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

Perceptual Differences in ADHD

ADHD continues to gain interest throughout those who do and do not have the diagnosis alike. Why is interest in this neurodevelopmental disorder gaining traction? Likely, it is a confluence of events, namely the movement toward neurodiversity, increasing acknowledgement of adult-diagnosed ADHD, and a continued normalization of mental health, in general.

As one of the most well-researched diagnosis, ADHD has been one of the first to lose some of its mental health stigma; however, this movement has been, in part, a result of a growing understanding that ADHD is not solely about difficult behaviors in children but also differences in information processing in adults (i.e., neurodiversity).

One of the hallmark features of these differences in perception between those with ADHD versus neurotypical individuals is an altered sense of time. Time perspectives, put extremely simply, different preferences in where people typically orient their attention in time, such as being future-oriented or past-oriented (see Philip Zimbardo writings for more on time perspectives).

While typically individuals have one that is preferred over the other time perspectives, Dr. William Dodson puts forth the notion that those with ADHD are immersed in the present. Thus, ADHDers have difficulty, likely at the expense of excessive working memory, to differentiate between time perspectives, such as being able to disentangle future events into categories like short-term, intermediate, and long-term future states. Conversely, the past is loosely structured, if at all, in typical time structures of memory and, collectively, the present is somewhat mixed together with the past and future. Dr. Dodson describes this state of time perception as being curvilinear, which is defined by Dictionary.com as “consisting of or bounded by curved lines.”

While this definition doesn’t clarify much more of what is meant by having a curvilinear perception of time, Dr. Dodson’s usage of the term is in respect to the point that people with ADHD have a skewed sense of time, and it’s particularly skewed toward the present. Therefore, this bias in time perspective could substantiate Dr. Dodson’s conception that ADHD makes it difficult to distinguish, or parse out, the future and past from the present moment.

If this is the case with ADHD, then it would help to explain ADHDers’ challenges with learning from past mistakes and effectively planning for the future. One extension from this idea is it’s likely also the case that ADHD impacts spatial processing, since space and time are interrelated. Collectively, it would stand to reason that the ability to conjure and manipulate mental representations may be a central aspect to the symptoms present in ADHD; moreover, this inability or deficit may be a transdiagnostic symptom of other psychiatric diagnoses.

Reference:

Hallowell, E., MD, & Ratey, J., MD. (2022, January 10). ADHD Needs a Better Name. We Have One. ADDitude. https://www.additudemag.com/attention-deficit-disorder-vast/?fbclid=IwAR3dvgGPAykYKUdsAiDqPRSv97fF1XV7SdmRVv_sUH-G_GXW0W_QlzjDc4g

Voices of the Collective

If only we changed this single aspect, then these types of tragedies would be reduced or elminated; it’s too much of that and not enough of this; it’s actually too little of that and too much of this.

In fact, it’s not so much either this or that but rather another singluar aspect that hasn’t been taken into account appropriately: mental health. Actually, saying this is only a way of scapegoating the real issue of gun control and is even harmful to the work to destigmatize mental health.

I think it’s the effect of these new and extremely life-like video games that are normalizing violence, even encouraging it. Actually, the research doesn’t support the connection between violence in video games as a predictor for the committment of violent acts.

It’s probably the constant coverage the news media provides that serves to amplify the perpetrator and allow for others to seek that kind of recongition, especially because of our culture’s emphasis on celebrities.

Whatever cause or combination of causes that resulted in the action does nothing to erase the actuality that it happened, and it hurts — it should hurt because it is a tragedy.

Often we become lost in muddled arguments and too quick to avoid genuine engagement in them. However, without the proper usage of argumentation and discourse within the public square, nothing has been processed nor any action taken toward the prevention. Consequently, we are just taken back to where we started; another repetition completed.

What was gained this time around?

Contemplation of the Rain

Let the dams be damned and ameliorate this famined land.

Upon what hills will you take a stand; amidst what turmoil will your integrity begin to disband?

Our resolve weakens, our countenance grays, yet a force continues to uphold our inner constitution. The nature of numbness raises doubts about whether it’s life or us that we should be praying about.

Unsure, we forget to let it out; no words pierce the silence, no vibrations ripple through the air.

We aren’t even sure how much it is that we truly care. We’ve moved passed the point of wanting to rip out our hair and rather have begun to embrace the catatonic stare.

Becoming increasingly less aware of what our left-hand does as we observe the ramifications of having lived a one-sided life for so long, dependent and trusting only of the right:

What good are either of these sides anymore? Where is the animosity of division when everyone’s poor? Rather, life’s questions confront us with more intensity than they did before, pestering us to decide some sort of answer to the question: “What is life for?”

Yet, no answers come; only noting how keenly one has become of observing the rising sun and how quickly it seems to run back into the shadows from whence it comes.

A repetition set for an undetermined amount of iterations – the next question becomes: “What have I done?”

Unified Rationality

In today’s socio-political climate, our attitude toward each other is often characterized as polarized, hostile, intolerant, divided, and so forth. The current situation’s emotional charge intensifies as the confluence of significant factors (e.g., pandemic, natural disasters, scarcity of resources including economically) both increase in magnitude and expand in scope. Consequently, the continuation of these tests continues to test the integrity of the system, as a society and as individuals.

