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In the Re-enactment between Belle and the Therapist, there is a Destructive Aspect at play. How might you understand this in terms of the Client’s early history?
It has been well-known and indicated explicitly by research that the therapeutic relationships are highly essential with regards to influencing the outcomes from the counselling of any particular therapy patient (Gomez, 1997). However, it must fundamentally be recognized that the scope of research illustrating the manner in which the therapeutic relationship occurs is still quite unclear. The major purpose of this paper will be to demonstrate a concrete comprehension of the transference dynamic and the manner in which it holds the early history of the client and the deficits noted in object relating. As such, the paper will also utilize a case study from a therapeutic patient, Belle, who while undergoing therapy, would hold back her earlier history.
Within a review of numerous, discrete articles concerning psychotherapy, it is suggested that therapeutic relationship is highly essential in determining whether the outcome of the therapy would be prospectively successful or unsuccessful (Thompson, 1995). Albeit distinctive therapies may be utilized in the treatment of patients, it is also suggested that majorly, the kind of responses given to either a therapist by a patient or vice versa may essentially determine the treatment’s outcome (Jacobs, 2004; King and O’Brien, 2011).
The transference technical construct has for long been utilized within psychotherapy processes such as psychoanalysis (King and O’Brien, 2011). Its opposite is countertransference. Both the duo are largely related to the kinds of feelings that may exist between a patient and the psychotherapist (Worden, 2009). Transference would normally be associated with negative feelings between the patient and the therapist whereas the positive feelings are usually associated with countertransference (Worden, 2009). However, it is significantly faulty to utilize the terms negative as well as positive within the scope of the technical constructs of transference and countertransference.
Tracing the history affiliated to transference may be of humongous benefit in really understanding what it may really means in therapy (Malan, 1995). When the term transference first emerged, it has largely been utilized in reference to a certain resistance that is witnessed during the process of therapy (King and O’Brien, 2011).
According to King and O’Brien (2011), “Freud thought that neurosis was largely a function of the repression of unacceptable ideas and impulses, and it would be natural for clients to resist the emergence of these ideas during the course of therapy” (p.13). During times of therapy, the patients would bring up any diversionary tactics so as to avert the repressive thoughts that would overwhelm their minds.
It is definite that the psychotherapist is responsible for making such repressive thoughts arise since their interactions with the patients may act as incentives in bringing up thoughts that are unwelcomed within the patient’s mind. It is such actions concerned with the bringing up of diversionary tactics as seen among the patients that largely bring about the resistance that is defined as transference (Kahn, 1997).
However, the resistance portrayed by patients may not wholly or solely be in regard to negative factors. As such, “this resistance could be served almost equally well by hostility (negative transference) or love (positive transference)” (King and O’Brien, 2011, p.13). In simple, transference is only a resistance that is portrayed by the patient towards a topic or question brought up or inquired by the therapist which they may deem uncomfortable.
It has been misinterpreted by various therapists that they are largely responsible for the transference that is portrayed by the patients they treat. However, this is not always the case. In a majority of situations, the figure that may compel the patient in resisting therapy is not the therapist who brings about the uncomfortable topic but rather, someone who is pivotal in the kind of topic that is brought up (Kahn, 1997). Perhaps, these may probably be the people at the centre of why the patients are undergoing psychotherapy in the first place (Kahn, 1997; King and O’Brien, 2011).
An appropriate case to utilize in understanding the transference dynamic is that of Belle which is illustrated in Susie Orbach’s The Impossibility of Sex: Stories of the Intimate Relationship between Therapist and Client. In this case, Belle seeks therapeutic assistance from a therapist whom she believed could have handed her a fast resolve for the numerous impediments that had confronted her rough life.
When Belle goes into the office, she amazingly begins narrating all the emergencies she had been in confrontation with previously. However, this makes the therapist suspicious and decides to instead, engage Belle therapeutically first. She suggests; “This was not an act of truculence on my part but a sense that there was something to be got hold of about her process of lurching from one dramatic emergency to another” (Orbach, 2005). According to Wampold (2013), the therapist behind any therapeutic session is more fundamental in ensuring that the therapy’s outcomes are largely effective. In Belle’s case therefore, the therapist was of the idea that she first had to bring up “a flavour of therapeutic engagement” (Orbach, 2005).
Belle’s trait of lurching from one of the emergencies she had previously confronted to another is thus, an explicit instance of the diversionary tactics that a therapeutic patient may frequently adopt for the purposes of holding back any negative or emotional occurrences concerned with the past which they had underwent.
Furthermore, when the therapist notices the drastic change of trust which Belle had first given unto her, she resolves to blame herself that perhaps, she really was not providing the help that her client required (Orbach, 2005). This similarly drives the notion that is largely held by numerous therapists that they are often responsible for the poor therapeutic presence between them and their clients.
