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Love in Therapy: Using Transference and Countertransference Benevolently
by Judith A. Schaeffer, Ph.D.

5 CE Hours - $74

Last revised: 12/10/2015

Course content © copyright 2015 by Judith A. Schaeffer, Ph.D. All rights reserved.


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Learning Objectives

This is an intermediate level course. After completing this course, mental health professionals will be able to:

This course is based on the most accurate information available to the author at the time of writing. However, cognitive psychology and neuroscience research on brain development, structures, and activities continues to shed light on what were once regarded as merely psychoanalytic concepts and processes. Thus, new information may emerge that supersedes some explanations in this course. Similarly, new research related to transference and countertransference interpretations as moderators and mediators of therapeutic outcome may call for some rethinking regarding their use, their timing and frequency, and their effectiveness with certain clients.

This course may provoke disturbing feelings in readers due to the sensitive nature of transference and countertransference love in tandem with painful affiliative conflicts readers have not resolved in their own lives. Guilt, remorse, shame, hate, and envy may be among these disturbing feelings. If they endure and/or become pronounced, readers may need to seek supervision, consultation, or personal therapy in order to deal with their distress.

Outline

Introduction

This course explores the potential of transference love and countertransference love to become opportunities for both clients and therapists to change the ways they try to meet their affiliative needs. This course facilitates skill building related to therapists’ identifying, managing, and – most importantly – using transference and countertransference love benevolently.

This course enables therapists to identify transference love and countertransference love as they arise and evolve in the therapy setting. It provides theory and research-based guidelines on how to enable clients to meet their affiliative needs through wholesome self-love and developmentally appropriate relationships with others.

This course deepens the therapist’s understanding of phenomena that become mediators, either negative or positive, of therapeutic outcome in non-analytic, no less than analytic, therapy. It gives therapists insight and skills related to managing the dangerous aspects of transference and countertransference love.

This course is the third in a three part series, based on the last chapter of a book written in non-analytic professional language for professionals with cognitive-behavioral, existential, humanistic, and other non-analytic theoretical orientations. (Transference and Countertransference in Non-Analytic Therapy: Double-Edged Swords, by Judith A. Schaeffer, Ph.D. (Lanham, MD: University Press of America, 2007).

Why capture what can cause us to make serious mistakes in our clinical work? Even if we did, why risk trying to make benevolent use of what is inherently dangerous and potentially malevolent?

Why? Because transference and countertransference love come alive in non-analytic therapy no less than analytic therapy. Just because we non-analytic therapists have minimal understanding of these two phenomena does not mean that they will not appear in our work. They will. Without question. In fact, over the course of time they will play a major role in our work (Mann, 1999). We need to make them assets, as they are for analytic therapists, though in our own way. Thus the wisdom of capturing them.

Why try to use them benevolently? Because transference and countertransference love used benevolently can free our clients and ourselves from the bondage of the past for a future full of wholesome human love, both self-love and developmentally appropriate interpersonal love. We can thereby move our therapy from helpful to benevolent and our professional expertise from average to expert. We can make therapy a sound learning process by which our clients find and develop their capacity for mature love and true intimacy (Schoenewolf, 2004). Indeed, transference and countertransference love can be transformational.

Yes, transference and countertransference love are double-edged swords; benevolent or malevolent depending on how they are used. They can benefit us and our clients immensely just as much as they can result in serious harm to our clients and wreak havoc in our professional lives.

Hence this course.

A caveat, however, is that this course – in and of itself – will not make therapists experts in phenomena known as transference and countertransference, let alone analytic thinking. Neither will they become so knowledgeable and skillful that they can glide into successful practice that incorporates transference love and countertransference love. No, they will always have to work hard to make benevolent use of what are two ubiquitous, complex, and difficult-to-work with phenomena that come alive in therapy, replete with their power to make a significant difference in outcome.

Preparatory Notes

First, note that each section of this course begins with questions relating to the material that follows. Taking time to answer those questions, however tentatively, will set in place a mental schema in which the information that follows can be accommodated or assimilated in the light of one's clinical experience and client population.

Second, note that because transference and countertransference love are basically the same phenomenon, at times we use the term transference to include countertransference. Furthermore, it is assumed that the reader knows that in analytic tradition transference refers to a client-originating phenomenon and countertransference, to a therapist-originating phenomenon.

Third, note that transference love does not include other forms of transference unless they are contextually intrinsic to it. Transference hate, for example, is characteristic of transference love during certain periods of its development (Blum, 1997).

Fourth, note that an effort has been made to change analytic jargon into commonly used terms that readers not versed in psychoanalytic “language” can read with comparative ease. However, because the material in this course is extremely complex, one should expect very gradual assimilation of knowledge and understanding. From the time of Freud in the early 20th century to the present, theorists and clinicians have endeavored to comprehend what are intricate, interactional phenomena operating in the unconscious mind. Differences and disagreements have been rampant. Freud himself revised his theory of what transferred or displaced processes and constructs are, to say nothing of how to deal with them. Fortunately, different theories have enlightened both analytic and non-analytic clinicians.

Fifth, the content of this course is accurate and useful in that it is based on significant theory and research pertaining to transference and countertransference love, beginning with Freud and ending with studies performed during the last part of the 20th century and the beginning of the 21st century. However, the content of this course is limited by the fact that research pertaining to transference and countertransference in general and transference and countertransference love in particular does not always meet current scientific standards. It has not often been replicated, for example, or the number of participants is too low. Or there has not been a control group. Thus it is not possible to draw firm conclusions from most studies conducted thus far.

At the same time, we can make valuable observations from which treatment decisions may flow. Extant research regarding transference and countertransference love has been routinely complemented by theory based on clinical practice. Developed by some of the best minds in the history of psychology, social work, and psychiatry, that theory is rich, diverse, and provocative. Thus most extant research studies and the theory behind them are truly enlightening.

Finally, note that in this course the impact that cultural diversity has on transference and countertransference love is short-changed because of space and time limitations. For the most part, it is left up to the reader to perform the extremely important task of tweaking information to fit unique culture-based situations and conditions. This uniqueness, of course, pertains to both clients and therapists.

Part One

Why Transference and Countertransference Love Come Alive in Therapy

Questions

Transference and countertransference love come alive in therapy for at least seven reasons, based on our very humanity and the interactions and setting that constitute therapy. These reasons include the following:

In sum, transference love – remember that transference love includes countertransference love unless otherwise noted – comes alive in therapy because those participating in it have innate, unmet affiliative needs and unconsciously believe that those needs must be met with and through others. We are social, communal creatures who want – indeed need – to love and be loved. Transference love comes alive in therapy because, in that setting, we are interacting intimately and repeatedly with another human being who bears a resemblance to a person or persons with whom we have wanted to meet our affiliative needs: to love and be loved.

Said succinctly, transference love comes alive because of “kernels of truth” (DeLaCour, 1985). On an unconscious level, our mind is struck by either sameness or similarity between the past and the present. The then and there and the here and now become one reality. Our therapist unintentionally contributes fragmentary, disguised data that serve as reminders of persons in our conflictual past. His harsh voice, for instance, gives us the subtle stimulus we need to notice similarities between him and a verbally abusive parent.

Our conscious mind knows there is a past and there is a present. But our unconscious mind – where transference love resides – knows only the present. We unwittingly want to love and be loved in the now, which is all there is. The past lives on. It isn't even the past (Faulkner, 1929).

Furthermore, processes and contents of the unconscious mind are virtually inaccessible to the conscious mind. Dreams, for example, which are products of the unconscious mind, are very difficult for the conscious mind to recall when we awake and begin to use that conscious mind. The two minds might want and need to work together, but they operate quite differently and quite separately. For the most part they operate in parallel fashion, interacting periodically. But by and large they are unable to take part in each other's unique processes.

Thus transference love is not easily identified by the conscious mind. It comes alive in therapy – in life in general – without the cooperation of the conscious mind. Yet it does so with tremendous motivational and transformational power. More about this later.

Transference love comes alive in therapy for yet another reason: it is extremely stressful to live with intrapsychic conflict, even more painful than interpersonal conflict. Part of us believes we deserve love; part of us does not. Part of us believes others should find us lovable; part of us does not. Part of us wants to believe we can be all right without love; part of us believes we cannot. Part of us wants sexual pleasure; part of us knows that getting that pleasure, at least with the wrong person, is morally wrong. And so on.

Yes, intrapsychic conflict causes emotional pain, often excruciating pain. In fact, according to recent neuropsychological research, our minds are made in such a way that we are forever looking for ways to resolve intrapsychic conflict because we fear for our very psychological survival if it continues (Ecker & Hulley, 1996).

What more do clients need than to use an opportunity to meet their affiliative needs during therapy sessions? To take advantage of a noticeably accepting, kind, sensitive, responsive human being who sits across from them in the therapy room session after session? (Covington, 1996). “Yes,” clients conclude unconsciously, “this is the perfect time and setting to try once again to meet my need to love and be loved. This person will respond to me!”

As a result, clients unconsciously re-enact the past. They unintentionally make their therapist into a figure from the past – usually a parent, sibling, or ex-lover – and assign him or her the role of loving them and being a person they can love. They repeat the past; they replay it. By engaging in transference they “actualize an internal scenario within the therapeutic relationship that results in the [person they are with] being drawn into playing a role scripted by [their internal role]” (Westen & Gabbard, 2002, 101). Thus transference love is an “adventure from which [clients] hope to emerge changed and renewed” (Cooper, 1987, 518).

Fortunately or unfortunately, the therapy setting bears striking resemblance to our prenatal and natal experiences. Except for multiple births, we are alone in the quiet, warm, safe womb. We are enclosed and protected, given what we need by another who is capable of providing not only what we need but also what we need done for us. Similarly, upon birth we are kept warm and dry, nourished and shielded from harm. Periodically we are picked up, held, and carried. There is another person who provides what we cannot do for ourselves.

So it is during the typical therapy session. Clients come to therapy because they have been unable to bring forth sufficient emotional and/or interpersonal life. They find themselves in a safe, “warm” environment where they can say anything to a human being who is focusing intently on them. Their therapist “picks up” their ideas and “carries” them forward, mirroring what they say overtly and commenting on the unfinished fragments they are trying to convey. Thus they are nourished with complete attention and helped to share what they know but cannot share. They are offered the “food and drink” of unconditional, positive regard.

Moreover, during therapy clients hear suggestions regarding how they might resolve their conflicts. They are introduced to new approaches to relieving pain. They experience another person saying the uplifting things they have always longed to hear. They find another person holding their emotional pain alongside them. Indeed, conflict resolution is in sight. Seemingly incongruent things are coming together. Yes, the therapist sets limits and keeps boundaries, but it seems to clients as if these necessary structures work to bring clients what they need. In the end they may have to act on their own, but in the meantime someone else is acting for them, with them, and in them.

Yes, the therapy room is a benevolent “womb.” Clients can be themselves in front of one who does not shame them, no matter what dark feelings and thoughts they share. They express anger without experiencing retaliation. Even their hate is respected. Hence clients begin to lose their fear of being unlovable.

Indeed, clients find themselves not just surviving but beginning to thrive. They start to believe they can individuate: become their own person and still be all right, perhaps even better off (Springer, 1996). They can finally become mature for their age and developmental stage. And most importantly, they can express love and receive love from another human being (Covington, 1996). They begin to experience wholeness of life.

Hence, as will be explained in detail later, it seems to clients that the yearned for past has become the present. They have unconsciously displaced the present with the past, yet experienced it as the present. They have engaged in transference love and found it echoed by countertransference love.

For their part, therapists have unconsciously enabled transference love to come alive by their corresponding countertransference love. It is a matter of co-construction: unconscious bidirectional collaboration. Without one, the other does not happen. Therapists unconsciously open themselves up to receiving transference love. In addition, they may actually be transferring their own transference love to their clients: trying unintentionally to resolve their own affiliative conflicts. The therapeutic setting can become for them the “womb” it is for the client. Furthermore, their tendency to take the parental role in the therapeutic setting is not mutually exclusive of their tendency to take the child role.

Fortunately, what is likely to come alive in therapy is non-erotic transference love. However, that form of love may evolve into forms that are erotic, even eroticized or perverse. And they can be initiated by either client or therapist. Similarly, they can be received and responded to by either client or therapist.

Hence, the importance of the next section: what transference love and countertransference love are and the forms they might take.

Main Points

What Are Transference and Countertransference Love?

Questions

Transference love takes four basic forms, as shown in the following diagram: non-erotic, erotic, eroticized, and perverse. They overlap but have unique characteristics. We begin with one that is not only non-pathological but also innately necessary for human development: non-erotic transference love.

 

Non-Erotic Transference Love

Freud (1912) taught that non-erotic transference love arises in the unconscious mind as an attempt to repeat early conflictual experiences of an affiliative nature. These experiences are both intrapsychic and interpersonal. They are grounded in our innate need to give love to and receive it from another person during infancy and childhood. Meeting this affiliative need is essential to our well-being not only in the womb and after birth but also throughout childhood, particularly when we are in the oedipal stage of human development.

We focus on unresolved affiliative conflicts with maternal figures in this course for the sake of continuity. But this is not intended to underestimate the presence and power of other affiliative conflicts, starting with paternal and sibling and extending into lover, friend, teacher, authority figure, and even God, to name only the most common. All can and do trigger transference love coming alive in therapy, for very few relationships completely satisfy human affiliative desires.

Indeed, Freud believed that, as a general rule, early attempts to meet affiliative needs were both positive and negative. Basic expectations were met but not well enough. We were loved but not fully, not consistently, and not flawlessly. Yet we not only desired that response from our caregivers but also felt entitled to it. Hence, to one degree or another we grew up conflicted and vulnerable. We were aware of this suffering, if only on an unconscious level.

As a consequence, throughout life we tend to unconsciously replay and reenact those early years so that painful memories can be replaced by positive experiences. We feel compelled to approach another empathic, understanding person as a potential nurturing mother figure (Freud, 1912; Covington, 1996). We want a reparative experience that is cognitive, emotional, and physiological: a mind-heart-body experience. We “seek intimacy, which ordinarily includes bodily contact with those we experience as warm and accepting” (Schaeffer, 2007, 187). We do this outside of therapy as well as within therapy.

Thus non-erotic transference love is a normative occurrence in the course of therapy. It is to be expected. The absence of it, in fact, is an aberration.

Indeed, the therapeutic setting is a natural, even fertile, ground for the development of non-erotic transference love. Clients look upon their therapist as a resource person, similar to those who performed survival functions in their childhood, both psychological and physical. Clients perceive their therapist as a person with whom they can enter into a simple, non-erotic relationship.

That love – clients hope unconsciously – will be a matter of the heart, mind, and body. It will bring whole-person gratification. Though it will not be genital, it will be sexual in the sense of sensual and pleasurable. It will be a matter of being loved as a baby or youth. End of story. But a most fulfilling human “story” that will enable the forgetting of the original, flawed “story.”

