Sunday, April 4, 2010

Negative transference and real feelings


I have written before about the process of transference that the client and therapist go through.


As one can see it includes what is called the positive and negative transference. Those are the stages where the client can have quite strong feeling reactions to the therapist. In the positive transference that usually includes the liking, loving and even at times erotic feelings.


This period can vary enormously in duration. Some times it is quite short and other times it lasts for long periods. One aspect of this is the attachment changes that occur during these phases.


In the positive transference the attachment develops and in the negative transference the attachment is broken down as the psychological separation occurs.


When the client switches to the negative transference they stop being friendly, helpful, agreeable and so forth and become disagreeable and argumentative. This can include arguing about the bills, changing appointments, getting appointment times wrong and so forth.


As regards the emotional quality of this stage I came across a blog post the other day. It was an open letter that had been written from a client to her therapist. I found it captured the emotional quality of the negative transference very well and I will use it in future as a teaching piece and hence I am writing about it here. It goes as such:


“Dear J,


I’m feeling angry about therapy. Here are some of the reasons why:


You always start the session by asking, “So what are we talking about today?” even if it is very obvious what needs to be talked about.


Every week feels like the first week all over again, instead of accumulating knowledge about me and reflecting back.


There is never any silence; I like to have silence occasionally.


I trusted you to read my blog and you searched for “sex” and “job” and then lied about it.


I gave you a really long account of 2009 and you said there was enough material in there to last for a few weeks of therapy and you never brought it up again.


You try to make everything logical and rational and then I feel guilty and I feel like a failure that it’s not sinking in.


You don’t pick up on what I need or what I feel. You never ask me what I need. I don’t even know what I need, but maybe if you ask me I’ll try to figure it out.


You once said in an email, “I think that one needs to work through or resolve issues in order to avoid repeating them.” All I feel like I’m doing is repeating the same things over and over and over.


Your office is so damn beige.


Tags: anger”

(end quote)

To summarise the grievances:

She questions his therapeutic skills

He is told he lied which implies he is also unreliable and untrustworthy

She reports he made her feel bad in this case guilty and a failure

He is told he does not give her what she wants, in this case silence

But it is best summed up in her last comment about the beige office. Translated = “I am angry at you”, as her tag so accurately portrays.


One of the difficulties of defining this as negative transference is the client can take it to mean that their feelings of anger are not real or are somehow invalid. That is not the case as the client feels what they feel and they are real and valid.


However the feelings are out of proportion to what is going on in the here and now because the client is misperceiving the therapist. It is a situation of misperception not ‘unreal’ emotions. I didn’t call it a problem of misperception because such misperceptions can lead to therapeutic gain if handled correctly by the therapist. The misperception is a positive thing in this sense.


If a client states they they have strong feelings for or are in love with the therapist that of course is great for the therapist’s ego. It’s great to think that I must be so attractive that someone has such feelings for me. But alas it is not so. A client does not fall in love with me they fall in love with what I represent to them.


How can you love someone when you hardly even know them? The client therapist relationship is a very specific and restricted one. The client only gets to see the therapist in a very singular way, that is in a sympathetic, understanding, reliable, caring role. The transactions would usually be as such:


In the therapy setting these transactions would most often occur 90% of the time. This is very different to the usual male and a female relationship which in part could be drawn as such:


Whether they be just friends or married both parties are supposed to express their Child ego state wants and needs about 50% of the time. In addition they are meant to be caring of each other about equal amounts as well. Both sides get to see the other’s Child ego state in particular. Thus they know them more ‘deeply’ than a client can know a therapist as the therapist very infrequently expresses such child needs to the client.


Thus the client does not really get to know the therapist even though the level of emotional reaction in the transferences would indicate that they do. In the positive transference the client unconsciously fills in the gaps that they do not know about the therapist thus giving them the perception that they know the person well.


If you go back to that letter one finds a lot of ‘gap filling in’ being done but in a negative transference way in that case. A good deal of therapist motivations and meaning to his perceived behaviour are added in such as about the silence. Also no therapist is that bad. In the letter none of his good points are being acknowledged.


For many years my parents an I ran a counselling training institute together. They were both psychologists and trainers like I was, and we trained many hundreds of people. Not uncommonly over the years a trainee and/or client of theirs would take me aside and tell me how lucky I was to have been raised with such healthy parents. I would just look a bit stunned, (as I was), smile blankly and change the topic.


Now my parents were OK as parents but they were far from perfect, god rest their souls. The client/trainee was in a positive transference and had filled in the gaps about them without even knowing it.


Graffiti

60 comments:

  1. I liked the beige office comment. I'm very prone to taking out anger in the form of interior design critiques in therapy.