Therapeutic presence is primarily “defined as bringing one’s whole self into the encounter with clients, by being completely in the moment on multiple levels: physically, emotionally, cognitively, and spiritually” ([Geller & Greenberg, 2002] as cited in Geller, Greenberg, and Watson, 2008, p.599). The therapist’s reaction to Belle may be termed as holding neutrality. However, Callaghan (1996) suggests that in therapy, neutrality should not be portrayed since it ruins the intrapersonal relationship that was to be created between a therapeutic patient and the therapists themselves. More often, therapeutic neutrality has been misinterpreted from what had initially been referred to by Freud.
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According to King and O’Brien (2011), “Freud’s position was that therapeutic neutrality meant that emotional responses to the therapist were likely to be transferential” (p.14). They thus, suggest that neutrality as portrayed by the therapist is a myth and has for a long time, been the major incentive towards poor patient-therapist relationships which compel the patient to hold back information affiliated to their past.
When Belle went back for therapy the next day, it was apparent that she was now willing and had gained the courage to open up to herself as well as the therapist. “She was starting to reach for something different – the potential to open up to herself, reflect, understand” (Orbach, 2005). From the actions she portrayed during the following therapeutic session, it was quite explicit that she had previously been holding back on some of her past events.
It later also appears that the numerous emergencies that had been created by Belle was simply a way to find solace and run away from the issues that had been at stake (Orbach, 2005). Belle’s major therapeutic challenges came about as a result of the fact that her family life had not been quite appropriate or that anyone could have wished for. Her father was always distanced from them whereas her mother was perhaps a “difficult character” (Orbach, 2005).
Belle’s childhood case may explicitly be well understood through the use of the “good enough mother” theory by Winnicott. It is suggested that at the time of a child’s infancy, numerous things – both good and bad, whose ranges are well-outside the infant’s abilities take place. The major incentive or determinants on whether these occurrences would either be good or bad centrally lies in the maternal care offered to the infant (Gomez, 1997).
Winnicott (1960) suggests that “The ego support of the maternal care enables the infant to live and develop in spite of his being not yet able to control, or to feel responsible for, what is good and bad in the environment” (p.585). It is also suggested that the infant’s earliest events are rarely forgotten and quite often, would manifest themselves in later stages. Thus, since Belle had confronted an extremely rough past, the past experiences had not faded away but were manifesting themselves in her later years.
Belle’s siblings had also been frequently further apart from her. Hence, her mother had been her only hope. However, she proved to be quite unreliable. The therapist decocted that perhaps, the unfortunate incidences and the poor family life that Belle had come into confrontation with may have had been the major driving factors behind the therapy that she had been undergoing at the time.
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In summary, from Belle’s case study, her first impressions during the earliest therapy session had been treacherous and filled with lies. It is therefore, definite, as concluded by the therapist too, that her past life had significantly resulted to this and as such, Belle had been fearful of evoking the past experiences she had seen from her family life. From Belle’ case, it may therefore be seen that the transference dynamic would often be motivated by something that had taken place within the patient’s past life and recalling such events meant tremendous harm.
For any therapist seeking to effect satisfactory outcomes among their patients, it is essential that a solid understanding of the transference dynamic is made. The transference dynamic, as shown in this paper, is important in the sense that it deconstructs the numerous fallacies and jargon that has surrounded therapeutic treatment. Therefore, all aspects concerning it have been comprehensively outlined for a clearer understanding among any given audiences.
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- Geller, S. M., Greenberg, L. S., & Watson, J. C. (2010). Therapist and client perceptions of therapeutic presence: The development of a measure. Psychotherapy Research, 20(5), 599-610.
- Gomez, L. (1997). An introduction to object relations. NYU Press.
- Jacobs, Michael. (2004 3rd ed.). Psychodynamic Counselling in Action. London. Sage.
- Kahn, Michael. (1997). Between Therapist and Client. New York. Holt.
- King, R., & O’Brien, T. (2011). Transference and countertransference: Opportunities and risks as two technical constructs migrate beyond their psychoanalytic homeland. Psychotherapy in Australia, 17(4), 12.
- Malan, David.(1995). Individual Psychotherapy and the Science of Psychodynamics.London. Butterworth.
- Orbach, S. (2005). The Impossibility of Sex: Stories of the Intimate Relationship Between Therapist and Client. Karnac Books.
- Thompson, C. (2003). Clients’ perceptions of the therapeutic relationship and its role in outcome (Doctoral dissertation, Lethbridge, Alta.: University of Lethbridge, Faculty of Education, 2003).
- Wampold, B. E. (2013). Qualities and actions of effective therapists. Research suggests that certain psychotherapist characteristics are key to successful treatment. APA Education Directorate.
- Worden, William. Grief Counselling and Grief Therapy. London. Routledge