However, the problem – or good fortune – is that sensual pleasure easily becomes sexual for at least three reasons. First, sexual desires lay at the deepest level of the human psyche. Sexual needs are as basic as needs for food, drink, and sleep. Second, “most clients experience themselves as unlovable at a very deep level” (Mann, 1999, 19). As a result, they instinctively search out that person who will finally make them feel lovable. Third, sensations and emotions are the same basic reality. Each emotion is felt as a sensation or a cluster of sensations. Each sensation or cluster of sensations sends a message to the brain that we are experiencing an emotion. Feeling warm, comforting sensations, for example, means we are in proximity to someone who has positive feelings toward us.

Thus, as therapy continues and therapists ask for additional information as well as reveal more about themselves simply because of what they say and how they say it, clients begin to feel something more (Dalenberg, 2000). They experience a complex emotion: the pleasure of mutual love and the “pleasure [of] proximity, [the} desire for fuller knowledge of [their therapist], [a] yearning for mutual identification and personality fusion” (Menninger, 1942, 272). They desire non-erotic love. They desire to know their therapist and be known by him or her. This experience will be sensual in a non-sexual way; but it will be permitted to evolve into something else if that “just happens.” And that something else might be a secondary sexual experience. It will not be genital but it will meet the client's need for closeness to, even a merger with, another person who is experienced as a maternal figure.

In other words, Jung's Mother Archetype becomes operational in therapy because, like the original mother-child relationship, therapy involves repeated, intimate contact between two persons through conscious and unconscious channels of communication (Tower, 1956). Therapy easily becomes an opportunity for clients to find the vanished mother figure (Ferenczi, 1909) and enjoy again the mother-infant quasi-union of the first months of life (Greenacre, 1954).

Similarly, therapy easily becomes an opportunity for therapists to play the maternal roles of creating and nourishing new psychic life (Schaeffer, 2007). Transferential love begins to gratify clients as they become aware of their therapist's caring feelings for them. It soon seems as if their transferential love has been accepted. They feel closer and closer to their therapist. They reveal more and more of what they have previously withheld. They believe that they can be intimate and all will go well. They will finally meet their early-life affiliative needs.

Indeed, when all goes well, non-erotic transference love assumes forms similar to non-erotic love outside the therapeutic setting. Expectations of being accepted, nurtured, protected, and loved by a maternal figure recede as expectations of working with an adult emerge. Love can be adult-adult rather than adult-child.

It is important to note that when the therapeutic alliance becomes adult-adult, developmentally appropriate maturation can finally come about: meeting affiliative needs primarily in and through oneself and only secondarily in and through others. For maturation depends on integrating the capability for self-nurturance and self-love into the psyche rather than depending on being nurtured and loved by others (Ferenczi, 1909; Freud, 1940). In other words, sole or even primary dependence on others is not developmentally appropriate beyond infancy and childhood.

But back to the therapeutic setting. When developmentally appropriate maturation is not occurring, non-erotic transference love can become erotic, eroticized, and/or perverse. The first, erotic transference love, is not pathological, but it can also distract therapists and clients from doing much-needed maturational work.

Before we explore erotic transference, however, we need to take a look at countertransference love and the contribution therapists might be making.

As a general rule, countertransference love begins non-erotically. It develops from simple empathy as therapists resonate with persons whose distress is real and whose life is adverse; whose efforts to correct a painful situation have failed.

Correspondingly, both male and female therapists fall quickly and naturally into taking on maternal roles and performing nurturing functions (Greenacre, 1954). To simple empathy, therapists add a caring attitude: they respond lovingly to their clients. Their clients, in turn, act intuitively in a situation in which they sense they can finally be healed of their emotional pain. They sense a phenomenon observed by Ferenczi: “It is the physician's love that heals the patient” (Gerrard, 1999, 29). Concurrently, their therapist intuitively senses a similar phenomenon observed by Freud: “Essentially, one might say, the cure is effected by love (Freud & Jung, 1974, 8-9).

Alternately, with or without a transferential stimulus, countertransference love can be sexualized from the very beginning. Indeed, “the therapist's desire [can ignite] the transference” (Schaverien, 1997, 6) in that the therapist brings to the therapeutic endeavor an erotic unconscious and an erotic subjectivity (Mann, 1999).

Erotic Transference Love

Erotic transference is clients' normal sexual response toward persons outside therapy being transferred to their therapist. Except for being transferred or displaced, it is identical to love in everyday life. It is a non-pathological form of transference that is normative in therapy. Sooner or later it will appear (Freud, 1912). Then, erotic transference love and non-erotic transference love will tend to vacillate rapidly (Slochower, 1999).

Erotic transference love drives client and therapist into a relationship in which clients expect their therapist to love them as whole persons: human beings with sexual impulses, sexual intimacy desires, and sexual needs. For clients are not just intellectual or even just emotional and spiritual. They are also physical. Their erotic transference love takes form “at the interface where mental and physiological experience come together” (Davies, 1994, 158-159).

Like all transference, erotic transference love resides in the unconscious mind. It is not willed. It is simply a matter of client and therapist becoming ever closer and then unconsciously “allowing” their imaginations to produce a fantasy: “my therapist loves me and I love him or her” (Mann, 1999). Indeed, there are “kernels of truth” to this fantasy; it is the product of the imagination on the part of both client and therapist.

Jung (1946) adds an interesting observation to this intrapsychic and interpersonal phenomenon. At a deeply unconscious level, he writes, erotic transference not only connects clients and therapists in a fantasy but also allows clients to find wholeness. They have split from an unlovable-unloving part of themselves. They want “to be reconnected to a missing part of themselves, to some aspect of their own souls,” (Ulanov, 1984). They hope to reconcile a split-away part of themselves: the one that they are transferring to their therapist. Thus, erotic transference love, like non-erotic transference love, is far from pathological.

Indeed, erotic transference love has as its foundation a willingness to share control of a relationship that blends love with other human feelings, aspirations, and needs. It integrates both aggressive urges and sexuality with love and tenderness (Gabbard, 1989). It is as complex as are human beings. It brings with it ever-shifting feelings of love, shame, idealization, envy, rage (Davies, 1999), and even hate (Blum, 1997).

As a general rule, erotic transference love develops gradually. At first it tends to engender shame and embarrassment, for both therapists and clients recognize cultural and moral prohibitions against fulfilling their desires with a socially inappropriate, unavailable person. But, as therapy continues, this form of transference love tends to wax and wane. Especially during very stressful stages of therapy, such as termination, originally non-erotic transference love can quicken strong urges to take advantage of opportunities to gratify sexual desires (Etchegoyen, 1978).

Freud (1912) wrote that transference love begins as non-erotic in the strict sense of the word. But, like all positive human interactions, it can be traced to an early erotic source: a sensual mother-infant relationship. Thus erotic love is “genetically linked with sexuality and [has] developed from purely sexual desires through a softening of their sexual aim (Wrye & Welles, 1989, 5). “The early mother-infant bond is the first erotic relationship” (Schaverien, 1997, 10). Transference love stems from the infant's spontaneous, primitive need to feel wanted and loved and to experience love physically (Covington, 1996).

Part of clients' unconscious goal is to elicit their therapist's loving, accepting response so that they can safely express their own love. They presume that doing so, far from backfiring, will replace painful memories of love being rejected in the past. They unconsciously deny the fact that non-erotic love tends to fuse with pleasure that is erotic. It becomes sexual – easily and naturally – for both client and therapist.

Yes, in spite of societal, professional, and moral prohibitions, the therapeutic setting can bring out therapists' needs to love and be loved in more than platonic ways. Therapists can fantasize sexuality as a resolution for their need for affection. They can unconsciously conclude that they can resolve a conflict of their own: not being loved and not loving another human being sufficiently yet deserving it. Indeed, therapists' desires can precede clients' erotic transference; it can ignite it (Schaverien, 1997) as therapists can bring to their clinical work an erotic unconscious and an erotic subjectivity (Mann, 1999). They are no less human than their clients.

Non-erotic countertransference can become erotic simply because clients and therapists are involved in an intimate exchange on a frequent basis. Week after week, therapists receive private and highly personal revelations that animate memories of their own mother-child and adult-adult affiliative relationships. Indeed, clients' tendency to discuss sexual material in therapy is the third most common characteristic of clients to whom therapists are attracted (Pope et al., 1994).

In sum, erotic transference love is a normal phenomenon in psychotherapy. Sexualized transference love and sexualized countertransference love easily trigger each other (Dalenberg, 2000). The therapy setting is a golden opportunity for clients and therapists to work together to enable clients to meet their affiliative need in mature, wholesome, fulfilling ways. At the same time, the therapy setting is fraught with danger, for unrecognized erotic transference and countertransference love can evolve into eroticized and perverse transference and countertransference love. And what is especially problematic is that the evolution is generally insidious.

Eroticized Transference Love

Eroticized transference love is a pathological displacement whereby clients unconsciously intend to heal their painful, negative memories of not being loved enough by expressing their attraction to their therapist in one or more forms of sexual behavior (Gabbard, 1994).

In the past they have experienced rejection from those whose love they sought. Now, they unconsciously fantasize that by acting out sexually they can fulfill their desire for intimacy. As they and their therapist express their love physically, a sense of goodness will replace a sense of badness (Slochower, 1999), and their self-esteem will increase exponentially (Stacy, 1998). Gratification of sexual desires will replace their quest for understanding and being understood, which are the very heart of therapy (Freud, 1915). “All other deep unconscious wishes will prove superfluous in the light of all-consuming sexual gratification” (Schaeffer, 2007, 190).

Unfortunately, eroticized transference love is a truncated form of love in that it consists of sexual components alone (Person, 1995). In contrast to mature, seasoned love, it makes sexual gratification the end-all of interpersonal relations, no matter who is involved and no matter what their commitments are to others.

Eroticized transference love that appears in early stages of therapy tends to result from clients' frustration over not having the control they want over their therapy and their therapist (Eickhoff, 1998). In other words, eroticized transference serves as a defense against fears of helpless and feelings of powerlessness. By contrast, eroticized transference love that arises at termination is usually a defense against the pain of being separated from a person clients love: their therapist.

In essence, clients engaging in eroticized transference love develop an intense sexualized love for an unavailable person: their therapist. Occasionally they are able to generate rescue fantasies in their therapist and actually seduce him or her to meet their sexual needs. Most often, however, their therapist feels captured and bound rather than free to love. Experiencing a negative form of sexualized countertransference, their therapist wishes to disconnect from an intensely needy, demanding, self-centered client. In that case, clients come to realize how misguided their efforts to force love have really been. They experience painful masochism.

Another scenario, of course, is that therapists actually enact their eroticized countertransference and meet their own and their client's sexual desires. In spite of years of ethics courses and information from professional associations and state grievance boards, engaging in sexual activity with clients remains one of the main reasons therapists lose their professional license. They deny their responsibility to those outside of therapy and, in the long run, damage their clients grievously.

Perverse Transference Love

Even more pathological than eroticized transference love is perverse transference love, for it is actually a form of hate (Stoller, 1975). It is the hate once inflicted on the client by an abusive or neglectful other and now projected into the therapist as the client unconsciously reverses roles and becomes the abuser.

Verbal signs of perverse transference love are hostile provocation, sarcasm, outright rejection of others' ideas and forcing one's own on them. Paradoxically, emotional coldness can be a manifestation of perverse transference. In any case, “the pervert is not making love; he is making hate” (Kaplan 1991, 40). He or she is sadistically reducing the therapist to an inanimate object that can be used, abused, and then discarded at will. There may be no physical contact, but the client's verbal and/or nonverbal behaviors make the therapist feel humiliated, violated, and exploited. The therapist's state of mind becomes one of aversive emotional confusion (Slochower, 1999).

Like eroticized transference love, perverse transference love is characterized by compulsivity, fixation, rigidity, and obligation (Kaplan, 1991). Those who suffer from perverse love appear to have little choice. Their hatred is so deeply entrenched and so little understood that they find it impossible to deal with. Rather, they feel compelled to protect themselves – by acting out – from what they sense will be their own psychological destruction: their own hatred (Springer, 1996).

Ironically, in some cases perverse transference love may take an apparently opposite form: an attitude of extreme, unfailing kindness as clients “groom” their therapist (Gabbard, 1994). Clients may normalize intimate exchanges in such a way that sexual material can be inserted and not noticed. Even so, informed and observing therapists will periodically perceive these clients as children who have been painfully abandoned or abused: powerless persons whose frightening emotional pain compels them to protect themselves against further abandonment and abuse by seducing another person with whom they are presently interacting (Springer, 1996).

Blum (1997) conceptualizes perverse transference love in a somewhat different way. He regards it as a sexualized defense against hate, hostility, humiliation, a desire to destroy, and a fear of being destroyed. It is a defense against the pain of having been deserted or abandoned – actually destroyed psychologically – in the early years of life. Clients are unconsciously hoping to seduce their therapist instead of being seduced. They are hoping to fulfill their desire to take revenge (Springer, 1996).

Thus, when clients enact perverse transference love, they get the sense of having eliminated – or at least separated from – their therapist. Their seduction, be it real or imagined, makes their therapist into an impersonal object. Thus they are “saved” from being rejected by a real person whom they actually love, their therapist (Khan, 1979).

Springer (1996) believes that at the deepest psychological level, perverse transference love is a sexualized defense against the self. It gives the one who enacts it an experience of pseudo-wholeness and completeness, which is extremely exciting. Thus it protects the person against threatening disintegration. If one is experiencing overwhelming excitation, he or she cannot be disintegrating. Hence, the powerful reinforcement that propels serial rapists into repeated offenses.

What might a therapist contribute to perverse transference love? Nothing, we hope. But let us not forget that enactment requires the cooperation of the two persons in the therapeutic setting. As therapists begin to feel the burden of their therapeutic work – especially if they do not lead a balanced, wholesome life – their anger and aggressive urges can taint their maternal erotic countertransference love. It can even disappear in the face of growing dislike or actual hate of a client (Schaeffer, 2007).

Most unfortunately, therapists who act out their eroticized or perverse countertransference love can unconsciously believe that they can discharge their disguised archaic instincts with impunity. They can hold the delusion that they can give sexual expression to their hatred and hostility without causing harm (Bachant & Adler, 1997).

Conditions Affecting the Development of Eroticized and Perverse Transference Love

It is important to note that under certain conditions the probability of eroticized and perverse transference and countertransference developing is higher than usual. Keep the distinction between transference love and countertransference love but stay aware of their co-occurrence.

Client-related conditions under which eroticized and perverse transference love are more likely to come alive include the following:

Therapist-related conditions under which eroticized and perverse countertransference love are more likely to come alive include the following:

Finally, if clients who have suffered from trauma and/or present with profoundly problematic characteristics meet with impaired therapists, the danger of pathological forms of transference and countertransference love developing will be significantly higher. It might even be exponentially higher.

Also remember that transference and countertransference love are basically unconscious phenomena. Those who enact them are unaware of being motivated by them. They can, however, learn to detect subtle signs of their presence and thus manage them. They can also put protective factors in place.

Protective Factors

Protective factors reduce the likelihood of clients and therapists enacting pathological forms of transference love and countertransference love. Protective factors for clients include a supportive adult relationship and a wholesome lifestyle. Protective factors for therapists include deliberate resolution of their own sexual and aggressive conflicts, a wholesome lifestyle, periodic consultation with experienced colleagues, and meeting with a trusted therapist during periods of more-than-normal internal and/or external stress.

