In transference interpretations transference interpretations

Brief Psychoanalytic Therapy Treatment Manual

Part 2. In transference interpretations transference interpretations

Part 2. In-transference interpretationstransference interpretations

It is important that in order to understand the nature and force of transfer-

ence interpretations, one appreciates the nature of the therapy within which

interventio

interventions are made. In order to avoid unnecessarns are made. In order to avoid unnecessary conﬂict wy conﬂict with those whoith those who

have argued for speciﬁc meanings to

have argued for speciﬁc meanings to attach to tattach to the notion of transference interhe notion of transference inter--

pretation, it is appropriate to provide a working deﬁnition of in-

pretation, it is appropriate to provide a working deﬁnition of in-transferencetransference

interpretations (see Hobson and Kapur 2005 for an empirical study of such

interventions). In-

interventions). In-transference interpretations elaborate on the transference interpretations elaborate on the here-here-and-and-nownow

transact

transactions between patieions between patient and therapist, viewed from the perspective of thent and therapist, viewed from the perspective of the

patient’s experience or the patient’s role in shaping the exchanges.

An interpretation is deﬁned as a comment by the therapist aimed to clarify

the mea

the meaning(sning(s) of t) of the patient–he patient–therapist interaction that have just taken place.therapist interaction that have just taken place.

An in-

An in-tratransference interpretation comprises a therapist statement or group ofnsference interpretation comprises a therapist statement or group of

statements that contains speciﬁc and direct reference to the therapist, usually

containing the word “I” or “me,” intended to clarify the patient’s current feel-

ings or actions in relation to the therapist. It is possible to achieve inter-

ings or actions in relation to the therapist. It is possible to achieve inter-raterrater

reliability in identifying such interpretations in recorded interviews (Hobson

and Kapur 2005). Te following are examples taken from videotaped assess-

ment consultations with di

ment consultations with diﬀerent paﬀerent patients, and are intended to iltients, and are intended to illustrate whatlustrate what

actually happened in therapy, and

actually happened in therapy, and not not to represent models of ideal interpreta- to represent models of ideal interpreta-

tions (which would be more succi

tions (which would be more succinct, for enct, for examplexample):):

•

• “Y“You see hou see how mow much you uch you have have to focus on what to focus on what is in my is in my mind. Immedmind. Immediatelyiately

you focus on what I

you focus on what I may have read [may have read [in a questin a questionnaire] and registered aionnaire] and registered andnd

how I am going to help you. I

how I am going to help you. I don’don’t know tt know the motive for your need to khe motive for your need to knownow

this but it’s clear you need the spotlight on me, what I’m going to do, what

I’m

I’m expectexpecting, what I’m thinking, what I’m thinking, what I’m staring about, what I’m inquisi-ing, what I’m staring about, what I’m inquisi-

tive about. Te whole of your thought seems to be occupied with what’s in

my mind.”

•

• “Y“You see ou see I think this goes I think this goes very deepvery deep. In . In the questionnaire two othe questionnaire two of the f the thingsthings

you mentioned, one was at one phase you had a, I don’t know, a true prob-

lem with eating but also you said something about this peculiar business of

THE TREATMENT MANUAL 74

sleeping a lot. At any moment in this contact between you and I, I’m not at all clear what you’re taking in from me and what you’re not. I’m not at all clear what you’re asleep to or what you’re awake to. Tere seems to be something that registers with you and then it seems lost, what I call a kind of deadening, as if you can resolve it without really thinking about it, or that you kind of take in but don’t really make your own, you don’t really assimilate it, you don’t really take in.”

• “I mean you know the difficulty of having a boyfriend, a relationship—you find it so difficult to meet in an engaged way—and something else, I think what you are doing to me might make you realize, because very much what you’ve described about your position in your family is that ‘I wasn’t allowed to exist’ … Almost to talk to you, my words might have been inter- esting but it was as if I really had to struggle to say, ‘Look I’m trying to talk to you or even talk with you,’ not just because you are elusive but becauseI

wasn’t allowed to really exist.” [Patient is moved, and reaches for a tissue]. Qualities of in-transference interpretation

Te current deﬁnition of in-transference interpretation is relatively spare, in that its focus is on the therapist’s intent to clarify the patient’s current feel- ings or actions in relation to the therapist himself. It may be helpful to consider the examples of in-transference interpretations according to (a) how the interpretations are anchored: (b) to which features of patient–therapist interaction they are directed; and (c) the kind of patient–therapist engagement they appear to foster.

