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What is transference?

I am sometimes asked, “What is transference?” Some clients are strongly negative towards the idea (of how they understand) the concept. A blog seems like a good opportunity to de-mystify this term and emphasise its importance to psychotherapy and to psychodynamic and psychoanalytic counselling.

Freud Again!

The notion of transference dates back to Freud. He used the term to describe how patients (clients) will project, or quite literally, transfer their feelings from a significant childhood relationship onto their psychotherapist.

The notion of transference is not limited to the therapy relationship. It’s something that affects many of our close relationships with others, particularly our partners. For instance, we may respond with anger or frustration if we ‘hear’ our partner use a tone of voice or phrase that a parent once used with us. Conversely, we may be drawn to someone because they remind us of a family member with whom we enjoyed a close relationship.

What’s Wrong With That?

The underlying principle of transference is that it is an unconscious process and therefore, we are unaware of it. While we are engaged in unconscious processes, the conscious part of us is always playing ‘catch-up’ by inventing reasons for why we behave in a certain way or for the way we feel about another person.

In the therapeutic relationship, the client starts to transfer ideas, fantasies, and feelings onto their therapist. This occurs because the client knows relatively little about the life of their therapist. What is transferred by the client onto the therapist becomes the basis of the collaboration in understanding the client’s relational patterns, childhood traumas and unresolved conflict.

Counter-Transference

Counter-transference is the term used to describe what the therapist feels in relation to their client. It is the therapist’s part of the entanglement of the relationship. It enables the therapist to become aware of what the patient may be feeling towards them or eliciting in them. Counter-transference shows why it is so essential for psychotherapists to be well trained and to have undergone their own rigorous analysis or psychotherapy. This enables therapists to distinguish which feelings come from their own unconscious process, and which are counter-transferential.

So transference matters?

Transference is the foundation of the work in any method of psychotherapy where the unconscious forms the basis of understanding a client’s struggles.

Is transference risky, or something to be scared of?

In a word, no, providing your psychotherapist is experienced enough to work in the transference and to be aware of unconscious processes. A psychotherapy process should never be dangerous, but nor should it be too safe. It is a daring adventure into the unconscious inner world that can be painful and difficult. Ultimately, however, it carries the goal of relieving suffering and trauma.

In other words

British analyst Harry Guntrip summarised the purpose and role of transference thus:

“Transference analysis is the slow and painful experience of clearing the ground of left-overs of past experience, both in transference and in counter-transference, so that the patient and therapist can meet “mentally face to face” and know that they know each other as two human beings. This is without doubt the most important kind of relationship of which human beings are capable and is not to be confused with erotic “falling in love”.

Mark Vahrmeyer is a UKCP-registered psychotherapist working in private practice in Hove and Lewes, East Sussex.  He is trained in relational psychotherapy and uses an integrative approach of psychodynamic, attachment and body psychotherapy to facilitate change with clients.

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Relational Therapy – a view

There are a number of core concepts in the Transactional Analysis model, which provide a framework and map for
fieldunderstanding our internal emotional landscapes and structures. The concept of “script” suggests that people will often make decisions about themselves and draw conclusions about life from a very young age. Such decisions are made out of conscious awareness, and at the time, they constitute the best option for survival in a world that for myriad reasons, social and environmental, may be frightening, incomprehensible or even life-threatening. A Transactional Analysis approach will invite curiosity about the origin of our script decisions as well as exploration and recognition of how we may maintain and live these (outdated) decisions in our current lives.

No one is an expert on life, and no psychological theory or method holds the monopoly on insight, wisdom or cure. When I first meet a client(s), I am interested in engaging with a whole person and not just the problem they may bring. Each therapeutic encounter is different, since each of us has our unique experience of being a person in the world. Working from a relational perspective, I offer a willingness to engage in a process with my client(s) rather than a promise of certain knowledge. A relational approach is paced and reflective. It does not rush towards interpretation or refrain from appropriate challenge. It involves elements of risk, including that of knowing and not knowing. When we believe we know ourselves (and for that matter another) we perhaps take ourselves for granted, assume our identities as fixed and neglect or foreclose on our greater depths and potentials. Therapy can offer an opportunity for us to be curious about ourselves and to track, understand and challenge our assumptions both about others and ourselves.

