Psychiatry & Psychotherapy Podcast - Using Transference To Improve Connection

Episode Date: February 24, 2023

In today's episode of the podcast, I would like to give you my take on transference. I want to share with you what I actually believe. Often lectures focus on the history of transference or what certain papers say, but I'd like to share my accumulated, internalized experiences and understanding of transference. My hope is to make this easy to read and understand. I want to give a talk on this that can be understood both by experienced clinicians who are familiar with these concepts, who will imagine where I am pulling different pieces of wisdom and maybe where I am being creative and uniquely contributing to the field, but also by people who don't have much of a background on transference and want to further explore it. By listening to this episode, you can earn 1 Psychiatry CME Credits. Link to blog. Link to YouTube video.

Welcome back to the podcast. I am going to do a solo episode today on using transference to improve connection. This will be part two of my psychodynamic series. The first part was listening psychodynamically. It will stand alone, but you can go back and listen to that afterwards if you like this one. And this is my take on transference. And I want to share with you actually what I believe, often in lectures, we can focus on the history or this paper says this. And what I want to do is I want to share what actually has been internalized in myself. Or, you know, I was thinking I could share, you know, studies on hysteria and walk through

the history of transference and how it happened. And maybe in a future episode, I will. But for this one, I want to be as I. honest as I can to my own experience. And I want to make this easy to listen to. So a lot of the things I've read on transference are very difficult to read. You have to kind of know who wrote what before. And then you have to then understand where they're coming from. And so I'm trying to create an episode on transference that can be understood by Climbabst. clinicians who know this stuff, maybe you've got some training in residency as well, or, you know,

therapy practice, as well as maybe someone who's listening and wanting a perspective who doesn't have a background in a lot of complicated words that are often used to describe such things as transference. So, okay, what is transference? Transference is how we understand future relationships by categorizing past close relationships. So by categorizing past close relationships, we can be prepared to meet new people. Past is always alive in the present in this way, in that it gives us a framework to understand

and categories to put people in. This isn't something that's going on consciously. It's often very unconscious, especially if you haven't done any therapy on your transference that you have. We have transference with every person in therapy or out of therapy. And when you are working in the transference in therapy, there's this focus on the present moment, what is going on between you and the client,

because the client is bringing their past relationships into session and how they view what you might be thinking or feeling about them. And I'm also in the camp that transference also extends to what you are really evoking in them as well, maybe by things that you are doing. So I don't, I think you can, it's almost like you can narcissistically imagine that any negative emotion a patient has towards you is their fault. Whereas I don't see it that way. I think like first and foremost, just like first and foremost, when a patient comes in after they started a medication with side effects, it's like we don't just blame something else. We actually think maybe we were the ones that caused it, right?

In the same way, transference in your relationship with a client, maybe it's something that we caused, right? And so we want to look at that as well. So as the patient places transference from the past on your case. you, they have this hope to be working through dynamics from their past that are unworked through, and they hope often unconsciously. This will be a way to overcome some obstacles, maybe moments or a series of thousands of moments of emotional dysregulation, maybe actual traumas, like capital T traumas, like abuse, physical abuse, sexual abuse, emotional abuse, And they're hoping in this to have a corrective emotional relationship.

Now, they wouldn't say that out loud, of course, but they're really hoping to work through this conflict, and that's why it comes up. Often transferences will wait to come up until they have increased trust in you. So raw, unmet needs are thus transferred onto the safest person in the room, so to speak. So this happens a lot, actually, to leaders in various places.

