Psychodynamic one of the prominent therapeutic tools

Psychodynamic therapy, or alternatively called as insight-oriented therapy, was one of the types of psychotherapy often used by clinical psychologist or counsellors in their professional practices. In this approach, the practitioner believed that there were underlying processes taking place in the unconscious mind in which influenced one’s behaviour (Gelso, Hill & Kivlighan, 1991). Therefore, the main aim of psychodynamic therapy was to bring those hidden thoughts and desires from the unconscious level into the conscious level (Feist & Feist, 2009). This would lead to a client’s self-awareness in which helps the client to understand effects of past experiences on current behaviour (Jacobs, 2010).

            During the therapy, therapist helped clients by discussing about their early life experiences, emotions, beliefs and thoughts to obtain insight into their lives (Langs, 1981). To be said, psychodynamic approach allowed the client to understand problematic symptoms arise from unresolved conflicts that happened in the past in which, were manifested unconsciously through maladaptive behaviours that affects daily functioning (Richardson, 1997) Meanwhile, being able to recognize recurring patterns enable the client to discover how distress was being avoided or how defence mechanism was developed as a method of coping (Patton, Kivlighan & Multon, 1997). Thus, psychodynamic therapy believed that once the client able to resolve issues of the past, the client would be able to overcome present problems (Spurling, 2004).

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            Several well-known psychotherapy techniques have been introduced by the psychodynamic theory such as free association, dream analysis, resistance and interpretation (Levy & Scala, 2012). Among those techniques, practitioners considered transference as one of the prominent therapeutic tools to be used in therapeutic settings (Gelso, Kivlighan, Wine, Jones & Friedman, 1997).

Transference occurred when the client projected certain feelings or reacted in a certain way toward the therapist during therapy (Anderson & Miranda, 2000). Usually, the client responded to the therapist as someone who represented an important figure from childhood (Correy, 2009). For instance, the therapist may be perceived as the father (paternal transference), the mother (maternal transference), an ideal lover (erotic transference) and so forth (Jones, 2004; Trop 1988). When transference occurred in a therapeutic setting, the therapist could understand the client better through focusing on those projected feelings (Gelso, Hill & Kivlighan, 1991). It was believed that this understanding helped therapist to address the client’s unconscious thoughts and feelings (Jones, 1957). Once the client understood one’s own conditions or the reasons of transference, it is the morel likely that the client achieve healing and prevent reoccurrence of problematic behaviours (Laine, 2007). This showed that the therapist could help the clients to gain an understanding on how past experiences may have influenced their current life through the process of transference.

Therefore, this paper aimed to present past studies done on transference. The effectiveness of this technique has been detected by numerous studies. Nevertheless, there were several concerns in relation to transference have been highlighted such as its measurements, validity and reliability. The discussion of transference has been elaborated in the following section.

 

Body of Essay

 

Population

            There were evidences that supported the use of transference on certain populations. According to Craig (1991), psychodynamic approach using transference was effective way to treat eating disorders such as anorexia nervosa and bulimia. The results were that one-third of the patients got fully recovered from the treatment, one-third has improved from the disorder and the final one-third was not affected by the approach. On the other hand, Caligor (2006), indicated that transference-focused therapy (TFC) showed effectiveness in treating borderline personality disorder (BPD). TFC mainly aimed to improve on the capacity of BPD patients to perceive and understood their unconscious processes better.

 

Types of Transference

            Transference could be positive or negative. Positive transference occurred when the client considered the therapist as someone who was helpful, kind, or approachable. Hanly (1982) highlighted that positive transference happened when the therapist provided conditions in which were missing in the client’s past experiences. He believed that it would enhance the therapeutic outcomes in the session. On the other hand, negative transference occurred when the client demonstrated anger or painful feelings towards the therapist. Melanie Klein (1952) considered negative transference as the most useful type of transference. She indicated that it helped the client to understand and recognize the root cause of anxiety and its associated problems. She suggested those negative feelings and fantasies induced by previous experiences could now be acknowledged in therapeutic settings through the expression of negative transference.

 

Views on Negative Transference

            Levy and Scala (2012) stated that the therapist could felt pressured by client through the process of negative transference. To be said, the characteristics and behaviour in the client that caused by the actual has now been projected towards the therapist through transference. As client perceived therapist as someone who created hurt to them in the past, the client started taking revenge on the therapist unconsciously (Fink, 2007). Therefore, it could possibly impose certain degree of danger to the therapeutic relationship if the transference was taken place negatively.

Another aspect that has been taken into consideration in negative transference was that there was no promise for therapist to show love and care as how the client had wished for. The therapist might unintentionally have demonstrated reactions that have similar behavioural patterns to those subjects in the past, towards the patients (Jacobs, 2010). This can be seen in Freud’s case, Anna O, known as Dora, where she transferred her vengeance ideas on her father to him. Freud felt threatened by Dora’s reactions and was unable to solve her case (Freud, 1905/1963).

