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Wednesday, November 10, 2010

Psychotherapy and the Positive Transference

In my last blog article, I discussed the erotic transference in psychotherapy. I also discussed the the overall meaning of transference in psychotherapy as well as transference in our daily lives outside of therapy sessions. In this blog post I will focus on the idealized transference in psychotherapy and how it can enhance treatment in many cases.

What is the Idealized Transference in Everyday Life?
As with the erotic transference, most of us have experienced the idealized transference at some point in our lives. Examples of the idealized transference would include the idealization that a student might feel for a favorite teacher, a church member's idealization of a minister, or a young person's idealization of a political candidate (e.g., John F. Kennedy in the 1960s or Barack Obama in the last presidential election).

As with any idealization, there is usually some distortion with the idealized transference because no one can be perfect, ideal or even very good 100% of the time. There are bound to be times when the person who is being idealized will be off the mark. Depending upon the strength of the idealization and how much the person feels the need to put the idealized person on a pedestal, he or she will often rationalize the idealized person's mistakes in order to maintain this person on the pedestal.

Psychotherapy and the Positive Transference

What is the Idealized Transference in Psychotherapy?
Similar to any idealization, the idealized transference is usually more about the client's need to see the therapist as being all good or all powerful or always right, especially if the client is coming to treatment with a history of abuse or neglect or feelings of low self worth about him or herself.

How Does the Idealized Transference Form in Psychotherapy?
Every experience of the idealized transference will be different. Very often, if the psychotherapist maintains good boundaries, the client often doesn't know very much about the therapist, especially at the beginning of treatment. If the therapist is empathic and caring, he or she will provide a safe emotional "holding environment" for the client. All of this increases the likelihood that the client will develop a positive transference (he or she has good feelings about the therapist and the work they are doing together) and, in many cases, will idealize the therapist.

No matter how non-hierarchical or egalitarian the therapist is in treatment, there is still a power differential between therapist and client with the therapist being in the more powerful position. This occurs, in part, because the therapist sets and maintains the treatment frame with regard to time and fees. It also occurs because the therapist is considered "the expert" that the client comes to see. All of this feeds into the transference, whether the transference is positive, negative, eroticized or idealized.

This is not a matter of therapists creating the idealized transference and pretending that they're something that they're not. In fact, if therapists did this, in most cases, it would be counterproductive because most clients would see through any deliberate efforts to create an idealized transference. And in the particular case of a narcissistic therapist, who might actually believe in his or her perfection or an idealized self, most clients would sense the inauthenticity of this as well.

Rather, when the idealized transference occurs, it's usually a naturally-occurring phenomenon that stems from the client's need to idealize the therapist, often without even realizing it.

As discussed in my previous blog article, transference can form quickly, especially if a client is coming for multiple sessions per week, and the client is emotionally vulnerable and has the need to be with a therapist who is "perfect." For many clients, having someone that listens intently to them and is empathic might be a new and much-needed experience.

There are many issues that can affect transference, including treatment ruptures, where the therapist unintentionally makes a mistake that might be hurtful. These ruptures can usually be repaired if the therapist is willing to admit that he or she made a mistake. Often, it the rupture is handled well by the therapist, this can strengthen the therapeutic alliance between client and therapist, especially if the client grew up in an environment where the parents were unable to acknowledge mistakes. However, treatment ruptures is a topic for a future blog post.

What Are the Advantages of the Idealized Transference in Psychotherapy?If we think of psychotherapy as being a treatment with a beginning, middle and end phases, the idealized transference usually forms at the beginning and/or middle stages of treatment.

This is a period of time, if treatment is going well, when clients often internalize their therapists to the point where, even outside treatment sessions, when faced with problems or decisions, clients can ask themselves, "What would my therapist say about this?" At that point, the therapist becomes a sort of auxiliary mind that the client can call upon internally for support and wisdom. This is a normal, natural part of treatment when it's going well.

Being able to internalize the idealized therapist usually allows clients to make positive changes in their lives.

The following fictionalized scenario, which is a composite and not about any one client, will illustrate these points:

Ted:
Ted was in his early 30s when he began attending psychotherapy for longstanding depression. His feelings of low self worth kept Ted from excelling in a career, and he was unable to form intimate, romantic relationships with women.

For years, Ted tried reading self-help books and going to workshops to overcome his depression, but nothing helped, and he knew now that he couldn't change his depression on his own.

Ted had never attended psychotherapy before, so he didn't know what to expect, and he felt anxious and ambivalent on the day of his first appointment. He almost cancelled the appointment, but he knew that he couldn't manage his feelings of low self worth on his own any more. In the past, he rationalized to himself that he didn't need therapy because he never felt suicidal so, in his mind, his depression wasn't so bad. But as time passed and he continued to feel stuck in his life, he knew he needed professional help.