As those experiencing these events transpire in the present, at the most technologically advanced point in history, there is a natural human tendency to amplify the significance of what is happening in the present and characterize these events as unprecedented. While these events may be unprecedented in many ways, particularly in their magnitude and scope, the psychological forces at play are anything but unprecedented. In fact, it is only due to our assumption of superiority over all previous stages of civilization that allow us to maintain a position of confidence when discussing these psychological matters, citing the advances in neuroscience among other disciplines of the mind to console ourselves that the deepest and most terrifying stages of psychic development are behind us, as a collective.

To expand on this point, I will return to Carl Jung’s 1957 book The Undiscovered Self for a humbling and frightful quote: “Consciousness is a very recent acquisition and as such is still an ‘experimental state’ ––frail, menaced by specific dangers, and easily injured” (p. 74). By returning to the level of consciousness, we shift to a universal plane of thought that is shared by all and even extends historically, stretching back to the origins of consciousness itself. Even through doing this as a cognitive exercise, there already is a greater degree of separation from the present day. Moreover, Jung reminds us that despite our technological advancements, that our consciousness is not to be taken for granted, explaining, “The development of consciousness is a slow and laborious process that took untold ages to reach the civilized state. . .Although the development since that date seems to be considerable, it is still far from complete” (p. 73).

If these quotes about consciousness seem too abstract and unrelated to the initial points of the first paragraph, then it might be useful to pivot toward addressing why this disconnect directly: Why does thinking of the term consciousness provoke a sense of resistance? Maybe it’s that discussion or thought of the matter seems arbitrary and futile, or possibly it is easier and simpler to dismiss the topic altogether, selecting from the various connotations linked to consciousness as a way of sidestepping further investigation into the matter.

There is another reason for the resistance or uneasiness to the idea of consciousness that also accounts for why mental health and psychology have lagged behind that of the physical sciences, as Jung puts it, “When it comes to psychology, one of the youngest of the sciences, you can see misoneism at work” (p.72). Misoneism is defined as “the hatred or dislike of what is new or represents change.” As Jung identifies its role in psychology, I am extending it to our general uneasiness toward the topic of consciousness and our specific aversion toward the talk of unconsciousness.

While our society may be characterized by stark divisions and widening schisms of perceived and real differences, we share many similarities with how we respond to the notion and the reality of the unconscious. While the mere mention of the unconscious may provoke an urge to double down on the supremacy of rationality, declaring “our present knowledge of nature to be the summit of all possible knowledge,” we, nevertheless, can be “possessed and altered by our moods, we can suddenly be unreasonable, or important facts unaccountably vanish from our memory” (p. 74). Furthermore, this “basic resistance of the conscious mind to anything unconscious and unknown” serves to further our state of division from one another and dissociation from ourselves (p. 72).   

Resistance toward change is at the core of both of these rifts, within and without. They fuel one another as we seek to compensate for our feelings of inferiority evoked by the mere acknowledgment of unconsciousness. Through rational compensation and continued one-sided emphasis of consciousness, we, at the forefront of humanity, revert back to primal methods of denial and suppression, just as our ancestors did when faced with unprecedented events. The primary difference between our moment in time and that of our ancestors is the artificial integration that the internet and, specifically, social media platforms have provided us with that allow us to pull at the seams of not only our individual psyche (the container of consciousness and unconsciousness) but also that of the collective psyche. Our fears are absolved as we allow ourselves to be dissolved into a group that grants us an escape; this temporary refuge can blur over time and transform into a constant on which we depend and from where we operate, creating such a degree of normalcy and familiarity that we invert even the most basic principles to the point that “the right hand does not know what the left is doing, and in a state of violent affect one frequently forgets who one is” (p. 74).

While people are finding ways to accept the severe divisions among political parties, ideologies, and directions for the future of these United States, it is of the utmost importance for humanity that we do not forget that “Even in our days the unity of consciousness is a doubtful affair, since only a little affect is needed to disrupt its continuity” (p. 75).  

References:

Jung, C. G., Hull, R. F. C., & Shamdasani, S. (2010). The Undiscovered Self: With Symbols and the Interpretation of Dreams (Bollingen) (Revised ed.). Princeton University Press. (Original work published 1957)

Analyzing the Tension of Opposites

All of existence is held together because opposing forces in equilibrium. But what holds these forces in equilibrium? Tension. When in equilibrium, the tension is equal; but, when it is broken, such as in the case of the aftermath of a war, the tension is unequally distributed, resulting imbalances.

But, where is the tension being skewed; where is this new unequal tension being held? In the minds, hearts and spirts of humans. Put another way, in psychic space. Psychic space is different than physical space in that it does not, to the best of our knowledge, consist of physical space; that is, in the means that it can be measured and said to be in this place or that one. Physical space is left to the quantifiable, the observable, and the seen (aside from dark energy, and dark matter that are, at the least, accounted for through negative derivation).