A final and very important point is that therapists with protective factors in place need not terminate with clients when transference love and countertransference love arise. In fact, referring them to others can even harm clients in that it can imply that they are less than respectable. Their unmet affiliative needs cannot be dealt with in therapy with the clinician toward whom they have exposed these needs. What clients need most, by contrast, is acceptance as persons in dire need of help to meet their affiliative needs in wholesome, developmentally appropriate ways. They need to work with therapists they have come to trust enough to share their affiliative pain, provided the latter are informed, skillful professionals.

Exceptions do exist, of course, but rarely can a clinician determine clients with whom they cannot profitably work when initial signs of transference and countertransference love appear. In fact, the majority of clients respond well to boundary-based acceptance by therapists who show them how to put protective factors in place while they and their therapist identify, take responsibility for, and deal with their unmet affiliative needs. Indeed, most clients benefit immensely from being respected as persons whose basic affiliative needs are legitimate and whose capacity to meet those needs in mature and responsible ways is developable. They are able to explore the complex nature of legitimate needs underlying their intense desire to resolve their affiliative conflicts. They are able to partner with their therapist to explore appropriate ways of meeting their affiliative needs.

Main Points

How Transference and Countertransference Love Come Alive

Questions

Projection, Introjection, Projective Identification, and Introjective Identification

Transference love – like all forms of transference – is the unconscious displacement of the past to the present or from one person/situation to another. It involves the projection of some affiliative aspects of a person in the client's past or non-therapeutic setting onto the therapist. These aspects include attitudes, ways of thinking, and behavior. As clients engage in projection, therapists automatically engage in introjection. They unconsciously receive what clients “send.”

However, it is important to note that therapists engaging in introjection receive projections without identifying with them or owning them and the feelings connected with them (Stamm, 1995). They “accept” projections without confirming the perceptions inherent in them (Schafer, 1968).

Rather, confirmation of a projection depends primarily on therapists' countertransference; their own unresolved intrapsychic conflicts (Westen & Gabbard, 2002). Confirmation depends on “the extent to which the [client's] projection meshes with aspects of the therapist's unresolved…conflicts” (Meissner, 1996, 43). For example, some therapists have not resolved their own conflict over their own mother being emotionally unresponsive in spite of their need for emotional closeness. They hold templates of mothers as emotionally unresponsive persons. Thus they are likely to confirm their client's projection of them as emotionally unresponsive. They will then unintentionally engage in some form of rejection, such as moving on even though their client is beginning to cry. On the other hand, if they have resolved their own conflict over their mother being emotionally unresponsive, they will spontaneously “hold” their client's pain. They will listen empathically and soothe through their words and tone of voice. They will not confirm the projection their client has sent.

Interestingly, clients who project do not recognize what they are projecting as their own. It feels foreign to them. Something that they dislike seems to be coming at them, but it is not theirs. So they sit back and criticize their therapist for what appears to be his or her – and not their own – negative trait or habit (Schaeffer, 2007).

Projective identification and introjective identification can be thought of as mutations of projection and introjection. Whereas projection is a matter of clients putting their own unresolved conflict-based pain onto their therapist and introjection a matter of therapists receiving that pain – taking it on – projective identification is a matter of clients putting that pain into their therapist. Similarly, introjective identification is a matter of therapists unconsciously permitting that pain to enter into them (Ogden, 1982).

Projective identification is a matter of a person with an unresolved conflict getting rid of unwanted feelings by assigned them to someone else who is unconsciously willing to accept the assignment (Klein, 1946). Our psyches fantasize that we can split off an undesirable part of ourselves, put it into another person, and some time later recover a modified, non-hurtful version of that part (Grinberg, 1962; Ogden, 1982). In fact, while the other person is containing that pain, we experience a oneness with that person (Schafer, 1977).

Clients engage in projective identification because they unconsciously know that they need to learn how to deal with the past (Schore, 2003a); to discover how they can manage the pain they have thus far been unable to manage. Those with depression resulting from not being loved, for instance, put their uncontrollable sadness and hopelessness into their therapist. Then they observe what their therapist does with it, noting how the therapist momentarily stops talking, for example, in order to think of how to talk about their powerful feelings. Their therapist, of course, is unconsciously collaborating in that process by internalizing the depression. When this is going on, clients get relief. Their therapist is depressed; they are not.

As time passes, however, clients attempt to recover the part of themselves they have put into their therapist. For example, they unconsciously believe that their therapist has actually felt depression and has not only tolerated it but also dealt with it. Consequently, their depression is not terrifying; it is not uncontrollably powerful. Indeed, it is manageable (Ogden, 1994). They can now safely re-own their sadness and hopelessness.

Correspondingly, introjective identification is therapists' experience of the emotional pain clients put into them. They appropriate it in the sense of taking it in. Then one of two things happens. In one case, therapists feel like their depressed clients and become very empathic toward them. In other cases, however, therapists feel like the person their client negatively affects because of their depression. They then begin to empathize with the person the client has affected. Fortunately for therapists, the second case provides important information regarding what the client has contributed to his or her own negative interpersonal situation and the client's inability to deal with what he or she is doing. Therapists can now use this information to facilitate therapeutic work that will bring about a positive outcome.

It is important to keep in mind that therapists who introject the material their clients put into them by projective identification appropriate that material without necessarily confirming it. They cannot help but feel what their client or the person affected by the client has felt, but they only make that feeling their own if they confirm the material that they have introjected. If confirmed, of course, therapists are likely to act on those feelings and thus create problems in their work with their clients.

Keep in mind that both clients and therapists engage in all four forms of sending and receiving emotional pain without realizing they are doing so. Also keep in mind that projection and projective identification cannot negatively affect therapy unless the material related to introjection and introjective identification is confirmed. In other words, the more clients and therapists resolve their intrapsychic and interpersonal affiliative conflicts, the less likely it is for transference and countertransference love to become problematic.

It is difficult, however, to completely resolve conflicts related to affiliative needs, partly because of our brain's limbic system, neuromodulators, neurotransmitters, and mirror neurons as well as our entire body's memory and nervous systems.

The Human Brain: Its Components and Their Functions

Simply put, our brains are “wired” to remember what happens to us. We are physiologically – and therefore psychologically – “programmed” to bring our past unresolved affiliative conflicts into the present; to engage in the processes of transference and countertransference love. Space and time permit only the basic facts that account for this reality.

Because of neuromodulators that encode memories, we are always in the process of forming painful memories of failing to love and be loved. Because of neurotransmitters that activate reward centers, we are always in the process of trying to get rid of our emotional pain and to experience the love of others. Because of our brain's limbic system's amygdala, we are always storing emotionally charged events, such as early experiences with caregivers. Because of our brain's limbic system's hippocampus, we are always tagging time and place to affiliative memories so that they can be stored as narratives (Schore, 2003b).

Furthermore, because of our brain's mirror neurons, we are reacting to someone else being loved simply because we are near them. Thus clients and therapists are automatically and unconsciously communicating with each other as soon as there is activity in one of their brains. “You are my loving mother,” the client's brain “says,” whereupon the therapist's brain just a few feet away receives information regarding his or her maternal assignment and the role he or she is being told to perform (Schaeffer, 2007).

In addition, our brain's implicit memory is constantly storing and then recalling what we learn experientially. Generalizations of experiences – called schemas – are constantly being encoded in feelings, sensations, and images. Thus they are available when there are similarities between the past and the present. They can serve as natural “building blocks” making the present temporarily indistinguishable from the past and the therapeutic setting indistinguishable from the setting outside of therapy. Consequently, they “encourage” transference and countertransference (Gabbard, 2001). “Mothers are emotionally cold even though I need to be loved” reads the schema in the memory of the unloved child. “This is exactly what my therapist, who looks like my mother, is going to do” reads the schema in the same, though adult, client. “I must reject this client who appears to need too much love” reads the introjected schema in the client's therapist. “My whole body tells me not be emotionally responsive to her.”

Thus the client's schema serves as a template that can be imposed on new reality not only for the client but also for the therapist. Should the therapist enact the schema, it will become an even more compelling belief in the mind of the client.

Matters are even more complicated because one schema builds upon the next developmentally. “Old schemas never die: they … are incorporated in various ways into subsequent schemas.” They are “periodically activated without conscious awareness” (Westen, 1998, 331) as human needs call upon similar information-processing channels.

What becomes problematic then in the course of therapy is clients' and therapists' transferring their intrapersonal and interpersonal struggles to each other as schema-nesting occurs. Neural pathways of schemas remain intact even though they may be weakened or even made temporarily unusable. “Although perhaps inhibited, [neural networks] are capable of reactivation in certain circumstances” (Grigsby & Stevens, 2000, 97). Fortunately, however, recently Ecker and his colleagues have found ways to destroy that capacity (Ecker, Ticic, & Hulley, 2012).

Similarity Judging: Pattern Matching

Transference and countertransference love can also be thought of as repetition and re-enactment due to similarity judging: pattern matching. The human brain is continually constructing and reconstructing experiences in the context of old ones. Thus new interpersonal experiences are understood in the context of the old ones. “Transferential processes always reflect an integration of current and past experience, as patterns of activation resulting from current life experiences…interact with enduring ways of responding” (Westen & Gabbard, 2002, 130).

It may seem as if we just “take in” the world as it exists – as does a camera – but in fact our perceptions are constructed by our brain (Gazzaniga, 1995). Acting like a feature detector, the brain uses already existing sensory cues based on prior experience to see and hear and feel what it saw and heard and felt before (Pally, 1997). The brain “searches for a match between the current [or present] pattern of neuronal activation and patterns stored in memory [because of prior experiences]” (Pally, 1997, 1021). It finds patterns within itself. It makes “a quick assessment of just enough details to find a 'good enough' match. When one is found, perception occurs” (Pally, 1997, 1025). We “see” what we have seen before. Thus, we transfer the past to the present.

Fortunately, however, transference love due to similarity judging need not result in negative outcome. Indeed, by performing subtasks that detect and manage transference, therapists can learn “how to exploit transference for its optimal learning potential…. They can thereby convert potentially…dangerous perceptual 'mistakes'…into an opportunity to adopt new, more effective patterns of meeting their own and [their clients'] affiliative needs” (Levin, 1997, 1147).

Main Points

Part Two

How Transference and Countertransference Love Can Be Captured

Questions

Because of an all-but-impenetrable barrier between the conscious and unconscious minds, the conscious mind cannot have direct knowledge of phenomena “residing” in the unconscious mind. Our conscious minds can detect transference only in the vague, shadowy signs of its presence. Thus we can “capture” it only when it manifests itself in forms such as dreams, slips of the tongue and other words, sensations, emotions, body language, and behavior. For each of these “voiceless and vociferous little parts of [the self]…do their best to add their 'two cents' into the final product” (Wittig, 2002, 143): truly meaningful communication.

As an intrapsychic phenomenon, that communication is from an individual's unconscious mind to the individual's conscious mind. The communication occurs because the two minds need to “talk” in order that the more logical conscious one can work with the more emotional unconscious one to resolve conflicts. Without the contribution of the unconscious mind, the conscious mind is ordinarily only partially successful in dealing with life's challenges (Schaeffer, 2007).

As an interpersonal phenomenon, transference in therapy – actually in life in general – is a matter of two persons' unconscious and conscious minds communicating. The communication occurs by means of subtle, indirect manifestations, such as “slips of the tongue” and dreams, rather than clear, direct information. Nevertheless, the reason for the communication is the same as it is for the individual: the four minds need to “talk” in order that the more logical, analytic conscious minds can work with the more emotional, intuitive unconscious minds to resolve conflicts.

This work, however, is difficult because manifestations of transference (including countertransference) cannot be taken at face value. They are sources of data regarding what is going on in therapy but not sources of evidence of exactly what it is (Smith, 1990). They must be unpacked “to the point of their yielding the truths they hold” (Schaeffer, 2007, 65). This is especially true regarding the cultural truths they hold. We must pay attention to transcultural as well as within-cultural variables in order to get at the precise meaning and significance of unconscious communications. Mothering and mother love in a Hispanic culture, for example, is generally quite different from a British culture.

The following categories of transference manifestations are artificial in one respect. Emotions, for example, find expression in words, sensations, facial expressions, and dreams even as facial expressions give evidence of emotions and sensations. We will examine the categories separately, however, in order to simplify complex phenomena and create templates that can be placed over what happens in therapy.

Words

Words might simply be means clients use to communicate the problems and concerns of which they are aware. If so, they can be taken at face value, that is, according to their dictionary definitions or denotations.

Even so, some words convey not only straight-forward messages but also emotionally tinged nuances: connotations. A client referring to her problem with her father, for instance, may also be unconsciously referring to all men she loves, including her therapist. Therapists should likewise suspect countertransference with words they sometimes choose, usually “out of the blue.” “I'm afraid I can't give you an appointment next week” may really mean “I am afraid of hearing more about your sexual issues and therefore do not actually want to schedule.” Bottom line: the unconscious mind perpetually tries to find ways to move its contents into consciousness.

Extra-therapeutic material that clients bring in at the beginning or end of sessions is especially noteworthy in terms of transferential messages. A client's saying at the beginning of a session, “I am so tired,” may also mean “I am tired of trying to get my need to be loved met by you.”

Words that convey seemingly unrelated material may also be transferential. When talking about a third part, clients may be unconsciously revealing their feelings about their therapist. “I feel so attracted to my boss,” for example, may also refer to the therapist. It may not, of course, which is why examining possible manifestations of transference is so important.

Emotions

Though single, obvious emotions would not appear to be transferential, what appears to be simple may be complex, with a second or third feeling at the periphery of the obvious feeling. Anger that a client expresses, for example, may also include sadness because the therapist, like the husband being overtly referred to, is not available as a lover.

Theorists vary as to which emotions are most likely to be transferential. Because clients and therapists want to bond with each other, love, and fear of disappointment are to be expected. Similarly, relief when therapy goes well may be accompanied by fear of therapy coming to an end and thus a loving person disappearing from one's life. In fact, earliest bonding experiences commonly consist of a positive experience of needs being met on demand, followed by a negative one of learning that one has asked too much or too often (Schaeffer, 2007).

It is important to remember that to decipher emotions one must study body language and voice quality. The meaning of words can change dramatically if gestures or tone of voice or volume do not match words. “I feel comfortable in here” said with strained facial muscles and in a listless, almost inaudible tone of voice may be conveying that “You make me comfortable, but I need more from you.”

In general, therapists first discover the truth about their emotions in those which seem excessive or inappropriate for what clients are saying (Tower, 1956). Their sudden anger, for example, is more than they would expect simply because their client came late. Moreover, therapists' behavior and somatic responses can signal already existing affect. Sleepiness, for example, might indicate that therapists have felt abandoned by clients because they intellectualize too much. Or they may be angry with clients because they talk in circles (Racker, 1972). Therapists' irritability may indicate guilt feelings related to disliking a particular client (Schafer, 1997) despite their belief that reaction is unacceptable in the therapeutic setting.

