The therapeutic relationship is designed to serve as a corrective attachment and a relational laboratory in which projections, expectations and wishes emerge.
It is the quality of this therapeutic alliance, which largely determines clinical outcomes.
Hypothetically, the greater the collaborative bond, the more likely successful processing of primal projections and provocations will occur.
Ideally, this offers the therapist and patient a satisfying, feeling of empathetic connection and resolve. Yet often these episodes are transient, and the clinician is unexpectedly blindsided by a defamatory email invalidating the therapeutic alliance and in some cases, even abruptly terminating treatment. Here one grasps that the vicissitudes of a negative transference has taken root.
Most clinicians who do psychodynamic work have experienced the excruciating foreboding of being on the receiving end of a suspicious, enraged client, who is primed to unleash their rancor in session.
The most seasoned therapists brace themselves for this turbulent ride, steeped in traumatic betrayal and deeply rooted underlying wishes and needs.
Successfully navigating vilifying projections and demanding expectations is no easy feat. Undertaking the task of distinguishing appropriate feelings of justifiable anger and disappointment from transference/counter-transference requires insight, patience and humility from both therapist and patient.
Transference, coined by Sigmund Freud, construes the unconscious recreation of formative dynamics and expectations within the context of the therapist-patient dyad. In turn, counter-transference pertains to the therapist’s visceral and emotional response to the patient’s conscious and unconscious provocations.
Additionally, the therapist’s personal history dynamically influences the experience of the client and the therapeutic relationship. Teasing out the unresolved unconscious material impacting transference/counter-transference is one of the primary goals in psychodynamic therapy.
When contemptible bad self-representations are brought into the therapeutic milieu, the traumatized patient may project that ‘badness’ onto the therapist in an attempt to destroy the hated object.
Unconscious collusion with these projections creates a malignant trap in which the therapist becomes the abusive parent.
To not succumb to these projections, the therapist must know with conviction what belongs to the patient’s psyche and what is an elemental aspect of her own personality.
This task is particularly complex often because the potency of the projections creates dissonance in the therapist. Furthermore, the therapist may feel ‘wronged’ by the devaluation and unwittingly collude in the projections by acting from a place of anger and anxiety.
While returning to reality based self-other representations and a positive love infused therapeutic collaboration is critical to harnessing the potential healing within the negative transference, moving from a primordial quagmire of hate to a more manageable reflective state is indeed challenging.
One must evoke and insightfully confront, explore and interpret the bad object relationship while remaining mindfully careful to not personify it.
In service to the integrity of the therapeutic process, the therapist must manage the overwhelming feelings evoked by devaluation and rage-filled projections and help bring into consciousness patterns of deep conflict, seeking resolution.
In “Negotiating the Therapeutic Alliance,” Jeremy Safran and Christopher Muran suggest that ruptures in the therapeutic alliance may present the richest-opportunities for therapeutic growth. Ultimately, how therapist and client confront such ruptures will likely determine either a therapeutic impasse or a renewed dedication to, and a deepening of the therapeutic process,
Therapy session photo available from Shutterstock