Examples of Traumatic Transference
When a client with a history of trauma goes to therapy, they are bringing with them a rich history and experience for the therapist, both consciously/explicitly and unconsciously/implicitly.
Conscious/explicit can refer to the stories, narratives, beliefs, content, or data they share with the therapist that is in their realm of awareness. Clients may say, “I struggle with boundaries because I grew up in a home where there were no boundaries” or “I struggle with trust because my I was abused”.
Unconscious/implicit can refer to what is not known or aware to the client such as patterns, dynamics, themes, and unprocessed experiences. Clients may be unaware of their anxiety, shame, fear, anger, or grief as they talk in session.
The themes of power, trust, control, safety, terror, shame, anger, guilt, etc. will inevitably show up in session and this is a core part of relational trauma therapy.
What is Transference?
Transference refers to the client’s transfer of feelings from the past to the present.
Transference is to be expected and is a normal part of trauma therapy.
It is the therapist’s job to manage these dynamics as they arise with a reflective lens versus a reactive lens.
Therapists must explore these abstract concepts within the therapeutic room, without explicitly acting out on them, in order to benefit our clients’ process of change and insights because “ the more sophisticated its management, the better the results of treatment will be” (Basch, 1980, p.39).
Transference must be managed; in order to be managed, transference must be tolerated and subsequently understood. Simply put, because individual therapy is a complex relationship with two people involved, “the two complex human beings who are interacting in the course of psychotherapy are mutually influencing one another all the time and are evoking a variety of feelings toward one another” (Gabbard, 2004, p. 132).
What is Counter Transference?
Clinicians also have their own history of emotions, fears, and desires which permeate into the therapeutic relationship.
Countertransference is the clinician’s reactions to the client’s material. What the therapist and client chooses to do with this material shapes the outcomes and effectiveness of therapy.
Click here to read my blog post on traumatic counter transference.
Examples of Traumatic Transference
Traumatic transference is usually almost always unconscious or unknown to clients which means there is very little awareness.
The following is from Judith Herman’s book Trauma & Recovery (Chapter 7 - A Healing Relationship).
Essentially, this chapter is about how many survivors of trauma project (or unconsciously put/give their experiences of trauma to the therapist in many different ways as outlined below.
It is the job of the therapist to use this transference as data or information to enrich the therapy and to ultimately give the client a corrective or new experience.
Helplessness transference. The client experiencing helplessness who feels hopeless, alone, and misunderstood.
"Nothing will get better" or "What's the point?" or "The legal system/society is messed up and my point of view/perspective is useless".
Therapy feels stuck, uncomfortable, and hopeless.
The therapist must interrupt this cycle to provide a new experience to help the client break out of the learned helplessness belief/protective mechanism/strategy.
Anger transference. The client that scrutinizes the therapist / devalues the therapist and feels anger, frustration, annoyed, and rage.
The therapist is the bad object and receives all the negative thoughts and feelings from the client due to processed traumatic experiences/memories.
Unprocessed anger to completion.
The therapist must interrupt this cycle of anger by helping the client process their anger to completion, getting unstuck from stuck points, owning her anger, providing psychoeducation on emotions, etc.
Rescue/save/fix/solving fantasy. The client that over values/puts the therapist on a pedestal. This fantasy/rescue protective mechanism helps the client against feelings of terror, fear, and helplessness.
The therapist must interrupt this cycle by providing psychoeducation, breaking out of the Karpman triangle, attunement, moment-to-moment tracking, helping the client mentalize, mindfulness, etc.
Mistrust transference: The client finds it difficult to trust and form a strong therapeutic relationship with the therapist.
The client believes the client has ulterior motives, will abandon them prematurely, harm them.
This mirrors the past experiences of past perpetrators/abusers or neglectful attachment/caregivers.
Sexualized transference: The client that imagines the only value they offer is their sexuality/physical attractiveness.
Bystander transference: The client telling their trauma stories and believing the therapist will not support/validate/align with them.
The client may re-traumatize themselves and the therapy may come to a standstill.
Repetition compulsion transference: The client may repeat unhealthy/unhelpful/maladaptive experiences in the present (e.g. self sabotage, confirmation bias, trauma mastery).
The therapist must interrupt this cycle of repetition to facilitate a new corrective experience (e.g. trauma processing, memory reconsolidation, stuck points, cognitive interweaves, socratic questioning, somatic work, etc.).
And more
Trauma Transference
The following are direct quotes from Judith Herman’s book Trauma & Recovery (Chapter 7 - A Healing Relationship) and go into details the transference examples from above.
..
Fear & Helpless Transference
Patients who suffer from a traumatic syndrome form a characteristic type of transference in the therapy relationship.
Their emotional responses to any person in a position of authority have been deformed by the experience of terror.
For this reason, traumatic transference reactions have an intense, life-or-death quality unparalleled in ordinary therapeutic experience.
