The Transference Game

With Borderline Personality Disorder relationships are difficult. The past is always the present: Old feelings are renewed under the stress of memory.

BPD patients provoke strong negative reactions in therapists — and vice versa. As Harvard psychiatrist John Gunderson states, ‘most clinicians don’t like borderline patients’

Granted a lot of that is ingrained prejudice on the part of clinicians – The word ‘borderline’ is laden with over 100 years of psychiatric misunderstanding – no wonder they’re so judgemental. In an environment rife with stigma, we’re continously misunderstood.

Nevertheless, perhaps there’s another reason therapist and patient don’t get along. It was Freud, who was the first to notice, therapy can get contaminated by emotion. He called it transference

The patient is not satisfied with regarding the analyst in the light of reality as a helper….the patient sees in him the return, the reincarnation, of some important figure out of his childhood or past, and consequently transfers on to him feelings and reactions which undoubtedly applied to this prototype….This transference is ambivalent: it comprises positive as well as negative attitudes towards the analyst, who as a rule is put in the place of one or other of the patient’s parents, his father or mother. Sigmund Freud, “An Outline of Psychoanalysis” 1940

Catching feelings

Ever taken an instant-dislike to a complete stranger without knowing why? Antipathy toward a work colleague? Aversion toward an ex? Maybe you have your reasons, but then again perhaps it’s more mysterious. You don’t like this person because they remind you of someone else – how they look, how they talk, their behaviour; everything about them, reminds you of a past life. Childhood is the lens which clouds the vision.

It begins in therapy. The patient transfers, their childhood feelings he or she had towards their mum or dad onto the therapist – anger, fear, unrequited love; all these emotions get diverted. They are spun out of the past into the present, before you even know it’s happened. Likewise the therapist transfers his feelings – his fear, anger, unrequited love back to you. The therapeutic alliance is damaged by a role play, and yet The roles aren’t static: emotions are bandied about, based on the interaction, leading into deeper states of misunderstanding. It’s like a radioactive ballgame, and the stakes couldn’t be higher.

In Borderline Personality Disorder splitting is very common: A individual will either idealise a person or devalue them completely. This is usually because in childhood, ambivalent displays of parenting, waxing between love and rejection created ambivalent feelings toward parents. We weren’t sure whether to love or hate them, but deep down felt we could no longer trust them. All this took place in early youth, however it carried over into adulthood creating profound dysfunction.

Its not unusual for BPD patients to fall in love with therapists. Alternatively we might hate them. If a therapist listens we see a rescuer, if they invalidate they appear as a persecutor. A therapist in turn may find a submissive tearful BPD patient, more like an abandoned child than a incompetent adult; he or she may unwittingly play the role of a parent. If the patient accepts their efforts he may be a protective parent, if he or she rejects it they may become a punitive one. This is counter-transference.

Nowadays therapist are told to “work with the transference” and reparenting is an important concept for treatment. Positive transference leads to a good therapeutic relationship which builds a strong foundation for recovery. Negative transference produces negative therapeutic reactions and prompts regression. Each therapy session can be a sparring match or duel, a dance or duet. Some therapies even use transference as the basis for getting better – if you can see transference as it happens you are no longer a prisoner to it. However, this doesn’t just take place in the consultancy room.

Individuation involves the transformation of the analyst as well as the patient, stirring up in his or her personality the layers that correspond to the patient’s conflicts and insights. Archetypal dynamics will affect any analyst, but particularly one whose life is not fully lived. Carl Jung, “Psychology of Transference” 1975, p. 172.

The same old pattern

Think of those cases you read in the paper – a child at school develops dizziness, suddenly everyone in the classroom gets dizzy. There’s no indentifiable cause and yet it’s happening. In the old days they called it mass hysteria, but its really transference – body-centered transference. The feeling of anxiety in one person is transferred onto others. They react in the same way.