Many pathologies arise from the mere fact that the psychic is perceived as being somehow less “real” than the physical due to its unobservable nature (even with the advances in the field of neuroscience). This distortion is being further augmented as we continue to place more faith in empirical methods and evidence-based approaches. In turn, this is implicitly discrediting the invisible and intangible, as something purely imaginative and, subsequently, inferior to that of the observable, empirical world nature that constitutes the truer form of reality.

However, to adopt this stance is to demonstrate one’s intellectual hubris; simultaneously, this stance toward understanding truth of reality narrows one’s field of view to an extent that our empirical sciences are becoming increasingly tunnel-visioned in what subject matter merits research and attention. All the while, the reality of one’s inner psychic world is, and will always be, the most direct experience and influential force to shape our lives.

Therefore, it is the exploration of the psychic frontier that demands one’s effortful focus, sensitive tools of introspection, and repeated trials of observation, self-reflection, and data collection. Our collective avoidance and/or belittling of the psychic realm (or mental health) demonstrates our aversion to explore the depths of ourselves that are unknown; our conscious mind soothes itself with rationality and is further reassured by the collective’s tendency toward prizing reason or emotion; however, as continue to witness in current events, we are not the one’s who choose how our psychic world, or mental health, affects us, at least, not in full.

The Fundamental Divide

Many living in this modern age will agree with the statement that “we have never been more divided.” If not to this extreme, then at least to the degree of acknowledgment of the strong division among the citizens of society.

While I am specifically referring to the discord within the United States, the principles and mechanisms of actions underlying this division are far more universal than any single country or period within human history.

Often when thinking about divisions within society or among peoples, there is a basic mistake made in the first movement of thought; that is, the natural tendency appears to look outward and continue the investigation from this starting point. However, while this can yield useful and insightful discoveries, it also serves to overlook another source of division because of this initial outward movement: We neglect to inquire into internal divisions.

The consequences of this inward inquiry are different from that of the outward one; however, there are many similarities between the internal and the external. Both are necessary for deepening understanding of each other.

Throughout the work of Carl Jung, there is an emphasis on the inner and outer, moreover, the interplay between these two. There is a tremendous amount to expand on from this point, so instead, I would like to redirect to the initial divide that he so often wrote about: the division of the physical and the mental (i.e., psychic).

While Jung is by no means the originator of this idea, his psychological approach to this mind-body division was novel for the time since this question had previously been delegated to the realm of philosophers. Moreover, Jung was one of the forerunners for the relatively young field of psychology, beginning as a discipline around the late 1900s. Still, more than a century after Jung’s first publication in 1912, it is only in recent years (especially the last two decades) that the field of psychology, mental health, and the psychic side of life are beginning to gain traction. At least, relative to being treated on equal terms with the physical side of life.

As a society, there is a growing movement to remedy injustices and advocate for equality. Yet, even with the increased acknowledgment and receptivity to the reality of mental illnesses and the necessity for psychiatric and other related interventions, the inner world or the psychic side of existence still must overcome a more considerable burden of proof than the physical side.

Jung emphasizes this disparity in our treatment of the physical and the psychic in his 1957 book The Undiscovered Self, writing, “One can regard one’s stomach or heart as unimportant and worthy of contempt, but that does not prevent overeating or overexertion from having consequences that affect the whole man. Yet we think that psychic mistakes and their consequences can be got rid of with mere words, for ‘psychic’ means less than air to most people” (p.47).

Even today, the term “psychic” is likely to be less well-received than “mental” or “psychological.” However, the correspondence between the terms physical and psychic is the most logical pairing and usage for the natures being described. This may seem like an arbitrary point, but I believe that solidifying psychological terminology is essential to increase understanding and awareness of the nature, components, and disorders that occupy this psychic landscape.

Moreover, Jung’s quote can be applied to the original point of societal divisions, for he is indeed addressing a very similar topic. This is evident in his subsequent writing, “when everyone admits that the weal or woe of the future will be decided neither by threat of wild animals, nor by natural catastrophes, nor by the danger of world-wide epidemics, but simply and solely by the psychic changes in man. It needs only an almost imperceptible disturbance of equilibrium in a few of our rulers’ heads to plunge the world into blood, fire, and radioactivity” (p.47).

While on the surface, these outer divisions appear distinctly separate from that of those inner divides, Jung’s work highlights how our inner and outer worlds are deeply interconnected. Furthermore, he emphasizes how the outer worldly situations are collective externalizations of suppressed content from our inner worlds. For example, the increasing focus on materialism and objectification has parallels to how the physical side of life, and, particularly the rational and scientific side more recently, represent a one-sidedness that obscures and diminishes the significance of the inner, psychic side of life; both on the individual and collective levels.  

As psychology and the mental world gain more acknowledgment and receptivity than in previous points in time, and there is increasing focus on the outer world, Jung’s work invites us to explore the inner world as a method for understanding and addressing the variety of manifestations that arise within the outer.

Reference:

Jung, C. G., Hull, R. F. C., & Shamdasani, S. (2010;1957). The Undiscovered Self: With Symbols and the Interpretation of Dreams (Bollingen) (Revised ed.). Princeton University Press.