This happens to teachers, you know, strong transference from the students, sometimes, pastors, bosses. Anyone who's in authority in someone's life will potentially evoke strong transferences. And also anyone who's in, like, an attachment relationship, attachment relationship, meaning, like, There is an aspect of connection over time. This will evoke transference as well. I might even add that people will transfer onto their conception of God, stuff from their past. And you can imagine how Greek mythology was actually born

from humans transferring their potential taboos, desires, anger, hostility on the God. and the characters as a way of talking about things in a way that they're not actually maybe talking about it in the first person. Okay, but back to our work as therapists. So just for a second here to help you immerse yourself in this empathic experience of what this is like and why this is important. Imagine you are the patient and you are spending 100 hours with a person pouring out your life, talking about the most stressful things going on, maybe traumatic memories from your

past, and at the same time, you secretively are thinking, this person hates you, this person has disgust towards you. This person, your therapist, wants your money, and otherwise they don't care about you. This person is secretively laughing at you, secretively persecuting you, behind closed doors they don't care about you this person is a quiet bystandard who does nothing who doesn't care doesn't have emotions towards you or about you or about what you're sharing maybe you imagine this person only will love you if you perform if you are perfect if you show up in a certain way or maybe you feel about this person that you're talking to for this hundred hours.

Positive feelings. Maybe those positive feelings are so positive. They feel overwhelming. Maybe you idealize this person and you feel like they are the embodiment of all things good that you aspire to be. Or you envy this person and their authority, their position,

how they wield that power over you. So it's like both envy and you're looking up to them at the same time. Maybe you feel so, safe with this person that you want them to be making all of your decisions. Maybe you have a desire for closeness, but a distance that you want as well, and you feel safer pushing them away. Maybe you even have sexual feelings towards this person, okay, that feel overwhelming, right? They feel very positive, but overwhelming. I had a person recently reached out to me by Instagram and say that they were having these feelings towards a therapist. And maybe I'll be able to be.

mention that more as we go on. Okay, so now going back to now we are the therapist. So how can we see that actually, if this was going on, right, during that 100 hours of work, let's say it was 100 hours, like two years of work, right? If this was going on during that time, can you see how it would complicate every story that they would tell you? And can you see that having compassion on what comes up is all important. By compassion, I mean, knowing that a lot of this contains suffering and conflict. And there may have never been a safe place to express such things before in an interpersonal relationship. And some of these memories, these things that get evoked, these feelings, may be pre-verbal, meaning early memories, repetitive.

very unconsciously experienced. If you don't have words yet to put to things, urnines, desires, then they may be more raw. And now when they put words to them, they may be very strong words. You know, it's like when my kids' heads get flipped and they're hungry and exhausted and they don't have any, you know, maybe they're tired from working out.

It's like they always say things like, you always or you never or you know like these kind of black and white. And in my mind these black and white words, these very strong words, like they by patients are often couched by, but I don't really think that. Okay. So there's like there's the, they feel this evoked, strong thing that then their logical brain, says, but of course, you know, like, there's a little bit of hesitancy there in believing it. If you have someone a little bit more primitively wired, they may 100% believe it, without a doubt. And it may be very, very difficult to directly counter the narrative that they have of what you're thinking or feeling towards them. Actually, if you directly counter it, it may just fuel

the thought that this is what's really going on. Okay, so people are not choosing. to have this transference. It's not like a conscious choice like, oh, I'm going to have this very strong feeling towards Dr. Peter. They are not choosing to have these strong feelings. Sometimes they're only experienced fleetingly or in dreams. Maybe they're not even, you know, often. It's like, what, after three visits, 50% of patients fire their therapist and move on. So, you know, maybe the transference happened that quickly in the first three sessions and then they just leave. And so maybe the patient doesn't even know why they're having a visceral reaction to someone. Okay.

The narratives that people have about you as the therapist and your narratives that you have about the patient are what we are talking about today, these stories that people have, how do they feel about you in between sessions? how do we put these into words? How do we empathize with the distress when these narratives come up? So as we talk about these things, my goal is to do four things. Decrease the shame and fear, the inner critic that the patient is experiencing. So that's number one.