I am always interested in the (often) impoverished stories that people tell themselves about the world and the enduring and sometimes debilitating impact that they may confer, physically, intellectually, emotionally, spiritually and relationally. In the speaking of and the listening to these stories it is possible that new stories may begin to be imagined. The therapeutic endeavour will be in part to hold a space in which we may tell, retell, de- and reconstruct and constitute the stories of our selves, such that we might understand more profoundly our appetite (or lack of it) for life.

Uncertainty is an inevitable part of being alive. Perhaps the only real certainty is that we will, one day, die. We are all subject to the urgencies and vulnerabilities of our bodies and our histories are written deep within its archaeology. Our bodies have much to tell us of our selves beyond logic, reason or words. A relational therapy is sensitive to the sometimes inarticulate speech of our more visceral selves, revealed at once in a movement or gesture, a tone of voice or rhythm of speech, a word, a silence. It is in the simple (and complex) practice of listening that I may begin to understand how experience has informed and shaped an individual’s sense of self. The relational practitioner is never a neutral observer but rather an active participant in the therapeutic process, always sensitive to news from within herself about what s/he is thinking and feeling and what this might mean for a client.

I believe that poetry, literature and art have much to tell us about the complexity of human existence and consistently seek to resource myself from these worlds. Sometimes we find ourselves moved to tears of joy or sorrow by the power of musical phrase or lyric, disarmed despite ourselves, absorbed in the experiencing of it, feeling at once known, understood, connected and transcendent. It is this capacity to experience, how we sustain and sabotage it, to enlivening or deadening effect that is of great interest to me and describes something of my own curiosity about the therapeutic endeavour. The language of therapy is at once pragmatic and practical, poetic and evocative, always unique to the individuals involved.

Gerry Gilmartin is is an accredited, registered and experienced psychotherapeutic counsellor who is available at our Hove practice.

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On Brexit and the Psychological Defence of Splitting

On Friday, everybody in the UK awoke to a new world. The dust has yet to settle and the repercussions of the vote to be enacted; we live in interesting times.GBP-Brexit (1)

Whilst I have a view on whether we should or should not leave the EU, this blog is not about that. It is about how as a population we have literally been split down the middle and how this process – splitting – can be seen as a psychic defence process of the same namesake. If it does, what does it say about all of us?

Splitting is the technical term for ‘black and white’ or ‘all or nothing’ thinking. We can all be guilty of this at certain times – particularly when put under pressure and feeling fear (more about this shortly.)

Splitting is therefore an inability of a person to mentally hold the positive and negative qualities of self and others: it a failure to mentalise – to hold an integrated self and other in mind. It is described as a primitive defence (primitive referring to a defence we learn early in life) and stems (or so the theory goes) from the infant’s inability to see both the satisfying aspects and frustrating aspects of their caregiver’s attention to them as being from one and the same person. The infant therefore ‘splits’ the parent (or object) into a ‘good Mummy’ and a ‘bad Mummy’.

How does splitting work in relationship? Well with relationship to others, it creates enormous instability, as the other is experienced as either good or bad, loving or hating, black or white, British or foreign. And this split is experienced in the relationship to self too, so that undesirable, unthinkable or unacceptable aspects of the self are ‘split off’ and projected onto others, further fuelling the relational instability. Interestingly, splitting is one of the defences most associated with Borderline Personality Disorder.

The campaign for the EU or for the UK – as it was presented to us – has left the population with little ability to hold their splits by virtue of it culminating in base choice of ‘Remain’ or ‘Leave’. Add to the mix the fear and hate-based rhetoric by politicians and the media, and it becomes a challenge for any one of us to not become aroused (impassioned) about our positions by denigrating the views of the other camp.

I would suggest that the reality for all of us is that how we feel about the EU and Britain’s identity and role in Europe – and therefore by extension our own role and identity – is conflicted. Again, whilst remaining unbiased in my views, factual evidence would suggest that being a member of the EU has brought benefits and challenges and idea of leaving promised, at least in phantasy, much the same (again, phantasy as much of what was promised stirred unconscious desires of identity and safety without us as yet having an evidence that this will be the outcome).

So now, in the aftermath of the vote, where the political establishment is in turmoil and the media in overdrive, how do we reflect and hold our splits? Perhaps we can recognise that in every Remain voter, there is a part that would vote Leave, and that in every Leave voter, a part that would vote Remain. To accept this means accepting that ‘the other’ is not inherently evil, stupid, or self-centred, but has felt obliged to split off their conflict and ambivalence.

