Monday, May 19, 2008

Bah Humbug Transference


On my post called It's My Life, I'll Blog If I Want To, one commenter ( green tea) wrote:

I would have a really hard time if my therapist had a blog. It would make them seem too "human" too fallible. I think part of the illusion of therapy is that the person sitting across from us brings their BEST person into the room. In the blog, it's hard to maintain that sense of bounded distance. That detachment that invites a client inward, and into themselves. As an aside-- why use the word "transference" when "relationship" is more apt?

Green tea, I have to say that I agree with you. Here's the issue though: it would be wonderful if every therapist was a wonderful, infallible, highly moral, human being who lived life on a higher plane than the rest of us, and if, barring that, the therapist could keep all skeletons, failures, incorrect or unplanned emotional responses safely locked in the closet and out of sight of any patients.

Sometimes this is so important to a patient that the patient goes to lengths to find distance in therapy: maybe traveling to a distant city, paying in cash so that a psychiatric diagnosis won't come around to bite, making every effort to avoid information about a therapist's personal life/blogs/writings/friends, whatever.

Here's my question: Where's the Line? The real life reality is that therapists have issues, they can endorse unseemly political opinions, have messed up children, icky public divorces, dirty secrets that aren't so quiet. Who wants to know that their therapist hasn't spoken to his own mother in 23 years? Or that he's a member of a church that insists all non-members (including said patient) are condemned to an eternity in Hell? That he buys kinky things in porn shops? What about that prison tattoo? I could go on and on.

At what point does one's profession dictate who one has to be in one's private life? If you think you may want to run for President or for the Supreme Court, well....we all want you to be perfect: pick your pastor wisely, don't inhale, never never never pay your nanny under-the-table, declare everything, deduct nothing, watch where you put that cigar, and don't have ECT. Try not to shoot the neighbors, even by accident.

If you're a psychiatrist, some things are clear: you can't be impaired by a mental illness or have an active substance abuse problem. Licensing boards ask about crimes (but not about tattoos). Direct patient boundaries are defined (or at least trying to be). But outside the office in settings that don't entail the purposeful inclusion of patients? Not many would criticize a doc for writing in academic journals. Novels? Blogs? A doctor who smokes but encourages his patients to quit? Take your lithium, but I've got to run to my hang gliding lesson now?

It's good to have a therapist who is a nice person, who is moral and ethical and kind and encouraging. It's good to have a psychiatrist who is well-educated about medications and up-to-date on treatment options (and kind and ethical and moral and encouraging and a nice person). Google your doc well if you want to be certain they don't have a blog or a strange hobby or affiliation, or crimes against humanity.

Why "transference" and not "the relationship?" Because that's how the question was posed to me. Sometimes my patients talk about the relationship, "transference" is not a word I tend to use in clinical practice, mostly because it's not a schema my patients bring to the setting.


13 comments:

shnayman said...

Hi,

Do you have any really excellent, original jokes about psychiatry/mental hospitals? I'm a psychologist and fiction writer, writing a novel (under contract) set in a psychiatric hospital in the late 1940's and I need some great jokes for the book.

This is a cry for help! Hope you can...

Shira

Therapy Patient said...

I have been thankful that my psychiatrist has never used the term "transference" in my sessions, even when we had a discussion about my feelings about him.

It's probably THE psychological term I dislike the most because inherant in the term is the implication that a patient is not able to distinguish feelings that they have for one person versus feelings they have for another person. If a therapist has positive feelings for a patient it must be "transference" or if a patient has positive feelings for a therapist it must be "transference". The theraputic relationship has distinct boundaries, but I feel it denies the reality of genuine feelings to say that the feelings are redirected feelings that "belong" to someone else.

My psychiatrist has EARNED my positive feelings towards him by the way that he has treated me with kindness and respect. I know more about him both in practical aspects of his life and about his emotional and moral makeup than about most of my friends. When my feelings would have been more appropriately called "transference" were in the first months that I started with him and was afraid of him. THAT was transference of how I felt towards my father. Yet what I generally hear is that when a patient feels POSTIVE towards her therapist, THAT is transference.

Anonymous said...

Where's the line? I think that is a great question. For me the answer is knowledge of unethical & illegal conduct. Had I known that my psychiatrist had pleaded no contest to a DWI & been found guilty less than a year before I walked into his office, I would not have made the appointment. For whatever reason it didn't show next to his name on the state board's website. The only thing that showed was that he was late paying his licensing fees a few times, and that to me wasn't enough of a reason not to see him. Do I expect a perfect therapist or psychiatrist? No, there's no such thing. But, I do expect ethical conduct, and I do expect them to follow the laws. He had problems in both of those areas.