In Kernberg’s words, “It is as if the patient’s life depends on keeping the therapist under control.” Some of the most astute observations on the vicissitudes of traumatic transference appear in the classic accounts of the treatment of borderline personality disorder, written when the traumatic origin of the disorder was not yet known. In these accounts, a destructive force appears to intrude repeatedly into the relationship between therapist and patient.
The traumatic transference reflects not only the experience of terror but also the experience of helplessness.
At the moment of trauma the victim is utterly helpless. Unable to defend herself, she cries for help, but no one comes to her aid. She feels totally abandoned. The memory of this experience pervades all subsequent relationships. The greater the patient’s emotional conviction of helplessness and abandonment, the more desperately she feels the need for an omnipotent rescuer. Often she casts the therapist in this role. She may develop intensely idealized expectations of the therapist. The idealization of the therapist protects the patient, in fantasy, against reliving the terror of the trauma. In one successful case both patient and therapist came to understand the terror at the source of the patient’s demand for rescue: “The therapist remarked, ‘It’s frightening to need someone so much and not be able to control them.’ The patient was moved and continued this thought: ‘It’s frightening because you can kill me with what you say . . . or by not caring or [by] leaving.’ The therapist then added, ‘We can see why you need me to be perfect.’ ”
When the therapist fails to live up to these idealized expectations—as she inevitably will fail—the patient is often overcome with fury.
Because the patient feels as though her life depends upon her rescuer, she cannot afford to be tolerant; there is no room for human error.
...
Though the traumatized patient feels a desperate need to rely on the integrity and competence of the therapist, she cannot do so, for her capacity to trust has been damaged by the traumatic experience.
Whereas in other therapeutic relationships some degree of trust may be presumed from the outset, this presumption is never warranted in the treatment of traumatized patients.
The patient enters the therapeutic relationship prey to every sort of doubt and suspicion. She generally assumes that the therapist is either unable or unwilling to help. Until proven otherwise, she assumes that the therapist cannot bear to hear the true story of the trauma.
Combat veterans will not form a trusting relationship until they are convinced that the therapist can stand to hear the details of the war story. Rape survivors, hostages, political prisoners, battered women, and Holocaust survivors feel a similar mistrust of the therapist’s ability to listen. In the words of one incest survivor, “These therapists sound like they have all the answers, but they back away from the real shitty stuff.”
..
Mistrust Transference
At the same time, however, the patient mistrusts the motives of any therapist who does not back away. She may attribute to the therapist many of the same motives as the perpetrator. She often suspects the therapist of exploitative or voyeuristic intentions.
Where the trauma has been repeated and prolonged, the patient’s expectations of perverse or malevolent intent can prove especially resistant to change.
Patients who have been subjected to chronic trauma and therefore suffer from a complex post-traumatic syndrome also have complex transference reactions. The protracted involvement with the perpetrator has altered the patient’s relational style, so that she not only fears repeated victimization but also seems unable to protect herself from it, or even appears to invite it.
...
Chronically traumatized patients have an exquisite attunement to unconscious and nonverbal communication. Accustomed over a long time to reading their captors’ emotional and cognitive states, survivors bring this ability into the therapy relationship.
Kernberg notes the borderline patient’s “uncanny” ability to read the therapist and respond to the therapist’s vulnerability.
Emmanuel Tanay notes the “sensitivity and intense perceptiveness” of survivors of the Nazi Holocaust, adding that “fluctuations in attention of the therapist are picked up by these patients with readiness and pathological hypersensitivity.”
...
The patient scrutinizes the therapist’s every word and gesture, in an attempt to protect herself from the hostile reactions she expects.
Because she has no confidence in the therapist’s benign intentions, she persistently misinterprets the therapist’s motives and reactions. The therapist may eventually react to these hostile attributions in unaccustomed ways.
Drawn into the dynamics of dominance and submission, the therapist may inadvertently reenact aspects of the abusive relationship.
This dynamic, which has been most extensively studied in borderline patients, has been attributed to the patient’s defensive style of “projective identification.” Once again the perpetrator plays a shadow role in this type of interaction. When the original trauma is known, the therapist may find an uncanny similarity between the original trauma and its reenactment in therapy.
Frank Putnam describes one such instance in a patient with multiple personality disorder: “As a child the patient had been repeatedly tied up and forced to perform fellatio on her father. During her last hospitalization, she became severely suicidal and anorexic. The staff members tried to feed her through a naso-gastric tube, but she kept pulling it out.
Consequently, they felt compelled to place her in four-way restraints. The patient was now tied to her bed and having a tube forced down her throat all in the name of saving her life. Once the similarity of these ‘therapeutic’ interventions to her earlier abuse was pointed out to all parties, it became possible to discontinue the forced feedings.”
References
Basch, M. (1980). Doing psychotherapy. New York: Basic Books.
Gabbard, G. (2004). Long-term psychodynamic psychotherapy : A basic text(Core competencies in psychotherapy). Washington, DC: American Psychiatric Pub.
Herman, J. L. (1992). Trauma and recovery. BasicBooks.