The transfer: Introduction.
In everyday life the term transfer is used to refer to bank transactions or more generally to those actions that involve transferring something from one object to another or from one person to another. In this work we are not going to refer to either of these two meanings when talking about transference and we will stick to the psychoanalytic field, since it is here where this concept has reached a greater significance.
Everyone agrees to point out the concept of the unconscious as one of Sigmund Freud’s greatest discoveries. But, no less important, was the speculation about the existence of the transference. The discovery of transference also made an important theoretical contribution to the doctrinal body of psychoanalysis. It is a valuable tool for analytical technique.
The human being creates interpersonal relationships from the moment of birth. These interactions generate desires, drives, emotions, feelings and fantasies that are related to the main figures that surround the child.
These productions of the psyche are specific to each individual. They are conditioned by the psychic and neuronal structure and the subject. These psychic responses are sometimes repressed in the unconscious during childhood. From here, they condition the specific behavior of that person for the rest of his life.
We can say that repressed drives, emotions and fantasies are housed in the person’s unconscious. These elements were originally directed towards people in the childhood environment. These repressed contents, throughout life, can be awakened by concrete situations and projected towards other people, different from those towards which they were originally directed in childhood.
Reactivation of unconscious content.
The individual, in the development of his daily activities , faces a multitude of situations, many of which awaken in him an emotional bond linked to those traces lodged in his unconscious, making him react in the same way as he did in his childhood. Each individual has multiple forms of reaction, which are set in motion depending on the external stimuli they receive in the present moment, triggering one or another form of action. This will vary with the person, the environment, the situation or the emotional load, triggering a repetitive behavior that he already experienced initially in his childhood.
The links that the subject establishes in their relationships in the present produce emotions, actions or behaviors, which are the result of reviving old childhood feelings, affections and desires, initially directed towards another person and repressed in the unconscious. This transfer of feelings and emotions is carried out with all the people with whom you interact, with co-workers, with your partner, with the family, with the neighbors, with the doctor or with the psychologist or analyst.
This psychic phenomenon, in which the patient acts in the present by reliving unconscious infantile situations, is what in psychoanalysis we call transference .
Now, in the context of the psychoanalytic relationship, the therapist is not immune to these transference relationships. As the patient relives before the therapist, different roles, depending on the analytic situation, the analyst reacts to the patient with his own transferences. In this way, the analyst can feel aggressiveness, affection, restlessness or endless emotions, during the course of the analysis, motivated by the repetition of their repressed childhood experiences, originally directed at the most representative figures in their environment, and at the moment current projected onto your patient.
This transference of the analyst, which arises during analysis, is what we call countertransference . It is easy to see that it is almost the same definition that we have used when talking about transference. Thus, some authors prefer to speak of cross transfers .
It is vitally important, for the correct progression of psychoanalytic therapy, that the therapist knows how to recognize and analyze the patient’s transferences, since transference analysis is a powerful tool to access unconscious contents. If recognizing the transference and analyzing it properly is important, it is no less important that the therapist knows how to see his countertransference and knows how to channel it so that the analysis progresses properly.
The analyst and his feelings.
El analista debe ser consciente de la transferencia del paciente y de sus propios vínculos afectivos, emocionales y conductuales con el analizado. Debe tener en cuenta en todo momento, que lo no trabajado en el análisis con el paciente durante la consulta, va a aflorar, en ausencia de éste, en su vida cotidiana: “Lo que no se trabaja en el análisis lo vive el paciente fuera de la terapia”.
En este artículo analizaremos la base teórica que sustenta la transferencia y contratransferencia. A efectos de aportar mayor claridad al trabajo veremos primero la transferencia y su evolución conceptual a lo largo de la historia. Posteriormente haremos lo mismo con la contratransferencia, que será tratada en otro artículo.
La transferencia: Antecedentes históricos.
Most authors agree in placing Freud’s discovery of transference in his published study of the Dora case, which we shall see later. However, we can find vestiges of what will end up being the concept of transference in some previous episodes.