(a) Anchorage Te first thing to observe is that in-transference interpretations are anchored in the immediate here- and-now of the patient–therapist exchanges (“Tere seems to be something that registers with you and then it seems lost”). Tey tend to be specific to what has just happened or is happening, and although they occasionally make reference to links with other relationships or with recurrent patterns of relating (“in the questionnaire two of the things you mentioned,” “you know the difficulty of having a boyfriend, a relationship,” “what you’ve described about your position in your family is”), these instances are immediately followed by reference to current transactions. Terefore in-transference interpretations are essentially local and tightly focussed, rather than general or abstract.

(b) Focus Secondly, in-transference interpretations are focused as follows: (i) on how the patient experiences the therapist, including qualities of anx-

iety and defence (e.g., “I don’t know the motive for your need to know this but it’s clear you need the spotlight on me”);

BRIEF PSYCHOANALYTIC THERAPY TREATMENT MANUAL 75

(ii) on the patient’s ocus o attention, including what the therapist is thinking or doing (“You see you have to ocus on what is in my mind”); and (iii) on what the patient is trying to do._{Tis “doing” is sometimes ramed}

in terms o the patient’s attempts to deal with his/her own mental states (“Tere seems to be something that registers with you and it then seems lost, what I call a kind o deadening,” “you kind o take in but don’t really make your own”), but more ofen in terms o how the patient is attempting to conﬁgure the interaction with the therapist (“not just because you are elusive but becauseI _{wasn’t allowed to really exist”). Ofen in-transerence}

interpretations reer to how the patient is maneuvering him/hersel and the therapist to eel certain things or to adopt a prescribed role within the exchange (“I’m not at all clear what you’re asleep to or what you’re awake to”). His/her actions in relation to the therapist, whether involving mani- est actions such as what he/she says or mental actions such as projecting eelings into the therapist, are ofen addressed (note: this does not _mean

that interpretations about the patient putting eelings into the therapist are encouraged). Tis kind o interpretative work gives emphasis to how the patient deals with the therapist’s own stance, and, in particular, to the ways the patient experiences and uses what the therapist oﬀers by way o statements that are intended to express understanding.

(c) Style Tirdly, the style o interpretation is direct, in the sense that the therapist does not explicitly invite the patient to reﬂect with him/her on his/ her observations or conjectures, but instead articulates what s/he believes s/ he is witnessing on the basis o evidence that is also available to the patient (and which thereore can be disputed). Obviously, s/he is also presenting his/ her observations so that the patient can make use o them—and as we have seen, s/he pays close attention to the patient’s reactions. Having said this, in the excerpts a substantial number o the therapist’s interventions began with “You see …,” or “I think,” and this conveys how s/he is putting a viewpoint that s/he hopes the patient may understand or at least consider.

Te above illustrations are intended to highlight eatures o interpretative activity that are likely to eature in BP, but not to prescribe that everything the therapist says should conorm to these characteristics. Much more important is that a therapist engages in sensitive therapeutic work directed to giving a patient a sense o being understood, while not also experiencing the therapist as needing to deflect rom, or as condoning or condemning, what is really happening. At the core o the therapeutic stance is an effort to conront and ace current emotional reality in the patient–therapist relation, in conjunction with and or the benefit o the patient.

THE TREATMENT MANUAL 76

Finally, it is worth observing that the psychotherapist plays an active role in BP (Hobson and Kapur 2005 provide evidence o my own high rate o in- transerence interpretations when conducting assessment consultations). In BP, there is urgent work to be done in helping to unold, identiy, and understand those o the patient’s relatedness patterns that are a source o ill-health. Although a small number o major relatedness themes will recur again and again in the course o therapy, both in moment-to-moment interactions and over more protracted periods o time, it is vitally important to express understanding o what is happening in the therapeutic relationship as ofen as the opportunity arises—provided, o course, it is possible to express that understanding in a way that is sensitive to what a patient needs at any moment, and what he or she is able to ﬁnd helpul.

Here the Manual ends.

In document Brief Psychoanalytic Therapy - R. Peter Hobson (OUP, 2016) (Page 86-89)