In this thought-provoking post, Robert Levin, LCSW, reconsiders the familiar concepts of transference and countertransference towards a fuller understanding of our patients and ourselves.

In preparation for teaching a class on countertransference at the Manhattan Institute, I want to share some thoughts on the topic and reveal my own struggles understanding this interesting and evolving concept.

Some of the questions I’d like to explore are: Do transference and countertransference still make sense as separate concepts? If we finally forgo their characteristics as distortions of reality (especially transference), what remains? Can transference and countertransference be seen as each participant’s best guess at what is happening between them? Another aspect of these concepts ripe for reconsideration is their designation as patient-initiating and analyst-responding (as the prefix “counter” implies). These questions stem from a feeling I have that, in spite of the so-called “relational turn” in psychoanalysis, many of us still view patients as self-contained, especially when it comes to knowing about our unwitting participation with them. While countertransference as a concept has shifted from its position as an unfortunate intrusion of the analyst’s private unconscious to a relational phenomenon revealing something about ourselves and our patients, transference analysis has, for many of us, not made the leap from distortion to significant information about our own participation. Since neither analyst nor patient approaches any session without memory or desire, each is therefore both initiator and responder to the other’s communications. My patient’s countertransference to me seems just as plausible as mine to him. Also of interest to me is the thought that we analysts could perhaps do better by gradually working our way out of a job rather than trying to maintain and reinforce our utility. Questioning our roles as we conceive of them allows us to be open to our unattended negative impact and alert us to other dimensions of our participation/countertransference.

Apparently, it is not what we know that helps initiate change in our patients, but the continual interest in what our metapsychologies might unwittingly inflict on them. I believe the only way to learn about that is through our patients’ direct expressions of their experiences of us.

A significant barrier to achieving this goal is a too-rigid adherence to the identity of “analyst,” the default position of assuming that we are supposed to be our patients’ new and better objects. That we are the good, kind and wise people we set out to be. That we are nothing like their flawed parents. The biggest obstacle to allowing patients to know their own transference, in other words, is our unwillingness to learn from them about our countertransference. To use Sullivan’s famous quip, “We are all more simply human than otherwise,” and therefore all relatively dissociated, defended, and self-justifying.

Inviting our patients’ direct expression of their experience of us puts us on somewhat paradoxical footing. It allows for our faults to be examined and their impact assessed; we are, in a sense, admitting failure. But it’s a necessary failure which allows our patients access to their own minds. It nudges us out of our perceived job as the authority on reality and into a more humble role of mutual curiosity and mutual influence. To invite and be curious about our patients’ perceptions of us which might differ from our preferred identities or call into question our valued skills, we are accepting that we are not aware of everything and that as unconscious beings our impact on others is largely unknowable and uncontrollable.

Transference, I believe, can be described as the patient’s varied efforts to influence the analyst to see things as they do, an effort to get the analyst to see them as they see themselves. In turn, countertransference can be seen as the analyst’s efforts to get the patient to see things as they do, get the patient to see them as they see themselves. Both identities are problematic, often wishful thinking and in need of revision and growth. Maybe the more we can (relatively, temporarily) relinquish our desire to be seen as anything at all, to be open to transformation, we would be encouraging and supporting our patients’ own analytic skills and interpretive abilities. If we remove reality testing, as many of us do, does it matter if we fully agree with our patients’ analyses of us? All we must do is take it seriously, try to accept the role assigned to us for a while and keep wondering about it as we do their other communications. Why do they see us that way? How do they feel about seeing us that way? What are the consequences for them in seeing us as they do? Do they sense our defensiveness about being that way? We might ask ourselves why it feels so intolerable to be seen in this way. The list of questions is endless.

Easier said than done, you might say. We are, after all, more simply human and thus more simply defended, needing to be seen in ways that are not shameful and disruptive to ourselves. We need our self-esteem to keep thinking and operating well. It can feel at times too destabilizing to be seen as possessing none of the qualities we value. (Some patients have a knack for making us feel awful.) By continually working on our ability to hear criticism without defensiveness, we strive toward the important goal of becoming less destabilized by our patients’ negative experiences of us and more able to accept their experience as valid. Is this not what we’re trying to help patients do as well?

Transference and countertransference can be seen as the negotiation of identities between patient and analyst. This is me; this is not me. This is how I’d like for you to see me; this is how I forbid you to see me. The mutual anxieties and resistances to be seen as anything other than what we would like to be is the stalemate in the analytic relationship, in relationships with significant others in our lives, and in our relationship to ourselves.

I try to read more of myself in my patients’ negative emotional responses to others in their lives in order to invite the disavowed or the difficult-to-mention experiences in ours, and to allow a richer, deeper, more intense examination of some intractable dynamics. Our countertransference is theirs too, theirs in the form of repetition and externalization of their internal worlds. We don’t always know what’s being played out, what belongs to whom, but by being open to seeing ourselves as our patients see us, we’re helping them reconnect to something lost, neglected, and essential. Transference and countertransference are not mysteries. They’re the relative abilities and the mutual courage of patient and analyst to allow themselves to be seen in ways they have not intended.

We all need to feel safe, patient and analyst alike, in order to explore our darker, unknown psychic areas. Therefore, humility, caution, openness, and daring are required to try new experiences of ourselves and of others on for size. It is what we teach and what we must practice to allow our patients to become fully themselves.     

Robert Levin, LCSW, is in private practice in New York City and is on faculty at the Manhattan Institute for Psychoanalysis.

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