14 Aug Terrifying Transferences and the importance of both understanding and working through Transference in Psychodynamic Psychotherapy
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 . 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.
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.
Transference – The ubiquitous behavioral phenomenon
Transference is ubiquitous in all relationships, successful therapy depends on the ability to both recognize and work with the transference as very often it is the way in which the sexual abuse of the past is communicated in the present when there are no words for the abuse or the affective state of the child before, during and after the abuse. We know that as human beings we have an entire biological apparatus which is dependent and designed for us to sustain and maintain healthy relationships, we also know that this apparatus is under developed in those who have experienced sexual trauma and healthy relationships can be the cost of this. Through the development of healthy relationships as an adult, these neurobiological effects can be completely reversed and new pathways in the brain developed to allow the adult survivor of sexual abuse to thrive in relationships. We see the role of therapy to do just this to build a healthy relationship over a period of time with the client through working with the transference, holding very strong boundaries and engaging in behaviour and attitude different to that of the original trauma, this is corrective action.
Adult clients of childhood sexual abuse both overt and covert abuse will be unconsciously driven to break boundaries, to collude in poor boundaries, to challenge boundaries, to test boundaries and to resist boundaries all in an unconscious way to reenact the original wound in order to heal. If we as therapists have poor boundaries and an inability to hold strong boundaries, recognize our own and other’s boundaries due to our own unresolved sexual trauma then the therapy becomes a reenactment without corrective action which is re-traumatizing, re-abusing, non therapeutic and redundant. This very often is the case with many forms of therapy including Tantra therapy. The re-abusing is symbolic as the most prevalent forms of sexual abuse both overt and covert is carried out by a parent or family member and therefore the client has been violated by the very person responsible for their safety, this sets up a very disorganized attachment imago which continues to be reenacted in adult relationships and therapeutic relationships, this reenactment and attachment imago can only be addressed and transformed where this transferential dynamic is recognized and worked with and boundaries are held very strong unlike the loose boundaries of the violating parent or family member in the original abuse.
By Darren Maguire, Psychodynamic Psychotherapist at Trauma Recovery Institute Ireland, specialising in complex trauma recovery using dynamic psychosocialsomatic approach with an emphasis on transference.
Retreating from Contact and Intimacy
There is a force in our lives that pulls us away from intimate relationships. While this force works differently for each of us, we all know its power. We feel it when we are with another person we want to be close to. We may be approaching some difficult-to-discuss subject. Or we may be considering initiating some more intimate mental or physical relating. Or wishing that the other person in the relationship would approach us more closely or initiate something more intimate with us. And then suddenly we begin to sense a distance between us being created. “Something happens” to change the scene, to limit the intimacy, to dilute the relating, to make real connecting impossible. It might be that one of us shifts position, becomes distracted, or changes the subject. It might be that one of us experiences irritation or impatience that can be felt by the other. Perhaps one of us is frustrated, bored, or restless. Or it may simply be that one or the other of us is uncomfortable and needs a little change or separation. Possibly something in ourselves needs some space, some fresh air, some elbowroom, or a more comfortable situation.If we have studied this hesitating or pulling away tendency before, we may get a quick glimpse of some hidden fear inside ourselves or in the other person as we feel the silent backpedaling beginning.
Lets us call this hesitating tendency “resistance,” because it marks a slowing down, an inertia in the forward movement of our relationships. If there is a high level of activity or emotion present, we may not immediately notice the resistance in ourselves or that the internal backpedaling has begun. If there is a change of focus in the relationship or some other slight discontinuity it may only be later, if at all, that we wonder about the nature of the discomfort being felt. Or why the contact we were experiencing at the moment may have been overstimulating, frightening, or numbing in some way. Our sense of mystery is increased further when the fleeing is from someone otherwise respected, loved, or sought after. As we study the pulling back tendency, our capacity to notice the finer details of emotional attunement increases. We then become skilled at observing the ways resistance operates in ourselves and in others. We then notice how often we slowly clamp down on emotion that is building. Or how we silently move away from certain kinds of intimate moments. We can become more sensitive to subtle forms of distance created by ourselves and by other people. We can soon detect small momentary decrements in attuned relating produced not only by our own, but also by their resistance. We can notice their pulling away or their defensive strategies. None of this is exactly new to us. Every day we approach people in various kinds of relationships. And we often pull away without quite knowing why. But the more we focus on the resistances operating in our relationships, the faster and more clearly we can detect the many and subtle ways our mind unconsciously avoids, limits, ruptures, or flees from intimate emotional contact. We can then begin to see more clearly how we limit and dilute intimate connections with members of our family, with close friends and associates, and with others whom we love.
