the present; reexperience them; and attach them to the therapist. For example, clients may transfer unresolved feelings toward a stern and unloving father to the therapist, who, in their eyes, becomes stern and unloving. Angry feelings are the product of negative transference, but clients also may develop a positive transference and, for example, fall in love with the therapist, wish to be adopted, or in many other ways seek the love, acceptance, and approval of an all-powerful therapist. In short, the therapist becomes a current substitute for significant others.
If therapy is to produce change, the transference relationship must be worked through. The working-through process consists of repetitive and elaborate explorations of unconscious material and defenses, most of which originated in early childhood. Clients learn to accept their defensive structures and recognize how they may have served a purpose in the past (Rutan, Stone, & Shay, 2014). This results in a resolution of old patterns and enables clients to make new choices. Effective therapy requires that the client develop a relationship with the therapist in the present that is a corrective and integrative experience.
Clients have many opportunities to see the variety of ways in which their core conflicts and core defenses are manifested in their daily life. It is assumed that for clients to become psychologically independent they must not only become aware of this unconscious material but also achieve some level of freedom from behavior motivated by infantile strivings, such as the need for total love and acceptance from parental figures. If this demanding phase of the therapeutic relationship is not properly worked through, clients simply transfer their infantile wishes for universal love and acceptance to other figures. It is precisely in the client–therapist relationship that the manifestation of these childhood motivations becomes apparent.
Regardless of the length of psychoanalytic therapy, traces of our childhood needs and traumas will never be completely erased. Infantile conflicts may not be fully resolved, even though many aspects of transference are worked through with a therapist. We may need to struggle at times throughout our life with feelings that we project onto others as well as with unrealistic demands that we expect others to fulfill. In this sense we experience transference with many people, and our past is always a vital part of the person we are presently becoming.
It is a mistake to assume that all feelings clients have toward their therapists are manifestations of transference. Many of these reactions may have a reality base, and clients’ feelings may well be directed to the here-and-now style the therapist exhibits. Not every positive response (such as liking the therapist) should be labeled “positive transference.” Conversely, a client’s anger toward the therapist may be a function of the therapist’s behavior; it is a mistake to label all negative reactions as signs of “negative transference.”
The notion of never becoming completely free of past experiences has significant implications for therapists who become intimately involved in the unresolved conflicts of their clients. Even if the conflicts of therapists have surfaced to awareness, and even if therapists have dealt with these personal issues in their own intensive therapy, they may still project distortions onto clients. Therapists’ countertransference reactions are inevitable because all therapists have unresolved conflicts and personal vulnerabilities that are activated through their professional work. From a traditional psychoanalytic perspective, countertransference is viewed as a phenomenon that occurs when there is inappropriate affect, when therapists respond in irrational ways, or when they lose their objectivity in a relationship because their own conflicts are triggered. Countertransference consists of a therapist’s unconscious emotional responses to a client based on the therapist’s own past, resulting in a distorted perception of the client’s behavior (Rutan et al., 2014). Over the years this traditional view of countertransference has broadened to include all of the therapist’s reactions, not only to the client’s transference, but to all aspects of the client’s personality and behavior. In this broader perspective, countertransference involves the therapist’s total emotional response to a client and may include withdrawal, anger, love, annoyance, powerlessness, avoidance, overidentification, control, or sadness. In today’s psychoanalytic practice, countertransference is manifested in the form of subtle nonverbal, tonal, and attitudinal actions that inevitably affect clients, either consciously or unconsciously (Curtis & Hirsch, 2011; Wolitzky, 2011b).
To avoid misunderstanding and overidentification with clients, the analytic approach requires therapists to undergo their own analytic psychotherapy. McWilliams (2014) emphasizes how important it is for therapists to access and understand their unconscious and suggests that a key outcome of therapy is humility, which provides a good foundation for creating authentic, egalitarian, and healing connections with clients. Personal therapy and clinical supervision for therapists can be helpful in better understanding how internal reactions influence the therapy process and how to use these countertransference reactions to benefit the work of therapy (Hayes, Gelso, & Hummel, 2011).
Not all countertransference reactions are detrimental to therapeutic progress. Indeed, countertransference reactions are often the strongest source of data for understanding the world of the client and for self-understanding on the therapist’s part. For example, a therapist who notes a countertransference mood of irritability may learn something about a client’s pattern of being demanding, which can be explored in therapy. Viewed in this more positive way, countertransference can become a key avenue for helping the client gain self-understanding. Most research on countertransference has dealt with its deleterious effects, but Hayes (2004) suggests it would be useful to undertake systematic study of the potential therapeutic benefits of countertransference.
Psychoanalytic therapists vary in the manner in which they use their observations of countertransference. In some instances the feelings may be shared with the client, but traditional analytic therapists strive to minimize their expression of countertransference while silently learning from its inevitable occurrence. The ability of therapists to gain self-understanding and to establish appropriate boundaries with clients is critical in managing and effectively using their countertransference reactions (Hayes et al., 2011).
It is of paramount importance that therapists develop some level of objectivity and not react defensively and subjectively in the face of anger, love, adulation, criticism, and other intense feelings expressed by their clients. If psychotherapists become aware of a strong aversion to certain types of clients, a strong attraction to other types of clients, psychosomatic reactions that occur at definite times in therapeutic relationships, and the like, it is imperative for them to seek professional consultation, clinical supervision, or enter their own therapy for a time to work out these personal issues that stand in the way of their being effective therapists.
Through the client–therapist relationship, clients acquire insights into the workings of their unconscious processes. Awareness of and insights into repressed material are the bases of the analytic growth process. Clients come to understand the association between their past experiences and their current behavior. The psychoanalytic approach assumes that without this dynamic self-understanding there can be no substantial personality change or resolution of present conflicts.