    ReplyDelete
  2. This is very interesting. I do have to comment about not acknowledging my t's good points however. He has lots of good qualities and abilities, but in this letter I was just focusing specifically on why I was angry. I don't want you to think that I don't see his positives.

    So what does one do with all of this negative transference?

    And can a therapist experience negative transference towards a patient as well? I would think not because the 90/10 ratio is going the other way and the patient is frequently expressing needs from all of their ego states.

    ReplyDelete
  3. Oh, and one more thing. Is it possible to cause oneself to feel negative transference on purpose, perhaps to avoid attachment?

    I had too much positive transference with a previous therapist, and I'm wondering if I am so afraid of that happening again that I am negatively transferring purposefully, albeit subconsciously.

    ReplyDelete
  4. Hey Major,

    Glad you dropped by. Maybe I will post a few photos of my office and you could give me some of your interior design "Tips"

    Graffiti

    ReplyDelete
  5. Hello Harriet,

    Those are pertinent questions you ask and you have kind of answered some of them already. Yes you are right it was stated as being an angry letter and thus not required to put in any positives and you still didn’t.

    I am glad you see lots of positive points in your therapist, as I am sure there are. I also need to say that what you have written may not be a statement of negative transference at all. For me to make that assessment I would need to know the context in which it has occurred and I have no information about that. However from a teaching point of view it is very illustrative which is why I asked permission to use it and thank you for agreeing. I am sure I will use it again in training workshops in the future.

    Also I am in no way making any kind of comment about your therapy or therapist. I have very little knowledge about both of those and just see the bits and pieces you write from time to time. I would imagine that your therapy is going well, and your open letter would indicate that.

    Clients have transference reactions (positive and negative) to their therapists.
    Therapists have counter transference reactions (positive and negative) to their clients. They are just opposite sides of the same coin. Different words for the same kind of thing. So yes a therapist can have a negative counter transference reaction to a client. Fortunately that does not happen all that often in a significant way because when it does it can result in damage to the client.

    Your question about using negative transference to avoid attachment gets a very definite, ‘Yes”. It happens often. If someone got very close to and had a big a attachment to some one in the past and then got hurt badly, they are going to be much more careful the next time around. One very convenient and easy way to avoid emotional closeness (& thus attachment) is to get angry at the other party. Anger pushes people apart psychologically (and often geographically) and causes a breaking down of the attachment.

    Thanks again for letting me write about your letter.

    Graffiti

    ReplyDelete
  6. Tony,

    I think it would be difficult to relate to a therapist. I think it would drive me around the twist.

    That would be so much fun!

    Happy easter Monday night!

    ReplyDelete
  7. Tony,

    I think relating to a therapist would drive me around the twist. An impossible situation.

    I left a comment before that was a bit like this one but i think it went 'right' instead of 'left' during processing cause it kind of just disappeared. Well, more than 'kind of' but more like 'actually did' disappear. Cause it appears to have dis-ed.

    Cheers to you.

    Oh... also... daylight saving has changed so now we're either only 2 hours different or 4 hours different. I'm going to visit dad and mum tomorrow (its mum's birthday) so i'm to tired to bother working out whether it's 2 or 4 hours difference. But i'm sure it really isn't that big a 'thing'. Cheers...

    ReplyDelete
  8. Good post with lots to think about.

    Thought about interior designs - do some therapists make them so boring to steer the attention and focus back to them? I know I spend time during my session examining the titles on the bookshelf (even though they haven't changed) and looking at the pictures. Makes me wonder if she moved her bookshelf to the other side of the room (with her facing and behind patients) to avoid the distraction.

    Take care.

    ReplyDelete
  9. Another question - your diagram and comments makes it seem like the negative transference is a natural part of the process that occurs to allow separation with the therapist. Or am I interpreting this wrong?

    ReplyDelete
  10. Well that is a good point OLJ and one I agree with. In my view one would want thier office and clothing for that matter to be a bit beige. Or put another way one would not want their interior design or clothing to be very eye catching or dramatic as it would seem to be a distraction. And in that situation an unwanted distraction at least in my view.

    About the neg transference. Yes it is a completely natural process and any relationship of any depth will go through the process of positive transference first followed by a stage of negative transference. They can be marital partners, friends, client and therapist, mother and child or any relationship where a significant attachment forms.

    Tony

    ReplyDelete
  11. Roses you will have to find yourself a therapist and experience the therapeutic relationship first hand.

    I know you would go very well in it. We must skype again soon. I have missed our cyber chats

    Tony

    ReplyDelete
  12. So Therapists are not really your best friends because one is there to do the transference work. For a while at least everything seems nice cosy. There is no reason for that relationship to be "lost" if the therapist is genuine.