Arlow (1985) believes that therapists' depression – in spite of their healthy lifestyle and overall professional success – is basically a countertransferential reaction: a defense against the depression of their clients. More often than not, clients project a bad self (Epstein, 1977; Racker, 1968) onto their therapist because of prior caregivers. What is equally problematic is that therapists whose own self-definition is negative may unconsciously add self-punishment to negative transference. They may “agree” intrapsychically that they are inadequate (Epstein, 1977). For example, they find it hard to work with clients whose affiliative needs are pronounced.

Therapists' fear sometimes develops because they unconsciously experience clients' hold on them as a form of voyeuristic intimacy, seduction, engulfment, or aggression (Langs, 1979). Therapists may become apprehensive when clients ask them for more time and attention than they can afford to give, perhaps in light of their own unstable marriage, or when they are already erotically attracted to their client.

Dreams

Dreams that clients bring into therapy are often rich sources of transference, especially when therapists are dream figures (Ferenczi, 1909). Therapists' dreams are also valuable sources of countertransferential material, particularly if dream figures are clients (Tower, 1956). The same is true of daydreams or fantasies.

A separate course would be needed to address the issue of transference in dreams, fantasies, and daydreams. Studying them in terms of their displaced material is highly recommended if therapists are not already proficient in benefiting from dreams that clients bring to therapy or that therapists have in which their clients appear as dream figures. Dream figures may represent the dreamer as well as someone with whom the dreamer is in close, frequent, and conflictual contact, such as the dreamer's client or therapist.

In sum, because affiliative needs are meant to be met, those not met create some form of intrapsychic and interpersonal conflict. Dreams, daydreams, and fantasies are common means by which the unconscious mind tries to get the conscious mind to help resolve the conflict.

Body Language, Complex Movement, and Somatization

Manifestations of transference in body language or simple movement, complex movement, and somatization are messages from unconscious to unconscious – therapist to client and client to therapist – through bodily means. Indeed, “the basic units of experience are [not words but] bodily interactions between self and others” (Fast, 1992, 449). The behavior of both clients and therapists contains key information about what they are trying to convey to each other (Scaer, 2005). Details of posture, gaze, changes in skin color – even respiration – are noticed and unconsciously recorded by both therapy participants (Meares, 2005).

Moreover, because the body cannot lie, it is a source of truth about the present as it embodies memories of the past. The body has “the ability to tune in to the psyche: to listen to its subtle voice, hear its silent music and search into its darkness of meaning” (Mathew, 1998, 185). It has the ability to do so and seemingly cannot resist actually doing so. Of particular importance are facial indicators, especially subtle movements around the left eye and left side of the mouth (Schore, 1994). They divulge hidden personalized feelings (Mandal & Ambady, 2004).

Of course, what happens on a one-time basis may not be worthy of much attention. But body language that persists or repeats itself becomes significant.

In contrast to body language that encodes a relatively simple message, unintentional complex movement communicates several displaced feelings and story-like thoughts. Thus complex movement that puts transferred feelings and thoughts into action is termed enactment. Thoughts and words become coercive action loaded with emotion that is related to figures in the client's and therapist's past, including the very recent, minutes-old past. It is action dictated by a “script” never actually seen, one written outside the therapeutic setting.

In carrying out transferential enactments, clients “assign” to themselves and their therapist roles specific to conflictual past experiences. They “intend” to play a part and have their therapist play a related one. In the case of transference love, they unconsciously want to have a wholesome affiliative experience with their therapist. For example, clients still conflicted over wanting to be nurtured gratis and finding parental figures unwilling to do so, fail to bring their copayments. Should therapists play a parental role by overlooking that breach of contract, they may well be enacting their own countertransferential conflict: needing to love unconditionally though they do not want to. Or perhaps they damaged their own child by not loving her unconditionally and now feel compelled to make amends.

Similarly, therapists can enact their own countertransferential affiliative conflicts by indulging their clients. They might ask less of them than they are capable of doing, absolve them of their obligation to change their behavior in a timely fashion, or keep them in therapy even though they have attained their goals.

Yet another manifestation of transference love is somatization, which is actually a matter of acting-in. A thought stimulates an emotion that easily find expression in bodily movement. A thoughtless emotion, an unknown known (Bollas, 1987), expresses itself in a sensation, bodily movement, or an inability to move.

Transferential somatization manifests itself in symptoms or pleasurable bodily conditions that have no real physiological cause. Common examples are sudden stabs of pain, tears, trembling, strange sensations in the solar plexus, poor sleep, and sensitivity to noise. Other indications are tightness in the chest, nausea, rising heat, cramps, barely perceptible odors or tastes, and – most revealing – sexual arousal (Boyer, 1997).

Indeed, somatization is the body's revelation of what happened earlier in the mind and “heart.” Hence, it can be a rich source of transference love, for so many unresolved affiliative conflicts occurred in a preverbal stage of development. For instance, a feeling of repeated and heightened physiological excitement when meeting with a particular client – even preparing for it – can indicate how much a therapist is unintentionally trying to meet his or her own affiliative needs. Getting a headache almost every time a client comes, by contrast, can indicate how much a therapist resents the client's request to meet his or her affiliative needs.

In sum, the only way we can detect transference love is to catch – or to catch onto – its manifestations. If indeed we suspect that a manifestation might be an affiliative communication – disguised in one or more of its common forms – we need to study that possibility. If not, we will simply be taking the communication at face value.

How long we should take to make that determination, of course, is difficult to determine.

One criterion we can use is repetition. A manifestation that is repeated – for example, a thought that becomes an obsession – is more likely than not to be an attempt of the unconscious mind to communicate with the conscious mind.

Another criterion is intensity. A dream we cannot shake, for example, is more likely to be transferential communication. So are emotions that are clearly overreactions, bodily comfort or discomfort that takes so much of our attention that we do not hear what our client is saying, and doing something for a particular client that we do not do for other clients. Going overtime with a long-term client who says she is in crisis and cannot deal with it herself, for example, may be unjustifiable if we are really honest. It may be a sign of transference love and/or countertransference love.

Yet another criterion is unexpectedness: things being said or done “out of the blue.” Reaching out to a client in the form of an embrace, for example, may be countertransferential.

A final criterion is complexity. A dream that repeats itself and causes our body to be noticeably tense is likely to be countertransferential. So is extending a session for a client that comes late on a regular basis and then going home with a headache or an inability to focus on the needs of one's spouse or children.

Now that we know what to look for in terms of possible transference and countertransference love, we are ready to explore how to do so: the subject of the next section.

Main Points

What to Do with Manifestations of Transference and Countertransference Love

Questions

“As a blind man might come across a gem in a heap of garbage, in this way the Awakening Mind appears within oneself.” Shantideva (7th century) India.

In order to deal well with transference love (including countertransference love), we need to slow down our mental activity. We must be like the blind man examining in his slow, methodical way the contents of the “garbage.” We need to slow down the fast pace of our conscious mind and give a transference or countertransference manifestation sufficient time to reveal its information throughout our person. We need to process what we suspect is our own and our clients' unconscious communication.

An effective way of doing this is to break the work into four distinct but interwoven subtasks. In the first we deliberately take in manifestations of transference. In the second we hold them and allow ourselves to regress in order to experience them more fully. In the third we decode them and hypothesize about them. In the fourth we verify our most likely hypotheses.

Performing these subtasks is a matter of supplementing the logic of our brain's verbal left hemisphere with the intuition of our brain's non-verbal right hemisphere. This is because transference and countertransference love, like most relational transactions, rely heavily on speaker-listener cueing and responding that occur too rapidly for simultaneous verbal exchanges and conscious reflection (Lyons-Ruth, 2000).

Of course, in order to integrate hemispheric information well, we must monitor ourselves. We must check how well we are performing each subtask and decide when we should move from one to another; when we should backtrack and when we should move forward. In other words, we must perform the subtasks separately as well as blend them into one multitask process in order to achieve our main goal: understanding as accurately as possible the unconscious “messages” regarding displaced affiliative conflicts being communicated in therapy.

 

 

First Subtask: Taking In Transferred Material

The first subtask is to decide to take in consciously what we suspect we have already received on an unconscious level, namely manifestations of transference, and have already responded to within our own unconscious mind, namely manifestations of our own countertransference. This subtask requires us to deliberately open ourselves up to what is happening: conflict-laden contents in our unconscious mind – and that of our clients – are causing such things as strange sensations and movements in our body, along with thoughts, images, attitudes, and emotions, for which we find it difficult to account.

Thus the first subtask is trying to “be there” for ourselves – as well as for our clients – in a new way (Heath, 1991). It is a matter of forming a composite picture of conscious and unconscious information from which we can, in time, derive fuller meaning than that based solely on conscious communication.

When we perform the first subtask, we intentionally “make room” for unconscious, displaced affiliative material in our conscious mind. We choose to increase our awareness of the feelings, attitudes, fantasies, dreams, images, thoughts, sensations, and behaviors that we and our clients are unconsciously transferring to each other (Bird, 1922). We permit ourselves to magnify our experience of the past converging with the present. We deliberately offer to our clients our “entire availability:” all the time and mental space they need to deal with the unresolved affiliative conflicts within them that they are transferring to us (Grinberg, 1997).

In the course of increasing our awareness of clients' transference love, we are also bringing to consciousness our own countertransference love. We are taking note of the roles we are unconsciously assigning our clients as well as the transferential roles they are unconsciously assigning us. If we are assigned the role of being a parent figure for someone working through an early child-parent conflict, for example, we deliberately “accept” a fleeting image of ourselves as an unloving, self-indulgent person. Similarly, if we ourselves are assigning the role of disobedient and thus unlovable child to our client, we hold in focus the self-righteousness we have begun to experience from refusing to love the child. We allow ourselves to note the muscle tightness of one who is “teaching a child” a necessary lesson.

Thus the first subtask consists of combining clients' unconscious body language and metalanguage – meaning how they say what they say – with what they consciously say. We also add our own unconscious perceptions and desires to the conceptions and intentions we suspect. Put in 21st century neuroscientific and cognitive terms, we allow right-brain learning to augment left-brain learning. We open ourselves to receive nonverbal communication that cannot be put into words. We allow ourselves “to keep adding spices and seasonings to the soup we are preparing, tasting frequently and adding one ingredient after another to bring out the soup's full flavor,” so to speak.

Second Subtask: Holding and Permitting Regression

We perform the second subtask by holding the manifestations of transference and countertransference love that we have received and permitting the psychological regression that tends to occur in a deepened and broadened holding environment. Before we can do something about an unfamiliar and mysterious phenomenon like transference love, we must experience it as fully as possible.

Thus the second subtask is a matter of deliberately embracing the full impact of our client's unconscious communication. As we hold a manifestation of a client's transference love, we will come to realize that “this is the clearer, sharper, more complete message my client is giving me,” (Smith, 2000). We will know experientially that “she is both fearful of losing my love and angry with me for not extending our session.”

We perform the second subtask by containing and autoregulating our own negative states long enough to act as affective regulators for our clients (Schore, 2003b). They can then become aware of our successfully managing the distressful feelings, sensations, and thoughts they have transferred to us. They can conclude that they can continue to reveal their unresolved conflicts without being overwhelmed by the distress, particularly the anxiety, that has heretofore kept those conflicts from reaching consciousness. We who have received their transference love are not only sharing their “burden” but also lightening it. Indeed, the safe holding environment that we are providing is one of the most potentially healing vehicles our clients will ever find (Wilkinson, 2003).

Casement (1991) describes the form of affect regulation demanded by the second subtask as a refusal to follow our natural inclination to disengage from the distressful transferential communication clients send us. Rather, it is a deliberate decision to avoid closure and tolerate ambiguity and uncertainty. It is choosing to not understand – for the time being – another's complex, displaced relational experience (Schore, 2003a). It is our best effort to not return prematurely what another is projecting onto or into us (Joseph, 1978).

In performing the second subtask, we refrain from taking refuge in words. We resist our impulse to shift into a left hemispheric state and to respond verbally to a client's overt communication. Instead, we hold uncomfortable sensations and awareness evoked by the client's unconscious communication (Stark, 1994) and sustain the countertransferential feelings that the transference love has triggered. We deliberately stay in the right hemisphere, which has a “Wait and See” mode of processing (Federmeier & Kutas, 2002). In essence, we do for clients what they were unable to do for themselves at the time of their original affiliative experiences: allow psychic pain to remain in their conscious mind long enough to get fully processed.

As we remain silent, we observe our clients very carefully. We permit ourselves to contain their unresolved affiliative conflicts in our own body (Kernberg, 1987). We endure their anger, depression, fear, dependence, sexual desires, and other disturbing feelings and sensations. We even let clients use projective identification to transform us into someone “bad,” someone deserving of disrespect, even abuse (Gorney, 1979). We let ourselves feel those negative labels in our very body.

The second subtask also involves allowing ourselves to re-experience the breadth and depth of our own unresolved affiliative conflicts (Kernberg, 1975). We willingly suffer the personal, painful countertransferential feelings and sensations that reflect our client's unresolved conflicts (Roth, 2001). We deliberately entertain the countertransferential phenomena that could well be triggering these conflicts.

The second subtask is very difficult for two reasons. First, as we hold our own and our client's displaced material and as we and they assign each other conflict-related roles, we suffer significant anxiety and vulnerability to rejection and humiliation. This, of course, was characteristic of earlier attempts we and our client made to meet affiliative needs. Indeed, we open ourselves to experiencing the deepest forms of emotional pain: being found inferior, flawed, valueless (Slochower, 1999), and thus unlovable or unable to love.

Secondly, we suffer fear, for regression is not only disturbing but also frightening. The use of regression in this context, of course, is an extension in meaning of a word originally reserved for an unconscious process. Strictly speaking, unconscious regression cannot become conscious. However, the process of willingly entering into a regressive state so resembles doing so unconsciously that no other terminology seems appropriate. As our fear compounds the fear of our clients, we easily slip into a psychologically primitive space. As a client's toxic material mobilizes our toxic material (Dosamantes, 1992) and we return the “favor,” we enter the realm of quasi-insanity.

Yes, the longer we deliberately provide a holding environment for our client's and our own primitive affective states (Winnicott, 1949), the more we regress. And regression disturbs us, even frightens us, as we experience disequilibrium within our right brain. Furthermore, as that disequilibrium persists, we experience deterioration in our technical competence (Spence et al., 1996). We are not able to think as clearly as usual. We are not able to find appropriate words to use. We become overwhelmed and fear we are “losing it.” Even so, the second subtask asks this of us.

In sum, when we perform the second subtask, we submit to the unregulated or underregulated forces that characterize transference and countertransference love. We relinquish some of the adaptive goals and values inherent in our rational minds (Schwaber, 1990). We allow disturbing images, fantasies, and memories to arise: pieces of internal, unconscious experience that are often contradictory, “crazy,” and disturbing (Isakower, 1963). We allow ourselves to undergo fragmentary experiences that we hope will shed light on or add clarity to the perceptions of our senses and the conceptions already present in our conscious mind.