The prehistory of the transfer.
Of course, none of these situations meets the requirements that define the transference relationship, but they do reveal Freud’s interest in the special bond that arises between analyst and therapist.
Freud worked in Paris, together with Charcot. There he used hypnotic suggestion as a form of treatment for hysterical patients. Already then he noticed the importance of the therapist-patient relationship while using the suggestive method. He expressed it in the text “Psychic treatment, treatment of the soul” of the year 1890. For him there would be a dependence that is established in the relationship between the physician and the hypnotized. This relationship in Freud’s words “… cannot be counted among the purposes of this therapeutic procedure”.
In 1882, Breuer told Freud about the tortuous end of Anna O’s treatment. The therapy ended the infatuation between the patient and Breuer and the jealousy of his wife. This event was seen as a human episode unrelated to therapy. Even Freud assured his girlfriend and future wife that something like this would never happen to him.
Years later, Freud tried to encourage Breuer to publish the case of Anna O. He encouraged him to overcome the uneasiness caused by the love story. To this end, he confessed that a similar case had also happened to him. Freud considered that this infatuation of the patient with the analyst is typical of hysterical patients.
The Dora case.
It was with the publication of “ Fragmentary analysis of a case of hysteria. Dora Case ”in 1905, when Freud spoke for the first time of the transference. He considered that the interruption of the treatment had been due to aggressive feelings that the patient had towards her father. These feelings would have been projected onto Freud.
In 1900, Freud treated a patient Ida Bauer for three months. This is better known by the pseudonym Dora . Treatment was abruptly interrupted by the patient. From this fact Freud formulated a posteriori the existence of transference feelings.
Dora was brought in by her father, Freud’s former patient. He observed clear neurotic symptoms in Dora. Dora had a cough, asthenia, depression, and chest tightness. The patient had been very fond of her father, but lately he was treating him coldly.
Dora’s father frequented marriage K, and Dora believed that Mrs. K. was her father’s mistress. Mr. K. for his part declared his love for Dora and sexually harassed her. Dora communicated this situation to her father. He did nothing about it, so as not to cloud his relationship with the K marriage. This attitude of the father bothered Dora who felt betrayed by her father.
Freud considered that Dora suffered from a clear case of hysteria. She, who was a cultured girl from a good family, felt belittled by this diagnosis and ended the treatment. Freud understood that Dora’s symptoms were a clear attempt to separate her father from Mrs. K. He assumed that once his goal was achieved, these hysterical symptoms would disappear.
Transfer as an obstacle.
Years later, when analyzing the case, Freud considered that Dora had projected on him the repressed hostility that she felt towards her father (because of the permissiveness she gave to Mr. K.) As a result of this finding, he formulated the existence of the transference. For him the transference was considered as an obstacle that stood in the way of the analytical treatment. It only disappeared when the patient was explained and interpreted.
As on so many other occasions throughout history, an error led to a great discovery. Dora did not interrupt the analysis because of her aggressive transfer to Freud. She did it because she felt unfairly treated, being diagnosed as hysterical. Freud was not able to recognize in his way of acting a negative countertransference towards Dora herself.
The aggressive transfer of the father figure to Freud existed. However, Freud was wrong in not seeing his countertransference as a reason for interrupting therapy. These countertransference phenomena would lead Jung in 1904 to propose to Freud that analysts be previously analyzed .
Freudian concept of transfers.
Freud, in the Dora case, asks what are transfers?
“They are reissues, recreations of emotions and fantasies that as the analysis progresses they cannot help but wake up and become conscious; but what is characteristic of the whole genre is the substitution of a previous person for the person of the doctor. To put it another way: a whole series of previous psychic experiences is not relived as something past, but as a current link with the person of the doctor ”(Freud, S. 1905).
