Transference and counter-transference in Gestalt Therapy

What is meant by transference: material from outside the therapy room which is brought into the therapy situation by the client. Counter-transference: material brought into the room from outside the therapy situation by the therapist, or the therapists response to the clients transference. These are more complex ideas than they seem. In Gestalt classically we understand both as projections.

Transference
Freud originally thought that the work of therapy was to facilitate the patient in remembering past material, the analyst worked with a medical model. What the doctor did to and for the patient was the focus - the relationship was dismissed as a bedside manner. Then he began to realise that the patients experience of the analyst was influenced by past relationships. This led him to formulate the theory of templates. In our earliest relationships we establish templates or patterns into which we tend to fit all our subsequent relationships. So if I had a good relationship with my father, I will tend to see all male authority figures in a benign way. Or I may look for what I didnt get in a previous relationship. He also formulated the theory of repetition compulsion: we have a need to create for ourselves repeated replays of the situations and relationships that were difficult for us in the past. It is not so that we replay it to make a happy outcome that seems to be unsatisfactory; we want a repeat of the original situation. In therapy this is played out in 2 ways they will see the relationship in the light of their earliest ones and they will engender replays of early difficult relationships. Sometimes the transference is a replay of the original situation sometimes it is how they wished it were. I.e. I may transfer my original disapproving mother onto my therapist or I may see him or her as the warm loving one that I wanted. I am likely to switch between the two. At first Freud thought that negative transference processes were distortions of the therapeutic relationship which got in the way and had to be interpreted and analysed, the positive transference was an important tool in facilitating the patients cooperation in the process of rediscovering memories which could be explained and interpreted and worked through with the client. He later decided that the transference material itself was important in the patients experiential learning. The analyst was to be a blank screen on which the transference would be projected the material could then be identified interpreted and worked with. Over the course of the analysis the client would begin to see the therapist as a real person in the room. The analysis would be completed when the transference is dissolved through analysis. More recently through the impact of humanistic thinking (Buber, Perl, Rogers, Friedman and others) analytic therapy has become more open to a more real person to person encounter in therapy.

NB Trubb in Jungian therapy, Kohut, Gill in self-psychology and the interpersonal schools of analysis, Fairburn, Guntrip et al. There was a growing realisation that healing not only rested in the intrapsychic growth of the client but also in the relationship itself. That is the relationship, the between, which heals (Martin Buber). Gill said remembering is necessary but not sufficient. Re-experiencing is also necessary in order to transform the patterns. The therapist has to help the patient get in touch with transferred feelings make it safe for the client to express them discuss these feelings in a non-defensive non judgemental fashion help the patient understand the origins of these feelings. The importance of transference is therefore not in the remembering of past experiences, but in the re-experiencing of the old impulses and feelings, and in receiving a different response. Therefore the classic analytical stance of the blank screen was no longer considered useful by this school of therapy. Awareness work was the first stage of therapy and then later, transference recognition. The most effective work is done in increasing the clients awareness of the relationship. Kohut said what was needed was a reparative relationship in order that the self could develop from its primary narcissism: In a reparative relationship the therapist will fulfil the need to be mirrored to have an idealised parental imago to be like others To do this s/he must give the client a sense of being to someone who is willing to work at understanding them a sense of being deeply understood a sense of being accepted an understanding of the roots of their difficulties new self structures, particularly new structures to compensate for old deficits Gestalt therapy has always been grounded in the real relationship between client and therapist. The dialogic relationship- inclusion, presence, confirmation and commitment are considered the ground on which the therapeutic work rests. The therapist brings him/herself to the relationship as a real person with all of themselves and their responses to the client but always in the service of the client. Laura Perls met Martin Buber when she was studying in Germany before WW2 and was very impressed by him and his philosophy.