Being honest with ourselves about our own splits and how fear, stress and the political system forced a split is the first step, the second is perhaps in noticing that nothing has as yet changed. We are all feeling stress and worry, which raises our arousal levels and drives us to seek a sense of knowing and security – this is human nature. But pausing, breathing, switching off the constant manic newsfeeds and slowing down will create significantly more of a felt sense of safety and security than continuing to allow the chaos to create psychic splits in us that cause us to react rather than act.

For some tips and guidance on developing a daily practice that can help bring about a felt sense of stability and calm, please see our blog on mindfulness.

Mark Vahrmeyer is a UKCP Registered Psychotherapist working in private practice and palliative care.

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What is attachment and why does it matter?

attachment1Attachment theory is something I draw on a lot in my practice.  However, unlike psycho-analytic theory, the concepts are relatively simple. Simply put, attachment theory describes how we respond to relationships.

There are broadly four different styles (or, as I prefer to think of them – adaptations) of attachment: secure; avoidant, ambivalent; and disorganised.  Briefly, they are defined as follows:

Secure individuals are people who received ‘good enough’ parenting (Winnicott) and feel they are able to navigate life without unnecessarily reacting to emotions and either becoming overwhelmed (fight) or dissociating (freeze).  They are also people who, generally, feel like they can get their needs met in relationships and for whom intimacy is possible.  Bar some later trauma in life, securely attached individuals rarely present for therapy.

Avoidant (adapted) individuals are those of us who feel that relationships are inherently unsafe and that they cannot rely on the other.  They have a tendency to keep people at arm’s length, especially when they experience a relational stressor.  To cope, they may make themselves unavailable to their partner (through other commitments) and avoid being vulnerable.

Ambivalent (adapted) individuals struggle with the internal conflict of wanting intimacy and thus moving into relationships quite quickly, only then to slam on the brakes when they perceive an attachment disruption.  They feel trapped (under stress) between wanting closeness but pulling away for fear of being hurt.

Disorganised (adapted) individuals are people who have experienced significant childhood developmental trauma and have more than likely been born to mothers who have also been traumatised at a relatively young age.  They are people who struggle enormously to contain (in the body) their feelings and to make sense of them (mentalise).  Relationships for people with a disorganised attachment adaptation are fraught with threats, intensity and chaos.  It is likely that individuals presenting with this attachment adaptation as their predominant style may have a personality disorder.  And, yet, personality disorders can be treated too, under the right clinical conditions.

Misconceptions

As is often the case with models and classifications, people can believe that they have one attachment style and that this is fixed. Whilst we may have developed a default adaptation in relating, this adaptation only surfaces when we are under stress. Let me explain:

Imagine you are with another with whom a budding relationship is developing. You are both relaxed and sitting in the sun in a place that both makes you feel safe and comfortable.  There are no stressors present – alcohol, drugs, conflicting conversations, other people who may threaten your relationship, etc. In this context, irrespective of what your default adaptation may be, you will most probably be in a state of secure attachment.  That is, in a secure relationship with yourself and the other.  This is really critical to understand, as it means that even in those of us who have experienced significant childhood developmental trauma and attachment disruption, the propensity to feel securely attached resides in us all and can be built upon in the therapeutic work.

Neuroscience and neuroendocrinology

What makes attachment particularly interesting is that it requires a focus on mind–body integration, as all emotions originate in the body (see my blog on the pyramid of change) and we need a mind to help us make sense of what we are feeling.

Theoretically, attachment principles can be applied to any psychotherapy ‘model’. as long as the emphasis is on helping the client understand what they are sensing in their body; what this feeling is telling them; how to contain it; how to make sense of it.

However, attachment theory is coming to the fore of psychotherapy thinking around change that happens as the principles of healthy attachment are being evidenced through neuroscience findings.

Neuroscience is showing that when we are securely attached, we are able to feel our emotions without becoming overwhelmed and reacting.  And it is showing how our fear centre of the brains (the limbic system) can become primed to react at the slightest perceived danger.

Neuroendocrinology – the study of brain and body (hormone system) integration is showing us that secure attachment is a state of optimal health in both the brain and the body. In brief, to be in a state of insecure attachment leads to higher stress hormones being present in the body; lower immunity; higher anxiety; and less ability to mentalise.

