Saturday, 12 February 2011

Transference and countertransference

As concepts, transference and counter transference essentially derive from Freud. Although empirical human behavioural sciences have moved on from many of his ideas, the usefulness of these two concepts to clinicians remains, and they are seen as essential elements in the therapeutic relationships; elements that need to be recognized, understood, and worked with. I think most psychotherapists would say that we need to be thoroughly trained in working with transference / countertransference, and I would not disagree that that would be useful; however, that is not likely to happen for residential staff and foster carers, and yet they will go through this process many times in their work. So it seems useful, in the spirit of working therapeutically, rather than being a therapist, for front line staff and their managers to have affirm grasp of the processes involved.
The other aspect of the therapeutic relationship is the therapeutic alliance. The therapeutic alliance is the rational relationship that exists between the child and the therapeutic worker; it is the mutual understanding that the one needs help, support and assistance and that it is the other’s role to provide it. This may be an overt and uncomplicated therapeutic relationship, but in many cases it is complicated by “unconscious” expectations of close relationships that have grown out of past trauma, relational failure, and unresolved separation and loss.
Transference involves the projection of a mental representation of a previous experience onto the present, transferring an inappropriate aspect of a past relationship onto the other person in the therapeutic relationship. (It is not inappropriate to mistrust someone who let you down in the past and therefore to mistrust someone who lets you down now, but it is inappropriate to assume someone will let you down in the here and now when they have never done so).
Transference is much more likely when the child / young person is under real or imagined threat, and when they have rigid and inflexible personality traits (e.g in individuals who show signs of borderline personality disorder).
Transference needs managing, or it will wreck the therapeutic relationship:
• Recognize the importance of the relationship to the child / young person(this happens when we get close)
• Maintain professional boundaries, and be aware of professional ways of working and responding so we can recognize when we begin to act in response to transference
• Not being pulled into complementary roles that reinforce transference
• Reflecting and interpreting these experiences for the child / young person at a pace and level that is bearable for them.
Countertransference is the response elicited in the worker by the child / young person’s communication of their distressing experiences through transference, and includes the feelings that are evoked in the worker (e.g. helplessness, hostility, fear). Countertransference can be a useful guide to the child’s experiences (e.g. being helpless, rejection, threat). Melanie Klein developed the idea of countertransference by recognizing that it could flow in both directions. I think you see this very strongly when placements are under pressure: adults may feel overwhelmed and needing a break (transferring fear and failure on the child / young person), and this elicits feelings of blame and rejection in the child (countertransference). Staff can feel very responsible for the troubling feelings engendered by the work, and become defensive, whereas understanding that these feelings may have been elicited in them by the distressed child, and can be seen as a window on their inner world, can reduce feelings of being overwhelmed and/or blamed, and therefore reduce the need to be defensive.
Countertransference also needs to be worked with:
• Countertransference is more easily recognized when it is out of character with how we would usually feel or respond
• It requires reflection: a reasonable level of self-awareness, a questioning attitude towards our own feelings and motives, recognition that we all have “blind spots”
• Understanding that we are all affected by the child / young person’s distress, although in different ways,
• Recognizing that they will have strong feelings for us (both negative and positive)
One of the most useful helping resources is the team; sharing our countertransference experiences to clarify what the child / young person projects onto each of us, and unpicking what these feelings tell us about the child / young person’s experience in the here and now. Another useful resource is external consultancy, both for the team and for individuals. It is important that understanding of the internal changes implicit in these processes are matched to individual’s own typical self-defence style; that is if an individual tends to become enmeshed in a child / young person’s difficulties, they need help to process feeling of rejection, but if they tend to dismiss these difficulties as behavioural, they need help in understanding the link between the behaviour and early trauma.

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