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

Deceiving Ourselves to Death

Regardless of when, where does this all end?

Living with an autoimmune disease both outside and within.

Voices tell me to pick up the pen.

“Don’t listen to them,” warns the opposing side.

There’s so many reasons to keep it inside.

Fears plead with me to hide.

Besides, what’s the point in speaking up anyways?

It’s not like anyone’s really listening.

We’ve even stopped pretending.

Isolated islands of insulated pain;

We’d rather bemoan our tragedies than recognize our pain.

What a shame—Though I understand it in the same vein.

So hurt from being misunderstood that you forget about the possibility of good.

Anchored down by all the ‘shoulds’ governing daily life.

What’s the point if there’s a never-ending price?

I suppose the appreciation of those things that constitute what is nice.

I suppose that’s right.

An unfamiliar phrase in a dizzyingly lost age,

Dysregulated by years of suppressed rage,

Manifesting in eruptions in underground caves.

What’s the saying about not making too many waves?

Then again, I guess there’s also the one saying not to sink but to swim;

And another suggesting to let things go in order to go with the flow.

But, I don’t know.

It seems suspicious that others keep saying such things to the point of becoming ingrained.

It’s almost as if there exists a concerted effort to distort my mind.

Serving to keep me distracted while I waste away time.

I think that must be right.

My internal fright transformed into a feeling of might,

Enticing an inner will to fight and disregard with being polite.

Now, this conclusion excites;

Therefore, it must be right.

Ascending the Depths

Everyday change creates a seductive argument urging my analytical brain to review the evidence yet again.
Could it be so simple?
Break down the principle.
Trace the threads that interweave reality.
Do the same patterns that govern the stars orient the psyche?

The lines of this poem were used to create the above image using NightCafe Creator, an AI art generator. You can view more of my collection here.

Psychological Fragments: Emotional Systems

Emotions are energetically charged psychic content. The magnitude and direction of this charge can be mediated or controlled by conscious cognitive processes, such as thinking, and less conscious aspects, such as attitudes.

Emotional charges have affinities for like-charged units and tend to form clusters that increase their gravity (psychic significance) and complexity. Moreover, these aspects can also extenuate similar features present in the particular situation, thus contributing to an increase in the energetic charge of the overall situation.

Emotions can also become encompassed in larger internal structures. An illustration of this might be something akin to adding a patch to a quilt that represents internalized emotions and activating affective structures. Through this process of extending into broader internal structures, subsequent effects or secondary effects may or may not be functionally autonomous from the initial point of activation. Thus, this secondary effect has the potential to become independent of the initial cause as the cascade of the activational pattern is set into motion.

Chained activation patterns are unconscious, at least in their totality, and only manifest or exert a force when tripped or activated.

Tracing activation patterns can provide information about core infrastructure of one’s inner world and information about one’s way of processing information. How an individual makes sense of and processes this environmental information sheds light on their cognitive style, comprised of attitudinal patterns and preferences for information processing.

A technique for investigating these affective activation patterns is an intervention similar to behavioral chaining, which involves the examination of antecedents and consequences. However, there is more of a need to focus on idiosyncratic associations to gather something of a nodal network of affective (emotional) infrastructure within the individual’s psyche, which, subsequently, allows for an analysis of themes, directions, and inferences about the aim and function of the individual’s emotional repertoire.

A Societal Denial

So many issues and challenges surround our daily lives. Our level of concern for ourselves and society at large has continued as a perpetual buzz that lies slightly below our conscious awareness.

To become desensitized to the chaotic nature of these times is one response to the presence of fear. There are other ways to respond to fear, such as fight, flight, freeze, or fawn (e.g., people-pleasing). There is plenty of accessible information about these types of stress responses, and I do not mean to belittle the importance of this information; instead, I am shifting my attention away from the more abstract realm of psychoeducation and to that of societal analysis of the variety of ways these fear responses are presenting.

As calamities have accumulated, social norms have broken down or altered to such a degree that they are no longer recognizable to their previous versions. This change is just one indicator that our physical bodies, on the individual level, and our societal body, on the collective and symbolic level, are being reduced further and further down to the level of base needs and primitive reactions. The most central fear (reaction) to security concerns (need for safety).

Similar to the individual needing the safety provided by having shelter, the citizen (i.e., the “mass man” as Carl Jung describes it) views the government as being the protector who provides some level of security; in fact, this is the most basic agreement of the social contract that connects government with the people it governs.

But what happens when components of one’s shelter break or deteriorate? When the A/C breaks in one’s house, stress levels rise as the discomfort sets in and frustrations build, as patience must be exercised while waiting on someone to fix it. What if a break in the mainline and the house’s water supply is disrupted? Would this result in the same kind of stress as that of the A/C breaking?

The responses are likely similar, but a house’s water supply disruption would evoke far more fear than the A/C disruption (in most cases). Moreover, in both cases, the hope of someone coming to fix and repair these issues allows for this stress, fear, and associated negative emotions to abate.

While most people might opt for some skilled professional to come and repair these types of issues with their shelter, the someone who fixes the problem and eliminates the associated fear needn’t come from the outside. That is, it could be the house’s inhabitants who fix their A/C or broken water system by taking matters into their own hands. Of course, this could also worsen the issue due to the lack of professional knowledge and understanding.

Say this situation happened to you: the water system to your house is malfunctioning so that the supply is disrupted, and you decide to take matters into your own hands to fix the issue, only to compound the issue, making it far worse than the initial issue.

What do you do? Would you be developed enough to recognize the error in your decision and reach out to ask a professional for help, or would you double down on trusting your own abilities to fix both the initial problem and the problem that emerged from your attempted remedy?

