Immediacy, Transference, and Countertransference in Therapy

Exploring Immediacy Transference and Countertransference

Immediacy Exploring Transference: clients projection of unresolved significant relationships onto the therapeutic relationship Why? Psychological attempt to resolve issues related to important relationships A working through of unresolved patterns of relating Recapitulation of significant relationships that remain unresolved Source of unresolved pain, rejection, or loss

Exploring Transference Therapy focuses on the relationship between client and therapist Therapist will address observations about the client s feelings/attitude towards therapist Client will confront feeling towards therapist Exploring the Process Exploring the metacommunication The here and now of therapy

Cues for Exploration Client Indicators: Client attitude towards therapist suddenly changes Angry, subdued, too friendly, vague, unusually talkative Client makes allusions to you ( no one understands me ; I disappoint everyone Client confronts therapist with accusation: I m not getting anything out of therapy ; you like your other clients more

Cues for Exploration Therapist Indicators: Boredom, angry, stuck, disinterested, distracted Sexual Attraction Avoidant or afraid Not using effective skills in therapy

Questions for Therapist What do I feel when I am with this client? What keeps me from being effective with this client? How does this client affect me compared to other clients? What about his client triggers my personal issues? What does the client contribute to the relationship that creates boredom, rejection, repulsion, exhaustion?

Questions for Therapist What about client s reaction to me is important to their interpersonal dynamic with people in their lives? Is interpreting the transference helpful to explaining client s difficulties? How do the feelings/thoughts I am having about the client help inform me about the client s interpersonal dynamic? Do others feel this way with the client? Is that meaningful insight?

Example of Working with Transference Cindy is seeing a female therapist at a college counseling center. She describes being raised by a single mother in subsidized housing complex in Detroit, MI. She recalled hardly seeing her mother for most of her childhood. She states that her mother worked multiple jobs, mostly overnight, and often had to feed herself and home alone overnight. She said neighbors came to know her and would check on her on occasion. Eventually, she states that her mother befriended a older male neighbor who would offer to buy groceries and would often stay with her when her mother had to work overnight. She states that she would wake up in the morning often to find the man in bed with her nude. She eventually told her mother who stopped asking the man for help. She recalls having night terrors, difficulty sleeping, and anxiety at night for years after. She is seeking therapy to address a resurgence of anxiety, with school phobia and difficulty sleeping. She attends 7 sessions and spends the session talking about her concerns about her mother s health. She also apologizes to therapist for not being a better client. What is the transference? Is it meaningful to interpret the transference? How would you approach discussing transference with Cindy? What are potential pitfalls? What countertransference is a female therapist likely to feel? Male therapist?

Mock Session: Working Through Transference Instructions for clients (while therapists out of class) Instructions for Therapist: Nancy presents with depression and narcissistic personality traits. She struggles with deep seeded feelings of inadequacy and superficial grandiosity. She forges relationships well, but overtime will develop hostility and feelings of victimization in her friendships. She often will distort people s actions to create feelings of victimization. Conduct a session acting out the recommended scenario Therapist goal is to address whether interpreting the transference lends insight into client s interpersonal dynamic Therapist: Address transference with client. Interpret Transference with client.