Number two, I want to celebrate their courage to share and to put it into words because I really believe it takes courage to share this. I'm not like ever going to say that when I don't believe it. I really believe it takes courage to share. Number three, I want to empathize with any distress in having these thoughts at all. Like even if they're positive, there can be distress. I want to make sense, number four, about what might be going on between us. And I want to look at that with curiosity.

with the client. And in looking at it, they will not feel judgment that they so deeply fear is going to be there. And that judgment, you know, they may imagine that you are going to reject them in some way. And so I want to, you know, help them make sense of this. And that actually is very stabilizing. I was just talking to a, one of my new,

therapist I've hired and he was talking about this client and I just recommended like I think you should put out in front of the client this trauma that was shared in the previous session and then the client has not been responding to communication and I think that the client in sharing the trauma imagined that Chris was critical of him or her after the sharing of the content. And I think that other people in the past were very critical of this incident. And so I think that they're having a transference on to Chris that this might be going on as well. And so my emphasis with Chris was how can you just put towards to that if you get a chance, which will help them make sense of what's going on?

Okay. Why help them decrease? negative internal voice. You know, what happens if that negative internal voice is decreased? First of all, there's a huge amount of increased creativity that occurs in patients. Anytime I've been able to do this deep work, it's like a creative explosion. It's just, it just comes to the surface, right? Because that critical internal voice shuts down creativity.

Secondly, they have increased connection outside of therapy. because these transferences are happening in all relationships, right? And so if they feel less of that negative internal voice, other relationships will be less overwhelming as well, and they'll have better connections outside of the therapy relationship. So having a good transference helps them process through life's traumas effectively. And that is what occurs in the subsequent.

So if you're able to navigate this transference that goes on, then as they bring up further traumas in their life. And it's interesting that once you have that connection with the client, once you've decreased the fear and the shame and they have that positive transference that's not too overwhelming, and they bring up previous events from their life, previous traumas, it's like just your presence is enough to stabilize and to help them take out that memory

and feel differently in the midst of that memory moving forward. And what happens over time is that the patient's transference will become less fixed, it'll be more chosen, and it'll be more context dependent. Okay, so how do we,

we come to now, like, how do we listen for that inner interpersonal conversation? And what do I do with it as it comes up in the here and now? So we're going to kind of wrestle through this a little bit. And I'm just going to say again, like, as safety is established, patients will be able to access memories and events that previously were compartmentalized in their mind, lonely memories. memories of trauma. It's like they dissociated those off somewhere, and it's like after they feel safe, then it comes up. And that takes time. Okay, I wanted to kind of back up a little bit and give like a little bit of the data for why I think this is important. First of all, most therapies have

very similar outcomes. Okay, so if you remember my acceptance commitment therapy, episode, I looked at all the studies comparing acceptance commitment therapy to an active control, and they were pretty similar. You can go back and look at my document. I have it all cited. I didn't find a lot of areas where acceptance commitment therapy was a ton better, maybe a little bit with some morbid anxiety, and maybe with some substance use and anxiety. Further, if you go back to the episodes on Borderline Personality Disorder with Dr. Feinstein, we looked at, like, there's a lot of therapies that treat this in a very similar fashion. There are, there's one specific study, though, that looked at dialectical behavioral therapy

versus transference-focused therapy. And it's Levi 2006, and they looked at transference-focused therapy versus DBT versus supportive psychodynamic therapy for borderline per salary disorder. And they found that transference focus therapy had increased secure attachment. And the other two didn't really change how the attachments were represented. Specifically, with increased narrative coherence, which is in the adult attachment interview, one way to gauge attachment, maturity, and also improved reflective function, the ability to mentalize thoughts, feelings, and goals of another person.

Okay. So those were things that were improved with transferous focus therapy. Further, Levi-2019 showed that with twice a weekly transfer of focus therapy over 12 to 18 months, there were changes in the brain. There was a relative increase in the dorsal prefrontal, the dorsal anterior cingulate, dorsal lateral prefrontal, and the frontal polar cortices activation. and there was decreased in the ventrilateral prefrontal activation and the hippocampal activation following treatment. So there were changes in the brain that occurred, and I will link that in my, in my, we always do an article with each episode, Psychiatry Podcast.com. I will link that. You can read that to your delight if you're big into neuroscience. Okay. So number one was that, It seems like most therapies are pretty similar.