Why Do We Resist Loving Contact?
If loving contact is what we desire most in relationships, how can we understand the universal resistance to intimate contact? Psychoanalytically oriented psychotherapists now make the assumption that human minds are organized by relationships. And that the mental and physical activities we engage in on a daily basis have been conditioned by the emotional relationships that have been available to us throughout a lifetime. When it comes to relationships, we have all been more or less fortunate in various ways. Our more fortunate experiences have taught us to reach out hoping to find various kinds of loving connections. And our less fortunate experiences have taught us to fear and to retreat from certain kinds of relationships. So on the basis of our past experiences in relationships; it stands to reason that we would naturally search out relationships, which are likely to be good for us. And that we would avoid relationships which are likely to be bad for us. But unfortunately, we do not choose our most significant relationships in this way! Why not? Because in our earliest months and years we all experienced disappointing, frustrating, and painful emotional relationships that influenced us in formative directions. As the twig is bent so grows the tree. As babies and growing children we learned a series of lessons about emotional relationships which have been fundamental in organizing our personalities and in determining our choices in later relationships. We learn quickly how to mold ourselves to what we perceive to be important emotional realities around us. So that our most basic sense of safety and love soon resides in the familiar patterns of emotional exchange we learned from our first caregivers–no matter how self-limiting or self-abusive those patterns might appear to an objective observer. We are attracted to that which is familiar in relationships, not to that which might be good for us. We are vulnerable to repeating interpersonal emotional experiences that are known to us and are often oblivious to or neglectful of those possibilities that are unknown. Listening for Movement and Contact in Relationships Psychotherapists are trained to listen carefully to relationship patterns as they appear in and out of the therapeutic setting. Therapists encourage expressions of relationships, past and present, in the general belief that the more we can understand our enduring emotional relationship patterns, the more choices we will be able to generate for ourselves in the future, and the greater our flexibility in relationships and life will eventually become.
Psychotherapists observe in their work the persistent tendency to transfer strong relationship patterns from the past into emotional relationships in the present. Therapists also note the tendency to resist entering more deeply into intimate relationships when there is the possible danger that previously experienced emotional injuries may recur–even when the overall relationship possibilities themselves are attractive. Therefore, when we find ourselves moving toward more intimacy in a relationship and at some point we begin silently backpedaling, the inference is that some form of avoidance has been previously conditioned to this particular pathway to intimacy. The further inference is that at some similar previous juncture relationship-pain was encountered that was severe enough to post an unconscious signpost that says, “Never go there again!” What has been transferred from past experience is wariness of certain kinds of intimate contact. What is being resisted is exposure to an intimate form of relationship that may produce intense pain similar to relationship pain known in the past.
What many people find surprising is that our own minds actually produce intensely painful, aversive, inert, and even confusing and disorienting experiences in order to warn us away from types of intimate contact and connection that have been known in the past to be disappointing or hurtful! Sometimes this warning may operate subliminally so that we are not aware of signal pain or anxiety, but simply of a strong aversion or a tendency to change the direction of the relating.
Seven Developmental Forms of Love and Fear
Psychotherapists now understand seven distinctly different kinds of emotional relationships based upon our desires for contact and intimacy in love and our corresponding fears of disappointment and injury in love. In the table below the seven kinds of desire and fear we experience in relationships are arranged in order of increasing complexity. Some people mistakenly think of this sequence as a developmental chart with the early infantile forms of relationship slowly growing into more mature forms. It is true that the most basic desires and fears are those experienced first in infancy and that the more complex forms of relationship only develop later. But it is also true that well-developed people live all seven levels of relationship complexity in most intimate relationships on a daily basis.
