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The labor alliance, transfer and countertransference in psychoanalysis

The labor alliance, transfer and countertransference in psychoanalysis

Psychoanalytic psychotherapies are basically processes that run on the emotions and feelings of the participants (patients and therapists). The psychoanalytic theory and technique give us the theoretical and technical instruments to try to better understand these feelings, it is true; but what we want to underline here is that the "raw material" with which one works in psychoanalytic psychotherapies are, neither more nor less, the feelings and affections (conscious and unconscious).

Content

  • 1 The psychoanalytic setting
  • 2 The work alliance
  • 3 The transfer
  • 4 The countertransference

The framing or setting psychoanalytic

In addition to the practical aspects that are formalized in the "therapeutic contract" (duration of the sessions, punctuality, vacations, fees, etc.), there is a problem that affects the therapist exclusively, the internal framing. Is about the need for the therapist to have internal conditions that allow him to understand and be willing to help his patients in a prolonged way. This aspect can only be achieved through personal analysis or psychotherapy. Personal treatment makes it possible to better understand oneself and, therefore, to better understand others, allows experience the countertransference that every patient provokes with the necessary neutrality and, instead of acting the - turning it into action -, use it for the benefit of the patient.

Work alliance

Although it is undeniable that in everyone's mood nests the desire to overcome the symptoms or experiences that have led the patient to the consultation, patient and therapist should be able to submit this desire to the requirements of the therapeutic method. The main axis of the psychoanalytic method is not precisely the direct and rapid approach of these afflictions, but the establishment of a therapist / patient relationship that allows a certain deployment (more or less taking into account the technique to apply) of the latter's psyche, For your analysis and understanding.

How can we define the work alliance?

Many definitions have been offered for this concept, but in general we will say that it is about the capacity of collaboration to which the therapist and the patient are able to reach to work together For the primary objective of all psychoanalytic psychotherapy: research (to a greater or lesser degree) on the mental functioning of the patient. In other words, therapist and patient agree on what they want to do. These ideas were already present in the clinical situations that Freud addressed at the end of the last century, when he said that his method was "inapplicable without the full collaboration and voluntary care of the patient."

Anyway, it should be stressed that the labor alliance does not "agree" in a single session And once and for all. It is a constant process throughout much of psychotherapy Psychoanalytic, although there is no doubt, its bases are established at the beginning of treatment.

The transference

"The first object love, the first object hatred are, then, the root and model of any subsequent transfer that is not a characteristic of neurosis, but the exaggeration of a normal mental process. "Ferenczi, S. (1909). Transfer and introjection. To Complete Works. Madrid: Espasa Calpe.

What is the transfer?

A look at any dictionary will show us that in common language (non-technical) transfer is "the act of transfer", and transfer is to pass or carry something from one place to another. And in that, precisely, lies the activity of the transfer, to transfer certain emotions, experiences, reactions, etc. from one place to another, from one time (past) to another (present) in the future of the vital course. The idea, then, is that when the transfer occurs a person is placed in his present in a very mediated way by his past. In this sense, the concept of transfer describes something that, in itself, is quite obvious: it is impossible to live without the constant influence of history itself. Therefore, in our current vital moment, in the here and now, there is always a subtle - but active - combination of "real" elements and previously lived elements. Thus, the main ideas of transfer in therapy would be:

  • The transfer is a universal phenomenon, occurs worldwide and in every situation.
  • The transfer is based on the premise that, by definition, always keep some of what you have lived or have "been" before.
  • The transfer entails an overlap of past situations to current situations; so, these last they are more or less deformed according to this overlap.
  • If the above points are true, there will always be transfer in all human relationships and, therefore, also in the relationship that therapist and patient establish in the practice of any form of psychoanalytic psychotherapy.

The transfer and especially its analysis (observation, understanding and interpretation) will be the best vehicles for the study of the psychic functioning of the patient. Therefore, it will be the most important phenomenon in the main forms of treatment that derive from psychoanalysis: psychoanalysis itself and psychoanalytic psychotherapy.

A scheme that can be useful to understand the phenomenon of transfer is that presented by Malan (1979) when he talks about what he calls the conflict triangle and the relationship triangle.