In gestalt therapy we aim to dissolve the transference rather than encouraging it. To this end we work transparently in a relationship were both parties are considered equals. However our clients do bring all of their past experience into therapy and often see us through the lens of past experience. We also bring our past material to the relationship and inevitably we will see our clients through the lens of that material. The process of dissolving the transference is part of the work of therapy and to which we must pay careful attention. In the therapeutic work we need to notice not only where the client is transferring material onto us but also our part in that process. As my first therapist always said, whenever there is a projection there is always a hook to hang it on. In Gestalt therapy the task of therapy is not to resolve the transference (classic analytic theory) but to learn to discriminate between what is from other situations and what is relevant to the present situation. Working with transference: Inclusion, seeing form the clients point of view while maintaining our own, accepting Presence, spontaneous, embodied, genuine meeting of human beings, respect, and transparency. Confirmation, Commitment to the relationship In working with the patient it is important to leave enough space for the patient to use you as s/he wishes. Important for relating and understanding to emerge in the patients own time, not to engage rapidly with interventions or pre-emptive interpretations. Stage1 Allow the transference issues to emerge. (Allow figure formation). Then work with the transference issues- who do I remind you of, who else was like that, is this familiar pattern etc. Explore the possible transference issues without interposing own material (or being defensive etc.) This way you will have more access to the deeper issues. Stage 2 Later it is possible to offer your own thoughts feelings and responses, This will support the clients ability to recognise their own material and to know what is real in the relationship. To withhold the therapists material is to be mad-making and to result in the Clint living in a self-referential world.

Transference exercise
In pairs: Describe a client How did you meet? What did you first notice about the nature of the contact with the client? Tell the story of the history of your relationship Find an image or metaphor to represent the relationship Imagine what the relationship you and the client might have in other circumstances How would you be if you were cast away on a desert island with the client Become a fly on the wall in the last session. What would you notice about the relationship? With your partner identify and discuss the transference from the patient to the therapist. In pairs : Be the client describe your therapist how do you feel about her? what do you think she thinks and feels about you?

Counter-transference
Counter transference is the transference of the therapist on to the patient. It is inextricably entwined with the patients transference. It would be more accurate to talk of the co-created transferential relationship. It is the between of the therapist and client. We attempt to look at each separately but this is not truly possible. There are several categories of counter transference : Pro-active counter transference; when the patient evokes material in the client from outside the therapy room. Reactive counter transference: when the patient evokes a response in me which may have resonance in my own life but is also a particular cry for helpcommunication by impact. Sources of counter transference: Realistic responses eg friendly attractive person- I warm to him/her, belligerent and threatening , I feel cautious and frightened. (Reactive ct) Response to transference; client is seductive , I feel excited or frightened. Client is flattering and I am inflated client is critical, I feel threatened. (reactive ct)

 Responses to material troubling the therapist. Arising when client explores material troubling to the therapist. Client talks about homosexual anxiety and I am uncertain about my sexual identity and so share the anxiety. (Proactive ct) Characteristic responses of the therapist: I like to be admired by everyone I meet , I expect my client to admire me or I am competitive with all women and also with female clients. (proactive ct) All forms of countertransference can be used to inform the therapist in the work if they are in the therapists awareness, and are not obstructive to the client. Obstructive CT CT that blinds us to areas of important explorationor that lead us to focus on our own issues rather than the client eg therapist avoids exploring areas of sexual anxiety for the patient because of hi/her own anxiety in that area or therapist focuses on issues of the patients difficulty with the mother because of his/her own difficulties with mother Ct can cause us to use clients for our own gratification. Eg encouraging the client tomore sexual freedom because of our own desire for more sexual freedom orencourage the client to be independent to mee our own desire to be less dependent Ct can lead us to give subtle clues that influence the client. Eg need for admiration, feelings of sexual attraction Ct can lead us to make interventions not in the patients interest eg retaliation if I am hurt. Ct can lead us to adopt the roles which the client projects onto us. However if we are aware of the ct we can use our responses to inform us diagnostically about the clients processes. It can be a felt understanding of the client which does not overwhelm the therapist. We let the client know that we can experience the feelings etc. that are evoked but they are manageable and we do not need to act on them.

Counter transference exercise In pairs Share your first spontaneous response to the repeating question who does this client remind you of? (part of self, relation, historic figure, mythic figure etc) What do they want to say to that person that is unfinished. What is the wildest most difficult thing they could say. Role play with an empty chair. How is the client different from that person? In pairs Think of a client who evokes a strong response in you. What feelings are evoked in you by the client? Explore what role you fall into in relation to that client? What might the client be trying to communicate to you?