However, in the great psychotherapy debate, which is a book by Wampold, they found that although treatment modalities were not significantly different, things like empathy, alliance, positive regard, congruence made a huge effect size difference in treatment. And we know from studies, that there is such a thing called therapist effects.

Some therapists are better than other therapists. A little bit of it has to do with how they handle conflictual interpersonal dialogues. Okay, so in my own research, which I created something called the Connection Index, which can be used in supervision, to look at your connection with your supervisor, I found that connection was actually containing

the four domains of empathy, therapeutic alliance or educational alliance, in this case, psychological safety and feedback, and that when you were high in one of them, you were high in all of them. So I think what we're really looking at is that connection makes the difference.

Okay. And so now you can imagine why transference might be so important because transference is the very essence of connection. it is putting to words the type of connection that is going on if you are if you are perceived by the patient as empathic with strong alliance with positive regard the therapy is going to work and transference is just a way of navigating that relationship to lead to change okay so I'm going to kind of jump to a practical understanding of transference work. So how do we see when transference is happening? We may identify small slips that speak about the relationship.

And how you respond to these dictate the safety of further exploration. So are you enthusiastic for their aggression towards you? They're positive feelings towards you. do you notice like if you are not enthusiastic that maybe it'll be harder for them to express aggression towards you in the future some of you may be like well I don't really want my patient to express aggression towards me

what if they're a very passive submissive person and that aggression is actually like one step towards them getting closer to having a voice having boundaries right and like aggression is like a diffuse word that we could use towards a lot of things that happen. Like maybe them not wanting to pay a bill or having boundaries or, you know,

these could be ways that they're trying to exert some of their frustration, right? I also use microexpression. So microexpression, if you don't know, is a thing that I have brought to psychotherapy. And they are fleeting emotions, one-th-th-of-a-second, anger, disgust, pain. And almost a decade ago, I made an app for it. I decided not to renew the app because I've made a full training program, EmotionConnection.com. And it does a good job of taking you through webinars on microexpression,

but also it helps you learn how to actually read them by watching videos of real micro-expression. expressions of the different emotions. And so these emotions will flash on people's faces. And if they flash on their face in the context of talking about your relationship, that's very interesting. We can have some curiosity about what's going on between us. Okay. So here are some other comments that are like gold to thinking about the transference.

last time I said something and realized you did not understand me. They are giving you what their transference is in that moment. How was it for them to not feel understood by you? That is, you know, what did they imagine you were thinking or feeling towards them? What did they fear you were thinking or feeling towards them in between session? Okay, so other things that are gold are like dreams and fantasies where you are, somehow represented in that. And Dr. Tar would say he was always represented as a black bear,

which is interesting because Dr. Tar is like this like Gandalf-looking old man. But for whatever reason, various clients had a very similar manifestation of him in their dreams. We can also see ourselves represented in poetry, if they write poetry about what it's like to be in therapy. I think poetry is a unique way of getting past some of, of the defenses sometimes where it's like you get to something very congruent. Also art can be a very congruent space. I once had a patient draw their psychiatrist on the couch with them while their parents were in the background and they felt a strong maternal positive transfer towards a psychiatrist.

There can be other more subtle signs, you know, how things are said, what is not said. your inner experience can give you clues to what might be going on. Are you experiencing them different than you did in prior? I want to say prior episodes, prior sessions. Are you experiencing something changed in the room? Maybe that can give you that subtle hint that something may be unfolding. Maybe they are reacting to you differently. You know, maybe there's a change in behavior all of a sudden they're showing up late.

They're trying to, maybe they're opening up stuff right at the end of session, the good stuff, right? Where it's like they want just a little bit longer with you. Maybe they're pushing away in some unique way that wasn't going on before. Okay. So you've identified that there's a moment of potential transference going on. And rather than tell you what to say, because one thing I found is like, it's just not very helpful to memorize Pat responses. Like it feels rehearsed, it feels, especially as I've treated more and more mental health professionals. It's like, I can't, like all this stuff, I have to like, you almost have to get away from anything that's like sounds like therapy.

