This is a post about transference and countertransference. Specifically, about how both can contribute to the creation of a deeper therapeutic relationship. How? By cultivating intimacy between client and therapist.
I take my view from the concept of 'intersubjectivity' and the mutual effects of transference. This suggests that co-transference is an inevitable part of the therapeutic encounter. Afterall, the client-therapist relationship is a subjective one, based on a stream of mutual (and often unconscious) interaction and merging moment to moment.
Why does this topic matter? Because our unconscious responses to our clients can either
keep their initial wound in the dark, or can be the shining light of awareness that they are looking for. Being aware of what is playing through us and being honest and open enough to work with it, is key to being able to build intimacy with our clients.
(Incidentally, I've changed the names and details of the clients mentioned, to maintain sacred confidentiality.)
Intimacy is a heavily loaded word. Maybe your inner alarm bell is already ringing. 'It's never safe to be intimate with a client, sort your boundaries out!' But real therapeutic intimacy is a real of beings moment to moment, characterised by more continuous moments of authentic personal disclosure, emotional reciprocity and embodied empathy.
It's not always easy to engage and communicate from this place. There are distractions. Habits. Inner emotions and outer judgements. Sometimes a session can feel like we've had a few moments of intimacy but the client is stuck in their story and keeps going back to it. Or maybe we can't get over something we think we know based on what we've felt. Intimacy is a willingness to flow from a fixed state and to be shaped by one another in the here and now.
Sammy called me one afternoon to discuss coming for a craniosacral therapy session. For 8 years she had been plagued with depression and constant fatigue. She had tried everything from anti depressants to mindfulness meditation and had even become a vegan. Nothing was working. The doctors couldn't find anything wrong and reluctantly diagnosed her with CFS (Chronic Fatigue Syndrome/ ME myalgic encephalomyelitis). Since receiving the diagnosis she was struggling to stay awake past 1pm in the afternoon, she had lost her job and her marriage was under pressure. Her young children were playing up at school and she would frequently lose her temper and then feel guilty for it. She told me she had 'almost lost all hope' that she would ever get better.
I found myself engrossed in Sammy's story and I noticed a feeling of awe within me as I felt her determination to find a cure. We spoke of yoga and I started to notice I was feeling quite proud of her for saying that yoga was the only thing that seemed to help her neck pain. A huge wave of hope passed through me. I needed to help her! I said to myself. It wasn't until I put the phone down that I asked myself, 'who am I to her? who is in awe and who is proud, who desperately wants to help her?' In this way, the transference dynamic was already set up between us.
'I feel really comfortable with you' Sammy said as she lay down on the treatment table. 'I don't know why because I don't even know you.' Her eyelids fluttered as she tried to relax herself. I could feel her system reaching out to mine and I felt something within me, trying to reach back out to her. I attuned to this dynamic and allowed it to develop. It felt like it was important for us, but at the same time, it wasn't us.
As I began to hear Sammy's system I was aware of the cranial base compression and left torsion in her neck. There was a strong tugging that was coming from her right shoulder. Energetically her legs were kicking back and forward although there was no physical movement, her body lay frozen on the table. Her emotional body revealed a desperate fight for survival and a gut wrenching fear of death.
I suddenly felt a huge wave of exhaustion wash over me. I looked at the clock and noticed it had only been fifteen minutes. I checked in with myself, I wasn't tired, but exhaustion was definitely present with me. What was happening? I honestly wasn't sure but it felt important. Instead of trying to ground and make the exhaustion disappear I just allowed it to stay and develop. I soon realised we were in a totally different field of reality, Sammy's frozen body had become a kicking new born baby fighting for it's life and I had become an exhausted mother. We were in the transferential field.
As soon as I acknowledged my part, I could see an image of a tiny baby with the umbilical cord wrapped tightly around its neck. The baby's face was blue. And as quickly as the image had revealed itself Sammy's body began twisting and her breathing became shallower.
'Sammy, what do you know about your birth?'
'I was just about to tell you- I can see my birth. I have the umbilical cord around my neck. I can't get it off....' her voice trailed off into the silence.
I was her therapist. Now I was also her transference mother. Together we were fighting for survival but this time, it needed to be different. When Sammy was born her mother was too exhausted to do anything. She was helpless as her baby fought for her breath. I knew that I couldn't let Sammy do this on her own, again.
'Shall we take this cord off together?' I asked
'Yes...I'm scared..but yes' she responded
I began to deepen my engagement with her compressed cranial base and her spinal accessory and vagus nerves whilst holding the fear of death that was in the field, far enough to be felt but not close enough to overwhelm. Her body began to respond and her neck began to unwind, the fascia melting gradually around her upper cervical spine. I could feel her feet slowing down as her spine lengthened itself out.
Sammy cried tears of relief as her body softened and relaxed, releasing a lifetime of fear and exhaustion. Due to her difficult birth she had not only held onto her newborn exhaustion but had also held onto the exhaustion of her own mother, absorbing her fatigue and fear to try to make up for the guilt that she had caused this all. Finally, she was free.
I realised that the cotransference dynamic had probably allowed a swifter resolution than might have been possible without it. The maternal transference enabled a deeper trust to be experienced than might logically be present during a first encounter with a new therapist or therapy. It allowed what was needed, which was for Sammy to experience her mother as an active participant in trying to save her life, rather than a helpless and exhausted witness to her struggle. It allowed her to experience her mother as hopeful, as a believer in her, rather than as completely hopeless.
It was two weeks later that I saw Sammy again. She was no longer constantly tired and now she could stay up for most of the day. Her mood was much better and she felt like she had her energy back. Her relationship was better than it had been in a long time and she was enjoying her time with her children again. A few months later, Sammy texted to tell me that she had just got herself a new job at a nursery near her home. She was excited to start.
Our journey through the maternal birth transference field was short but powerful and it began with that phone call. I learned alot about allowing sensation in, even the strange or difficult ones. I learnt that they carry a lot of information that can facilitate the healing process. By allowing myself to be moved by my client, to be proud of her, to be exhausted by her, I let a painful but critical fulcrum emerge. In this fulcrum, we both engaged in embodied empathy, authentic personal disclosure and emotional reciprocity.
Therapeutic intimacy can't be made up or strived for. It's not professionalism and it's not rapport. It's something so much deeper than that. It is a place of mutual vulnerability that offers a richness of experience and potential for transformation. Perhaps through the mystical participation of the co-transference dynamic this sacred space was created.
Working in this cotransference depth requires both personal and professional willingness to step into the vast unknown with a client and to be moved by them and have no idea where you're going. It requires radical honesty within yourself, in order to understand the role that you are playing as a therapist in your client's process and the steadfastness to know when to activate or harness this role for their highest good. It requires the compassion, the art and the heart of trust. To work in a co-transference field you need to know who you are and who you are not, any every point in time that you have your hands on someone's body and your field is merged with theirs. Holding clarity in muddy waters and not being afraid of the muddy, dark depths of the human experience. In this way, with this capacity, you find yourself able to be almost anyone you need to be, in order to allow truth and love to arise. Artist cover image: Andrew Blucha @metafables