Recurrent themes affecting the transference and countertransference with people who have suffered huge trauma in early childhood, start with the patient’s wariness of the therapist and the dangers involved in intimacy. In addition, dependency, reliance and counter dependent and counter phobic defenses tend to emerge, often-cloaked in overt idealization of the therapist. In this idealization, patients may expect the therapist to be all attentive, nurturing, non-seductive and nonabusing parent who will heal and undo the trauma. All these themes tend to appear in concerns about boundaries, secrecy, control and power and in discussion of fees, confidentiality, and other issues related to the frame of the treatment.
"Transference is the source of conflict but also expression of conflict"
Behavioral reenactments in treatment allow a patient to communicate previously dissociated and therefore unsymbolised, material to the therapist. By exploring verbally what has been communicated through behavior the therapist and patient initiate a process by which the dissociated material becomes encoded in language, and therefore available for conscious consideration. Behaviors associated with a reenactment in therapy are unconscious messages from the patient to the therapist and to himself about a traumatic past. They represent an attempt to bypass the need for symbolized experience. Reenactments are most likely to occur when the patient has a reduced capacity for self-reflection, another result of being unable to verbalize traumatic experiences that were never encoded when they first occurred, as a result of not have a present witness to their pain. Memories became trapped encased within a wordless world. Incapable of articulating what he has never symbolized verbally, the patent repeats behaviorally or reenacts an aspect of his dissociated trauma.
"Transference is also an assimilation of what might happen in the future if we act on the impulse in the here and now, also as mirroring of the past"
Such reenactments are crucial disclosures about un-integrated, un-symbolized unformulated experience. Understanding the unconscious communication within a reenactment is often pivotal point in therapy with a traumatized adult, in particular a sexually abused adult. Seen in this light, enactment is a way for the patient to allow himself/herself to be known by co constructing, with the therapist, a means of living out a new, less disabling version of the original trauma. In this co construction, cognitive symbolization of trauma occurs when the trauma is reenacted within a therapeutic relationship, reproducing the original interpersonal context but not leading to the original outcome. Once this happens, dissociated experience is transformed to internal conflict and human relatedness, which are more available for verbal consideration in psychotherapy. By working through reenactments the therapist thus gradually obtains access to the patients various multiple dissociated self-states.
The exploration of the reenactment is embedded in the therapeutic relationship. The therapist is both the magnet that draws out the reenactment and the architect of a transitional arena in which the patients experiences of self and other can be reconfigured in more harmonious ways. We rely upon the hope that the therapist and patient together will become enmeshed in complicated reenactments of early unformulated experiences with significant others, that can shed light upon the patients current interpersonal and intrapsychic difficulties by reopening in the therapeutic relationship, prematurely foreclosed areas of experience. If the reenactment is to be integrated as other than the original trauma, however something essentially different must happen. The relational models of transference and countertransference are reenactments of different aspects of the dissociated relationships involved in victimization by a parent or a caregiver. Many therapists assert that, abusive countertransferential reenactments are an inevitable part of the treatment of sexually abused patients.
"We learn about normal function through pathology when things are working right you don’t notice them. Transferences comes to observation when it is maladaptive and non flexible"
Transference – countertransference reenactments are vehicles for communication to the therapist about the internal relational experience of the child as he/she was being abused. As such they are powerful tools but they are also forceful and often coercive catalysts in the therapeutic relationship. Reenactment compels the therapist to experience the patient’s original reactions to abuse, reactions that are dissociated aftermath to a deeply traumatic childhood experience. To heal the patient of the trauma, the therapist must experience that trauma in some way.
The reenactment may be symbolic of the abuse but the feelings engendered in the therapist are very real. Theses may include helplessness, impotence, rage, inadequacy, shame, guilt, idealization, omnipotence, overstimulation, humiliation, torture and fear, all internal states with which the patient is very familiar. Thus treating patients whose relationships and personalities are organized by dissociation involves a challenge psychological encounter with the trauma that caused the dissociation in the first place. Therapists can easily feel traumatized themselves under such circumstances, yet it is important to remember that neither reenactments nor countertransference reactions to them are necessarily mistakes rather they are unavoidable phases in the treatment of traumatized dissociated patients.
"The road to an increasingly secure relationship is usually and exceedingly rocky one precisely because the defenses the patient used to avoid the painful past often wind up provoking it's recreation in the present."
It has commonly been noted that the abused patients tend to identify with their abusers and then to be transferentialy abusive to their therapists. In doing this they are repeating with the therapist what happened to them as children. The abuse-victim relational configuration is particularly upsetting work with both patient and therapist because of its ubiquitous intense transference and countertransference enactments. Written by Richard B. Gartner- Director of Centre for the study of psychological Trauma and The Sexual Abuse Program New York City. Author of Betrayed as Boys.
Transference remembering in Therapy by Lawrence Hedges
4 stages of Transference remembering in Therapy
- Relational memories from the triangular family life of the four to six-year-old child are generally revived by means of words, stories, symbols, and impulses that were painfully repressed at the time;
- The self-consolidation and self-fragmentation relationship memories from the three-year-old relationship era are later remembered in the ways that people seek out, demand, and utilize or fail to utilize self-confirming interpersonal resonances in the present;
- The four to twenty-four month relational bonding memories become available in the therapeutic interaction through the affective ways in which the client experiences the therapist and interactions with the therapist as good, ideal, and enhancing or as bad, abandoning, and damaging;
- The relational traumas from the last trimester of intrauterine development and the first four months after birth are somato- psychically recalled later in life by people coming to experience intimate trust relationships as being characterized by cruel neglect, terrifying rejection, and life-threatening, body-shaking, and mind- shattering confusion and hatred which become systematically projected into the therapeutic situation and onto the person of the therapist.
"Only connect! That was the whole of her sermon. Only connect the prose and the passion, and both will be exalted, and human love will be seen at its height. Live in fragments no longer. Only connect, and the beast and the monk, robbed of the isolation that is life to either, will die. E.M. Foster "
"The being who is the object of his own reflection, in consequence of that very doubling back upon himself, becomes in a flash able to raise himself into a new sphere. In reality, another world is born. Pierre Teilhard De Chardin"