The therapist I worked with after the psychiatrist wasn't some perfect human being who has experienced no tragedy or problems in her life. I know she was divorced & remarried. I didn't care about that, and frankly it's none of my business. It's a non-issue. She was ethical, professional, wasn't getting arrested for drunk driving, and she provided good care. THAT is what mattered to me.

Aqua said...

All I want from my relationship with my psychiatrist is that he shows respect for my trying to get well, even if I feel like I can barely move,because he understands this is a symptom. I want him to be compassionate and thoughtful, but also honest and open with me in our sessions. I also want him to be a person who values and abides by personal and professional boundaries as laid out by his profession.

It would help me to know he was falliable, that there is no such thing as a perfect human being. I want him to make mistakes. Often I learn the most when he or I make mistakes, or misread what is going on in the session. These times are opportunities for me to speak up and address topics I otherwise avoid with anyone else for fear of being dismissed or rejected. With him I feel safe to say anything. That is the most important thing.

Anonymous said...

I like when my docs- whether PCP, psychiatrist, therapist, etc. show a human side. None of us are perfect. I prefer something that feels more like a team approach than a I am weak and you are strong approach.

The Silent Voices in my Mind said...

I would not be able to trust my therapist at all if I didn't know he is human, complete with human failings. The more "real" he becomes, the more I can trust him and the more progress we make. I don't do well with the whole "blank slate" concept.

But everyone is different. Some patients need a doctor who is the face of "the right way to do things" while others need a human face. My guess is that a good therapist learns how to represent themselves on a case by case basis.

Psychiatry101 said...

Since I am no therapist or even patient only thing comes to my mind is the series 'in treatment'.

I guess transference as well as countertransference was a little too much there.

I watched each and every one of them and yes my husband would be sitting on the table and snickering on how unreal it is but I LIKED IT!

Anonymous said...

I'm not understanding psychiatry being put side by side with psychotherapy.
The relation with a psychiatrist is totally different with a therapist.
"Transference" is not a "psychological" term.

Anonymous said...

One can have a relationship within the established confines of the boundaries of the therapy. Having a decent relationship with the therapist does not mean that transference will not happen. No matter how much you like the therapist, you really do not know them outside of the therapy when they are behaving like anyone else, being irritable with a spouse or being the person three cars back honking in traffic. Even if they are a fabulous person, the fact that you don't know them in this way means that a lot of what you imagine them to be is based on wishes or projections and that part is transference. I think that transference doesn't have to mean something awful. It happens in all relationships if you stop and think about it. We just don't call it that. We say: I can't stand my boss, she is just like my mother ,always critical. Or we don't say it, but relate to her in that way.Transference is not good or bad, it just is. That doesn't invalidate positive or negative feelings. If the shrink is never on time, it is normal to be angry and to label that as tranference will only set a person off because it is the shrink's issue. If the shrink is 30 seconds late one time and the patient is very angry,then it is a different story.

Dinah said...

shnayman: in the last week, three people have asked me for jokes: you, Roy (he wanted funny youtubes), and a patient. Another patient brought me a joke but it wasn't good enough to be memorable. What do I look like, Joke Network?

Too many anons, makes it hard to respond. I liked the comment from the one who talks about transference as just happening. It just is and it's there all the time. However, I do agree that to say to anyone that they're expressed feelings are somehow not valid is insensitive. I'm not sure that to say that they are influence by feelings one has had towards others in the past in any way discredits them as real or valid.

It's fine to like your shrink. Really.

Anonymous said...

"It's fine to like your shrink."

According to Freud it's the only way a psychoanalysis can happen. According to Lacan it's the wrong way.

According to my experience I admire and like my therapist and it would be impossible if it was another way.
But if I had a "relationship" it would not be therapy.

I'll search the blog and try to understand this strange relationship between psychiatry and therapy.

Both are quite different approach.
And I've heard about terrible stories when these two are put together.

I hope I can find the difference here.

As far as psychiatry is concerned it has been acting very unethically when prescribing drugs.

Even the concept of "neurosis" was banned from diagnosis which lead to PTSD and other labels.

Anonymous said...

Hello,

I've been to a shrink and only had one session with him.

I was under the impression that he was inducing transference from me. Is this ethical?

jimmy said...

can you explain what you mean bu "inducing transference from me"?? HOW did he try to do this?? was he flirty???