Transference, unconscious communication, and the therapeutic relationship Transference and unconscious communication

The transference relationship is central to STPP, as it is to all forms of psychotherapy that pay attention to unconscious mental life. It may become manifest through verbal communication, but it may also take the form of placing the therapist in the position of experiencing some of the patient's problematic feelings, in the hope that these feelings may prove to be manageable. (This may be the result of projective identification, as discussed above.) For example, some young people may ask the therapist, implicitly or explicitly, to fulfil various roles in a drama, such as the role of being excluded, and to express appropriate emotions about this. This can be a useful form of communication, but the therapist may also have to consider whether it is being used to control him or her or the scope of the work if it becomes habitual. (See Boston & Szur, 1983; Sandler, 1976.)

Such aspects of the relationship constitute an important part of the therapeutic experience, since it is hypothesized that the therapist's ability to deal with difficult experiences will be internalized and henceforward will become part of the young person's own equipment (Bion, 1962a). These internalized qualities are applicable beyond any specific insight that may have been achieved, so that the therapeutic experience becomes generalizable rather than being confined to solving specific problems. This is very important in understanding why time-limited work with a specific focus (such as arising from a depression diagnosis) can have a much wider impact on the young person's functioning.

Working directly with the negative transference is also extremely important. The capacity to acknowledge all the young person's negative feelings - pain, rage, destructiveness, hostility, self-destructiveness - and to put them into words and be able to tolerate them without the need to "look on the bright side" is crucial. Being able to allow and tolerate the young person's negative feelings and thoughts in relation to the person of the therapist are important aspects of the STPP process, although from the outside they may appear to indicate a breakdown in the "therapeutic alliance". The development of such negative feelings during the course of the work is especially important in the context of depression, where idealization and denigration, self-hatred, and guilt are likely to be central issues (Emanuel, Miller, & Rustin, 2002; Rhode, 2011; Trowell & Dowling, 2011).

The techniques of interpretation are central aspects of psychoanalytic work, and these are described below ("Varieties of interpretation"). The concept of the "mutative interpretation" originates with Strachey (1934), who argued that interpretation within the transference relationship had the power to bring about profound change by encouraging the patient to recognize his or her unconscious instincts, particularly aggressive ones.

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