You know, it has to be real. It has to be raw. You have to feel it. So I'm going to tell you what I believe and what I believe impacts what I'm going to say. So I believe it takes courage to share interpersonal vulnerability. I think it takes courage to share what might be going on between us or what their fears are, if they have frustration. And I think that because I believe it takes courage and it takes, it takes,

It takes a lot to share. I'm going to be positive and grateful for them to have opened that door. And I think that comes from that belief that it takes that courage to share. You know, we must expect hesitations to trust us. We must expect that they potentially want to avoid us, avoid feelings, that they feel some embarrassment about sharing things, it's uncomfortable to share what we feel ashamed about. What would normally, in a normal relationship,

maybe alienate us, what would cause rejection, loss of face, cause us maybe to not feel, maybe it would cause us to feel unloved or unliked, right? So these are things that are very hard to share. And so I really, I come back to it. This is courageous to share this. And I'll say that in one way or another. Okay.

Second thing is I believe that what we bring to session also impacts the transference. So I want to reiterate this. I mentioned it briefly before. But it's important to notice that their transference is a valid experience and your actual, my actual behavior influences it. And sometimes more than others, right? Like sometimes it's influenced more than others. But to think of it as valid

and to think of it as potentially you're impacting it. And so I think it removes a little bit of that sort of negative, I'm the expert, I see this, you know, and moves you into more of a student of what might be going on between you. Number three, sharing more easily in the future will help the work move forward. And so I therefore want to open this door

of this discussion in different ways. I want to normalize discussions of the interpersonal that are going on. I want to put to words even fleeting thoughts about what happened in session or what's going on between us.

And so I may say even fleeting thoughts may be helpful to disclose. Any thoughts, positive or negative will be helpful. And was there any moment where you felt connected? Maybe we can explore

good feelings first, right? Was there any moment that you were afraid, I would not grasp what you were saying. Can we normalize that it will not be perfect? And so this habitiates them to a unique state of permissiveness. Like it's okay to talk about this stuff. Anything that goes on is okay to put to words. anything that we put to words we'll not necessarily put into behaviors, right? So we're going to put to words and that's what we do here.

There would be no actions, just words. There may be some doubt, shame, diminished esteem that they feel in sharing it all, right? And so be prepared to say something like, when that happens, let's learn together what is happening and how we can repair our connectedness. You know, like if we can put to words, if you do feel doubt, shame, diminished esteem

while we're processing stuff, you know, maybe we can just look at that together and have some ability to connect and repair our lack of connectedness. You know, I co-teach with Dr. Tar. He's in his late 90s. At this point, he's traveling through China with his wife right now, which is delightful. And he would say something like this at the end of maybe like an early session.

We can now say it is now time to put in two words some of the feelings we don't express anywhere else in life. We want to be able to share with each other some of the happiness. and gratification that goes on between you and me. And I would like to say I'm delighted that if you have any feelings of sadness or lack of gratification with me, it will be helpful for me to know that. You can't do this anywhere else in life as safely as you can do it here. Do you feel this is bewildering, odd? Does it help you relax or make you more tense?

when I just said that to you about your mother, do you think I did not grasp what you were feeling? Or did you hope I could be angry about what you were telling me? What were you hoping I would feel? You are now overcoming the social restraints. You feel anywhere else. Here it is unique and a special place. It resembles more of an early maternal nurturance.

I don't know if you're not. would say early maternal nurturance, but this is the quote that I have from him. So what's another belief I have? I want them to feel heard and understood and empathize with in whatever they bring up. So as I listen to the patient's world, acknowledge their subjective perspective, resonate with their affect and look at their meanings. Then an alliance is formed with the patient's expressed experience. We attempt to listen for an other-centered perspective,

for what is going on in a different person, right? And we're opening up interpersonal feedback possibilities from the beginning, and we introduce the patient to the likelihood that he or she will develop feelings of being misunderstood at times. And we can look at that and explore that, and that will be very helpful for us. I also believe I do not want to over-intellectualize in the present moment. And I want an integration of emotion and cognition.

