1. Human Connections The New Emerges out of the Old: Working within the Transference- Countertransference Matrix

2. Programme;  Examine the nature of the transference- countertransference matrix.  Transference-countertransference enactments.  Explore the therapist’s stance and the treatment implications?

3. What is the nature of the Transference-Countertransference Matrix?

4. Transference & Countertransference  Transference is defined as the conscious and unconscious responses --- both affective & cognitive --- of the patient to the therapist.  Countertransference is defined as the conscious and unconscious responses of the therapist to the patient. Maroda (2004, p.66)

5. A TA View of Transference (Erskine, 1991)  The means whereby the client can describe his or her past, the developmental needs that have been thwarted, and the defences that were erected to compensate.  The resistance to full remembering and, paradoxically, an unaware enactment of childhood experiences.  The expression of an intrapsychic conflict and the desire to achieve the satisfaction of relationship needs and intimacy in relationships.  The expression of the universal striving to organise experience and create meaning.

6. Transference Cues Schore (2003) states that;  ‘it is now thought that “cues” generated by the therapist, which are absorbed and metabolised by the patient, generate the transference (Gill, 1982).’  ‘transference crystalizes around perceived expressions of the therapist’s personality, therapeutic style, and behavior‘,  ‘the patient is especially sensitive to perceiving aspects of the treatment situation which resemble “the parent’s original toxic behavior.’ (p72)

7. Here-&-Now Perspective Hoffman (1983) describes a radical view of the transference reaction as having a basis in the here-&- now interaction. From this perspective transference is viewed as having four distinguishing features: 1) the patient’s selective attention to certain behaviours in others, 2) a predisposition to choose one set of interpretations regarding behaviour over possible others, 3) the patient’s adaptations are unconsciously determined by and governing of their beliefs, 4) a tendency to behave in a manner that elicits responses consistent with one’s expectations.

8. Countertransference Countertransference is generally taken to mean the therapist’s ‘total’ response to the client (Kernberg, 1965), and may include;  The therapist’s identification with the client’s ego state relational units (Little, 2006) projected onto the therapist.  The reality of the client’s life and the therapist’s reactions.  The therapist’s own transference dispositions, as determined by his or her ego state relational units.  The reality of the therapist’s life that may influence how the therapist behaves with the client.

9. What does the Transference- Countertransference consist of? The transference-countertransference matrix consists of two individuals bringing together their internal world of relational schemas, both integrated and un- integrated, to form a unique coupling. (Little, 2011). When these two individuals come together, two subjectivities, with their respective organising principles, are being elicited and regulated by one another. (DeYoung,2003).

10. Transference-Countertransference Enactments  The literature suggests that the client’s problem interacts with difficulties that the therapist is experiencing either temporarily or chronically in his or her own life.  The result: the client & therapist both unconsciously find expression in the other for their own difficulties.  Enactments are therefore joint creations of the therapist and client (Mann, 2009, p.8), probably consisting of two sets of ego state relational units.

11. Enactments  Enactments are transacted in moment-to-moment Right brain-to-Right brain emotionally charged attachment communication. These rapid implicit transactions occur in milliseconds (Schore).  A spontaneous enactment can either blindly repeat a pathological defensive relational schema, or  Creatively provide a novel relational experience via the therapist autoregulation of projected negative states & coparticipation in interaction repair (Schore).

12. Working with Enactments 1.Getting caught in the pattern as an accomplice. 2.Reflection, processed as an experience, not analysed. 3.Corrective emotional experience (Wachtel, 2008, p. 237)  It is suggested that the therapist’s eventual self-awareness of her own participation, followed by self-disclosure of her experience, promote a conscious, verbally articulated encounter with the patient's unconscious relational styles, creates opportunities for emotional and neural integration.

13. What are the Treatment & Clinical Implications?

14. The Therapeutic Stance In relation to this formulation of the Transference- Countertransference Matrix the therapist’s stance consists of;  Maintenance of the therapeutic frame & alliance.  Appropriate management of optimal neutrality.  The interpretive process; particularly of the relational schemas.  Integration & use of countertransference.  Engaging appropriately in Intersubjective Interchange

15. Optimal Neutrality ‘Optimal Neutrality’ (Little, 2013) is an attitude of mind entailing a non-judgemental stance, finding a balance between engagement and observation as well as finding a balance between being perceived as both the new object and the old object (Greenberg, 1986). Involving acceptance of all parts of the client; not being invested in any one aspect over another.

16. Optimal Neutrality Old Object Repeated Needed Relationship Relationship New Object

17. The Old & New Object  The Old Object consists of those experiences of an-other that were either attacking, traumatising, rejecting or that were tantalising but disappointing.  The New Object consists of what the therapist provides, including containment and holding, and will also include “optimal responsiveness” (Bacal & Newman, 1990).

18. The Repeated Relationship The Repeated Relationship is potentially traumatising, non-gratifying, attacking and/or rejecting, and will be likely to evoke the defensive behaviour. Stern (1994) describes this relationship as consisting of the client’s experience of the therapeutic dyad as ‘being organised in terms of familiar pathogenic relationship patterns’. The relationship usually involves the bad object which the individual “hates and fears, who is experienced as malevolent” (Rycroft, 1968, p.100) and persecutory. This pole of the transference is the source of conflict, with its expectation of selfobject failure (Stolorow et al, 1995).

19. The Needed Relationship The Needed Relationship consists of the client’s experience of the other as a ‘self-facilitating object’ (Stern, 1994, p.317), who can attend to the vulnerable self with its unfulfilled need for growth and development. This aspect addresses a selfobject function that was ‘missing or insufficient during formative years‘. (Stolorow, et al, 1995, p 102). This desire represents the sought after good object whom the client probably loves, and “who is experienced as benevolent.”. This relationship may contain the unmet need for attachment and an empathic, attuned relationship that would constitute a secure- base (Bowlby, 1979, p103).

20. Impasse Clarification: The Relational Impasse

21. Optimal Neutrality & the New Bad Object Old Object Feared Bad Needed Object Good Object Relationship Relationship New Object

22. Ray Little Psychotherapist, Supervisor & Trainer Enderby Psychotherapy & Counselling Associates Edinburgh, Scotland. www.enderbyassociates.co.uk Tel: 44 (0)131 667 2005 This presentation is copyright © 2013 Please do not photocopy or circulate.