To extend this line of questioning further, which of these responses would most likely lead to a reduction in general distress, both for the person who is attempting these repairs and those witnesses to it?

It seems relatively clear-cut within the context of home repairs, but what if the context is transposed to the societal plane involving the relationship between citizens and their government? Sure the citizens may be able to identify breaks and/or deteriorations in their societal shelter, but does that translate into having the necessary understanding to attempt to remedy the situation by taking matters into their own hands?

As the saying goes, “be careful what you wish for because you just might get it,” and what then? What happens when you are the person attempting to fix a problem but refusing to acknowledge your incompetence and need for cooperation because your fear of being embarrassed is blinding you? What happens when you decide that the citizens are the only ones who can successfully remedy the complex societal problems yet only make matters worse with each successive attempt to remedy these ails? The dripping leak within the system turns into a raging torrent of your own making.

But is it actually your fault if you were only trying to help? If there is already water dripping from a crack in the system, how is it your fault if it worsens when you try to fix it? And away we go – swooshed up and transcended from these terrible and frightful discussions of matters of reality and into the realm of argumentation, semantics, and logical fallacies to pacify as illusions for the weakened (or undeveloped) ego to, once more, evade looking into its shadow avoid taking responsibility. Both to ignore the damage it has done through over-estimating itself (ego inflation) and for denying the seriousness with which the reality of the situation demanded.

It is not an excuse to say, “I didn’t know that would happen,” when trying to perform home repairs on issues you are not qualified to do. Neither is it an excuse to perform fallacious lines of questioning in such a way as to distract from the real issue at hand and then pretend as if the distraction is a solution. Nor is it one to become entrapped in perpetual argumentation about the right solution does not resolve any given problem in itself.

Whether it is performing home repairs or seeking to address societal issues, operating from an inflated sense of self-confidence, blind sense of duty, and uncompromising stubbornness in admitting one’s mistakes not only does nothing to work toward a solution, but it also actively resists the necessary cooperation required for any meaningful and sustainable solution to be achieved.

Image: “Arrogance, Fear, and Pride.” Self-created image using AI Generator: https://nightcafe.studio/

The Universal Restlessness

How much of our strivings are aimed at procuring some point of satiation and safety; how bored we become when we find it…

Messiness and chaos that which we say we hate, yet we nevertheless continue to create in our own lives. It may manifest in peculiar forms, like scrutinizing the true orderliness of things, as if to secretly be searching out chaos. But, why seek this out? Boredom.

If there exists chaos, then there exists an opportunity for work, and, if there exists work, then there exists an opportunity to feel productive. But what if we don’t believe it, or our standards are too high and nothing is ever enough? What then? Then, I suppose is where cultural influences and macroeconomics comes into play, and I am not up for expounding upon those matters today.

Now What?

And who can argue for the living when confronted with the grave need to litigate for the dead?

Where do we go from here as we look off the face of this ledge?

Walk away, shake our head, go to bed and blame the issues on what’s wrong in other peoples’ heads.

What good does this do for the land of the living? Where are the debates of the corporeal? And why is it that those with whom we disagree somehow reside in a lesser reality?

Why bother to debate about the unborn or where we go when we die when the land of the living has become but a standstill, where even reason has found its capacity to cry?

“Oh, let’s have a debate,” they’ll say, but it disintegrates the moment of invoking things of the transcendent. We muddy our own waters with our dual-mindedness of both wanting to be right and to prove others wrong – yet, we like to nod our heads and go along with all those with charisma who play the song: it’s not us who are lost but them. Thus, it’s not me who is lost but him. Thus, the problems that exist are among those things outside of myself.

How dangerous it is to live in the fantastical lands such as these, where behind every door there must be some new mystery? The search is never over; the investigation never done, and the anticipation of the revelatory moment somehow still yet to be won…

But, alas, as to be expected with such things—we mustn’t concern ourselves with these things—rather, look another way to find a friend, and together we’ll find our fellowship in scapegoating a common foe.

We’ll vent and fume before sighing and saying, “What is life but full of woes?”

Oh, how we sow and sow—sometimes even forgetting to reap…even secretly, restraining ourselves from making a peep about the disharmony of the cycle. Why have we become so maniacal? Because of our love to sow and bask in the flow of more and more – after all, what is all of our work for?

This question takes a dark turn when the sowing has been overdone. There’s no land left to till, and no straw to continue to feed the spinning wheel—what is one to do when idleness creeps into one’s hands? Exercise patience, sort the harvest, and pursue leisure as a source of gain? A laughable notion, as absurd as turning water into rain, fears into pain, and grain into gold…but, then again, we are all getting old; it’s possible the same rules no longer hold…to venture closer to the edge and peer a bit further or to stay and stand firm in the trust bestowed from the ground beneath our feet—what if your feet begin to sink?
Would you fight and climb or say everything’s all fine; cry out to the world, “are we all losing our minds?” Then turn back around and continue with the dinner table discourse.

Awaiting Discovery Within

Make a mistake.
Go outside with your rake,
Take take take;
It’s time again to placate

Listen to the breeze and let yourself believe that the rustling leaves whisper to you. Allow yourself this one break.

Reason says otherwise, and I surmise that it’s choices which have me temporarily paralyzed. Forget to realize that the leaves aren’t alive?

Atop the fragments float, tethered to nothing – we drift further apart. Do you remember the start? Remember thinking I was so smart? All that’s left now are frozen embers some might call art.

Where does it all go And who really knows? Do the islands that time split apart ever mend back into a continent again?

If the answer is no, would it not be better to pretend?

Defend against the horizon for it brings darkness and takes away our days; Pretend with the sunrise that our spirits will be raised.

Deafen oneself from the beating drum from the ceaseless march of time. Better to say that we are fine than to waste anyone else’s time.