DBT calls this wise mind. Spinoza talked about how the mind and the body were one. I want to see beyond the defenses and stay present. I want to stay in the emotion. So I don't want to too quickly move to like an intellectualization. So I don't want the exploration of transference to be an over-intellectual thing. Once in a while, putting it towards letting them know what I think might be going on, help stabilize them immensely.

But often, I want to empathize with the distress of what they're feeling, if they're feeling something. Distressing. If some of you had listened to the episode I did on Karen Hornay, neurosis in human growth, she talks about the false self. This idealized image that we wish to portray to the world. And I see that this false self, which is governed by shoulds, I should be perfect, I should have it all together, is an adaptive response to belonging to a clan, whether it's your family clan or it's a larger clan. And so I call this actually clan leader transference. And I googled this and Google has never seen that word. So this is the first time ever to be saying clan leader transference. And what do I mean by that? Well, obviously people have talked about what I mean by this. I'm just calling it something different. That's what most new therapies do, right? But I think it's a little bit different. Okay, hear me out. So someone who's very invested in the false self, someone who lives out of the shoulds, someone who believes the facade of themselves that they wish to portray to the world, this idealized person. Okay. Someone's very invested in that. May have transference of either idealizing you,

as being the summation of all things that are shoulds in their mind, or imagining me to be judgmental, like embodying their shoulds in a judgmental way towards them. So the clan leader is the person that they may see you to be. It's the idealized person, right? the clan leader. It's like, here's someone who has it all together and they're idealizing you. And that can feel, that can, that can feel weighty, right? Okay. Or they imagine you to be very critical of them as the clan leader and like a critical clan leader. Okay. So I should be

perfect. Maybe they believe that deep down, right? That's part of their shits. He knows that I'm not perfect and therefore is critical of me. So I was discussing this with a patient and they said I could share a little bit about their journey in this. I'm obviously not going to give names or locations or any HIPAA identifying information. Always changed things. I think just the general gist of this might give you an example. So I was talking to a patient about this specific dynamic of her fearing that I was critical of her and the way that she was critical of herself. And this is someone who grew up

at a very performance-driven family. There was expectations to always be at like a national level in a specific area. Let's say a sport or an art or music or something like that. And so this patient today share some gratitude. you did not leave.

I used to have a lot of repeat tapes when we left, repeating what I said. I should have said this instead. I think it is just that the freedom to be myself, and there was a little bit of sadness on her face here. Of course, I wish to be around you all the time. So maybe that's where the sadness was from. It was like, it was a desire to be around me all the time

and a loss and not having that. She went on. But the end result is that life can be free and there can be acceptance and care and authenticity. And I think that there was a little bit of flash of anger here, a micro-expression of anger.

And I think that the false self diagram, so I showed her this kind of diagram in that, this thing, was kind of how I was raised. I had to wear the mask, at all times. That is how you earn your approval. It is your, it is the earnings, the shoulds, the achieving, accomplishing to get love,

which is not real love, which is false love, which leads to emptiness because it isn't, it is an insatiable addiction. And the difference is peace and love that I, I feel here, I can access any time. This is someone who's seen me for years. I can access any time. And I love spending time with you, but I know you have exemplified trust, which I struggle with trust. The feelings of hearing this are fresh and alive to me at this point. So this is my statement is feeling this from her. There was just an aliveness in the session.

She went on, I can run hard enough and fast enough. Being a workhorse, it is letting go of that. So there was, I may have written this down slightly wrong here, but there was this feeling that she needed to be a workhorse most of her life. And she said she was like letting go of that. At times there is this sad and, bleakness of the world. I can't believe I'm in the situations I am. But I have to trust that, this is what she said, God brought me to you. And I have to trust that I am thankful for where I'm now.

I'm thankful for my story that was an expression of pain on her face at this point, even when it has been painful and difficult. I am able to forgive in a way. I can understand. it could not have been different. I am grateful to how I am supported and I manage to transcend that difficulty. And there are certain things, a new home, a new creation, a new journey that bring me joy.