Fortunately, our clients can benefit greatly from what we are doing. They can deepen their trust of a “kindred soul” who is willing to learn their primitive “language” bodily. Their therapist is not simply saying, “I understand.” As a consequence, they too can learn how to quietly and calmly hold the present rather than simply re-enact the past. In the end, they can finally resolve their affiliative conflicts.

At the same time, it is essential for us to remember that when we are performing the second subtask, we must not permit conscious regression to go so far or last so long as to impair our basic ego functions (Levin, 1997). In particular, we must not lose sight of the fact that what clients are transferring to us still belongs to them (Deutsch, 1926). Furthermore, we must not believe that we are allowed to actually perform the transferential roles we are being assigned or the countertransferential roles we are assigning ourselves.

Nor must we allow ourselves to regress to the point of suspending our ability to recognize our own countertransference and regulate its negative affect and disturbing sensations. In fact, in performing the second subtask, we must frequently dialogue with ourselves in order to balance affect and sensation with thoughts about what is occurring and what needs to be done with it (Kernberg, 1987). We must continually self-monitor and set limits to our regression even as we are allowing ourselves to experience it.

Third Subtask: Decoding and Hypothesizing

Once we have acquired sufficient material by holding and regressing, we can perform our third subtask: decoding and formulating hypotheses about what we are experiencing.

Decoding is a matter of extracting the probable meaning of transferential material. It is a matter of deriving hidden significance from apparent meaning. In “breaking the code,” decoding brings clarity to what we and our clients are unconsciously trying to share.

Decoding what our clients transfer to us is difficult because we are simultaneously reacting to our own feelings, attitudes, and thoughts. Decoding is laborious because “transference [love] . . . has to be detected almost without assistance and with only the slightest clues” (Freud, 1905, 116). Decoding is even harder with countertransference love.

Hence, we are wise to think of decoding as a multi-step process of interweaving intensive cognitive work and meticulous attention to detail with the emotional-sensory-motor experiences we are having.

First we must identify what makes us suspicious: choice of words? expressed affect? reported dreams or fantasies? easily observable behavior? Then we must put to the side the apparent meaning of what we have observed so that we can identify less obvious indications of meaning, such as tone of voice, volume, word emphasis, gestures that match or fail to match content, muscle movement that supports or contradicts speech, and other nonverbal forms of human communication.

We must also identify our own spontaneous response to what we are noting: our feelings, sensations, thoughts, movements, and urges to do something. We must determine whether they contradict or correspond to what our client is overtly communicating. Those which contradict are more likely to be transferential. Those which correspond may or may not be transferential. Especially if they are exaggerated and/or sustained and/or repetitive, they may be triggering our own unresolved issues.

Keep in mind, of course, that we are always contributing something to our client's transferential communication. It is a matter of how much and to what degree:

“Why does this woman irritate me so?” the therapist queried. “Why am I not simply flattered that she has asked to meet with me more often? She is intelligent and articulate and seems to want to make progress.”

“Yet there seems to be something subtly seductive about her. Though she does so nonchalantly, she keeps placing her hand on her low-cut blouse.”

In looking at his own countertransference, however, the therapist recognized that he was also experiencing distress in his abdomen. He had to admit that he was frequently looking at where that hand was guiding him.

“Something is not right here,” the therapist acknowledged. “Although what I am doing corresponds to what she is doing – it's just a natural human response – I must get at the deeper meaning of what is going on. What are some hypotheses?”

Hypothesizing follows decoding when it seems more obvious than not that those transferential and countertransferential phenomena have become – or will become – problematic in our work with clients. Hypothesizing means coming up with possible causes for what we and our clients are finding distressful.

Ideally, hypotheses are simple statements. A hypothesis about what is occurring in the previous vignette, for example, might be:

I am bringing to the sessions my own need for erotic love. My distress is related to sensing the inappropriateness of my indicating that I am available.” Another hypothesis might be, “Though I may be somewhat vulnerable, my client is unconsciously trying to seduce me because her past affiliative needs were not sufficiently met.” A third hypothesis might be, “We might both be contributing equally because we both have an unresolved conflict regarding our need to love and be loved.”

In sum, hypothesizing is a matter of determining possible explanations for why the phenomena we have decoded are occurring: the most probable reasons why certain aspects of the past have become part of the present.

After hypothesizing, we remain open to additional material that might shed light on what we already have. This, in turn, permits new hypotheses to formulate.

Fourth Subtask: Verifying the Most Likely Hypotheses

The fourth subtask is a matter of verifying the most likely hypothesis or hypotheses that we have formulated. Sometimes we simply do so by ourselves. At other times we seek out third parties, or we share the hypotheses with our clients and ask for their feedback.

One would presume that the fourth subtask is easier than the previous three, that just as we are eager to confirm our hypotheses, we are also eager to disconfirm them. In fact, however, disconfirmation is more difficult for us than confirmation, for formulating hypotheses inaugurates a bias or fondness for what we have conjectured and an unconscious search for supportive evidence. Indeed, most of us do not actually want to re-consider our hypotheses. We just want to accumulate more evidence to prove them – and ourselves – right. Hence, the fourth subtask requires us to impose on ourselves the discipline of being as objective as possible about our hypotheses, whether we verify them by ourselves or do so with others.

When we have more than one most-likely hypothesis, one effective way to start is to pay close attention to our own somatic response to the one or two that are most emotionally powerful. Our body will invariably – though sometimes subtly – “agree” or “disagree” with what our mind is concluding. Being physically energized, for example, usually suggests an accurate hypothesis, while experiencing uneasiness or tension suggests the hypothesis is at least partially inaccurate.

Third parties can be invaluable during the verification process. Particularly in cases involving significant countertransference love, we are wise to share our hypotheses with colleagues, supervisors, consultants, or our own therapist.

We might also share our hypotheses with our clients, sometimes before, sometimes after getting supervision or consultation or meeting with our own therapist. If we share sensitively and tactfully, we can give our clients a wholesome interpersonal experience. We can help them clearly identify their affiliative needs and desires rather than continuing to engage in fantasy or – what is even more maladaptive – acting them out.

However, before considering just how we might share our hypotheses with clients, let us explore a meta-task that must be performed throughout the four subprocesses: monitoring.

Overarching Meta-Task: Monitoring

Monitoring consists of both self-monitoring and client-monitoring. We monitor ourselves in order to evaluating how well we are performing the subtasks and auto-regulating our countertransferential love. Concurrently, we monitor our clients in order to make sure that they stay within a window of anxiety: permitting meaningful, even deep, experiencing of transferential and countertransferential love but not to the point of being overwhelmed or retraumatized.

We maintain a “binocular vision” (Holmes, 1992). As we attend to material that we and our clients are consciously communicating, we attend to our own and our clients' emotional and physiological functioning in the course of allowing our unconscious minds to penetrate our conscious minds.

Self-monitoring begins with noting how well we are observing our own countertransference love, for we must base our outward response to clients no less on how they are doing than on how their displaced material is affecting us. Clients may be extremely embarrassed, for example, and therefore unable to hear what we have to say. At the same time, we may have become defensive and very desirous of setting limits to our clients' expression of affiliative needs. The question, of course, is always what is best for clients within the limits of our own tolerance.

We must continuously self-monitor because transference love and countertransference love can impact the therapeutic relationship at any time. We never want to either minimize or maximize them, but neither do we want them to impair our clinical functioning. We want to give transference love and countertransference love enough “room” to display themselves – even to develop – but not so much “room” that we end up thinking so poorly that we act in an unprofessional manner.

As we self-monitor, of course, we monitor our clients' tolerance levels. We observe how well they are auto-regulating: balancing thinking with emotional experiencing. As a consequence, we can create the conditions under which they can become increasingly aware of what once was – and remains – conflictual, but not repeat past experience. We do not want them to have one more negative affiliative experience. Rather, we want them to feel safe enough to risk feeling unsafe again in order to work through their affiliative conflicts.

If a client is assigning us the role of a sexually abusive caregiver, for example, we want to permit ourselves to experience being so to the degree that we know experientially what the client has gone through. Concurrently, we want the client to know experientially that we have accepted our role and thus understood what he or she went through. However, we are not going to go so far as to abuse the client, even verbally. Rather, we are going to help the client learn how to defend herself or himself; how to stop victimization from occurring in the present and how to lower, if not erase, its past-originating impact.

Similarly, if clients displace positive feelings toward us – experience us as a nurturing mother figure, for instance – we will allow the transference love to continue until basic bonding takes place. But we will not allow clients to become dependent on us for meeting their affiliative needs. We will not console them each time they are disappointed. We will not protect them from feeling abandoned when we take our needed time away. We will not be the mother figure they are capable of being for themselves.

Self-monitoring is important during the first subtask when we consciously take in transference and countertransference (Hinshelwood, 1999), for we need to decide whether we might perform those roles on a temporary basis as a means of bonding with clients. Those who feel very unlovable, for example, might benefit from time-limited signs of parental acceptance and approval. They might not be able to bond with those who do not appear to accept or approve of them. Even so, they need us to help them accept and approve themselves along with experiencing maternal and/or paternal love from appropriate people in their everyday lives.

Self-monitoring during the first subtask also enables us to gauge the extent to which we are unconsciously projecting our own unresolved affiliative conflicts onto or into our clients. Without this internal supervision, even experienced therapists are prone to simply re-enact their own and their clients' maladaptive interpersonal experiences in countertransferential behaviors (Dreher et al., 2001). As a result, clients never realize the contributions they make to therapeutic failures nor determine how they might conduct themselves differently (Weiss & Sampson, 1986).

Self-monitoring is also crucial during the second subtask when we contain transferred material and permit appropriate regression. We must stay with clients on a psychobiological level in order to engage in necessary experiential learning. But we must not go so far as to lose our ability to stand apart and take note of our participation in the realms of transference and countertransference love (Racker, 1972; Gorkin, 1997; Gelso & Hayes, 1998). We must remain disengaged enough to ask questions such as, “How am I being manipulated to play the role of a seductive person?” and “What is this client trying to have me experience?”

Self-monitoring becomes especially important when we permit conscious regression. We must become vulnerable to the workings of displaced material at a sufficiently – but not dangerously – deep level (Winnicott, 1965). We must be partially aware of the process we are undergoing in order to discontinue it at any time. We must periodically employ our observing ego to “keep track of the pressure to become trackless” (Schafer, 1997). We must “'swim' in the sea of others' transference love but not 'drown' in our own countertransference love” (Racker, 1972, 16).

Furthermore, only if we monitor our own regression can we be aware of the regression our clients might be undergoing. They can benefit only from carefully regulated exposure to the pain that so overwhelmed them in the past that it could not be processed. They cannot benefit if they become retraumatized.

Self-monitoring is necessary during the third subtask when we decode and hypothesize about transference and countertransference love, for these phenomena are operating even as we are deriving meaning from them. We must stand aside to decode and hypothesize yet remain available to our clients. We must not allow the length and intensity of the decoding and hypothesizing processes to eliminate interpersonal contact. Clients want to be accepted, listened to intently, and followed closely. They do not want us to engage in difficult cognitive tasks for what seems to them to be “forever.”

On the other hand, we need to self-monitor to see if we are allowing ourselves enough time to decode and hypothesize. Though we may not be certain of what is occurring, we must come up with hypotheses that can be tested.

Self-monitoring and client-monitoring are crucial during the fourth subtask when we verify hypotheses, as we need both to test hypotheses and to balance this intellectual effort with keeping an emotional connection with our clients. At the same time, we must continue to receive and hold new material that will allow us to revise inaccurate hypotheses.

Finally, we must self-monitor during all four subtasks in order to be able to move quickly and smoothly from one subtask to another. At times, we must decode what we have uncovered in order to know what more we need to discover. Similarly, we may need to experience more in order to verify what we think we understand. At other times, we must gather new information in the light of our hypotheses proving inaccurate. At still other times, when we suspect inaccuracy, we must stop decoding and test our hypotheses. Put simply, wholesome interpersonal interactions rely heavily on self-monitoring our decisions related to focusing: what to focus on, whom to focus on, where to focus, and even how to focus (Hubble, 1999).

To summarize, by systematically performing the four subtasks while judiciously monitoring ourselves and our clients, we can know our clients on a deeper, more meaningful level than we could otherwise know them. We can also gain insight into ourselves. Thus we can facilitate a detoxification process whereby clients can finally address their unconscious affiliative conflicts. They can strip transferential material of its dangerous characteristics (Grinberg, 1997) and make it a resource for meeting their affiliative needs.

Main Points

How, Why, and When to Engage Clients in Hypothesis-Testing

Questions

Attitude Required of Therapists

Therapists who share their hypotheses about transference and countertransference love provide a protective factor for both themselves and their clients by fostering within themselves an attitude of humility and detachment. They thereby reveal that they do not have all the answers. They are simply observing and wondering. They are saying in effect: “Let us together determine whether what I think is going on between us rings true for you.”

To observe and wonder with humility and detachment is not to have an agenda for what clients are to supposed to think or feel. It is not to be ahead of clients in ascertaining personal and interpersonal reality. Indeed, it is to be open to whatever happens when two persons try to understand new, unfamiliar phenomena. “As clinicians, we are enjoined to be agenda-free; we may have our preferred models of the mind, but they are not to be superimposed on [clients'] material” (Schwaber, 1990, 237). We are to simply observe and wonder so that we do not become attached to our interpretations despite our attempts to treat them as hypotheses (Cooper, 1993).

To simply observe and wonder rests on therapists' willingness to describe nonjudgmentally what seems to be clients' transference love and their own countertransference love. An effective interpretation of transference and countertransference love – particularly in non-analytic therapy – rests on an attitude of “I know less rather than more” (Schwaber, 1990). It echoes what Winnicott (1960) said whimsically: “I interpret mainly to let the [client] know the limits of my understanding” (7ll).

In other words, therapists need to be open to rejection or revision no less than acceptance or confirmation of their hypotheses. They need to respect clients' experience of their therapy sessions.

At the same time therapists need to bring directness, pertinence, inclusivity, and concreteness to what are fundamentally subjective experiences. Rather than dispense truths and meanings they have already gleaned, therapists need to prepare for a trial-and-error process involving dialogue with their clients (Cooper, 1993). They need to await something relatively definitive: truth that requires the active cooperation of clients to develop (Bezoari et al., 1994). For both therapists and clients are holders of partial truth that can be known in its fullness only when the parts are shared. Indeed, if transference love or countertransference love are occurring during therapy, it will be verified – eventually if not at the moment – in the psyches of both therapist and client.

Therapists who wish to collaborate with their clients to verify suspected transference and countertransference love begin the process by using a transference or countertransference interpretation.

A Transference Interpretation

A transference interpretation (TRI) is an explicit reference to what a client appears to have displaced from the past, including the very recent past, to the present therapeutic setting. A TRI makes unconscious material conscious so that it can be subjected to legitimate evaluation. If it is inaccurate, it can be revised. If it is accurate, it can be used to help clients resolve an intrapsychic affiliative conflict.