    If one wishes to marry or make close friends in the same kind of ways then I guess they will need to marry someone like a therapist?

    k

    ReplyDelete
  13. Oh K, I like people who are not so 'adult' in everything or we wouldn't have any fun! Where would be all the things that we talk about in years to come and laugh so hard about? Probably seriously scary and painful at the time they happened, but so funny later on.

    Does it always have to be transference work or is a therapist allowed to be a human (a person) atleast sometimes?

    The therapy transactions... it would be such alonely place to be all the time, wouldn't it?

    ReplyDelete
  14. Well it would be my view Kenoath that whilst there is a strong transference then a freindship in the usual sense of the word is not possible, but post therapy there is no reason why that could not develop over time

    Graffiti

    ReplyDelete
  15. You make a good point Roses,
    In one sense being a therapist is quite a lonely occupation.

    Of course therapists can be human should they choose to be rather than just a clinician. Whether that is a good thing or a bad thing in the therapeutic relationship is a matter of much debate and conjecture me learned friend

    Skype 1 to skype 2 over!

    Graffiti

    ReplyDelete
  16. "Also no therapist is that bad"

    I am sure there are some that bad.

    ;-)

    ReplyDelete
  17. I cant find where your quotation comes from Kahless

    T

    ReplyDelete
  18. It's in your post... End of the third to last paragraph.

    ReplyDelete
  19. Oh yeah! Under the "Do not cross" picture. I see what you're saying though Tony. I find it difficult to believe that anyone with any psych/counselling training could be 'all' bad - with absolutely NO positive traits.

    But i must agree that if i were having a 'not so good' time with someone, it can be very difficult to remember that a person is even human! Not that being human is always a good thing but that we are alive creatures and as vulgar and distructive (as we are) we must deserve some compassion?

    Well, i guess that depends on one's point of view.

    Cheers...

    ReplyDelete
  20. Thanks Annalynn and Roses.

    it is interesting that someone can be angry like that and see the therapist as not knowing what they are doing and yet there is no way they will miss the next appointment.

    I have had people ask me over the years that in the angry transference wouldn't the person just leave and never come back. Definately not, people are more likely to return than if they just stay in the positive transference. Because at some level they are aware of the psychological benefits that come from the negative transference

    Tony

    ReplyDelete
  21. Have you ever considered Skype for therapy sessions? My daughter's therapist was talking about brief checks with her to monitor her adherence to a contract. My daughter suggested Skype - therapist wasn't too keen on it.

    OLJ

    ReplyDelete
  22. Yes I have OLJ. I have been doing regular Skype counselling and supervision for about 6 months now. Particularly with the counselling it has been an intersting learning experience for me (See post of Feb 12th, 2010) as one has to adjust how they counsel to fit in with this new medium and I think I an getting there. I now have a skype counselling style that is different from my face to face counselling style I think.

    I have done email counselling for many years but it is clealry second rate compared to face to face. However I have found that skype very much narrows that gap between face to face and internet counselling. It is still not as good as face to face but it is getting much closer and I have found it quite workable whereas email was not all that workable.

    Obviously your daughter’s therapist and I are of different views. To my mind its not a matter of simply switching from face to face to skype counselling. I have had to learn a different style of counselling that suits the skype medium. I might think about this more and articulate it.


    Tony

    ReplyDelete
  23. Hi T,

    3rd para from the bottom. In full
    "If you go back to that letter one finds a lot of ‘gap filling in’ being done but in a negative transference way in that case. A good deal of therapist motivations and meaning to his perceived behaviour are added in such as about the silence. Also no therapist is that bad. In the letter none of his good points are being acknowledged."

    xx.

    ReplyDelete
  24. Ooops,

    I commented and then read the other comments to see that others have already pointed out the place.

    My comment was kindof tongue in cheek. But then again, I was rather peeved with that male T I saw and dumped him. I think I quit in the negative transference. He misjudged me and offended me at a personal level.

    ReplyDelete
  25. Tony,

    I fired my therapist on thursday
    Afterewards I realized that part of the furstration was probably related to a maternal transference (my mom never stopped doing things that were upsetting after being asked to stop and having it explained to her and this therapist was continuing to do upsetting things after I explained the problems. He wanted me to stay and try to work things out, but I don't believe its possible for it to work. The not beleiveing there is anything that can be done to change things being the transference.)
    Still think it was a good idea to leave though.
    I gave it a shot for 7 months and there was never much in the way of positive feelings towards him.
    Too much negative feelings provides no basis for it to work.

    Anyways, on the last session
    There was a pile of board games on his shelf and the monoply board was askew
    I got up and pushed it into place.
    It was such an aggressive act of cleaning.

    ReplyDelete
  26. That sounds good.
    A peeved kahless!

