Being a Psychotherapist: The Role of Transference

Working as a mental health professional is taxing on the individual. Some recent studies have shown that 78% of psychiatrists and more than 50% of psychotherapists reported work-related burnout, according to self-reports (Summers et al., 2020; Olazagasti et al., 2021)

As a psychotherapist myself, I can speak to the reality of this experience; however, I would like to explore the underlying psychodynamics of the phenomenon of burnout by examining psychotherapy from a psychoanalytic perspective.

In Carl Jung’s 1933 book, Modern Man in Search of a Soul, he provides a physical analogy to illustrate the dynamic within the therapeutic relationship, stating, “The meeting of two personalities is like the contact of two chemical substances: if there is any reaction, both are transformed” (p.49).

This quote serves as a starting point for tracing to main themes: the bi-directional nature of the therapeutic relationship and the need for physical comparisons to ground psychic experiences.

Elaborating on both these themes, with an emphasis on the latter theme, Jung drew this comparison between medical doctors and psychotherapists while lecturing at the Zurich Medical Society in 1935, “Just as all doctors are exposed to infections and other occupational hazards, so the psychotherapist runs the risk of psychic infections which are no less menacing. On the one hand, he is often in danger of becoming entangled in the neuroses of his patients; on the other hand, if he tries too hard to guard against their influence, he robs himself of his therapeutic efficacy” (p.19).

Not only does this quote further expound upon the specific “occupational hazards” associated with psychotherapy (and mental health professions, broadly), but it also highlights how therapist and therapeutic effects are interrelated and dependent upon the psychotherapist themselves. This is not strictly speaking about clinical methods and techniques; as Jung states elsewhere, “Every psychotherapist not only has his own method—he himself is that method” (p. 88).

The emphasis here is less on clinical methods and differences in therapeutic approaches and more on the central importance of the therapeutic relationship between the patient (or client) and the psychotherapist (or counselor). Jung describes that it is the psychotherapist’s responsibility to “voluntarily and consciously tak[e] over the psychic sufferings of the patient,” which, subsequently, “exposes” the therapist to “the overpowering contents of the unconscious” (p.176).

The theoretical explanation of the process that follows from this initial encounter is an activation (or constellation) of unconscious content in the psychotherapist that corresponds to the “activated unconscious content” that the patient brings into the consulting room. This results in the initial therapeutic relationship being “founded on mutual unconsciousness,” which is where the risk for the psychotherapist lies, who might be “affected in the most personal way by just any patient” (p.176).

However, as mentioned in the second quote of this essay, introducing the term “psychic infection,” Jung believed that the manifestation of the unconscious materials was not just associated with risks but also “therapeutic possibility,” though this demands that the psychotherapist is “better able to make the constellated contents conscious,” lest risk “mutual imprisonment” (p. 176).

Therefore, the challenges posed to the therapist are, as Jung puts it, to “the whole man.” Moreover, the challenges are inextricably linked to both the therapist themselves and the emergence of the therapeutic effects. And all of this is shrouded in a veil of danger – a risk to let the tides of the unconscious rise within and take back territory that one’s consciousness had gained. This is the battle that each of us faces within, a push and pull between the tension of opposites, but, for the psychotherapist, the danger is magnified, and there seems to be no escape; thus, one must press onward.

References

Summers, R. F., Gorrindo, T., Hwang, S., Aggarwal, R., & Guille, C. (2020, October 1). Well-Being, Burnout, and Depression Among North American Psychiatrists: The State of Our Profession. American Journal of Psychiatry, 177(10), 955–964. https://doi.org/10.1176/appi.ajp.2020.19090901

Jung, C. G. (1933). Modern man in search of a soul. New York: Harcourt, Brace & World.

Jung, C. G., Adler, G., & Hull, R. (1985, December 1). The Practice of Psychotherapy: Essays on the Psychology of the Transference and Other Subjects (Bollingen Series) (Second Edition Used). Princeton University Press.

Olazagasti, C., Velazquez, A. I., & Duma, N. (2021, July). Tackling Burnout: An Endemic Problem in the Medical Field. ASCO Daily News. https://dailynews.ascopubs.org/do/tackling-burnout-endemic-problem-medical-field