Years later, Freud, compiling his experiences, wrote in “Scheme of psychoanalysis” about the phenomenon of transference:
“The most amazing thing is that the patient sees in the analyst a reincarnation of an important person from his childhood, from his past, and that is why he transfers feelings and reactions to him that undoubtedly referred to that archetype. This fact of the transference soon proves to be a factor of unsuspected significance: on the one hand, an auxiliary resource of irreplaceable value; on the other, a source of serious dangers. ” (Freud, S. 1938).
Freud used as a traditional method of work free association and the interpretation of dreams. In his therapy he suddenly found something very different and that he could not ignore. He found something that could be a valuable work tool or an insurmountable obstacle .
Over the years, Freud reformulated his initial approach to transference. He ended up accepting that the transference is a psychic process that extends outside the therapeutic relationship. This process would manifest itself in many ways in everyday life.
Types of transfer.
Sigmund Freud classifies the transference into two basic types. It is important to recognize them in order not to lose the reins or orientation of the therapy. These two types are:
- The positive transfer. It is the one in which the affections projected towards the psychoanalyst are friendly and pleasant. This transference of a favorable nature, if it becomes too intense, can be harmful (eroticized transference) since it becomes a resistance that entails the end of the associations.
- The negative transfer. It is in which there are feelings of hatred and aversion towards the specialist. For Lacan, a gentle negative transfer is beneficial for the treatment. On the contrary, a strong negative transfer can lead to the end of therapy.
A link between past and present.
In psychoanalysis, transference and countertransference have their origin in the experience that creates a psychic link between the past and the present. This experience does not depend on the social, cultural or educational level of the person. It depends on a specific and individual psycho-neurological response, which makes it different from another in the same circumstances.
The therapist does not escape the bonds formed in the remote or recent past. He also “undergoes” the transfer process. What makes you different from your patient is having the technical knowledge to recognize that transfer and learn to use it. For this, it is necessary to overcome them with the right person (support therapist or didactic psychoanalysis). All of this will be discussed further in the chapter on countertransference.
To start the path of knowledge of the genesis of transference , it can be said, first of all, that it is the way in which the human mind relives situations from the past . We are facing a complex concept of psychoanalysis, which involves the psychic function of the patient who unconsciously transfers his old repressed childhood feelings , affections or wishes (in his relationship with people close to his childhood, parents, siblings and others), and projects them into the present to another person , in this case the therapist.
Extension of the transfer concept.
The classical conception of the transference, initially assumed by Freud, is that it is a mere repetition. Today we know for a fact that this statement is incomplete. It is, in effect, a repetition, but it is a repetition that needs to be activated by the presence of the analyst, a specific analyst. Another analyst could have triggered a completely different response.
Let’s see this in detail. Each person has numerous patterns of relationship with different people in their unconscious. In front of some individuals you may feel attacked, in front of others you may feel seductive, in front of others paranoid and so on in a long series of “film roles”.
In the analysis, each therapist, depending on the moment, can have the patient “interpret” one or the other of these scripts. Freud was right when he spoke of “transfers”, in the plural, since there are many ways in which it can manifest itself. What Freud failed to see is that it was his own figure that activated the different behaviors of the patient.
This means that we are no longer facing a mechanical repetition, and it makes us ask ourselves a question: In the face of a transference phenomenon, how much of that transference depends on the patient and how much is awakened by the figure of the analyst? This question changes the way we view analytic therapy. It is no longer just a matter of observing the patient, but of observing the behavior of the analyst and the patient and seeing how they interact.
Understanding this required the development of what is known as an intersubjective approach . The transference is not only something that the patient has but something that is developed in conjunction with another person. If the patient has a series of organizational schemes or internal relational models, they will be activated in certain circumstances and with certain people.
We should make a reservation to the general rule cited above. In some patients, who present excessive rigidity of character, it does not matter how the analyst acts: The patient has so little spontaneity and flexibility that he always reacts in the same way.
