Unconscious communication through the transference and countertransference

We will discuss the countertransference and working in the countertransference in detail in the next chapter. For now, it is relevant to note that unconscious processes are at work in the transference and countertransference. The patient often communicates unconsciously through the therapist’s countertransference, leading to a reformation in the way countertransference was first seen (Heimann, 1950). This is a wordless form of communication from one unconscious to the other. We may all have had experience of working with patients who have porous boundaries with others where they can intuit things that are going on in the therapist’s life or mind with uncanny accuracy. The following example illustrates the way the therapist can be informed by their countertransference reactions to unconscious aspects of the patient:

/ was listening to my patient, Lola talking in a matter-of-fact way about her interaction with her aging mother, as if it did not hold much emotional significance. And yet, I became increasingly aware of feeling intense sadness as I listened to her. I chose to interpret this, based on careful consideration of my countertransference in order to bring Lola’s repressed emotions into awareness in the session. I said, “You’re telling me about what happened with your mum, as if you were unaffected by it, but I wonder if there is a great sense of sadness and loss that you are reluctant to feel right now?”

Different patients evoke different affective reactions in the therapist at different times, reflecting the transference-countertransference dynamic. At times, the therapist may feel pulled right into the patient’s emotional world, perhaps feeling tears well up in their eyes. At other times, they may feel disconnected, even bored as they listen to their patient. It is important to reflect on what belongs to the therapist and what is information communicated by the patient; what is it that makes the therapist feel over-identified or distant?

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