During his first session, he was surprised that he actually felt comfortable and he was able to talk relatively easily to the therapist. He liked the therapist and also felt very comfortable in the office. He discussed his family history, including how depressed and anxious his parents were when he was growing up. He also talked about how critical his father was and how his father made him feel that he couldn't do anything right. He knew that his parents did the best that they could but, as an only child, he felt alone and lonely. He excelled at school, hoping to get his parents' love and approval, but they were too preoccupied with their own lives to pay attention to Ted.

By the time Ted went away to college, he went from being a "straight A" student in high school to being an average student in college. He had given up trying to please his parents, and he had such a poor sense of self that he didn't care about how he performed in college. He also felt socially inept, so he hardly attended any social activities. And when he did, he felt awkward and shy. He dated a few women, who took the initiative of asking him out, but nothing ever came of these dating relationships.

After Ted graduated college with a major in psychology, he took the first job that he could find as a sales clerk in a clothing store. He was bored and, on some level, he knew that he was underemployed, but he lacked the self confidence to get a job that was commensurate with his education.

Ted had a few close friends, but he had not dated anyone in over a year, and he felt lonely.

After he was in therapy for a couple of months, Ted began to admire his therapist. He really liked that his therapist listened to him attentively and that he was also so empathic with Ted and seemed to understand him. Ted had never experienced this before. He felt that his therapist cared about him, and he looked forward to his sessions.

Ted imagined that his therapist was everything that Ted was not. He didn't know anything about his therapist's personal life because they focused on Ted in their sessions, but he imagined that his therapist was happy in a relationship and successful in his private practice. He imagined that his therapist was everything that Ted wanted to be in his own life.

Without realizing it, Ted began to change the way that he dressed so that it was similar to his therapist's appearance.

He also liked looking at his therapist's book shelves, and he was fascinated by all the psychology books. Ted used to enjoy reading psychology but, other than self-help books, he stopped reading scholarly psychology books. But when he noticed his therapist's books, he felt more curious and open again, and he started taking out these same books from the library, and this re-ignited his interest in psychology.

Whenever he encountered problems outside of treatment, Ted asked himself what his therapist might say. And, when he spoke to friends, he often spoke highly of his therapist to them.

Step by step, Ted began making changes in his life. After about six months, Ted began to feel a sense of optimism again. He was beginning to see a glimmer of a possible future for himself. He began having thoughts about going to graduate school for psychology or clinical social work. Just having these thoughts was surprising to him. This was the beginning of an upward spiral for Ted.

As he talked to his therapist about his thoughts about going to graduate school, his therapist encouraged him to explore various possibilities. Ted began to fantasize that he might have his own psychotherapy private practice one day.

About a year later, Ted began attending social work graduate school. He continued in therapy and he often spoke to his therapist about his internship. It was during this internship that Ted realized that he didn't like seeing clients one-on-one as much as he had anticipated.

This was a surprising disappointment to him. He discovered that he really liked his community organizing classes. There seemed to be two primary groups at his university, those who wanted to go into psychotherapy private practice and those who were passionate about community organizing.

Ted began forming friendships with the students who wanted to be community organizers. He liked their ideas and their passion. He also felt that he could help many more people if he became a community organizer than if he became a psychotherapist and worked with people one-on-one.

This made him wonder why his therapist became a psychotherapist and not a community organizer. It was the first time that Ted began to have some doubts as to whether he wanted to be just like his therapist (or as he imagined his therapist to be). This made him feel a little sad because, until then, he thought of his therapist as being "perfect."

Ted was able to discuss this with his therapist, including the sadness that he felt about it. At first, he was hesitant to tell his therapist that he had some doubts about him for his career choice. But what came out of these discussions was very important: Ted was beginning to see his therapist as a person and not as an idealized figure. He was also beginning to see himself as a separate person from his therapist who could have his own feelings and ideas.

Over time, Ted was able to achieve some balance in his feelings and perceptions about his therapist. He still liked his therapist and found their sessions to be very valuable to him, but he no longer idealized his therapist and he felt comfortable with that. Along the way, he also developed more confidence in himself, and he began a relationship with a woman that he met in his social work program.

A year after Ted became a community organizer and he and his girlfriend moved in together, he successfully completed treatment. During the final stage of treatment, Ted and his therapist reviewed their work together and Ted had a sense of how far he had progressed. He also knew that he could return to see his therapist in the future.

As demonstrated above, the idealized transference is often useful in helping clients to make positive changes in their lives during the initial and middle stages of treatment. The client uses his or her own idealized fantasies and projections about the therapist to make personal changes.

There are times when the idealized transference is not resolved because the client has a need to maintain that view of the therapist. Not only is this true about clients coming into therapy, but it is often true of psychoanalytic students at institutes, some of whom never lose their idealized view of their psychoanalysts. But, once again, this is another topic.

I am a licensed NYC psychotherapist, hypnotherapist, EMDR therapist who works with individual adults and couples.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist

To set up a consultation, call me at (212) 726-1006 or email me: josephineolivia@aol.com



photo credit: FlickrJunkie via photopin cc