Going deeper into how the patient and the analyst’s transfers interact with each other, we can say that there is a binomial “analyzed analyst” and that these two elements are involved in a type of interrelated game and, therefore, influence each other in a way. reciprocal.
This mutual influence occurs through a dynamic process that leads to the path of creating a unique space, which in some way is conducive to the emergence of a third subjectivity. We can understand the creation of this third space as the result of the intersubjective encounter between the analyst and the analyzed.
Reformulation of the transfer concept.
The successive conceptual reformulations of the transference have brought us some interesting contributions. In the classical conception of transference, the patient relives his past. Today this definition has been surpassed and it is accepted that the patient can not only relive the past, but also the desired that he did not have the opportunity to live in the past. The classic concept is very mechanical: the past is relived as is. What is currently being considered is an extension: some patients do not only relive what they experienced, but what was highly desired for them in their childhood, but never came to be lived .
Sometimes the patient tries to induce the patient to act in a certain way. This was studied by Sandler, who established the concept of role response . For Sandler, sometimes the therapist must respond to the role that the patient tries to drag him into, in order for the therapy to flourish. The concept of role response will be seen more fully in the countertransference chapter.
The transfer to Greenson.
Over the years, the initial concept of transfer has been enriched with the theoretical contributions of various authors. I think the definition of transference proposed by Greenson is worth citing, as it adds a new element. Greenson says that “the transference is living fantasies, feelings, attitudes and defenses towards a person in the present that are not appropriate for that person or situation and that are a repetition of a significant relationship from the past, now displaced into the present.”
We see that this author incorporates a new element “revive defenses.” That is, the patient can not only live repressed fantasies and desires, but can also relive and the defenses that he used in his childhood.
The nature of the defenses that the patient can revive is very varied. A patient may adopt, for example, a kind, condescending, not very assertive attitude, continually conforming to the wishes of the analyst. What does this tell us? Well, it is, neither more nor less, the way in which the subject reacted in childhood to flee from conflict and persecution.
The transference is a resistance to therapy, since as Freud described, it appears when the patient is silent and free associations cease. At that moment the unconscious contents that cannot be verbalized are projected and lived on the therapist. In this sense, it is the best of resistances (transference neurosis), because through it the patient transforms a repressed memory into something present, alive and direct.
Clinical importance of the transfer.
The transfer has a higher value than the story told by the patient. The patient narrates his experiences from the present and always in a subjective and biased way. On the contrary, the behavior shown in the transference allows us to see clearly how the subject lived his life.
This assessment is not irrelevant, since it follows the clinical importance of the transference. In the analysis, the patient can tell us with his narrative what he is like, how he feels or how he acts, but then his words can be denied by his way of living the bond with the therapist. The examination of the transference allows us to see the unconscious automatisms of the analysand, which may differ, on occasions, from his narrative.
Approach to the transfer.
Throughout psychoanalysis, there have been different attitudes when it comes to carrying out the therapeutic approach to transference.
The classical attitude has been to expose the transference through interpretation. For a long time, classical analysts have tried to modify the distortion of the analyst, generated by transference, through interpretation. That is, the analyst explains to the patient that he is mistaking him for his father or mother. He says “this is not with me, this is with dad”, “I am not your father, I am not your mother”.
This classical attitude to expose the transference through interpretation may be useful in some cases, but in other cases it is of little use.
New ways of approach.
In these situations the analyst, instead of interpreting what he is doing is trying to establish a type of relationship that modifies the experience, he tries to favor the bond and the union between the analyst and the analysand.
This is the case of paranoid patients who see the analyst as someone who is always going to question, as someone who is always right, the indication of the paranoid position generates a greater paranoid defense, with which the opposite effect is achieved. In these cases it may be more useful to say something like ” I was thinking again what you said and I think you are right, and I did not take it into account .”
This attitude implies the recognition of error , something that has been ignored for years by classical psychoanalysis. This recognition of errors creates a bond of trust in the relationship between analyst and patient. Interpretation is not the only instrument of change . The therapist’s attitude and what one does can produce exceptional changes. At certain times, what most transforms a patient is the bond of the therapeutic relationship .