Mind-body integration in attachment reparation

How do attachment adaptations come about? Why would one child generally be considered securely attached and another a variant of insecure? The answer to this is complex. However, two variables stand out above all others, and those are how much the child was attuned to as an infant (particularly pre-verbal) and how much the child was encouraged to be themselves in the relationship with their primary caregivers.

It is these two variables that stand relational psychotherapy is a very strong position to repair attachment trauma – to re-parent the client.

The role of the therapist is therefore to help the client understand what they are sensing and feeling in their body and what feeling that translates to: a variant of the five core emotions of joy; anger; fear; sadness; and disgust.

The therapist is then there to work with the client in remaining present to the feelings in their body – avoiding overwhelming or dissociation – so that little by little the client learns to navigate their universe of emotions.  And how does all of the above happen?  Through careful attunement – nervous system to nervous system; body to body; mind to mind – and through validation of what the client discovers they feel.

Secure attachment is the goal of therapy for a healthy mind; healthy emotional system; healthy immune and endocrinology system; and healthy relationship patterns (intimacy with self and other).  Sounds like a good goal to me!

Mark Vahrmeyer is a UKCP Registered Psychotherapist working in private practice and palliative care.

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What doesn’t kill us makes us weaker: Developmental trauma and attachment styles

AttachmentThere is a lot of wisdom in sayings that have been part of our language and culture for as long as we can remember.  For example, being ‘on the back foot’, meaning to be at a disadvantage or on the defensive, is a perfect expression of how our relationship to our body influences how we relate to ourselves and the world around us.  Likewise, to have a ‘gut feeling’ about someone or something, is really very profound as our emotional system (our unconscious) resides in the body and expresses itself somatically through, amongst other parts of our body, the gut.

However, one expression I come across quite often that is not only incorrect but also harmful is ‘what doesn’t kill us, makes us stronger’.  It is an expression which is frequently accompanied by a disavowal of any felt emotion in relation to the event being described and suggests that somehow we grow stronger and more resilient through trauma.  The latter is particularly true of childhood developmental trauma where an individual has been regularly misattuned to, neglected or abused.  In the case of developmental trauma, what doesn’t kill us makes us weaker and less adaptable to the realities of life.

Developmental trauma, also known as complex trauma, arises ‘when caregivers are emotionally absent, inconsistent, frustrating, violent, intrusive, or neglectful, children are liable to become intolerably distressed and unlikely to develop a sense that the external environment is able to provide relief’ – Dr. Bessel van de Kolk (2014).  Developmental trauma directly impacts on cognitive, neurological, psychological and immunological development of infants and maps onto our attachment patterns in later life.  In other words, we grow our brains and minds from our early experiences with our primary caregivers which lays down a belief system about ourselves, about those around us and about the world in general.

A little about attachment

OK, so developmental trauma correlates to attachment patterns.  What are attachment patterns and why do they matter?  It is generally accepted that there are four types of attachment: secure; avoidant; anxious-ambivalent; insecure-disorganised.

If a parent has been available to their infant and able to attune to their child’s needs, the child learns that it is safe to turn to that parent in order to seek soothing and reassurance, and then safe to turn away and carry on exploring the world when they feel calm again.  This child is securely attached and will likely carry this attachment style into his or her adult relationships.

The other three attachment styles are all classed as insecure and arise from childhood developmental trauma.  Avoidant infants learn that they need to be self-reliant despite their anxiety; Anxious-ambivalent children seek out their caregiver but fail to be soothed through a lack of attunement – they pick up their mother’s anxiety; children with disorganised attachment feel enormous conflict in their main attachment relationship wanting to approach for security and feeling frightened of doing so.

Attachment patterns matter for a whole host of reasons, however, on the most fundamental level, attachment patterns dictate whether we are able to use relationships (with ourselves and others) to regulate our emotions, arousal and anxiety.  An inability to regulate our arousal state means it is more likely that we will suffer with higher levels of anxiety and be predisposed to emotional, mental and physical illness.

Thus, in the context of trauma, attachment and our relationship to self and other, what doesn’t kill us progressively makes us weaker.

The role of psychotherapy is to help individuals process trauma and through the therapeutic relationship start to challenge attachment styles and patterns.  It is possible to shift over time from an insecure- to secure attachment pattern.

 

Mark Vahrmeyer is a UKCP Registered Psychotherapist working in private practice and palliative care.

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