Psychotherapists, Relationships With

Psychodynamic Concepts of the Relationship

Psychoanalytic and psychodynamic theorists, from Sigmund Freud onward, have focused on a distinction between the real relationship and the transference. As described by Charles Gelso and Jean Carter, the real relationship is characterized by genuineness and realistic perceptions. Genuineness involves being honest and open with the other. Realistic perceptions are understood as seeing the other clearly, in ways not distorted by transference or other psychological defenses.

Transference involves aspects of the therapist-client relationship that are transferred from earlier significant relationships, including inaccurate perceptions and expectations about the therapist. This may involve the repetition of past conflicts with parents or other significant people. Feelings and behaviors from these other relationships may be transferred into the relationship with the therapist. For example, a client who felt deprived by her mother may begin to feel deprived by her therapist. Countertransference refers to the therapist's reactions to the client's behavior in therapy, which may trigger the therapist's own past conflicts.

Both the real relationship and the transference contribute to the alliance, which is the basis for the work of psychotherapy. Primarily, the alliance is understood as the realistic joining of the client's reasonable self with the therapist's professional self for the purpose of therapeutic work. However, the working alliance may also incorporate positive elements from the transference, such as idealized expectations about the therapist's ability to help—the sorts of expectations children may have about their parents' ability to solve any problem.

Although all aspects of the relationship are important, psychodynamic interest has focused on the transference. The transference concept is a way of understanding how past hurts, including early relationships that interfered with or failed to support healthy development, can be manifested as problems in the present. Theoretically, the problematic relational patterns that brought the client into treatment are likely to be reexperienced and acted out within the therapeutic relationship. By understanding and correcting distorted feelings about the therapist, a client can resolve conflicts that have interfered with daily life outside of therapy.

Manifestations of the transference in treatment can be dramatic, and observations of transference phenomena have figured centrally in the psychoanalytic literature since Sigmund Freud's famous case studies of Anna O. and Dora. Psychoanalytic theorists have elaborated the concept of transference in many ways. For example, Heinz Kohut distinguished between mirroring transferences, in which the therapist is experienced as an extension of the self, as a twin, or as an appendage whose function is mainly to support the client's (unrealistically) grandiose views of the self, and idealizing transferences, in which the client draws strength or reassurance from being associated with an idealized therapist's exaggerated virtues. In this view, progress may come when the therapist fails to fulfill these unrealistic expectations. The client's resulting frustration brings the expectations into awareness, making it possible to examine and change them within the treatment.

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