Transference in therapy

You may have come across the notion of transference, which is a psychoanalytical notion in which someone takes their feelings about one person and transfers them to someone else. The original theory focussed primarily on a client’s relationship with their parents, and how they projected that into the therapeutic relationship. But it can be useful (unless you are working from a strictly psychoanalytical perspective) to broaden this to include other people as well, and even objects. 

It’s said that when Walt Disney was looking for an actress to be the voice of Snow White, he made candidates sing from behind a screen, so he wasn't influenced by whether or not they looked like the character. In some ways, this is a conscious attempt to avoid transference. However, as it's generally an unconscious process, we are usually not aware of making these assumptions, let alone of where they come from. We just know that we have a liking (or dislike) for someone that we meet, something we might call a ‘gut feeling’. But if we look closer, we might find that the new acquaintance reminds us in some (perhaps subtle) way of our best friend or a nasty neighbour, and that this is influencing the way we respond to them.

Transference in therapy

Within the therapeutic relationship, the term transference is generally used about a client transferring their feelings to the therapist. 

Sometimes, especially if a client is referred by an employer or GP, they don’t get much say in who becomes their therapist. But most hypnotherapy clients have complete freedom of choice in who they see. True, factors like geography, your working hours, and even price will factor into this but once they have a short-list, they choose you based on what you say and how you say it, on your website for example. Or perhaps even because they like your photo. 

Here’s a brief experiment for you to try. Go to the Hypnotherapy Directory and search for therapists in a town that’s far from where you live (so you are less likely to know any of them). Ignore the words, and scan quickly down the list of photos as if you were a potential client – which person would you be inclined to go and see? Would you rule any out, based entirely on their photo?

Now read the introductions, does that change your mind?

When you have narrowed your choice down to a couple of people ask yourself these questions…

• Does this person remind me in any way of someone significant in my life, especially someone who was important to me when I was a child?
   
• If yes: who is that person? Am I responding to the therapist as if they will be like that person?
   
• If no: are they the opposite of someone significant in my life, especially someone important to me as a child? Do they seem to be the way I would have liked that person to be?
   

This is brief and not very scientific, of course, but your answers might give you some insight into transference. And some tips about what sort of photo you need on your website!

Anyhow, remember that clients are going through this process with your online presence all the time. For the ones who pick up the phone, something in their perception of you attracts them, and it may be because you remind them of someone else who helped them, or who was a friend or a trusted authority figure. Or you may find that a client who a difficult relationship with (for example) a parent or teacher would choose someone they think is going to be completely different. 

Any of these responses would be transference. And once you meet and begin to work together this can become stronger (or not, depending on whether you meet their expectations). As a caring therapist, you may be the only person in the client's life who is supportive and non-critical or, in a more practical way, their only social contact. 

In part because of this, transference is a normal part of the therapeutic relationship and it may result in a client experiencing a 'crush' or sexual attraction, mistrust, anger, over-dependence, over-compliance, and many other feelings towards the therapist. Psychodynamic therapists often use transference to identify unresolved unconscious feelings and conflicts, and they consider it a normal part of any therapeutic journey. Therapists who do not follow the psychodynamic approach must still be aware of the possibility that some of the stages of healing through which the client passes may involve transference.

Transference and Projection

Since we’re talking psychodynamics here, you might have come across the concept of ‘ego defence mechanisms’ - broadly these are the different tools that the unconscious mind uses to try to protect the self. They include projection, which is assuming that other people share your view of something. 

Both transference and projection involve assuming what the other person is thinking, or what they are like, but there are differences. 

Projection is assuming the other person feels and thinks the same way you do. For example, a bully might think their victim is inadequate or vulnerable because this is the way they feel themselves. 

Transference is assuming that, because they remind you in one way of a person you know, they are like them in all ways. For example, your new boss looks like someone who bullied you at school so you assume they will also be a bully.

Countertransference

Counter-transference is a similar process but it works the other way, when the therapist transfers some of their own preconceptions or issues onto the client. For example, we may 'like' some clients more than others or feel it‘s easier to empathise with them. It’s not very politically correct to say this, but it’s an inevitable part of being human. Perhaps they remind us of someone we already know and are fond of, or perhaps they share similar interests or attitudes to ourselves. 

Equally, they may remind us of someone we dislike or find overbearing, or their situation somehow echoes the events and feelings we are experiencing ourselves. Then we may find ourselves dreading their appointments or avoiding discussing certain aspects of their situation. 

Counter-transference can lead to blurred boundaries and inappropriate self-disclosure, complicity in continuing the client's maladaptive behaviours (because we share them), difficulty in ending therapy, and the breakdown of the therapeutic relationship.

If you feel from the get-go that you will find it difficult to work with a client, you should refer them on instead of working with them. There is nothing to stop you doing this, unless you always refuse to work with a particular group of people who are protected by anti-discrimination law. (There’s a whole discussion on this aspect of things, based on wanting to work only with female clients, in The Hypnotherapist’s Companion, if you want to know more about the legal situation.) Assuming it’s the individual client, though, rather than a class of clients, I’d say trust your gut, it’s your unconscious mind telling you something important.

What if transference or counter-transference becomes a problem after therapy has started?

The direct approach is often the best one, if your concerns are expressed constructively, with specific examples, and not as a personal attack. 'It feels as if you sometimes think I'm being unsupportive when I ask you to come up with your own solutions to the situations we talk about in therapy. There was an example a few minutes ago when I asked how you would like to deal with your cravings. If so, I want to make it clear that that isn’t my intention, and maybe work out why it seems that way. How would you like to approach that?'

You also, of course, need to be honest with yourself about your own responses to what your client is doing or failing to do. It might be annoying that the client wants you to wave a magic wand, or tempting to provide the ‘right’ answers. (If that last is a big temptation for you, you might like to check out my earlier blog, on whether therapists should give advice around now.)  

Either way, self-awareness and reflective practice are important, as is asking questions like

• Is this response my usual one?
   
• Does this client remind me of anyone else?
   
• Do I have any particular feelings towards them?
   
• Do I feel differently about this client than about others? If so, how?
   
• Are my feelings affecting the way I work with this client?

Transference and counter-transference are unconscious mechanisms and cannot be avoided, but if they are recognised it's possible to reduce or remove any negative or restrictive impact they have on your relationship with clients. You may even be able to use them constructively to improve progress.

References

Holans, Kimberley. (2019). Transference: What It Means and How It May Be Used in Therapy. [online] Available at: https://www.healthline.com/health/mental-health/transference#different-than-projection. [accessed 10.1.21]

Waller, D. (2016) Their Worlds, Your Words. Jaloba Publishing: UK.

----------------------------

 

Author: Debbie Waller is an experienced hypnotherapist and hypnotherapy trainer. She is the author of The Hypnotherapist's Companion and Their Worlds, Your Words, and a co-writer of the Hypnotherapy Handbook, all of which are available from Amazon.
Find out more about Debbie's services on
Yorkshire Hypnotherapy Training - multi accredited hypnotherapy practitioner training, taster days, and foundation levels.
CPD Expert - accredited CPD and other therapy training (online and workshops options), expert and qualified hypnotherapy supervision