A victim of domestic violence beaten by a high school boyfriend ends up with a man in marriage who does the same. A bullied schoolboy is more likely to perceive colleagues as threatening authority figures in the work place. A female survivor of sexual abuse may find all men scary and avoid intimacy altogether. This is partly the result of transference: Those old feelings of the past, originating in one person, are transferred onto another in the present. Sometimes we like what’s familiar and slip easily into a previous role, other times we are repulsed, and challenge stereotypes by reversing roles around. That’s why the bullied schoolboy, becomes a workplace tyrant, or the victim of domestic violence starts a course of self empowerment.

When you have BPD it seems we’re more likely to experience criticism as an attack. That’s because we’ve been attacked so frequently in the past. There’s always an element of truth in the accusation “you’re attacking me” but it’s distorted , because a mild criticism becomes equivocal with a scathing assault. We are more likely to split the other person into a god or a devil depending on what they say, but this itself is derived from the constant dialectic of war and reconciliation we experienced in childhood. As a rule all relationships contain transference, only with a condition like BPD, or any other trauma-related mental health condition, feelings are much more intense, and so the risks are higher. We can only break the cycle if we know what’s happening.

The Game is not a Game

Of course transference is not a game. In real life — in the marriages, partnerships, relationships and friendships — it’s dangerous and can lead to mutual hearthache and self-destruction. We’ve seen examples of toxic relationships, perhaps we’ve been in one ourselves. Personalities clash, we carry our pain with us. It’s like a dark light we shine on others and they reflect it back on us. In that darkness are the secret fears, desires, wishes and regrets of the past. We no longer see what’s in front of us we only see individuals framed with childhood-tinted glasses. But it’s possible to see with clarity.

If a personal or professional relationship or friendship, has become toxic reflect on why. Is it because it’s a personality mismatch? Or is it because you and the other person are catching feelings, passing them back and forth, and you’re unconciously transferring emotions onto one another? It’s important to know we can’t reduce life to a psychological defence mechanism. Carl Jung once said: ‘The dissolution of the transference often consists in ceasing to describe the nature of one’s relationship as “transference.” This designation degrades the relationship to a mere projection, which it is not.’ It’s more complicated than that. In fact, in therapy as in life there’s legitimate reasons for liking or disliking an individual, based on their character. However sometimes the problem goes deeper. The ambivalence of any interaction often leads to self-discovery.

As mentioned some therapies see transference as a principal goal of treatment. Take Transference Focused Psychotherapy (TFP) a highly specialised treatment for Borderline Personality Disorder, created by the eminent psychiatrist Dr Otto Kernberg, in 1990. It’s aim is to unify the split self, by systematically unravelling the transference and counter-transference in any interaction. Mentalisation-based treatment (MBT) created by Peter Fonagy in 1995 also has a similar goal. The transference is observed in situ, that is to say, the whole point of therapy is to safely confront old feelings as and when they arise. Often, in BPD we may know something intellectually but not intuitively. We are stuck in what Fonagy calls “pretend mode” in which there’s room for words but no insight. Activating old object-relation dyads, forces us to recollect the unbearable pain we felt when we were young, and this in turn can prove cathartic. We experience healing and also growth.

What about in In real life though? We can manage transference by observing it as it happens. Do other people evoke strong positive or negative reactions in you — if so why? Really examine it. If you find yourself stuck in “pretend mode” there’ll come a time when you’ll be forced into a confrontation. You don’t have to play the game if you don’t want to. Accept the feelings are real, but are detached from their source. Their untrustworthy and unreliable, so we can let them go, and vice versa if feelings are passed onto us, we can let that go too. It’s like the radioactive ball game, if you have the ball drop it. If they have the ball, refuse to catch it.

we all carry the heavy burden of childhood and so we can’t help but sometimes see the world through a child’s eyes. A rather innocous peculiarity of human nature, under the pressure of trauma or mental illness creates a dangerous pattern of volatility in any interaction. So be vigilant, it’s game-over when you decide you no longer want to play — that’s a good thing, because it means you understand what’s happening. Rather than transferring the burden onto another, why not discard it all together. Let go, and see the other person for who they are. It won’t change how the other person sees you, but you’ll feel better knowing you don’t have to play along.

Be sure to check out my new BPD support & coaching site to find more information and guidance.