A TRI is “a creative redescription that implicitly has the structure of a simile. It says 'This is like that'” (Schafer, 1977, 57). A TRI reveals how present behavior is a re-enactment of past experience rather than something happening on its own. “I wonder if I strike you as motherly when I listen to one more problem even though our time is up,” is an example of a TRI related to an affiliative issue.

The use of TRIs is based on a therapeutic premise espoused by clinicians of major theoretical orientations: it is crucial they be subjected to legitimate conscious evaluation as well as to unconscious attitudes and beliefs to which clients have been holding fast. Some of them may be adaptive and thus worth holding. Others, however, may have been adaptive in the past but are detrimental to wholesome relationships in the present. They create unresolved conflict-based anxiety both for the one who holds them and the ones to which they are supposed to apply. “I don't care if my father does not love me because my mother does,” a client may have believed as a child. That belief – that maternal love can replace paternal love – kept anxiety in check at the time. Thus it became a schema or principle of knowing that the client could unconsciously use in both male and female relationships. It became a “certainty” in spite of its never being validated (Schafer, 1997).

As a consequence, the client continues to rely only on maternal love without questioning her belief. She not only overvalues it but also requires one maternal figure after another to play a maternal role in her life even though having to mother another adult does not work well for most maternal figures. Even if it did, because the client is no longer a child, it is developmentally inappropriate. Hence, it is “ripe” for processing by means of a TRI.

In brief, a TRI is intended to help clients acquire new experiences from which more adaptive principles of knowing can be derived and reality-based schema can be created. The TRI in the previous paragraph, for example, is intended to help the client question her belief that all maternal figures should be willing to give her extra time and attention because she must rely primarily on maternal love. It is intended to help her restructure an old belief and resolve its underlying conflict: being an adult biologically and intellectually but a child emotionally and interpersonally.

A TRI is a therapist's means of asking clients to consider how their thoughts and feelings toward their therapist might be coming primarily, though not solely, from past experiences with persons similar to the therapist. “Could it be that your resentment toward me because I ended our session on time is tied to your mother's not giving you enough attention?” a therapist might ask.

Though it may or may not directly mention the client's past, a TRI is intended to address what the client has displaced from the past. “Could it be that you are sad because I kept you waiting, just as your busy mother made you wait?” and “Could it be that you are sad because I made you wait?” are both acceptable TRIs. So are “Could it be that you are frustrated with me because I reminded you of your fee, the way your teachers reminded you of unfinished homework?” and “I wonder if your sadness comes from my telling you that I will be on vacation for two weeks.”

Thus a TRI is an invitation for a client and a therapist to consider together various explanations of the dynamics of their sessions, to tease out what is past-based or outside-of-therapy-based and what is actually happening in their sessions. It is an invitation to distinguish between the past and present as well as between the in-here and out-there foundations of feelings and thoughts. A TRI is an implicit acknowledgment of the powerful impact that people not actually in the therapy room and events connected with them can have on what “comes alive” in therapy. A TRI is also an implicit acknowledgment of the need to make conscious an unconsciously held maladaptive attitude or belief.

Though a TRI may be stated in the declarative as in “I think you may be sad because I acted like your mother,” it remains opens to evaluation. Thus, “when the interpretive process is working well, therapist and patient are engaged in the exploration of hypotheses [regarding their relationship] arrived at by a collaborative process…” (Meissner, 1996, 257).

Consider, for example, the following vignette:

At the beginning of the session, the therapist remarked that her client had not paid her fee for the third time in a row. Though the client acknowledged this and promised to send a check the following day, she responded curtly to several of her therapist's subsequent reflections on her accomplishments that week. Recalling the client's accounts of her overly critical father, the therapist finally said, “It seems to me that you are annoyed with me today, perhaps because by referring to your unpaid fee I reminded you of your critical father.”

Using this feedback the client admitted that she was angry with her therapist. She refused to admit, however, that she was expressing that anger inappropriately, at least not during that session and the next two.

During the third session, though, when the therapist again made a tentative connection between what the client felt and its connection to what her father did, the client conceded. Afterward, the therapist and client were able to explore together the deep pain she suffered because of her father's chastisements and how they were still affecting her. Thus TRIs enabled the client and therapist to uncover together material that had never been dealt with previously.

A Countertransference Interpretation

A countertransference interpretation (CTRI) is an explicit reference to the client-therapist relationship as it is being experienced by the therapist. For example, “I wonder if I am hurt because you won't talk to me today, kind of like your mother treated you when she gave you the 'cold shoulder.'”

A CTRI is based on the therapist's countertransference: what the client has displaced onto or into the therapist. However, it can also be based on what the therapist has displaced to the client from his or her own past, that is, on the therapist's own transference. Thus a CTRI reflects the fact that countertransference, like transference, is co-created.

Said a little differently, a CTRI is a revelation of the therapist's reaction to what the client does and/or says. It primary purpose is to share what the therapist believes the client is unconsciously communicating as he or she is reminded of past events and persons. At the same time, a secondary purpose of a CTRI may be for the therapist to share with the client what the therapist is bringing from her or her own past to the therapeutic setting. “I am hurt by what you just said. I wonder whether that reminds me of the hurtful words my mother used with me,” a therapist may say when describing both transferential and countertransferential love phenomena. Another example would be, “Could it be that my headache is due to how hard it feels to have my thoughts accepted by you today in addition to my work overload?” But it is very important to note that a CTRI is not an invitation to explore the therapist's conflict as such. Rather, it a springboard to explore the client's conflict.

Often a CTRI refers to a conflict the therapist is experiencing while working with the client. Ideally this conflict is connected with or reflective of a conflict identified or implied in the client's presenting problems. Consider, for example, this CTRI shared with a client wanting to deal with her habit of obsessing about the mistreatment she has suffered: “When you focus repeatedly on how badly you were treated, I begin to feel mistreated myself in that I can't do what I believe I should do in our sessions.”

In any case, a CTRI is an invitation to the client to understand therapist-client dynamics during therapy. It is an invitation to identify distortions, misinterpretations, and unfair attributions as a prerequisite for arriving at accurate meaning, with the hope that this understanding will increase clients' insight into their personal and interpersonal affiliative problems outside of therapy:

The client elaborated on a pleasure trip he had just made, providing comical anecdotes interspersed with interesting descriptions. Though at first the therapist was intrigued by her client's account, she soon noticed herself becoming morose. The incongruity between his enthusiasm and her negative response was striking.

The therapist began to recall confronting him previously about taking numerous trips with his friends in the light of his goal being to spend more time with his autistic son. She thought that she, his therapist, had certainly modeled how to put the child first by rescheduling an appointment so that the client could attend his son's school play.

Suspecting transference love, the therapist interrupted the client and said, “I'm saddened by your account of your trip. Is it shedding a light on how your son might have felt when you left home without him?” Then after pausing, the therapist added, “Could it be that my sadness is what you also feel when you focus on your autistic child?”

Thus the therapist suggested what might be at the heart of her client's difficulty in implementing his goal: the deep sadness that impairs his judgment when it comes to choosing himself and his friends over his son. Though it was true that the therapist was also recalling times when her alcoholic father's failure to keep his promise to come to her school events caused her deep emotional pain, she did not refer to it in her CTRI. Rather, she chose to set an appointment with her own therapist.

In sum, CTRIs are intended to shed light on the heart of the matter, the reason for clients' presenting problems: why they might find it challenging to bond with another, for example, in spite of their good intentions; what they might need to address before they can even address their goals as such; and how they might be contributing to problems they see as being caused solely by others. If countertransference truly opens the “door to a slice of life,” then by using a CTRI to hold that door open for clients, therapists can enable clients to collaborate with them to observe and explore what they have not even suspected. When new insight and emotional processing then follow, the “slice of life” has indeed yielded its rich contents.

Let us consider another example:

The client insisted that his wife, who had recently divorced him, was unjustified in saying that she was doing so because of how angry he was. He was conscious of the opposite: he did not express his anger. He simply accepted her verbal abuse and went on. “As long as she takes good care of the children,” he told himself, “I can live with what she does to me. I do not have to retaliate or even express my own anger toward her.”

However, gradually his therapist became aware of subtle signs of feeling belittled during sessions with the client. It seemed that he routinely corrected her reflective summaries with low grade impatience and subtle criticism. His facial expression and tone of voice said in effect, “You didn't remember what I told you and therefore missed the mark again. You should be smart enough to remember and get it right!”

She reminded herself, however, that she saw him at the end of a long day. “It is annoying to hear distortions of what you say,” she added to his criticism. “I might need to change the time of his appointment.”

But she also heard the nagging thought: “I am not an acceptable person because I do not remember all the details my client shares with me. I am not that perfect recorder of his communications, that infallible computer that encodes every communication given me.”

Rather than change his appointment time, she chose to stay with the pain of being an unacceptable person. It reminded her of how she had been found unacceptable by her best friend in middle school and her mother's dismissal of it as just “an opportunity to get rid of a 'bad apple' by finding a really 'good apple.'”

As she regressed, the therapist experienced excruciating sadness seemingly related to her own past. She also noted subtle signs of distress in her client: his fighting back tears, his furrowed brow, and his hunched shoulders. “Could it be,” she asked herself, “that he tried hard not to express his anger toward his wife in the hope of at least keeping her at least nominally in their marriage? Was he doing the best he could to prevent her from finding him unacceptable?”

Because her countertransferential reaction had allowed her to put her finger on what neither she nor her client had previously suspected, she formulated a hypothesis. “The indirect expression of his anger might well be what his ex-wife had experienced: his passive-aggressive, difficult-to-identify expression of anger.” This insight permitted her to formulate a countertransference interpretation: “I feel belittled when you correct what I say, even though I believe you are not consciously demeaning me. Could your ex-wife have felt the same way?”

Though her client wanted to dismiss the interpretation as meaningless, he was willing to look at it when he sensed the empathy of his therapist. In the next session, he made efforts to stop himself in the course of correcting his therapist. He tried to focus on how she might feel. He was on his way to becoming aware of the contribution he had unconsciously made to his divorce and to other interpersonal difficulties.

Interpreting countertransference is especially valuable, perhaps even essential, when clients have experienced trauma at preverbal stages of development or trauma so severe it could not be put into words. In cases like these it is only through countertransference that therapists can gain insight into the troubled world of clients (Racker, 1968; Sandler, 1976; Viederman, 1974), phenomena already “known” to them on some level (DeLaCour, 1985; Herron & Rouslin, 1982; Lear, 1993).

Consider the following vignette:

Regardless of how many times the therapist returned her client's frantic phone calls – or chose not to in non-emergency situations – he consistently rebuked her for either taking too long or not doing so at all when she sensed she was being manipulated. The therapist found herself feeling resentful. She became increasingly eager to enforce the limits she had set early in their work: no phoning between sessions unless there was a true emergency. “Though he was severely abused and neglected as a child, my consistent patience and responsiveness over the three years of our work should certainly have given him ample evidence of my care and concern,” she reasoned.

In any event, the therapist endeavored once again to help her client see how some of his frequent phone calls were not as necessary as he made them out to be. Nonetheless, each time the client disparaged his therapist's explanations and protested that he had to have his phone calls returned.

Finally, the therapist decided to share her countertransference. She said in a calm voice: “I'm feeling resentful because it seems as if your frequent phone calls are making me parent an adult. Could we talk about this feeling of mine?” During what ensued, the therapist added that she might have been trying too hard to be an all-good mother to make up for his experiences of an all-bad mother. Then, when her client continued to have difficulty appreciating his therapist's resentment, she said, “When I feel verbally abused for not being responsive to you, I feel like separating myself from you, even when I should actually return your call.”

At the time the therapist voiced a second CTRI, her client was incredulous but willing to talk about what she said. During the following week, he called only once. Shortly thereafter he playfully referred to her as “a mother that had to have time for herself so that she could be there for her children when they really needed her.” During his termination session, he described his therapist as the good-enough “mother” he had never had as a child.

Thus by using carefully worded CTRIs, the therapist modeled how to be honest as well as how to explore unintended consequences of her client's behavior. She gave him a real-life example of how his behavior was contributing to his unmet affiliative needs. Additionally, by interpreting her countertransference, the therapist strengthened the therapeutic alliance. She offered concrete and convincing evidence of her attunement to her client and her willingness to accept and respect him. She gave him a safe place to consider replacing his maladaptive way of meeting his nurturance needs with more adaptive ones.

To summarize, transference love-related TRIs and countertransference love-related CTRIs are statements or questions that shed light on client-therapist dynamics in therapy sessions related to affiliative needs. They are means of bringing into consciousness unresolved conflicts regarding those needs. They enable the client to work with the therapist to replace old schemas and patterns of relating with other people with new, age-appropriate ones. Thus they give the client an opportunity to finally meet their affiliative needs, perhaps not totally, but as satisfactorily as possible.

This is not to say that TRIs and CTRIs regarding transference and countertransference love are usually comfortable for therapists to voice and clients to hear. Rather, because they can make therapy participants experience embarrassment and shame – let alone humiliating rejection – therapists tend to shy away from using them.

It is true: if TRIs and CTRIs are verified, they call for the difficult, risk-taking work of replacing familiar old patterns with unfamiliar new ones. If, however, TRIs and CTRIs are worded carefully and shared sensitively, they create a safe environment in which to launch that hard work. We now explore the qualities of effective TRIs and CTRIs.

Qualities of Effective Transference Interpretations

Calming

TRIs (including CTRIs) are to be given in such a way that they calm clients (Strachey, 1934). However clients respond, they will not be criticized. They can deny, confirm, question, revise, or reject the TRI, all with impunity.

TRIs calm a client when therapists clearly indicate they have received a simple communication even though it might be a criticism of the client (Casement, 1991). They say, for example, “I wonder if by coming late you are telling me that I said something hurtful during our last session. Am I right?”

Bollas suggests that therapists introduce TRIs with such calming phrases as, “What occurs to me” or “I have an idea” (Bollas, 1987, 206) or “I'm curious about what you think of this” or “I'd like to share a thought with you” or “You may not agree with me but ....”

TRIs that calm make clients feel secure. Their therapist can survive the negative thoughts and feelings they have transferred. Their therapist can hold their projections up to the light of scrutiny without “falling apart” or being devastated if negative messages are confirmed.

Of course, therapists must convey calm through such prosody as tenor, volume, tone, and pitch. In some cases, they must even add a respectful look, a reassuring gesture, or a gentle facial movement.

In order to make TRIs calming, therapists might need to take a moment between hearing and speaking: a short pause between what clients say and what they say. During that time they not only become calm themselves but also find gentle wording for potentially disturbing thoughts. By pausing, therapists indicate that they are “holding” their client's communication calmly before asking their client to consider the truth it might reveal.

Emotionally Immediate

TRIs must also be emotionally immediate (Strachey, 1934). They must clearly identify feelings, however uncomfortable it may be for both client and therapist to hear them. Furthermore, to be most helpful, TRIs should be given as closely as possible to client's experience of their feelings.

At first it seems a contradiction for a TRI to be both calming and emotionally immediate. But these qualities are not actually mutually exclusive because emotions can be expressed in varying shades of intensity. The challenge for therapists is to find that balance between accurate reflection of and containment of the client's feelings. Even a TRI like “You seem to hate me. If that is true, can we talk about it?” can be voiced quietly in a polite tone of voice. Thus it conveys that although hate seems to be the primary feeling of the client toward the therapist, the therapist has not internalized the hate. It is not being returned.