            As mentioned earlier, Klein proposed that negative transference was of great use to client since it allow the client to elicit behaviours in therapist that may be similar to the original source (Klein, 1952). However, Freud regarded transference as a relationship that consisted of partly distortion and some aspects of a real components from the clients to the therapist (Freud, 1905/1963). Regarding of the different view on negative transference, it could still be used as a technique that provides the client a platform to vividly express those unresolved concerns in the past (Remenderia, 2011)

 

Evaluation on Transference

            Although there was evidence supported the use of transference in therapy, but there are various aspects of transference need to have further exploration. Jones (2004) mentioned that the process of transference was lacking in empirical validation and verifiability. Other factors such as the individual differences and the process of countertransference would have different impact on the quality of transference.

 

 

Validity of Transference

            Marmamosh (2012) pointed that if transference is a relationship established based on the unconscious process of projecting internal representation on another person, it would mean that transference could take place in any context or relationship. Transference would not be considered as something that only occur within therapeutic settings. Meanwhile, a study was done by Andersen and Przybylinski (2012) on transference in interpersonal relation to that transference happened in all types of therapeutic approaches. They mentioned that how certain approaches do not emphasize on transference in which indicated it was not considered as a technique due to lack of validation. These approaches gave therapist the freedom to handle the transference on their own while the therapy process continues. In addition, the same research also challenged that the idea of transference does not exist (Marmarosh, 2012).

            There was concern for transference that the individual is forming a relationship with someone whom they have projected feelings on to rather than with the real subject (McLeod, 2009). He challenged that such relationship would not be able to truly solve the client’s issue.

 

Measurement

            Bogwald, Hoglend and Sorbye (1999) have done a study in which intended to find out whether operationalizing and quantifying therapeutic intervention influences transference interpretations. There were two types of interventions: general and specific. Their results failed to show that there was a significant difference between the two factors.

            A study done by Hoglend and his colleagues (2008) on long-term transference interpretation. The sample with different psychological issues received psychodynamic psychotherapy every week for one year. The sample was divided into two groups: with and without transference interpretations. The results indicated that transference identification and interpretation could enhance therapeutic outcomes in which influence the relationships of the client positively beyond therapeutic settings. Furthermore, it was also found that clients with more difficult issues and received therapy for a longer time were benefited more than the rest.

            Studies highlighted in this essay were either of theoretical approach or quantitative designs. Hoglend et al (2011) indicated that both types have provided important findings that helped to contribute towards the refinement of the theory. Seemingly, these studies were not able to provide much regard concerning of having a better apprehension on the authentic value of the concept of transference and its operationalization in therapy. Furthermore, attempts to prove the works of transference in terms of its mechanism have failed in responding to traditional quantitative methods. However, studies with qualitative methods were helpful in offering more information about transference. This was also considered as something to be carry on in the future studies and discovery (Eisner, 1991; Polkinghorne, 1994).

 

Other Concerns

            Oelsner (2013) stated that other factors such as subjective biases from the therapist or client’s limitation on their understanding of transference relations and underlying processes needed to be taken into consideration. These issues could create undesireable effects during the therapy.

            With regards to client’s perspectives, practices in the past implied that it was not as simple as it sees to connect to their unconscious process and be aware of their possible transference, not until post-hoc verification (Oelsner, 2013). Meanwhile, another aspect to be considered was that therapist were not only involved in the therapeutic process and analysing transference but also their possible countertransference. Therefore, Carter (1996) indicated that the further study on countertransference could help to enhance the understanding on transference.

 

Conclusion

            Psychodynamic approach is all about bringing those unaware feelings and thoughts into the client’s awareness. It helps the client to obtain a better understanding of themselves. Transference is a technique originated from the psychodynamic approach. Transference can be said as a “tool” which therapist can consider in the therapy. The function of transference is to explore and bring to those unresolved conflicts in clients that were stem from past experiences especially during their childhood times into the light. Such attempts from the therapist are regarded as valuable since it contributes to the psychodynamic counselling relationship (King & O’brien, 2011).

            Researchers have proven the significance results of transference used to treat eating disorder and borderline personality disorder (Craig, 1991; Caligor, 2006). On the other hand, researchers argued that more attention should be given to negative transference since it has various impacts on the therapeutic relationship.

            Although several studies have tried to gain empirical proof of transference with the intention to further add on to the knowledge of transference, however, the results did not turn out as satisfactory as expected to be. The issues of validation and measurement still remained as unfixed (Hoglend et al, 2011). Meanwhile, since both processes of transference and countertransference are deriving from an internal state of a individual (Freud, 1912; Carter, 1996), a large amount of undiscovered information is still waiting to be explored on in order to settle to a more secure interpretation of these concepts.

            The facts that comprehension of transference have been greatly advanced was owning to the contribution from a group of diverse professions such as theoretician, clinicians and researchers. They have contributed in their way together with their personal insight for the elaboration of transference. Apparently, the concept of transference was not only important for the theory but also useful in practices. In therapy contexts, it helps to gain a better understanding of any unconscious feelings from the clients to the therapist. Nevertheless, transference interpretation has continued to remain as a challenging issue to deal with. It was regarded as a very complicated topic in which many researchers found it difficult to further explain (Carter, 1996).

            While to fully understand how transference works, the recognition of its contribution should not be neglected. The analysis of transference is still considered as a centrepiece to the current psychodynamic therapy (Dispaux, 2010)

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