01 Dec Perspectives on Transferences

Transferences, unlike descriptive unconscious processes are dynamically repressed object attachments that transfer in the wrong place with compulsive, repetitive and affective charge. – Freud
Transference, Countertransference and reenactment in Therapy by Richard B. Gartner- Director of centre for the study of psychological Trauma and The Sexual Abuse Program New York city.
Recurrent themes affecting the transference and countertransference with people who have suffered huge trauma in early childhood, start with the patient’s wariness of the therapist and the dangers involved in intimacy. In addition, dependency, reliance and counter dependent and counter phobic defenses tend to emerge, often-cloaked in overt idealization of the therapist. In this idealization, patients may expect the therapist to be all attentive, nurturing, non-seductive and nonabusing parent who will heal and undo the trauma. All these themes tend to appear in concerns about boundaries, secrecy, control and power and in dicussion of fees, confidentiality, and other issues related to the frame of the treatment.
Behavioral reenactments in treatment allow a patient to communicate previously dissociated and therefore unsymbolised, material to the therapist. By exploring verbally what has been communicated through behavior the therapist and patient initiate a process by which the dissociated material becomes encoded in language, and therefore available for conscious consideration.Behaviors associated with a reenactment in therapy are unconscious messages from the patient to the therapist and to himself about a traumatic past. They represent an attempt to bypass the need for symbolized experience. Reenactments are most likely to occur when the patient has a reduced capacity for self-reflection, another result of being unable to verbalize traumatic experiences that were never encoded when they first occurred, as a result of not have a present witness to their pain. Memories became trapped encased within a wordless world. Incapable of articulating what he has never symbolized verbally, the patent repeats behaviorally or reenacts an aspect of his dissociated trauma.
Such reenactments are crucial disclosures about un-integrated, un-symbolised unformulated experience. Understanding the unconscious communication within a reenactment is often pivotal point in therapy with a traumatised adult, in particular a sexually abused adult. Seen in this light, enactment is a way for the patient to allow himself/herself to be known by co constructing, with the therapist, a means of living out a new, less disabling version of the original trauma. In this co construction, cognitive symbolization of trauma occurs when the trauma is reenacted within a therapeutic relationship, reproducing the original interpersonal context but not leading to the original outcome. Once this happens, dissociated experience is transformed to internal conflict and human relatendness, which are more available for verbal consideration in psychotherapy. By working through reenactments the therapist thus gradually obtains access to the patients various multiple dissociated self-states.The exploration of the reenactment is embedded in the therapeutic relationship. The therapist is both the magnet that draws out the reenactment and the architect of a transitional arena in which the patients experiences of self and other can be reconfigured in more harmonious ways. We rely upon the hope that the therapist and patient together will become enmeshed in complicated reenactments of early unformulated experiences with significant others, that can shed light upon the patients current interpersonal and intrapsychic difficulties by reopening in the therapeutic relationship, prematurely foreclosed areas of experience.
If the reenactment is to be integrated as other than the original trauma, however something essentially different must happen. (Corrective action) The relational models of transference and countertransference are reenactments of different aspects of the dissociated relationships involved in victimization by a parent or a caregiver. Many therapists assert that, abusive countertransferential reenactments are an inevitable part of the treatment of sexually abused patients.
Transference – countertransference reenactments are vehicles for communication to the therapist about the internal relational experience of the child as he/she was being abused. As such they are powerful tools but they are also forceful and often coercive catalysts in the therapeutic relationship. Reenactment compels the therapist to experience the patient’s original reactions to abuse, reactions that are dissociated aftermath to a deeply traumatic childhood experience. To heal the patient of the trauma, the therapist must experience that trauma in some way.The reenactment may be symbolic of the abuse but the feelings engendered in the therapist are very real. Theses may include helplessness, impotence, rage, inadequacy, shame, guilt, idealization, omnipotence, overstimulation, humiliation, torture and fear, all internal states with which the patient is very familiar.
Thus treating patients whose relationships and personalities are organized by dissociation involves a challenge psychological encounter with the trauma that caused the dissociation in the first place. Therapists can easily feel traumatized themselves under such circumstances, yet it is important to remember that neither reenactments nor countertransference reactions to them are necessarily mistakes rather they are unavoidable phases in the treatment of traumatized dissociated patients.
It has commonly been noted that the abused patients tend to identify with their abusers and then to be transferentialy abusive to their therapists. In doing this they are repeating with the therapist what happened to them as children. The abuse-victim relational configuration is particularly upsetting work with both patient and therapist because of its ubiquitous intense transference and countertransference enactments.