When and how does Transference link to Harm in Therapy?

It can be argued that transference and countertransference are ubiquitous phenomena in the therapeutic relationship, and much of the time the multi-layered relational responses that occur for both therapist and client either do not dominate the therapeutic work or become a fertile and productive means of gaining relational understanding and effecting therapeutic growth. In my work as a therapist, my understanding of the feelings and interactions which transpire between myself and a client play a crucial role in how I make sense of the therapeutic process and my client’s way of being in the world.

I believe wholeheartedly that transference and countertransference can hold great value in the therapeutic process (from my experiences as a client as much as anything else) so  how do I understand the significant prevalence of transference being cited as a cause of harm in books, articles, internet forums and in blogs, most frequently cited first-hand by the people who have experienced harm in therapy?

Often, when people experience difficulties in their feelings towards their therapist, they Google it. That’s what I did, and it’s also how I make sense of the fact my blog posts on transference, countertransference, and particularly, erotic transference receive more worldwide hits than any of my other posts.  When clients type ‘feelings towards my therapist’ into Google, they receive access to thousands upon thousands of resources and online discussions on transference. They will probably read that it’s important to talk to their therapist about how they are feeling, and those who feel able to, might attend their next session ready to tell their therapist about their understanding of transference and desire to talk about it. What happens next can vary widely.

In her 2016 article for Therapy Today, Dawn Devereux writes “The risk of AIT [adverse idealising transference] can also be reduced by responding appropriately when clients bring up transference concerns, as AIT is much more likely to occur if the first indications are ignored.”.

I would posit that the transference is far more likely to have a long-term adverse effect (distinct from here-and-now discomfort) if the therapist shows discomfort, rejection or denial towards the client’s feelings. Devereux continues “We have observed that therapists whose clients develop AIT are unlikely to discuss transference, and are dismissive or hostile when clients suggest it. Clients also describe therapists becoming irritated, defensive and rejecting in response to discussion about the adverse effects on the client’s life.”.

What is happening for therapists here? It is tempting to say “What terrible therapists; how dare they respond in such a way to a client!” however I think the uncomfortable truth is that any therapist could be vulnerable to responding in a hurtful way to their client and when we ‘other’ the harmful response, we avoid the necessary self-reflection for safe and ethical practice. I really want to take a look at why therapists might respond in this way and how the risks of such a harmful (and potentially retraumatising) response can be reduced.

I have experienced some mixed responses from therapists about my interest in harm in therapy, and I sometimes wonder when I receive confrontational correspondence whether this might relate in part to a reluctance on the therapist’s part to acknowledge their own potentiality to do harm (in fact I recall that this sense was once freely admitted to me). When I hear of therapists’ dismissive or rejecting responses to a discussion of transference, I wonder whether a similar avoidance occurs. It’s almost as though we can, as therapists, bask in our sense of doing good, yet have trouble reconciling ourselves with the inevitable shadow of our virtue. So how can we manage that response as therapists? I would argue that the only way we can reconcile this shadow, is by facing it head-on. I often retweet Carl Jung quotes, because he professes it so boldly and so unequivocally: “People will do anything, no matter how absurd, in order to avoid facing their own soul.”. If we find ourselves shaming and invalidating our clients in order to avoid facing our own soul, we do ourselves, our profession, and crucially, our clients, a terrible disservice.

Hostility as a response to idealising transference is an interesting one; it seems counter-intuitive to meet positive feelings in an ill-disposed manner, particularly as therapists. It seems to me that the therapist who acts with hostility (and quite possibly those who act with defensiveness and rejection too) are likely to be chin-deep in countertransference without the first idea about it. After all, I think it unlikely that any therapist would say it’s okay to act in a hostile and rejecting way to a client expressing such feelings, so if it’s happening, something may well be occurring for the therapist outside of awareness.

My supervisor said to me recently “Awareness is key, and always in the service of the client”. With that in mind, I would say, awareness, reflection, robust scrutiny, and a crucial container for all of these processes: supervision, each have a role to play in managing our own responses to our clients’ feelings in a way that reduces the risk of adverse effects when transference and countertransference emerge in the therapy room.

I don’t think this is by any means a comprehensive exploration of this huge and under-researched area, however I have tried to touch on some of the ways in which we might work to mitigate harm and engage positively with this fascinating and valuable area of the relational dynamic.

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