Seven Increasingly Complex Desires and Fears in Relationships
Relationship Strivings:The Sensual/Sexual Desires
1. To reach out and touch
2. To connect
3. To bond with another
4. To assert my autonomy
5. To be affirmed as a person
6. To succeed or fail in competition
7. To thrive in a group
Relationship Inhibitions: The Seven Deadly Fears
1) Nobody will be there.
2) I will be hurt.
3) I will be abandoned.
4) I will be crushed.
5) I will be unacceptable.
6) I will be injured or left out.
7) I will be devalued or rejected.
Transference and resistance are assumed to emanate from relationship experience at all seven levels of complexity. That is, each of us has our own version of each kind of relationship desires and fears and we transfer those anticipated hopes and dreads into current intimate relationships. It is generally thought that the first two desires for contact and connection constitute a “one- bodied psychology” since emotional separateness is not fully acknowledged. The third through fifth desires for bonding, for autonomy, and for affirmation are generally regarded as “two-bodied psychology,” because they entail various forms of mutual recognition and reciprocal interaction. The desire for success or failure in competition and the desire to thrive in a group, desires six and seven, are considered “three-bodied psychology” since social triangles are always implicitly or explicitly involved.
“The Organizing Experience” (Hedges 1983, 1994a,c, 2000) arises from difficulties experienced in the first two levels of relationship complexity above. That is, from the desires for and the fears of human contact and connection in which the other person is seen and approached–but not fully, mutually, or reciprocally related to. In the desire for contact, reaching out in relationships has been disappointing in that it has not produced reciprocal responsiveness and has thus given rise to the pain of being alone. It has also created an ongoing constrictive fear manifest in a general body-mind withering and a terror of ever again reaching out for contact. In the desire to connect with another, reaching out in the past has produced a connection that was experienced as painful. It has also created an ongoing contractive fear manifest in a body-mind inhibition and a terror of ever again reaching out for connection.
The “Organizing Transference” refers to the particular ways we each re- experience these early conditioned desires and fears in current relationships and to the subtle ways we each pull back and resist intimacy in relationships. All mammals are born with the genetic instruction, “find the warm body or die.” All people experience the human desire for contact and connection. All people have experienced to a greater or lesser degree the fear of nobody being there and the fear of being injured as a result of a connection with another person.
The term “organizing” refers to the fundamental activity of organizing a channel, a pathway, or a link to another human being that either fails to take by virtue of unresponsiveness of the human relational environment, or which aborts by virtue of the conditioned pain that prevents ongoing reciprocal connecting. In either case the person is left perpetually organizing a reaching channel toward others and then–based on transference and resistance learning–either withering or constricting out of discouragement or pulling back or contracting out of fear. Both varieties of “organizing experience” are universal to a greater or lesser extent. And both kinds of organizing transference form the foundation for all subsequent kinds of relational learning. An important corollary of this line of thinking is that people severely traumatized in utero or in early infancy may find it nearly impossible to trust relationships enough to allow more differentiated forms of desire and fear to develop. A second corollary is that when certain kinds of reaching are curtailed by a person’s early organizing experiences that further development along these particular relationship lines is likewise curtailed. What might a more average expectable development look like?
How the Organizing Experience Works in Our Lives
The person living predominantly at the organizing level of relationship complexity does not generally engage others as separate or independent psychological selves or centers of initiative. This is because at the level of the organizing transference and resistance the sought-after contact and/or connection does not fully “take,” in the sense of being ongoing, mutual, and reciprocal. Such people have often been described as “cut off from the world of relationships” or “living in a world of their own.” I have come to use the metaphor “organizing pockets, limited or pervasive” to describe people who live significant parts of their relationship experiences in an “organizing state.”