Example of transfer in psychoanalysis

Here is an example in which the transfer attitude stains the patient's relationship with the therapist from the beginning:

It is a woman, Mrs. E., twenty-four and four years old, who lives tormented by an endless series of intense anxieties, changes in mood, feelings of emptiness, doubts about identity and sexual orientation, conflicting relationships with their supporters, etc. He complains, already in the first interview, of having received very little affection from his mother and inadequate attention as a child. Its entire existence is marked, then, by the claim that they do not give enough. This attitude is presented immediately in the first interview with the therapist. When he, after a 60-minute interview, makes a brief summary of everything that has been said and invites her to attend a second visit, the patient responds:

P: Ah! But I would have to explain something else ... I can't go like this. What I do? Tell me something ... I thought you would give me some advice or something. Can't you help me anymore? Haven't you seen that I need a lot? Will it always be like this? If only I have spoken ...

In this example, the patient comes to take the therapist as a mother figure that is expected even if she receives little. Its more adult aspects, which would indicate that it is impossible to resolve in 60 minutes all its symptoms and difficulties, are collapsed by the repetition of the experience of abandonment, and the subsequent hostile and complaining reaction of the patient towards the people of whom It feels dependent. Thus, in an almost instantaneous way, the patient lives the therapist as a mother who does not take care of her properly, gives her little and leaves her without taking into account the needs of her little girl.

Countertransference

According to Eskelinen (1981), we understand by countertransference the set of emotional responses of the therapist to the communications of his patient.

What is countertransference?

These emotional therapist responses are your most faithful ally to understand, "capture" and be able to analyze the transfer of your patient. This is the same as saying that it is thanks, in part, to the countertransference that the therapist can help his patient. A therapist without countertransference would be a situation as strange as that of a mother who does not respond emotionally to her baby (a situation that, if given, is of enormous mental and physical "toxicity" for the baby).

We could summarize this idea with a kind of equation that would be represented as follows: "manifest feelings (of the patient) +" observed feelings "(those of the same therapist, who observes and studies himself) = therapist willing to understand and help Only then is the therapist a human being who helps, and not a "robot" that mechanically interprets what his patient tells him.

Now, once things have been posed in this way, the question that arises is obvious: how do you get that the therapist's emotional response to your patient is not influenced excessively by the therapist's personal experiences and unresolved conflicts? The therapist should observe your countertransference; to be able to separate which aspects belong to him as a person and which have arisen in response to the patient's listening. For this, it will have two fundamental resources: its personal treatment and the supervision of therapeutic work with a more experienced professional. If, through personal treatment, the therapist has been able to observe and, in some way, resolve their childhood conflicts, this will help this desirable "objectivity" of countertransference. With supervision, you will be able to perceive the nuances of patient communication that have escaped your understanding and better outline your interventions, direction and purpose of the treatment.

Example of countertransference in psychoanalysis

We will give an example of the good use of countertransference:

In the sessions with Mrs. D (a young woman who had suffered anorexia during her puberty and attended the consultation after an acute, seemingly unmotivated alcohol intoxication, which alarmed her relatives), the therapist felt, for a certain time, very comfortable It is a collaborating patient, who associates and seems very motivated to investigate her psyche. But as the treatment progresses the therapist has a vague sense of futility and, later, boredom, although the patient's behavior to the consultation has varied little. The therapist then has the feeling that in that treatment "nothing happens", curiously before a person to whom "so many things" had happened. With the help of supervision the therapist could point out the following:

T: It seems to me that for some time you have made a considerable effort to soften your treatment. It seems that it is difficult for us to see other aspects that are more conflictive or complex ..., as if nothing happened, as happened with alcohol consumption that time ..., which seemed to be "for nothing" ...

Q: (Surprise) Yes ... I think so ... in fact I come here with a prepared topic, already thought out, and as everywhere I can hardly talk about myself, about my things ...

T: And it seems that it is difficult for her to find her feelings, the things that really move her, as if inside she might find herself empty or something similar ...

Q: Yes ... sometimes it seems to me that I know very little, I do things a little "just because" or even as if I give myself a role in a play or a movie ..., and I just believed the movie . Sometimes I see myself doing something without knowing very well how, I get in and point.

Now the therapist's countertransferential response (feeling of futility and boredom in a patient who superficially seemed to be very active in the treatment) becomes more understandable. What at first seemed to be a true display of his personality was no more than a theater piece repeated to satiety, little alive, destined to distract the therapist and herself from her true feelings of emptiness and futility. Thus, behind the scenes of the stage there was a personality impoverished by the lack of contact with their feelings and overcompensated in an action "as if". In this case, the therapist's countertransference helped to profile the patient's problems and turn the treatment around.

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