With certain kinds of material, it is especially important for therapists to make TRIs emotionally immediate. In the realm of sexual abuse, for example, if therapists wait too long to interpret the client's communications, clients may experience their therapist as being afraid to face facts. As a consequence, the therapist's activity can become a re-enactment of a past person who turned a blind eye to the client's plight (Casement, 1991).

Neutral

TRIs must be neutral statements, not unquestionable pronouncements or indisputable moral judgments. They must come across as objective observations that expose, clarify, or explicate. They simply reflect what the therapist has noticed.

TRIs should be said without defensiveness on the part of the therapist (Gill, 1982) because clients “are acutely sensitive to the hidden meaning in what their [therapist] says. It is harmful ... when [therapists] appear to ignore a client's accurate perception or interpret defensively in the face of it” (Casement, 1999, 131).

Neutral TRIs invite clients to observe what seems to be the case: to check out impressions (Schwaber, 1990). They are invitations to do some reality testing in order to acquire insight (Casement, 1991).

Neutral TRIs do not imply moral judgment. They do not suggest that their therapist finds clients guilty of something. Thus, therapists say, “You may be angry with me” or “You appear to be angry with me” or “I believe you are angry with me” rather than “You're angry with me.” Neutral TRIs give clients the “okay” to feel and express feelings, even very primitive ones (Gill, 1982), with impunity.

Of course, the requirement to keep TRIs neutral requires an accepting tone, courteous tenor, modulated volume and speed, calming pitch, and respectful inflection, which combine to create mood and interpersonal atmosphere. This is extremely important because clients tend to listen primarily to “mood;” some do not even hear the words (Pick, 1997). Especially when very disturbed and in need of soothing, clients acutely scan interpretations to assess what is happening in their therapist's mind (Hinshelwood, 1999). Is it retaliation? Is it resentment? Is it forgiveness?

Neutral TRIs voiced with neutrality enable clients to conclude that their therapist is simply noticing. Examples of TRIs that connote neutrality are the following:

“You may be angry because...” or

“It appears as if you are angry because ...” or

“I wonder if your anger with me is something even you don't feel good about” or

“I wonder if you are suffering a great deal from punishing yourself” or

“It is almost as if you are experiencing this suffering as some kind of punishment.”

An important corollary to making TRIs neutral is that it is helpful for therapists to use what they think they know and to find a way of approaching this through not yet knowing than it is to simply reflect what clients are saying. “You seem to be suffering a great deal from punishing yourself” or “It is almost as if you are experiencing this suffering as some kind of punishment, but it isn't clear what you are feeling guilty about” are examples of TRIs worded with the “not yet knowing” corollary in mind. They convey that the therapist needs the client's collaboration to arrive at the truth of the matter.

When clients use strong terms in describing themselves or others, formulating neutral TRIs becomes a special challenge. For example, soon after a therapist has set limits to the client's in-session behavior, an adolescent might cry, “My mother is a witch!” To maintain neutrality and calm and yet keep the interpretation emotionally immediate, the therapist might reply, “You put great emphasis on how your mother seems to you to be a witch. Would you like to say more about her being like a witch?” An alternative might be, “I wonder if by referring to a witch you are saying that you find your mother mean to you. Am I on target?” Still another would be, “I wonder if you are referring to me when you say your mother is a witch.”

In phrasing TRIs in these ways therapists play back clients' descriptions as clearly their perception, rather than both theirs and their therapist's. Thus therapists keep a balance between respecting clients' points of view as subjectively valid and questioning their objective validity, that is, their being the individual's perceptions and not necessarily objective facts. As a consequence, the therapy room stays a safe and secure – as well as open and receptive – space in which to process what is most disturbing to clients. Their therapist has remained neutral but has also noted the forcefulness and immediacy of their feelings. They can safely look at a painful experience that they might or might not be perceiving accurately.

Neutrality is extremely important when clients give therapists feedback in such a way that they feel criticized. Therapists must then find some way of dealing with the clients' experience without reacting with hurt feelings or anger that might dissuade clients from being honest going forward.

At times it is best for therapists to simply refrain from even naming their client's or their own feelings. They can simply acknowledge what is transpiring, as in “I can see how you could have heard what I said as critical.” If, by contrast, therapists focus first and only on transference or countertransference feelings, clients might experience their therapist as not only defensive but also intent on denying elements of objective reality in the client-therapist relationship (Casement, 1991).

Precise, Clear, and Concrete

Though TRIs are neutral, they must also be precise and clear about the transference love distortions clients seem to be making or about the specific relational actions that are affecting their therapist (Kiesler, 1982). They are specific: detailed and concrete (Strachey, 1934).

TRIs are not abstractions or vague assertions. If clients hear, for example, “You seem to be getting upset about what I'm saying,” clients might well be left an ambiguous message. They might also have a chance to thwart their therapist's attempts to make unpleasant unconscious material conscious (Strachey, 1934). They might take the opportunity to slip out of responsibility for their communications into what has felicitously been called a “gentleman's agreement.” “We won't get into difficult, painful matters,” that unspoken agreement goes. “We will just note in passing that we don't feel comfortable with something going on between us. Like gentlemen, we will cease and desist and thus resume our comfortable relatedness” (Wolstein, 1996, 507).

If, on the other hand, TRIs clearly identify the observable signs or manifestations of the suspected transference, clients are given a sound foundation on which to consider their therapist's hypothesis. If the hypothesis is shared in a clear, concrete, and precise TRI and it is true, the client will find resonance with it. Intrapsychic boundaries will be will be permeated (Lear, 1993). Client and therapist can then collaborate to discover the exact nature of an interpersonal affiliative issue:

“Could it be that you are angry with me because I said your behavior is inappropriate?” is clear and concrete. So is “You seem to be resentful because I commented on your tardiness.” So is “I'm wondering if you dislike me now that I have questioned how much you, rather than your sister, are to blame.”

Tentative

Effective TRIs are tentative. They are not as much informative as communicative (Brodbeck, 1995), not as much certain as probabilistic (Schafer, 1983). “Could it be that ...”, “I wonder if ...,” “Perhaps it's that ...” all invite the client to respond in agreement, disagreement, or partial agreement. Thus, TRIs pave the way for further clarification. They allow therapists to watch and listen for evidence of consensual reality or organized experience that supports clients' – as well as their own – perceptions or conclusions or judgments (Schafer, 1985).

Tentative TRIs are intended “to be played with – kicked around, mulled over, torn to pieces rather than regarded as ... official versions of the truth” (Bollas, 1983, 7). If therapists come across as certain rather than tentative, clients then have to contend with one who seems to already know what is going on. They have already decided what the client is contributing – versus what the therapist is contributing – to an interpersonal problem in therapy. But the truth is that there are no reliable means of identifying for sure what belongs to whom (Field, 1989) other than through interactive work: client and therapist testing the validity of the TRI together (Bacal, 1990).

Thus clients benefit from TRIs therapists phrase tentatively. Far from being dogmatic and certain, therapists make it clear that they are intending their perceptions to be explored for potentially different meanings (Winnicott, 1971). They are offering to their clients “a scrap of material and a chance to elaborate on it” (Bollas, 1987, 206), to understand rather than automatically validate their therapist's feelings and judgments.

Tentative TRIs often convey that therapists are having difficulty putting into words what they believe their client is feeling or thinking. When therapists openly struggle to find the right words, they model how to deal with what they somehow “know” but cannot easily describe or what they suspect but do not really know. They counteract that certainty with which clients have often been judged and judge themselves. They invite clients to collaborate in an effort to discover the complexity of the human person, especially in relationships. They emphasize the value of putting subjective experience under scrutiny (Bollas, 1987).

Pertinent

If possible, TRI should refer – directly or indirectly – to the goals that the client has set. While they may refer to past figures, it is more important for TRIs to address material relevant to those problematic core conflicts the client is dealing with both outside and within the therapeutic setting. TRIs that are pertinent give clients the assurance that issues they have come to work on are being dealt with (Gill, 1982).

Ideally, TRIs are based in the here-and-now and the there-and-then on the maladaptive patterns clients are revealing in their relationship with their therapist and with others. Indeed, what happens in therapy is usually the same as, or at least similar to, what happens outside therapy to causes the problems the client must address.

However, in wording TRIs, therapists are not required to tie “then” and “there” happenings to “here” and “now” incidents. If they are actually linked, clients will link them, mentally if not verbally. Or therapists will get further data to link them themselves in subsequent interpretations.

Pertinent can also be taken to mean exactly what clients need at the time, that is, during a given session. Stereotypic interpretations those we tend to use easily, those foremost in our thinking – are better off delayed. In that way clients can lead therapists to insight that is pertinent for them and often quite new (Casement, 1991).

Similarly, therapists must always be wary of their tendency to see evidence of what they are expecting to find, for it is human to relate to something familiar as if it were universal and ubiquitous (Casement, 1991). “[Therapists] do not have to be so quick to use old insights when [they] can learn to tolerate longer exposure to what [they] do not yet understand. And, when [they] do think [they] recognize something familiar from a [client], [they] still need to be receptive to that which is different and new” (Casement, 1991, 29).

At times, however, there is a place for inclusive TRIs that make the link between the here-and-now or the there-and-now, or the there-and-then. “I wonder if you are being unintentionally seductive with me, just as your brother was seductive with you” is an example of a TRI that is valuable though uncomfortable or even painful to hear.

In some cases, if TRIs are not inclusive, clients may feel more comfortable but may draw erroneous conclusions. Simply here-and-now TRIs may lead clients to think that their therapist's examination of the therapeutic relationship is being done at the expense of their presenting problems or experiences outside of therapy (Bauer and Mills, 1989). Similarly, if TRIs are not inclusive of the here-and-now, sometimes clients might see their therapist as afraid of their feelings. As a consequence, they might suppress their love or deflect it away from their therapists for fear that they will be overwhelmed by strong feelings.

One way to meet the criterion of inclusivity is to start with an observation the client has made about the past and then follow the direction of the transference to where the past is spilling into the present. For example, “When you were dependent upon your parents, they went away and left you. When I went away on vacation, did I seem like your parents?” By formulating the TRI this way the therapist offers some insight into the client's past distress but still keeps the immediate focus in the present.

Similarly, it can be beneficial for therapists to introduce material from a previous session or outside the session while keeping the focus clearly in the present. They might say, “Last week you spoke of John's unkindness toward you. I wonder if today you are finding me unkind.” Or “You seem so intent on raking your father over the coals. Could it be that you would like to do that to me also?”

In fact, Gill (1982) recommends routinely including the words also or in addition in TRIs. Thus clients can learn the ancient and deep source of the feelings and impulses they are re-experiencing. “Remembering and re-experiencing will become organically blended” (Kahn, 1997, 59).

Brief and Simple

As valuable as inclusivity is, however, it must not do away with the brevity and simplicity of TRIs. Though complex in that they link key events, effective TRIs focus on one and only one main point. They do not require such extensive cognitive work that their affective impact is diminished. In fact, the very reason they are mutative is that are charged with emotion.

To make TRIs simple is to acknowledge the fact that transference is a relatively simple unconscious mechanism. The unconscious mind considers only one characteristic of an object, disregarding all others and making this feature equal to the whole (Matte Blanco, 1975). Thus, Harry Stack Sullivan has been quoted as having said that interpretations should not be longer than seven words (Swift, 1990).

For the sake of brevity, therapists might have to divide a TRI into two successive TRIs. The first would address just the emotional or cognitive-emotional nature of the client-therapist relationship. The second would add the extra-therapeutic or pre-therapeutic aspects. For example, after processing with the client such a TRI as “I wonder if you are turning me off because I have hurt you,” the therapist might add, “It might be that you feel that same hurt when your wife fails to appreciate your help, as you mentioned in your first session.” Similarly, the first TRI could address the present or in-session phenomena, and the second could link the present with the past or with out-of-session phenomena (Roth, 2001). For example, “Could it be that you are very attracted to me because I come across as maternal?” would be followed by, “Is it possible that I remind you of the loving mother who died when you were a child?”

Respectful

TRIs that are respectful leave clients feeling esteemed even though they have developed dysfunctional patterns of relating. They feel respect for their approach to life and for their struggles to change (Kiesler, 1982). Far from feeling attacked in isolation, they feel included as collaborators in a process designed to gain them more respect than they presently enjoy.

Clients Who Can or Cannot Benefit from TRIs and CTRIs

Distinguishing clients who can benefit from TRIs and CTRIs from those who cannot is far from easy except for the following two principles. First, TRIs and CTRIs are appropriate only with clients who are open to them, ready for them, and thus able to benefit from them. Second, in general, clients with at least moderate ego-strength and generally low-to-medium levels of affective arousal have the capability of benefiting from TRIs and CTRIs.

Though these clients may be temporarily hurt or angered by what they hear, they can use higher level defense mechanisms to protect themselves from the worst of the pain. In particular, they can avoid the use of the splitting defense that labels them as “all bad” and prevents them from using their cognitive abilities. They can use their reality testing function. They can counteract their tendency to confuse facts with feelings. They can subject perception to rational scrutiny.

To say this, however, is not to imply that TRIs and CTRIs are appropriate in any and all sessions of these clients. For there will be times when highly aroused clients simply need to be listened to and allowed to process their feelings in their own way. Even if that takes the entire session, TRIs and CTRIs should not be used.

On the other hand, clients with at least moderate ego-strength sometimes do not need the entire session to lower affective arousal. Because they are not in the habit of relying primarily on the splitting defense, they routinely return to more discriminating cognitive functions. If needed, they use less primitive defenses like intellectualization and rationalization.

At the same time, some clients with moderate ego-strength and generally low levels of affective arousal present with embarrassing or highly sensitive identified problems. If therapists experience these clients as repeatedly defensive, oppositional, or passive, they should conclude that they are not ready for TRIs.

Similarly, when clients repeatedly or strongly reject material, more often than not, they are indicating their inability to use their cognitive functions well. Their therapists should then engage in reflective listening and clarifying what the clients are trying to say. TRIs could easily seem invasive, especially if the clients are highly internalizing persons.

Similarly, highly externalizing clients under great stress usually need help with symptom reduction and skill building rather than insight and relational work even though they have moderate ego-strength. They can probably benefit from carefully timed and infrequent TRIs, but outcomes will be most positive when the relative balance of interventions favors externalizing interventions, such as those termed cognitive-behavioral, (Beutler, 2000) over TRIs.

Clients who generally cannot benefit from TRIs and CTRIs include those who lack ego-strength and have other serious deficiencies, such as pervasively high levels of affective arousal. They generally cannot tolerate the honest feelings and thoughts of their therapist. Similarly, clients with a strong need to merge with idealized others cannot stand to have it disrupted by being asked to work with therapists who appear limited or flawed. Simply stated, it is usually necessary for therapists to leave unchallenged an idealized transference in the beginning phase of therapy (Kernberg, 1987) or during brief therapy.

