Transference and countertransference in cognitive and psychodynamic psychotherapy
Interview with Tarja Melartin
Transference is a term that is used in psychology and psychotherapy. It was first described by Sigmund Freud in his psychoanalytic practice in the 1890s. Freud, who is considered as the founder of psychoanalysis, regarded transference as an important part of psychoanalytic treatment. Fast forward to the present day and transference still plays a pivotal role and is used as a key therapeutic tool in today’s psychodynamic therapy. However, is transference as relevant in other psychotherapies? And what are the benefits of studying both psychodynamic and cognitive psychotherapies?
Transference describes a phenomenon, in which a person redirects his/her emotions and thoughts of another person to an entirely different person. This is often an unconscious process, and these emotions and thoughts are considered to be representative of the patient’s experiences of early childhood interactions. Transference occurs in everyday relationships and it may lead to relationship difficulties and harmful patterns of behavior and thinking. Tarja Melartin, a psychoanalytic and a cognitive psychotherapist, says that in psychodynamic psychotherapy transference is expected to arise in the relationship between a therapist and a patient: “By gaining insight of these projected feelings, a therapist acquires knowledge of how a patient has experienced their childhood relationships”. This process helps the patient become conscious of things that have previously been left unconscious, and furthermore, it may resolve their issues, or at least reduce their effect on the patient.
Countertransference, on the other hand, occurs when a therapist transfers his/her unconscious feelings onto the patient. This is not a working method but a possible problem if a therapist has not gotten to know him/herself enough through their own therapy.
Melartin describes herself as a relational psychodynamic therapist. In relational approach, the emphasis is on the relationship between the patient and the therapist. Unlike in traditional psychoanalysis, in relational approach, the therapist is not expected to present a “blank screen”. Traditional psychoanalysis has had an idea that the therapist’s neutrality offers a platform for the patient’s unconscious to come to light. Melartin argues that this expectation of therapist’s neutrality is unrealistic as therapists are also human. Relational approach emphasizes the present moment and the fact that the therapist also plays a role in interaction.
During her career Melartin has noticed that there are people, for whom psychoanalysis is not the best option. These people have felt alone and isolated during psychoanalysis. “Sometimes people need more concrete validation for their emotions and to express their feelings. This might happen even if a person does not have a strongly damaged attachment style”, Melartin says and continues, “I like working with people that do not have secure attachment styles. These people may have bigger difficulties in the beginning of therapy and that is why validation, normalizing, and reduction of shame are critical parts of the treatment”. Melartin adds that traditional psychoanalysis never felt like a perfect fit for her own personality. She wanted a more interactive role as a therapist and a more equal relationship with her patients. This and the need for tools to work with people that are more vulnerable were some of the reasons Melartin decided to study cognitive psychotherapy.
Melartin’s cognitive training included schema therapy. “Cognitive approach talks about schemas and their activation in therapy”, Melartin says and adds, “Transference on the other hand was only mentioned once as a term during training”. Schemas that a patient has of themselves and of other people are given names and studied together with the therapist. “Therapists are also expected to be aware of their schemas that may arise during therapy, so these would not negatively affect the treatment”, Melartin adds. Yet in cognitive therapy, transference and interaction between the patient and the therapist are not of focus, and compared to psychodynamic therapy, they are not used as a tool.
To Melartin, therapy has offered much needed cognitive vocabulary and theory, with which she can explain things to her patients, who hopefully gain enough understanding of themselves that they may use these tools even when psychotherapy ends. Psychoanalytic training, on the other hand, has shown her the importance of interaction and transference. “In long therapies, interaction and transference will eventually become important despite the therapeutic approach”, she says and continues, “I think with work experience cognitive therapists will gain knowledge of transference and the importance of interaction, although these are not taught in their training.” It seems that even if we have these different theories, there is something crucially similar when working with people. To humans, as a social species, interaction is always important. □