The Helping Relationship: Healing and Change in Community Context

IV. Working with Transference and Countertransference in Psychotherapy

79 The meeting of two personalities is like the contact of two chemical substances; if there is any reaction, both are transformed . (Jung, 1933, p. 49) Introduction The concept of “alliance” is rooted in psychoanalysis and Freud, who viewed the alliance as the connection between client and therapist (Horvath, 2001). Although there is no precise definition of alliance, the concept has been a topic of theoretical and empirical interest for the past quarter-century, particularly in counselling and supervision. A review of the professional literature on the helping relationship and specifically the therapeutic alliance has consistently shown a positive relationship between client-therapist alliance and therapeutic outcome (Lambert & Barley 2001). Indeed, most therapists would agree that a positive alliance is critical to the therapeutic process. Decades of research suggest that the nature of the therapeutic relationship is the main curative component of IV Working with Transference and Countertransference in Psychotherapy Shelley Briscoe-Dimock 80 Transference and Countertransference in Psychotherapy therapy (Lambert & Barley 2001). Current research on the therapeutic alliance suggests that the therapist’s skills and personal factors most influence the alliance (Horvath, 2001). Although there is consensus on the importance of the alliance, currently there is no precise and/or universal definition of the therapeutic alliance (Bordin, 1979) but an ongoing debate and substantial disagreement among the various helping relationships (Andrusyna, Tang, DeRubeis, & Luborsky, 2001). Despite this lack of consensus, Bordin (1979) offers a definition of the alliance that is gaining much acceptance in the field of counselling and psychotherapy. He defines the alliance in three related components : client-therapist agreement on the goals of therapy, clienttherapist agreement on the means to achieve the goals of treatment , and development of a personal bond in the client-therapist relationship. Among the various theoretical approaches that have evolved, all with their roots in psychoanalysis and each with its own view of the helping relationship, there is general consensus that the therapeutic relationship plays a critical role in treatment outcome and that the ultimate goal of therapy is change. This is most apparent in psychodynamic therapy, which views the relationship between therapist and client, similar to Bordin’s (1979) third component of the alliance, as the main vehicle for change. A Psychodynamic Perspective on the Helping Relationship In psychodynamic therapy, the therapeutic relationship is the “vehicle” for change (Leiper & Maltby, 2004, p. 70). The relationship provides a context that promotes the communication and exploration of the relationship processes and supports “expressive catharsis” and “insightful understanding” (p. 70). Underlying these processes are unconscious conflicts and patterns originating from early relationships that affect the client’s Briscoe-Dimock 81 current life experiences and relationships. The aim of therapy is to uncover unconscious processes and conflicts and trace them back to their roots. The therapeutic relationship creates an opportunity for clients to access and resolve their conflicts by discovering new ways of being with another person. The relationship is the agent of change, an interpersonal experience capable of producing transformation. The psychodynamic perspective views an individual’s personal relationships as consistent patterns that link similar themes to different contexts. Underlying these patterns are unconscious conflicts and their respective defence mechanisms. These conflictual patterns are rooted in the individual’s developmental history and reflect formative experiences and the mechanisms developed to cope with these experiences. These patterns are re-created in subsequent relationship contexts, including current life difficulties and the relationship with the therapist. It is this last idea that forms the basis of transference, a central concept in psychodynamic theory of change. Although it is not the only medium of communication and understanding, transference is the necessary agent and the crucial link in the entire change process. Transference and Countertransference Defined Transference and countertransference are psychoanalytic concepts originally articulated by Freud over a century ago. In 1889, he identified the phenomenon of transference during his formation of ideas about psychotherapy and particularly in his detailed account of the infamous case study “Dora,” which he published in 1905, and in his paper on countertransference published in 1910. Since that time, Freud’s classical phenomena have undergone significant development and continue to generate debate in terms of both their definitions and how these concepts are used. Throughout its development, psychodynamic theory has consistently acknowledged transference and countertransference 82 Transference and Countertransference in Psychotherapy as central concepts and paramount to the change process. The interplay between the two, in large part, constitutes therapeutic change. Transference In...