So you can see in this journey that this client had with me, moving through the transference, creating a positive space to explore painful things she was actually going through. there was a shift and I would say a creative explosion in her life where it's like tons of meaningful meaningful relationships are being created every day and not that same critical voice like

something about our sessions goes with her the acceptance goes with her and then that last statement about her pain and the story and her story and how difficult it is. And then her acceptance that it couldn't be different that she had to go through these struggles to get to where she is. Beautiful. Absolutely beautiful. You know, it's such a privilege. And I asked her if I could share that.

I wrote this section down because it was so beautiful. I'm pretty fast hyper, so it doesn't get in the way of much. But it was a special moment. So getting back to my thoughts here on what do I believe. Okay, so I talked about the idealized facade, the false self that we create and how there can be transference based off of that. I think there's also transference in the shadow. And so I see the shadow as part of the real person, right?

It's like it feels very real. It's a part of their experience. It's the maybe it's the it or the competitive or, you know, genetically if you're wired, for example, high conscientious, maybe it's like you're wired naturally more to be competitive. Maybe there's some dark archetypes in the shadow as well. Like maybe the person feels like if they could, they would be like Genghis Khan, you know.

Maybe these dark archetypes are like the warrior, the inner warrior that needs to be brought into conscious awareness and utilized to create boundaries and advocate for themselves. Okay. So this shadow that I see has multiple heads and each of these are like maybe traumatic developmental figures that they've had. So they have all this raw and unworked through aspects. I kind of use some object relations theory to kind of inform me about that. The multi-headed shadow

that they might perceive is there. And what I see is that because the attachment figures are so internalized, the work takes longer, it doesn't feel like just a facade of false self. It feels like it's really a part of the person. And it's like there's a need for an integration

and a need for processing, but out of those traumatic early relationships will come transference. And so if the work out of the false self is being more congruent with your true emotional self, what's going on through art, through music, through poetry, moving out of the false self into the real self, I think the work out of the shadow is connection in the midst of transference and an integration

of our emotions that we may have really suppressed deep down, potentially destructive emotions or competitive, competitive emotions. So one more sort of thought thread, thank you for your patience, if you're still listening, is I believe that the patient, if you think about the hero's journey, Joseph Campbell wrote about this, and I've talked about it in a prior podcast, I think that the patient should be positioned as the hero. But imagine that the patient desires to place you as the hero. And it may be seductive. Maybe there's something a little bit narcissistic in yourself or myself that wants to be the hero at times.

And by narcissistic, I don't mean like NPD. I mean like, you know, everyone has slight bits of narcissism. And we can feed that or not feed that. So they may want to give you the power, not face the dragon themselves. At times I'll watch residents doing more work than the patients in therapy. And I'll be like, you know, I think you could just sit back a little bit more and let them do the work. So in the patient's hero's journey, you are one of their many guides, not the main character. They come with maybe an unmet need that they need to work through and the temptation maybe to move into the hero role.

But the frame is to keep you grounded as the guide. Now their hero's journey is an internal one, not necessarily an external one. The internal one is as they walk into, for example, the more chaotic parts of their experience. Maybe they view their shadow or their false self. Maybe their journey is to find a way back into their truest part of themselves, their real self. Maybe, you know, keeping, of course, the facade when they need it, keeping the facade when they're maybe in professional meetings or, you know, when there's not a level of safety and vulnerability, when there's not safe people. And the same thing is true about the shadow. Maybe like part of their journey is to access their competitiveness or their suburbability.

anger which they've suppressed. So often the patient hero has this creative untapped genius, especially those high in openness in the big five. Like if you have someone really high in openness to the big five and they're not doing creative work, it's just that's like part of the treatment. And this can be blocked for so many reasons, right? Maybe they're not in touch with their emotion and desires and playfulness. There's, huge unconscious resistances that lead to a lack of their creative life being explored. And if they're having a hard time with emotion, any one emotion, they may have hard time expressing all sorts of emotion or even entering into playfulness. You can also, in the hero's

journey, their hero's journey, become maybe the villain. Maybe you, you know, as the they're getting in touch with the, you know, that multi-headed shadow, which some of their shadow faces may have hate and just anger, you know, that they've internalized from their past abuse. Maybe you become the hated person. Maybe you are the abuser, right? The villain. And so that could be one of the transferences is to place you into that point. And so empathizing with the distress when that comes up will be very important. And they may test you to see if you are uncaring, unloving, secretly laughing, critical, right? So it kind of reminds me of the grand inquiscer actually, like where there's this thing of like, what do people really want?