By using the inventiveness and cleverness present in good cognitive and emotional intelligence, the person living organizing experiences soon learns a variety of ways of limiting interpersonal relationships so that they can be experienced as somewhat safe. The diversity and complexity of human intelligence allows people to avoid certain kinds of emotional relationships and to develop into fine human beings in many, if not most, ways. But intimate forms of relating deemed possibly dangerous and pain-producing are regularly avoided with accumulating consequences. Notable among the unfortunate consequences are the tendencies to imitate human life and to conform to human expectations rather than to engage in the arduous task of negotiating the complexities of emotional-relatedness learning.6 As a result, the person may develop tendencies toward mania and/or depressive activities in order to join with or to avoid others–depending on the need, given her or his relational environment. Alternatively, the person may develop withdrawing, autistic, or schizoid tendencies in order to stay safely outside of the dangerous pale of human interactions. Or the person may develop what appear to others as unusual, persecutory, or bizarre thoughts and behaviors based on early cause and effect response patterns that originally had a motive to stay safely out of the way of interacting relationally with others perceived as frightening or dangerous. The person may have learned to dissociate one cognitive-emotional aspect of self from others in order to achieve a break in human connections, thus producing the sense of multiple personalities. Or compulsive and addictive patterns of consuming, holding, or evacuating various liquids, and solids or a habituation to other substances and behaviors may have evolved to serve the purposes of keeping the person out of contact with the human milieu or its representations.
Psychotherapy with the Organizing Experience
Psychotherapists study all of the relationships in a person’s life for clues that will permit formulations about how the person regularly moves toward human contact and connection. And then how that person regularly accomplishes some–transference or resistance-based–form of interruption or breach, which prevents sustained mutual and reciprocal relatedness. “Where exactly in the arc of energetic enlivenment has the person learned to interrupt the relating and in how many different ways can the interruption be accomplished by this person?” are the questions of the therapist.
Contrasting the Fear of Abandonment with the Terror of Connecting
Most therapists have been trained to believe that when people are having trouble with intimacy it is because they are afraid of emotional abandonment. And that the therapist’s job is then to provide some sort of emotionally empathic “holding” or “containment.” This truism holds if the transferred relational experience is from the more complex desires and fears referred to as “two- bodied” psychology–the so-called borderline and narcissistic states. But in “one- bodied” psychology in which the person has experienced early trauma associated with frightening aloneness or painful connection, empathic holding and containment does not work. In fact, attempts at empathic connection serve to re-traumatize the person in therapy, so that terror and various kinds of “psychotic symptoms” result.
The optimal responsiveness required to work successfully in the area of organizing experience begins with the establishment of a safe interpersonal environment, which can take from months to years to accomplish. The therapist gently but persistently encourages movement toward dynamic emotional relatedness. The therapist remains constantly alert for subtle signs of an emotional retreat that signals the arrival of a possible interpretive moment. Optimal responsiveness to the organizing experience, however, entails a realization on the part of the therapist that interpersonal emotional contact and connection transferentially warns the client of an immanent re-traumatization, so that the person quickly moves into some safety-searching, contact-avoidant activity (or symptom). If the therapist is prepared and moves quickly enough she or he may be able to seize the moment of retreat with a verbal or nonverbal interpretation of the emotional contact now being experienced. And of the terror, numbness, or retreat mechanism which is ensuing to avoid or rupture emotional contact. The client can be forewarned of the importance of such moments. And forewarned that the therapist will attempt some interpretive intervention at such moments in order to hold the interpersonal contact whenever the therapist senses it slipping. The client may then be willing to sustain the relating momentarily in order to experience whatever forms of pain, withdrawal, numbness, fragmentation, confusion, or terror may ensue so that two can experience them together. And so that the experience can be later processed and understood by both.