The fact of dual diagnoses adds to our list of clients who do not ordinarily have sufficient ego-functioning to work with TRIs and CTRIs: those with significant alcohol and drug dependence; those who habitually act out their feelings and desires, especially those that are generally antisocial or even occasionally suicidal; and those without the mental capacity to see connectedness (Crits-Christoph & Barber, 1991; Pollack & Horner, 1985; Davanloo 1990).

Clients with a borderline personality disorder deserve careful evaluation because of their tendency to act out their feelings and be impulsive. Particularly if they are functioning at a low level, these clients are likely to perceive TRIs as expected and deserved counter-assaults. Instead, therapists might simply clarify the way these clients use splitting and other defenses and thereby distort perceptions.

Occasionally, however, even highly disordered persons can benefit from interpretations. Franch (1996), for example, writes of a child client with autism and an inability to overcome two-dimensionality and the existence of a world without meanings. Because the child could experience neither inside nor outside as such, France started to work almost exclusively with his own countertransference. Fearing that interpreting the child's transference would seem invasive to him, he used his own feelings, sensations, fantasies, and associations to get information about the client's state of being. He then assigned meaning to the countertransferential data and communicated it through CTRIs. Somewhat surprisingly, as France communicated the information, the child's “frozen” internal world began to “thaw.”

His transference had arisen in response to his therapist's countertransference interpretations.

Timing and Frequency of TRIs and CTRIs

Timing depends on clients “inviting” their therapist to interpret (Joyce & others, 1995). They generally do so by identifying a conflict or problem and then elaborating on their distress related to it. They focus inwardly and focus on their feelings. They attribute personal significance to the content of a trial-TRI or trial-CTRI and show willingness to elaborate on it (Sifneos, 1979; Winston, McCullough, and Laikin, 1993).

As with many other principles, however, it may be easier to identify times when TRIs and CTRIs should not be used.

It would be unwise to use TRIs and CTRIs, for example, if moderately ego-strong clients were already dealing with significant past conflict (Swift & Wonderlich, 1990). Their attention should not be diverted to a negative therapist-client relationship and its unwholesomeness if they are already exploring a past unwholesome relationship that is being repeated in the present. These clients have gotten the point {Pearson, 1995). They have seen the destructive pattern they are using outside the therapeutic setting.

Similarly, it would be unwise to use TRIs and CTRIs when clients were already dealing with highly intrapsychic material, such as death, rejection, humiliation, and severe abuse. Much more effective in these cases would be simple reflective listening.

It would also be unwise to use TRIs and CTRIs when clients were dealing with material too primitive for language, when they could not “give voice” to what they were experiencing. If clients could not give information, talk slowly enough to be heard, or speak coherently, TRIs and CTRIs exposing those phenomena would only expand their uncomfortable state. Attentive silence or short affective responses would generally be more effective.

Yet another situation for questioning the wisdom of using TRIs and CTRIs is when transference is positive. Though positive transference is a distortion to some extent, it might be necessary for the therapeutic alliance to develop in clients whose ability to bond is elementary at best. If their attention were called to their positive transference, it might frighten them, make them highly self-conscious, or discourage future bonding efforts (Freud, 1905). As a general rule, positive transference is best left alone if it does not interfere with therapeutic work or if it is clearly a means of solidifying the therapeutic alliance.

Furthermore, TRIs and CTRIs should not be used too soon, even under the constraints of brief therapy. They should be used only when there is some evidence of the necessary comfort level associated with the therapeutic alliance (Benner, 1982).

In addition, TRIs and CTRIs should ordinarily be used after, not before, more supportive interventions (Gabbard, 1994). Clients must feel accepted and valued in their therapy before they can look at how they have contributed to their failures. This is especially important if clients are suffering from intense guilt.

In some cases, however, TRIs and CTRIs can be used to further – even establish – the therapeutic alliance. They can be used to help clients see that their strongly positive or strongly negative unprocessed feelings toward their therapist are creating an impasse in their therapeutic work. TRIs and CTRIs can also be used when the therapeutic alliance or the working alliance has been ruptured (Schaeffer, 2007).

The answer to the question of frequency of TRIs and CTRIs begins with a general, research-based rule: since other interventions are often equally or more appropriate, TRIs and CTRIs should be used infrequently rather than frequently (Piper et al., 1991; Hoglend, 1993; Joyce & Piper, 1993). They should be alternated or interwoven with active listening, explorations, clarifications, confrontations, and other forms of interpretation (Grunebaum, 1986).

It is especially important to move back and forth between TRIs or CTRIs and supportive interventions (Bond et al., 1998). In that way a solid alliance can be established and maintained, especially for personality-disordered persons.

Main Points

Part Three

How to Decide What to Do with Transference and Countertransference Love

Questions

Abstinence

Whether transference love and countertransference love become an asset or a liability depends on how therapists deal with them. To ensure their not becoming a liability, therapists must refrain from enacting them. For without exception, when clients' “advances [are] returned it [may be] a great triumph for [a client or therapist] but a complete defeat for the treatment” (Freud, 1915, 164). “Treatment must be carried out in abstinence” (Freud, 1915, 163). For treatment to be effective, both therapists and clients must refrain from any form of physical expression of their felt need for love and affection.

The principle of abstinence is absolute in the case of erotic, eroticized, and perverse transference (includes countertransference love). But even non-erotic transference love that is acted out can cause confusion and distress in a therapeutic context. Accepting gifts, for example, on all but a rare occasion can give clients the impression that their therapist is willing to be in a love-based relationship. Touching clients more often than absolutely necessary can also “say” to clients that their relationship with their therapist is virtually the same as those who express their love in tactile ways outside of therapy. As stressed earlier, the four forms of transference love are neither mutually exclusive nor likely to stay distinct.

Therapists bear primary responsibility for maintaining abstinence. They must set limits. They must replace their felt needs and those of their clients with the “counterweight” of a greater love, either the love of truth and one's obligations to self and others or the passion for healing others (Freud, 1937). Therapists must set firm boundaries. They must even go so far as to tell clients that therapy will be terminated if abstinence cannot be maintained (Kernberg, 1998).

Clinical Choices

Having accepted their responsibility to abstain from enacting transference love (including countertransference love), therapists can make the choice of putting it aside – virtually ignoring it – during sessions with clients. In order to be safe in doing so, however, therapists will want to engage in one or more of the following: evaluating between sessions the impact of transference love during sessions, using interventions other than interpretations to address transference love that becomes problematic, consulting with supervisors or peers, and dealing with countertransferential issues in their own personal therapy.

This first choice is based on the theoretical position that non-analytic therapists in general are insufficiently prepared to deal directly with transference love and that there are other ways to help clients deal with unconscious desires and motives related to their affiliative issues. Furthermore, there are other, purely personal and/or collegial ways to process countertransference love.

Therapists' two other choices are to draw clients' attention to transference love and countertransference love and invite them co-process them during sessions either by using TRIs, CTRIs, or both. Using TRIs alone or in combination with CTRIs is based on the theoretical position that abstinence from enactment should not mean “deprivation of everything that the [client] desires” (Freud, 1915, 163). It does not mean becoming cold, aloof, or distant, for these can imply that transference love is unacceptable, even disgusting. It may even reinforce the belief of many clients that they are truly unlovable (Gerrard, 1999).

Therapists who choose to use TRIs but not CTRIs base their decision on theory that holds that therapists' intrapsychic processing of their countertransference is usually sufficient to counteract enactment of it unless it is extremely subtle or unusually potent. Furthermore, using CTRIs can give clients the impression that their therapist is more interested in himself or herself than in them (Schaeffer, 1998).

In addition, pinning down the exact nature of countertransference love is generally more difficult for therapists than doing so with transference love. It is hard to meet the criterion of emotional immediacy with CTRIs. Even if it is met, CTRIs can be meaningless to clients in that they may be inaccurate or incomplete. If countertransference is especially negative, it is also hard to meet criteria of calmness, neutrality, and tentativeness. Thus CTRIs can damage clients because of prosody: tone, volume, and body language (Schaeffer, 1998).

Therapists who choose to use just TRIs also base their decision on theory supportive of their relationship to positive outcome. TRIs affect that outcome because they build rapport as well as strengthen and repair the therapeutic alliance. Furthermore, TRIs that clearly refer to clients' here-and-now core conflicts and/or connect therapists to parents and siblings contribute to treatment efficacy. Clients can also benefit from TRIs that link their affiliative needs and wishes with the responses of others, beginning with their therapist's. Furthermore, TRIs are easily combined with non-transferential interventions, such as reflective listening, explorations, clarifications, questions, and even gentle confrontations. These interventions, in turn, have been found to be very efficacious (Schaeffer, 1998).

Finally, therapists who are adequately prepared to perform the subtasks related to formulating and verifying transference love are in a position to use TRIs to help clients with a variety of mental health diagnoses. Unless clients' goals are purely personal, therapists can use the therapeutic setting to help clients attain those goals by relating to others in truly loving ways. They can make the therapeutic setting a safe place to do that difficult work by putting clients' transference love into words and inviting their clients to collaborate with them so that they understand what they are bringing to their sessions. Therapists can become safe persons with whom clients can learn how to meet their affiliative needs in mature and wholesome ways – loving themselves along with nourishing adult-adult affiliative relationships – perhaps for the first time in their lives (Schaeffer, 2007).

The third choice is to use both TRIs and CTRIs. It is based on the theoretical position that both transference love and countertransference love deserve to reveal their potential for helping clients resolve their past-based psychological conflicts and meet their present affiliative needs. Therapists who adhere to this position consciously choose to “sink into” affiliative phenomena, their own and their clients, without “drowning” in them (Gabbard, 1994). They work to increase their own and their clients' comfort level with viewing themselves as human beings complete with erotic – no less than non-erotic – desires. They have by nature pathological – no less than non-pathological – propensities to meet their affiliative needs. Most importantly, therapists are willing to incorporate TRIs and CTRIs related to affiliation into their work. By using these interpretations, their work can become relational as well intrapsychic.

Indeed, using TRIs and CTRIs makes clearly explicit the potential transference love and countertransference love have toward meeting affiliative needs in truly wholesome ways. Doing so means directly helping clients replace mindless and unproductive action, namely simple reenactment (Freud, 1915), with conscious and productive processing of affiliative needs. They can thereby experience a generative shift leading to a deeper level of self-experience (Slochower, 1999). They can experience themselves and others as profoundly good, genuinely desirable, and actually loved (Schaeffer, 2007). They can move from “I love you mainly because you love me” and “I love you because I need you” to “I am loved because I love myself” and “I need you because I love you” (Fromm, 1976).

In addition, using TRIs and CTRIs enables therapists to help clients realize that with transference love and countertransference love comes the opportunity to mourn, perhaps for the first time, the loss of early parental love. Their grief is appropriate because what they always wanted from parental figures was and still is unattainable (Maroda, 2000). However, they must actively provide that love for themselves rather than passively yearn for it from others. By truly loving themselves, they have the power to enter into unselfish, loving, and mutually satisfying relationships with others. They can be free from simply repeating the past.

The decision to make the second and third choices, of course, also calls for a nuanced approach made possible only by weighing the following pros and cons based on extant research findings.

Research Findings

Main Points

Conclusion

Transference love and countertransference love come alive in therapy because both clients and therapists have unmet affiliative needs. Furthermore, they unconsciously believe that they can meet these needs with and through each other.

Transference love and countertransference love come alive in therapy because of “kernels of truth” (DeLaCour, 1985). In the protective, nurturing, intimate setting of therapy, clients and therapists have ample opportunity to unconsciously perceive resemblances between the person with whom they are interacting and a person from the past: one whom they have loved and from whom they wanted to receive enough love to meet their affiliative needs. As unconscious minds find sameness or similarity, the present becomes the past and one person becomes another.

Thus non-erotic and erotic transference love and countertransference love arise. So may eroticized and perverse transference love and countertransference love, for both clients and therapists are in dire need of resolving the intrapsychic conflicts their unmet needs have created.

Indeed, clients unconsciously look upon therapists as resource persons with whom they can resolve their affiliative conflicts. Therapists, likewise, unconsciously regard their clients as resource persons, though perhaps less so and less frequently. Provided the therapeutic alliance is characterized by positive regard, acceptance, and empathy, clients and therapists can trust each other. They can “ask” each other to play affiliative roles that will finally resolve their conflicts. Yes, both clients and therapists are physiologically – and therefore psychologically – “programmed” to bring their past unresolved affiliative conflicts into the present; to engage in transference and countertransference love.

Engaging in transference and countertransference love is done unwittingly. The conscious mind can become aware of it only if it is open to subtle, disguised manifestations of what the unconscious mind is doing. For therapists, being open means performing four subtasks designed to integrate the activity of the conscious and unconscious minds, both their own and their client's, and all the while carefully monitoring themselves and their clients.

Once successfully performed, these subtasks enable therapists to take appropriate action. They may choose to get help from other professionals. Therapists may also choose to invite their clients to partner with them to gain further insight into how their affiliative conflicts can be resolved. If so, therapists will then use carefully worded and sensitively timed TRIs and/or CTRIs to get the work done.

Indeed, effective TRIs and CTRIs can result in both clients and therapists replacing mindless and unproductive reenactment of affiliative needs with conscious and productive processing of them. The result? A generative shift leading to clients, if not therapists, experiencing themselves as innately good, genuinely desirable, actually loved, and able to love others in developmentally appropriate ways.

Finally, extant research does not find the use of TRIs and/or CTRIs a requirement for successful management of transference and countertransference love. Neither does it find TRIs and/or CTRIs causative of positive outcome. But research does suggest – and strongly – that TRIs and CTRIs are moderators and mediators of positive outcome when used appropriately. They enable therapists to help clients mourn the absence of love in their lives and provide that love for themselves rather than passively yearn to get it from others. Thus clients are able to enter into unselfish, loving, and mutually satisfying relationships with others. They are free from old maladaptive ways of trying to meet their affiliative needs and free to use their basic sense of goodness and capacity to nurture as means of loving themselves and others.

Similarly, research findings support theory that regards TRIs and CTRIs as means by which therapists can effectively manage transference and countertransference love that arises in the course of their professional work. Careful, sensitive use of TRIs and CTRIs can free therapists from making serious mistakes related to transference and countertransference love. TRIs and CTRIs can free therapists to facilitate a positive outcome related to clients' unmet affiliative needs. In the course of that, it is likely that therapists will also resolve their own affiliative conflicts. Consequently, therapy becomes a rewarding experience for both themselves and their clients.

Finally, transference love and countertransference love that are processed well can make therapy a truly benevolent experience. A therapeutic relationship informed by displaced love has been empowering, strengthening, nourishing, and life-giving. Clients have felt cherished and respected as their therapist channeled transferential and countertransferential love into unconditional acceptance, profound respect, and willingness to explore a fundamental human desire for love. Clients have learned how to deal with equally difficult situations outside of therapy. Having learned to tolerate passions of love and hate, they have undergone a maturation that would not have occurred otherwise. By processing transference and countertransference love, they have learned the deepest lessons of the heart (Bachant & Adler, 1997). And their therapists have done the same.

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