Well, they want to be told what they can do and they want to lose their autonomy. me. No, actually, there's a part of the human experience in which we want to give away our freedom. This is what the Grand Inquisar was about. But really, freedom is actually, like, really difficult to grasp, right? And it's kind of like moving from the external locus of control. The world is happening to me to an internal locus of control. Like, I can make some changes here, right? Maybe it's easier to just stay in an external locus of control. external locus of control for people. It's harder to embrace the internal locus of control.

And so in the hero's journey, right, if you are placing an external locus of control, maybe part of the hero's journey is moving back into that internal, like, oh, I can actually be an actor in my story. And maybe there's the temptation to not let them go on the journey,

right? To not let them venture out. Like the Oedipal mother, right? keeping them home, not allowing them to leave, to explore, to be in danger. Right. So we don't want to fall into this sort of edible mother place of overprotection. And there's also, I think, that you can almost become like the observer of the hero's journey, where it's like they imagine you. to not really be a part of the story,

like not as the guide, like not someone who has emotion, who feels deeply, who cares, but you are the passive observer who doesn't care. That is actually something in trauma that is very painful, right? So often the patients express the most anger towards the passive observer of the trauma,

the maybe the father was the one sexually abusing them but they're most angry at the mother who knew about it who didn't do anything and so maybe they put you into that transference now you are the passive observer of their journey okay so you could see how you get moved around in the hero's journey in their story and there's transference there and there's i think there's some richness that may be helpful i want to end on this and this is my last belief. It comes from Victor Frankel, and it is about the way that we will actually see the most true version of them is through love. So this is what he said. Love is the only way to grasp another human being in the innermost core of his personality. No one can become fully aware

of the very presence of another human being unless he loves him. By his love, he is an to see the traits and features in the beloved person, and even more, he sees that which is potential in him, which is not yet actualized, but yet ought to be actualized. Furthermore, by his love, the loving person enables the beloved person to actualize these potentialities. By making him aware of what he can be and of what he should become, he makes these potentialities come true. Another quote by Rumi said, your task is not to seek love, but merely to seek and find all the barriers within yourself

that are built against it. I will leave you with those thoughts. I hope this was an interesting and helpful session with me. You may have transference towards me and that's okay. I, of course, am probably not your therapist, so you can talk to your therapist about your transference towards me. I don't know. Is that a joke or not a joke? I don't know. There's some uncomfortableness that is there, right? So I hope that you get the big picture, though, that it's like, how do we empathize? How do we co-participate? How do we feel present in the midst of their journey as a guide, not as the one who is the hero? How do we, help them see beyond us as idealizations of their false self or critical of them like the false self

structure creates. How do we help them know that we are not afraid of their shadow and not afraid of the emotion that is evoked from the different, you know, internalized objects from their past, you know, from their, maybe their attachment figures where there was abuse or neglect or just a disowning of emotion. And then furthermore, how do we, how do we have them leave with the experience of empathy,

with your positive regard, that there was connectedness going on? And if your therapy modality, maybe you're not mainly a transference focused therapist or, you know, maybe you are not someone who normally thinks about transference. But just think about like any good therapy modality will help you do those things, connect better with your client, feel less strong negative internal transference towards them, and feel positive towards them, right? And so if your modality is allowing you to navigate and create and maintain a positive transference and empathy

and create psychological safety for them to give you feedback. Then I would say it's probably working and that's great and you should feel confident in that. All right, we will leave that there for today. I wish you well.