The Transference Game
With Borderline Personality Disorder relationships are difficult. The past is always the present. Old feelings are always new. Under the stress of memory how can we build bridges.
BPD patients provoke strong negative reactions in therapists — and vice versa. As Harvard psychiatrist John Gunderson states, ‘most clinicians don’t like borderline patients.’
It’s a bit unfair isn’t it. And granted a lot of that is ingrained prejudice on the part of clinicians, and with over a century of criticism, it’s no wonder they’re so judgemental. In an environment rife with stigma, we’re continously misunderstood.
Nevertheless, perhaps there’s another reason therapist and patient don’t get along. It was Freud, who was the first to notice, therapy can get contaminated by emotion. He called it transference
The patient is not satisfied with regarding the analyst in the light of reality as a helper….the patient sees in him the return, the reincarnation, of some important figure out of his childhood or past, and consequently transfers on to him feelings and reactions which undoubtedly applied to this prototype….This transference is ambivalent: it comprises positive as well as negative attitudes towards the analyst, who as a rule is put in the place of one or other of the patient’s parents, his father or mother. “
Freud, “An Outline of Psychoanalysis” 1940
Ever taken an instant-dislike to a complete stranger without knowing why? Antipathy toward a work colleague? Aversion toward an ex? Maybe you have your reasons, but then again perhaps it’s more mysterious. You don’t like this person because they remind you of someone else – how they look, how they talk, their behaviour; everything about them, reminds you of a past life. Childhood is the lens which clouds the vision.
It begins in therapy. The patient transfers, their childhood feelings he or she had towards their mum or dad onto the therapist – anger, fear, unrequited love; all these emotions get diverted. They are spun out of the past into the present. Likewise the therapist transfers his feelings – his fear, anger, unrequited love back to you. The therapeutic alliance is damaged by a role play, and yet the roles aren’t static: emotions are bandied about, leading into deeper states of misunderstanding. It’s like a radioactive ballgame, and the stakes couldn’t be higher.
In Borderline Personality Disorder splitting is very common: A individual will either idealise a person or devalue them completely. This is usually because in childhood, an adult’s ambivalent displays of parenting, in infants created ambivalent feelings toward parents. We weren’t sure whether to love or hate them, but deep down felt we could no longer trust them. All this took place in early youth, however it carried over into later life. As a result we split other people into good and bad object-representations or images.
Its not unusual for BPD patients to fall in love with therapists. Alternatively we might hate them. If a therapist listens we see a rescuer, if they invalidate us they appear as a persecutor. When we feel we are being rescued we feel like a helpless victim, when we feel we are being persecuted we tend to think we are a bad person who deserves to be punished. The split also applies to us.
Health professionals aren’t not immune to this. Sometimes the emotional intensity of BPD is so strong, via projective identification it can force the same mindset onto the therapist. They may find a submissive tearful BPD patient, more like an abandoned child than a incompetent adult and so unwittingly play the role of a parent. If the patient accepts their efforts he may be a protective parent, if he or she rejects it they may become a punitive one. If the BPD is violent, angry and hostile, they may see a manipulator and either fight back or withdraw completely. This is counter-transference, but it is also a failure in dialectics in other words splitting.
The same old pattern
Nowadays therapist are told to “work with the transference” and reparenting is an important concept for treatment. Positive transference leads to a good therapeutic relationship which builds a strong foundation for recovery. Negative transference produces negative therapeutic reactions and prompts regression. Each therapy session can be a sparring match or duel, a dance or duet. Some therapies even use transference as the basis for getting better – if you can see transference as it happens you are no longer a prisoner to it. However, this doesn’t just take place in the consultancy room.
Think of those cases you read in the paper – a child at school develops dizziness, suddenly everyone in the classroom gets dizzy. There’s no indentifiable cause and yet it’s happening. In the old days they called it mass hysteria, but its really transference – body-centered transference. The feeling of anxiety in one person is transferred onto others. They react in the same way.
There are also more subtle examples: A victim of domestic violence meted out by a parent, may end up being married to man who does the same. A bullied schoolboy is more likely find other bullies in the workplace. This is partly the result of transference: Those old feelings of the past, originating in one person, are transferred onto another in the present. Sometimes we like what’s familiar and slip easily into a previous role, other times we are repulsed, and challenge stereotypes by reversing roles around. That’s why the bullied schoolboy, becomes a workplace tyrant, or the victim of domestic violence, may start attacking back.
The Game is not a Game
As a rule all relationships contain transference, only with a condition like BPD, or any other trauma-related mental health condition, feelings are much more intense, and so the risks are higher. In this constant dialectic between war and peace we can only break the cycle if we know what’s happening.
Transference is not a game. In real life — in the marriages, partnerships, relationships and friendships — it’s dangerous and can lead to mutual hearthache and self-destruction. We’ve seen examples of toxic relationships, perhaps we’ve been in one ourselves. Personalities clash, we carry our pain with us. It’s like a dark light we shine on others and they reflect it back on us. In that darkness are the secret fears, desires, wishes and regrets of the past. We no longer see what’s in front of us we only see individuals framed with childhood-tinted glasses. But it’s possible to see with clarity.
If a personal or professional relationship or friendship, has become toxic reflect on why. Is it because it’s a personality mismatch? Or is it because you and the other person are catching feelings, passing them back and forth. Are you unconsciously transferring old emotions onto one another in the present? It’s important to know we can’t reduce life to such a simple idea. Carl Jung said: ‘The dissolution of the transference often consists in ceasing to describe the nature of one’s relationship as “transference.”’ That’s a point worth remembering. Nevertheless, the problems in relationships can be located in the past, but the past is also a means to discovering the future.
As mentioned some therapies see transference as a principal goal of treatment. Take Transference Focused Psychotherapy (TFP) a highly specialised therapy for Borderline Personality Disorder, created by the eminent psychiatrist Dr Otto Kernberg, in 1990. It’s aim is to unify the split self, by systematically unravelling the transference and counter-transference in any interaction. Meanwhile, mentalisation-based treatment (MBT) created by Peter Fonagy in 1995 also has a similar goal. The transference, or rather observed in situ, that is to say, the whole point of therapy is to safely confront old feelings as and when they arise in real time.
Often, in BPD we may know something intellectually but not intuitively. We are stuck in what Fonagy calls “pretend mode” where there’s room for words but not insight. Activating old object-relation dyads, forces us to recollect the unbearable pain we felt when we were young, and this in turn can prove cathartic. We experience healing and growth.
What about in In real life though? We can manage transference by observing it as it happens. Do other people evoke strong positive or negative reactions in you — if so why? Really examine it. If you are being forced to play the game play it well. That is to say, accept the feelings are real, but recognise that they are detached from their source. They are untrustworthy and unreliable, so we can let them go. Vice versa if feelings are passed onto us, we can let them go too. In this ball game it’s ok to drop the ball.
We all carry a heavy burden from childhood. Sometimes so we can’t help but see the world through a child’s eyes. A rather innocuous peculiarity of human nature, under the pressure of trauma, creates a dangerous pattern of volatility in any relationship. So be vigilant, it’s game-over when you decide you no longer want to play — that’s a good thing, because it means you understand what’s happening. Rather than transferring the burden onto another, why not discard it all together. Let go, and see the other person for who they are. It won’t change how the other person sees you, but you’ll feel better knowing you don’t have to play along.
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