Working Through the Organizing Transference and Resistance
The working through process consists of therapist and client learning together over time how to catch in the moment the transferentially-based resistance to sustained emotional contact and connection. And learning how to hold these contactful moments together through whatever body-mind reactions of terror, numbness, fragmentation, and/or confusion may occur. It may be helpful to study the approach-avoidance patterns participated in by two in terms of basic freeze, fight, and flight reactions. And it will likely be interesting to notice how the client not only breaks contact within her or his body and between two bodies, but also how the client arranges to break the reciprocal energy arc in the mind and body of the therapist by precipitating various countertransference reactions. Accusatory “clamoring for more,” “demanding better attunement,” or “insisting upon needed kinds of responsiveness” often become ways of disrupting the therapist in such a way that the interaction or “interacting energy arc” is broken in the body-mind of the therapist! (Hedges, 1994a, c, 2000).
The “Organizing Experience” refers to the earliest human desire to organize channels for contact and connection–first with the maternal body and later with the maternal mind. And the corresponding fears of being painfully alone in the universe and/or of being injured as a result of contact. The specific fears associated with reaching for contact and connection are transferred into later relationships and serve as resistance to certain or all kinds of interpersonal intimacy. In psychotherapy, at the moment when the relationship desires are overshadowed by the relationship fears so that some form of withdrawal begins, the therapist can interpret the backpedaling movement as unnecessary–based on faulty perception and/or interpretation. The goal of psychotherapy with the organizing experience is to demonstrate in word and deed that the transferred terror of contact and connection is essentially delusional–as it is based on early developmental experiences and not on the current possibilities for rewarding intimate relating.
By encouraging the client to remain emotionally present in the relationship at a time when her or his internal instructions signal urgently for a retreat, the therapist fosters the reappearance for study of various terrifying conditioned reactions created by previous traumatic experience. Through repeated interpretive demonstrations of the essentially safe relationship with the therapist in contrast to the internally anticipated disappointment or injury, the person slowly experiences transformations in how she or he approaches and sustains relationships in the real world.
By Lawrence E. Hedges, Ph.D
Working through Transference at Trauma Recovery Institute
Trauma Recovery Institute offers unparalleled services and treatment approach through unique individual and group psychotherapy. We specialise in long-term relational trauma recovery, sexual trauma recovery and early childhood trauma recovery. We also offer specialized group psychotherapy for psychotherapists and psychotherapy students, People struggling with addictions and substance abuse, sexual abuse survivors and people looking to function in life at a higher level. Trauma recovery Institute offers a very safe supportive space for deep relational work with highly skilled and experienced psychotherapists accredited with Irish Group Psychotherapy Society (IGPS), which holds the highest accreditation standard in Europe. Trauma Recovery Institute uses a highly structured psychotherapeutic approach called Dynamic Psychosocialsomatic Psychotherapy (DPP).
Dynamic Psychosocialsomatic Psychotherapy (DPP) at Trauma Recovery Institute Dublin
Dynamic Psychosocialsomatic Psychotherapy (DPP) is a highly structured, once to twice weekly-modified psychodynamic treatment based on the psychoanalytic model of object relations. This approach is also informed by the latest in neuroscience, interpersonal neurobiology and attachment theory. As with traditional psychodynamic psychotherapy relationship takes a central role within the treatment and the exploration of internal relational dyads. Our approach differs in that also central to the treatment is the focus on the transference and countertransference, an awareness of shifting bodily states in the present moment and a focus on the client’s external relationships, emotional life and lifestyle.
Dynamic Psychosocialsomatic Psychotherapy (DPP) is an integrative treatment approach for working with complex trauma, borderline personality organization and dissociation. This treatment approach attempts to address the root causes of trauma-based presentations and fragmentation, seeking to help the client heal early experiences of abandonment, neglect, trauma, and attachment loss, that otherwise tend to play out repetitively and cyclically throughout the lifespan in relationship struggles, illness and addictions. Clients enter a highly structured treatment plan, which is created by client and therapist in the contract setting stage. The Treatment plan is contracted for a fixed period of time and at least one individual or group session weekly.
“Talk therapy alone is not enough to address deep rooted trauma that may be stuck in the body, we need also to engage the body in the therapeutic process and engage ourselves as clients and therapists to a complex interrelational therapeutic dyad, right brain to right brain, limbic system to limbic system in order to address and explore trauma that persists in our bodies as adults and influences our adult relationships, thinking and behaviour.”