Transference: A reflection on not being the Other

Transference happens. We could argue about how much, exactly how, and whether the name is right, but that would be pointless. The point is that we can, at times, react towards another person as though they were not who they actually are (friend, boss, shop assistant etc), but an important other from our own past or distant lives.

Some of us do it more than others. Some people seem almost to do nothing else. It can be trivial, but it can also seriously hamper relationships and personal development. People who enter therapy and are likely to be doing so exactly because they do have problems with their relationships and their personal development. They may be expected to be particularly prone to this type of relating. For this reason, therapists need to be adept at managing the situation.
                                                                                                                                                          Therapy encourages transference by 1) establishing a particular kind of relationship which has inherent in it a degree of asymmetry, and then 2) having as its remit the exploration of areas in which the patient or client is unconfident or unskilled and which evoke earlier relationships. Some styles of therapy may further encourage this by their use of silence and by developing what has been called the “frustration tension”.
                                                                                                                                                                  The therapist cannot simply dismiss the confusion by saying, for example, “Stop it. Don’t be ridiculous! I’m not you mother!” They have to keep it going enough for it to be seen, understood, and worked with. It would be unforgivable, though, if the therapist were to encourage or consolidate the confusion, by continuing to play the part and recapitulate the original trauma.
                                                                                                                                                                      In other words – and here I am getting to the crux of it – the therapist has to be able to be enough of all these others (these fathers, mothers, lovers, siblings etc) to be plausible to the client’s unconscious whilst manifestly NOT being these people. In a sense, they need to be able to be any number of people whilst emphatically not being them.
                                                                                                                                                                           Not being should perhaps have a hyphen, because this activity of not-being is different to a simple absence. As in the mind-experiment of trying to not think of a pink giraffe, not-being to a large extent draws attention towards being. Not-being subsumes a degree of being. In a sense, it flirts with being. Think, for example, of the counsellor whose skill set should include knowing how one might take the session deeper, in order to not-do so. Or the doctor who is required to be able to prescribe a medication before their decision to not-do so can take on significance. The mountain guide must know what would be a reckless action in order to be saved from carrying it out.
                                                                                                                                                            Adding to this, the therapist must also be genuinely themselves and 100% present whilst in a way leaving much of themselves outside the room: bringing their skills, attention, and beneficial intent into the room – giving them a voice – yet leaving their own factual lives outside. They have to remember the right things. They have to remember who they are without the constant rehearsal of self-revelation and, whilst stripped in this way, they have to not-accept the roles and characteristics transferred within the therapeutic relationship.
                                                                                                                                                            Therapists, then, if they are to be therapists rather than functionaries, have to be sufficiently capable and supported to perform this balancing act; a balancing that includes things repeatedly touched upon in Being With and Saying Goodbye such as equipoise, believing whilst suspending belief, uncertainty, and paradox. The space between being and not being (which I have here called not-being) is what Winnicott might have termed a “potential space”. It is there yet not-there; the essential ambiguity needed for the play that is therapy.
                                                                                                                                                                    Do think, reply, discuss. Here, or @afwesty via Twitter
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Attitude

The Concise OED describes attitude as settled behaviour indicating opinion, and attitude of mind as settled mode of thinking. It calls to mind  a sort of consolidation or gathering in preparation for doing something, and an orientation of intent and approach.

My dictionary does not refer to the spirited and somewhat oppositional sort of attitude that is sometimes associated with adolescence.

Both meanings apply in understanding what I mean by Therapeutic Attitude. A grounded, consistent, aligned position is needed, and this needs to be oriented towards the subject of the therapeutic intent (in clinical contexts the patient or the clinical problem). But this settled alignment and orientation is not enough. It is no use being too appeasing or mainstream. At some point the person needs to reach a place that they, or the government of the day, did not expect or want. This is the more (at least potentially) oppositional aspect of attitude. Without it, what follows risks being neither therapy, nor in the untrammelled interests of the person.

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Being With And Saying Goodbye – the book

It would be foolish for me to advertise, with shoddy writing, something that according to the generous endorsement it has received is written well. I could hardly do better than to quote from these endorsements:

‘Informed by a lifetime of experience in the author’s own field of child and adolescent psychiatry, the “therapeutic attitude” for which he argues has much to offer caring clinicians in every area of medicine.’
– Professor Bill Fulford, St Catherine’s College, Oxford

‘Anyone working in the field of child and adolescent health, education or social services will come away inspired and refreshed by Andrew’s candour, his ironic humour and superb writing.’
Dr Sebastian Kraemer, Honorary Consultant, Tavistock Clinic

‘ This is a timely, important book because the attitude so beautifully described and illustrated is in danger of being squeezed out of us. Reading it will help you survive through difficult times whilst rekindling the hope that things could and should be done better.’
– Penelope Campling, medical psychotherapist and co-author of Intelligent Kindness: Reforming the Culture of Healthcare

‘This book inspires hope that we can recover a kind of professionalism that has been undermined by our current target-driven culture. Andrew West’s  vision is compelling. A book that should be read by all those involved in commissioning services as well as by practitioners.’
– Sue Gerhardt, author of Why Love Matters

I can direct you to Karnac Books where you can get a better idea of this title and order it:

Click here to go to Karnac UK

Click here to go to Karnac United States

Of course I would love it if you ordered it from your local “High Street” bookshop. Blackwell’s in Oxford have it in stock, for example, and at the time of updating (Sept 2018) Blackwell’s Online have it at a reduced price! Alternatively, you may want to by it online, using one of Ethical Consumer Magazine’s high-scoring sites.

Please take a look, read, comment, recommend…..

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