    I might write a bit about your neg trasnference in another post my pommy mate. thanks for adding to the discussion

    Graffiti

    ReplyDelete
  27. Hi Major,

    Another one!!
    I must say you do seem to go through therapists, but that must mean you know what you want my friend. I must admit though that 7 months is quite a extensice period of time.

    I like that

    Aggressive cleaning!
    Interesting idea.

    As you said before my friend you do form opinion about therapists offcies. I will post photos of mine and look forward to your views.

    Take care

    Graffiti

    ReplyDelete
  28. I'm not mad at you so I imagine my comments will be a bit kinder:P
    Unless of course you have awful interior decorating skills.

    Yea, I do tend to go through a lot of therapists. I'm picky

    I can't be bothered to stay with it if it isn't going to help.
    And I'm sure my avoidant attachment style is somehow involved.
    I stick around pretty long though considering I've been tempted to leave since the first appointment. I was just so sick of dealing with the process of finding a new therapist that I stayed so I didn't have to go through that mess again.

    ReplyDelete
  29. sorry for double post. it looked like blogspot ate my first comment so I rewrote it but I guess it wasn't eaten after all.

    ReplyDelete
  30. Hey Major!

    Two comments are better than one.

    My interior design is OK but that is not hard for a therapist's room. As Harriet mentioned some therapist's rooms can be beige. I would say that mine is somehwat as well as indeed as are my work clothes.

    As a therapist one would not really be wanting to make a fashion statement with their dress or their interior design. I suspect it would tend to distract the client and certainly reduce the client's ability to do their projections.

    Stay safe

    Tony

    ReplyDelete
  31. So how does your practice break down now between face to face, skype and email? How do you get your skype/email clients - by a web page (or perhaps from this blog?) Do you do skype sessions for those who are normally face to face?

    I think it is great that you are branching out into other modes of therapy - I hope that the up and coming therapists will be trained in this. That is my biggest complaint (really probably the only real complaint) about my T. Even though she is now is a practice where she can send/receive secure email, she doesn't do it. I'm sure it can become overwhelming as some clients might abuse it, but it's all about the T setting boundaries.

    Take care.

    ReplyDelete
  32. talesofacrazypsychmajorApril 21, 2010 at 3:04 AM

    Some therapists do make statements with their offices though or more often, they do with their waiting room. In some fancy-pants neighborhoods I have seen some interesting offices/waiting rooms.

    Some therapists I've seen have taken me up on my interior decorating advice. Like one who added some pictures on his wall when I commented on how everything felt squished down because he had these high ceilings but all the furniture and everything was low to the ground.

    The one who I just fired and I discussed his pillows and he was concerned they didn't match, but I felt they were fine.

    ReplyDelete
  33. Interesting conversation.
    One therapist I saw had two large grandma sofas and several chairs that one could potentially sit in. I thought it was ridiculous. I felt like I was there for a party not therapy. I would sit in a new spot every week to see where the therapist would sit in relation to me. It was like a game. And to top it off each sofa had an unnecessary amount of pillows. Now I am not a germaphobe, germs don't usually ever cross my mind. But everytime I had to relocate the pillows away from me, I felt dirty.

    ReplyDelete
  34. Hello OLJ,

    At the moment I am doing up to 6 skype sessions per week which includes both therapy and supervision. Most of them I have met before face to face in some way but there are a few that I have only ever known over the internet.

    Clients can push the boundarties about contacting the therapist in anyway including skype as you say. So I would not see it as any different to a phone call or email. It is an interesting point.

    Some therapists report considerable difficulty in clients contacting them excessively. I have never had that problem. There have been a few over the years where I have had to clarify such boundaries but it has been rare. Not too sure why that is so.

    Cheers

    Graffiti

    ReplyDelete
  35. I have seen a few therapists offcies over the years as well major. Maybe I don't go into fancy pants neighbourhoods all that often but i do not see a lot of fashion statements made by them which I have never really noticed before until you started talking about it.

    the ones I have seen do tend to be like the picture of the therapy room at the top of this blog. That to me is beige but they also tend to have kind of deep and meaningful symbols like her two statues on the window sill and then of course there are the books!

    Tony

    ReplyDelete
  36. Sitting in a new spot each week is very unusual Annalynn.

    Most clients will find their chair and never stray from it. Indeed if you do a bit of furniture readjusting - like I have done just recently - one gets lots of comments about that . Some times there is a bit of slight disapproval along with it. Possibly an ulterior transaction of, "How dare you mess with my security".

    Regarding germs. Occassionaly a client will bring their dog with them and want to have it in the session. That does not happen as the dog gets to sit outside. Don't get me wrong I like pets and relate quite well to them but no pets in my offcie whilst counselling seems to be the modus operandi for me.

    Cheers

    Graffiti

    ReplyDelete
  37. so - do you readjust your furniture to provoke such responses (tongue in cheek question).

    ReplyDelete
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