The attitude of the analyst.
Another question of considerable importance is the attitude that the analyst shows towards the transference of the patient. Some analysts, with a wrong attitude, can reinforce the patient’s pathology. If we have a very emphatic patient and I as a therapist am very emphatic, I can reinforce the patient’s pathology. The therapist’s attitude can model the patient, either for better or for worse.
With regard to the therapeutic approach to transfer, it is important to take into account the mode of action against the patient’s defenses. On this there are two orientations in psychoanalysis: Some analysts work directly on defense and yet others prefer to work on anxieties first.
The drawback of initially pointing out the defense is that we question the patient without first pointing out the hidden anxiety behind the defense. On the contrary, if we analyze anxiety and anguish first, the patient has the peace of mind of knowing and understanding that his defense is a way of protecting himself and he feels justified in his attitude and is not questioned. As a general rule, it is preferable to show what causes the patient anguish, rather than show him how to defend himself against this anguish.
Performances and “acting out”.
Now, within all the aspects surrounding the transference, the approach to the term “acting out” in its acronym in English deserves a special section. The “acting out “ must be taken into consideration during the analytical treatment, since what is not worked on in the patient-therapist relationship, remains as something not faced, and the patient acts out of the consultation.
What is acting out?
In 1914 Freud published his work “Memory, repetition and elaboration” . There he describes a novel concept for psychoanalysis called “agieren”, which has been translated into English as “acting out”.
Freud describes “acting out” as a way of “repeating” rather than “remembering.” It is “a push to repeat the childhood past in one act, without remembering it.” That is, the subject is not aware of the motives for said act. Through this repetition he relives “repressed emotional experiences of childhood” either with the figure of the analyst or with various aspects of the frame.
In other words, their actions, more than forms of rationally undertaken activity, are repetitions of childhood situations or attempts to put an end to childhood conflicts. They use a real situation, somehow linked, by association, with a repressed conflict, as an opportunity to discharge.
This phenomenon that the patient uses as a repetitive resource, trying to hide the root of the situation that makes him act in this way, is of utmost importance for the psychoanalyst. He must know how to identify and interpret said act in order to make the original problem conscious.
Later, Freud in 1940, expanded the meaning of the term “acting out”. He pointed out that it can appear outside the psychoanalytic setting and outside the transference. This caused the term “acting out” to become popular. It was used to define “any inappropriate, disruptive and unexpected behavior” that the patient could present, inside and outside the analytical setting.
If the analyst does not detect and analyze, for example, the suffering of the patient, he can act outside the consultation and experience what he has not worked on inside. In 2014, in his ” University specialist course in clinical and psychotherapy “, in the chapter on transference, Bleichmar points out:
“ What is not elaborated with the therapist, is acted out. The dialectical fight that was not had with the therapist, ends up being outside ”.
What happens in the session is as important to the analyst as it is outside it. Sometimes, what the patient keeps silent and omits in the session he acts outside. At other times, the impotence that the patient has in his daily life makes him come to therapy and work it out with the analyst.
It is interesting to highlight a point: if someone is in different contexts or settings (for example, therapy / daily life, or work / couple), what cannot be achieved in one setting is about achieving in the other by acting : if at work they feel harassed, in the couple will be a stalker. Thus, it is not only the past, but also the present that determines behavior.
Alexa Clark specializes in Cognitive Behavioral Therapy. She has experience in listening and welcoming in Individual Therapy and Couples Therapy. It meets demands such as generalized anxiety, professional, love and family conflicts, stress, depression, sexual dysfunction, grief, and adolescents from 15 years of age. Over the years, She felt the need to conduct the psychotherapy sessions with subtlety since She understands that the psychologist acts as a facilitator of self-understanding and self-acceptance, valuing each person's respect, uniqueness, and acceptance.