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

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.

Meaning in Repetition

The only way to determine significance is to view the contents within their context. We live an embodied cognition, meaning we are intertwined, psychic and physical experiential states enmeshed. To separate the two, for study or any meaningful inquiry, requires a degree of acknowledging at the onset that error will occur and, indeed, already has merely due to limitations of the observer and the infinitesimally small uncrossable separation between me and it. This and that. Object and subject.

We always have a personal and collective aspect of our life; we cannot separate one from the other even if we have convinced ourselves of the lie that we have successfully performed this task. No. You may never escape that which you don’t know; because how would you even know what it was that you were escaping? The most blind individual is the one who only understands themselves as an individual and never as an object in context.

To maintain such a psychic position requires a strong degree of hubris willpower. It is effortful and painful to push against the currents of life—yet, that is by no means a declaration that we are not allowed to try! In fact, many of us, myself included, have spent significant portions of our life striving against ourselves. Like an auto-immune disease attacking its own body, we utilize our mind to attack the very roots that hold us up.

Then, when we imagine ourselves to have succeeded in such an absurd task, we reverse course in a dramatic fashion, worrying about our isolation and complaining about our separateness. Given enough time, this mindset begins to take hold as the default position. It extends a step further, lamenting the initial act of severing one’s own roots—then, another step, vilifying the agent that could carry out such a horrendous action against our body—the body wherein our personal, individual mind resides.

And, with the small steps of each movement, the fact that we were the initial cause and agent that cut us from our roots slips into the unconscious, where the forgotten and repressed mingle and plot their schemes for returning to the light of our conscious mind.

When looked up from the depths of this dark, bottomless abyss, the stream of consciousness appears as an illuminated flow crossing across the mind of the liver. And so the process repeats: unconscious content vie for life in the spotlight of the stage of consciousness, and we go about operating from this place of awareness, left once more with the choice of acknowledging the existence that there exists far more within ourselves persistently knocking at consciousness’ door, or relying on more effortful and convoluted measures to attempt in vain to seal this unknown door.