In Therapy

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Cool Intervention #1: Transference Interpretation

10CTI: Just who do you think I am?

Time to pop a cork and celebrate the top selection from the Ten Coolest Therapy Interventions: transference interpretation. I raise a glass and yield the stage to Dr. Glen O. Gabbard, a true connoisseur of psychological theory.

You know transference. It's that psychoanalytic concept where feelings for one person are applied or transferred to another. It's having irrational sympathy for a coworker who reminds you of your sickly brother, or cowering around a boss who feels like your domineering mother. If a current relationship is distorted because of unfinished business from a prior relationship, it's probably due to transference. 

Don't worry, it happens all the time, even in therapy. In fact, psychodynamic therapists look for transference because it helps identify the skewed expectations or unmet needs in the client's unconscious. Once the therapist identifies the transference, he shares it with the patient in a statement called an interpretation. According to Gabbard:

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A transference interpretation is often thought to be one of the most mutative interventions in psychoanalysis and psychoanalytic psychotherapy. The idea is that something from the patient's world of internal object relations is being repeated in the here-and-now interaction with the therapist, but the patient is unaware of it. The interpretation of the transference situation is designed to make something conscious that has been unconscious.

So why is this the #1 intervention? First, let us recall the criteria: Creative, Bold, Compassionate, Mysterious and Cool Name. Nailed each one, then goes above and beyond. Through the years, transference interpretation has set off more lightbulbs than the Vegas Strip as the original "ah ha!" moment in therapy. This co-created epiphany helps thoughts, feelings and behaviors suddenly make sense and seem manageable. 

It's not only the results, but the meticulous craftsmanship. Somewhere in your neighborhood tonight an argument will cause someone to utter the words, "I'm not your mother" or "stop treating me like a child," which is the transference interpretation equivalent of Two Buck Chuck. Affordable, mundane, not terribly transformative. In an analyst's office downtown you'll find a complex, elegant, aged-to-perfection transference interpretation delivered at exactly the right time with exactly the right words, and the patient's world will never be the same. It's the '29 Chateau Latour of interventions, served in Tiffany stemware. 

Glen O. Gabbard, M.D. shared excellent responses for last year's Seven Questions Project and joins us again today. He is Professor of Psychiatry and Brown Foundation Chair of Psychoanalysis at Baylor College of Medicine in Houston, Texas. He is also Training and Supervising Analyst in the Houston/Galveston Psychoanalytic Institute and former editor of the International Journal of Psychoanalysis. He is the author or editor of 23 books, including Psychodynamic Psychiatry in Clinical Practice: Fourth Edition and Long-Term Psychodynamic Psychotherapy: a Basic Text, coming out in its second edition in the spring of 2010. Every therapist needs some Gabbard in their library.

Hear, Hear! To an intervention with a good nose, thick legs and a great finish: the transference interpretation.
 
1. When would a clinician use transference interpretation?

Several factors must be considered in the timing of a transference interpretation:

    a. If things are going well, you may wish to postpone the interpretation. We generally wait to interpret the transference when it has become a resistance--e.g., the patient cannot open up because he imagines the therapist will be critical.

     b. Transference interpretation is a high-risk, high-gain intervention so the therapist must first pave the way for it by empathizing with and validating the patient's perspective so there is a strong therapeutic alliance before the interpretation.

     c. The therapist must assess that the patient is in a reflective state of mind where a transference interpretation could be heard and reflected upon.
 
2. What does it look like?

A transference interpretation links three sides of a triangle. One side is the patient's transference to the therapist; a second side is the patient's experiences with current relationships outside of therapy; the third side is the patient's past relationships with parents and others. So it might sound something like this:

"When you express your fear that I will criticize you if you speak openly here, it sounds so much like your fear of speaking forthrightly to your husband that you brought up last week and your anticipation of criticism from your Dad that you brought up a few minutes ago. I'm wondering if you have retreated from your intimate relationships with men for fear that we will all put you down for having your own views on things."

3. How does it help the client?
 
Transference interpretation helps our clients by enabling them to see broad patterns of fantasies, interactions and object relations that they had never put together before. When the same fantasy or pattern emerges in the relationship with the therapist, it is much more difficult to disown it or deny it.
 
4. In your opinion, what makes transference interpretation a cool intervention?

What makes this intervention "cool" is that it links information in the here-and-now unfolding before your eyes with the ancient past in a way that helps the patient see that the ghosts of childhood continue to haunt him/her in the present moment.


**** Stay tuned for a summary of the Top 10 with a list of honorable mentions and a wrap up coming soon.

Ryan Howes, Ph.D., is a clinical psychologist, writer, musician and professor at Fuller Graduate School of Psychology in Pasadena, California.

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