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.

A Reflection from Within

Night falls, winter crawls, and summers to remember.
When forced to reflect and recall, we decide to deny it all.
Seeking inner recesses from the worries outside.
Where do we go to hide when there is also division inside?

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.

Tension of the Times

One of the hallmarks of Carl Jung’s work is his conceptualization of the shadow. Roughly speaking, the shadow consists of instincts, aspects, qualities, and the like that are unrecognized or repressed in oneself. Jung did not believe that the shadow was only comprised of bad things but also included good parts and positive potentialities (Sharp, 1991).

However, Jung believed that ignoring the shadow had dangerous consequences since he believed this simply contributed to the person continuing to operate through life in an unconscious manner, driven by forces unknown to the individual. Therefore, Jung earnestly believed that the task (or process) of assimilating one’s shadow is an essential one that each individual has a responsibility to undertake for the development of one’s personality.

Another central feature of Jung’s work is not solely focusing on the individual but instead demonstrating the interconnectedness between the inner and outer worlds, the individual and the collective. This lens allows us to observe the ways our interactions with the outside world affect the state of our inner world. This can be reversed to observe the way our inner world is affected by the happenings of the outer world. It is the latter of these two vantage points that offer an entry into what is called Shadow Work, which is the conscious process of becoming aware of parts of oneself that had previously been hidden or repressed and working to find a way of coming to terms with these parts that are viewed by the conscious mind as being in someway unacceptable.

Below is a quote from Joseph R. Lee, who is a Licensed Clinical Social Worker (LCSW) and Certified Jungian Analyst, sharing his thoughts on a recent episode (#217) of the podcast This Jungian Life:

We are in a stunning time in the western world. Where powerful cultural mechanisms have been set in motion which support us in disavowing enormous aspects of our own nature and allowing us to weaponize our own denial, so that we will find targets of people, institutions, religions, any numbers of things, where we will lay parts of our own unacceptable nature and then participate with great fervor in the destruction of the thing we’ve landed our shadow on and the motivation to annihilate the thing that I have pushed my shadow into has reached a shocking, shocking level in our culture.

Jung offers us an antidote for that, but it cannot be forced on anyone; the only way out of the place we are in our culture is to see that the enemy is us, and if we have any hope for transforming this muddy painful mess that we’ve all created in our culture it’s in the redemption, and the purifying fire that is set in motion when we reclaim our accusations and transform them into statements that declare what I do not want to know about myself (Lee, Marchiano, & Stewart, 2022, 44:46-46:47).

This excerpt addresses the rampant and intensifying reliance on and usage of projection to sidestep our dire need for inner work, both as individuals and as a collective society. It is through our perpetual avoidance, assisted by the mechanisms of denial, projection, and the like, that the societal we have been able to maintain this unyielding holding pattern between the polarizing forces vying for societal control.

Nevertheless, the underlying tension between these opposing forces has not been stagnant; rather, it is growing in intensity with the amassing of each piece of reality suppressed, denied, distorted, or in any other way blocked from the path of integration. The path that is not sought after—at least collectively—is nonetheless the path necessary for wielding the enormity of the tension between the opposites present in our time. Nevertheless, the responsibility lies on each of us to learn to navigate this path, if not for the purpose of growth as an individual, then, at least, as a citizen indebted to some degree or another to each other.

References

Lee, J. A, Marchiano, L., & Stewart, D. (Hosts). (2022, June 10). Death: A Jungian perspective [Audio podcast episode]. This Jungian Life. https://thisjungianlife.com/episode-217-death

Sharp, D. (1991). C. G. Jung Lexicon: A Primer of Terms and Concepts (Studies in Jungian Psychology by Jungian Analysts) (First Edition). Inner City Books.

Holding Pattern of the Tension of Opposites [Digital Image]. Self-created (2022). https://nightcafe.studio/

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/

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

Decisions of Motion

Why is it that whenever something comes to an end we tend to, or inevitably succumb to the urge, reflect back upon how it all began?

There is a part of me that wants to refuse the tug of the past and instead continue steadfastly moving forward, with my gaze fixed upon the potentialities held within the unknown mystery of the future. Thus, I’m also pulled forward by my anticipation of what lies hidden and awaits being actualized, while simultaneously being tugged on by the past’s allure to be reflected upon and mined for gems of wisdom and treasures of meaning. The result is a state of tension and disequilibrium; my inner world stirs with the restlessness of indecisiveness of where to place my focus – which direction should I place my attention and, subsequently, galvanize my energetic resource to pursue.

Life is held in this dialectical tension, if by nothing else, by the law of entropy, which is solely responsible for the arrow of time. Consequently, we fill our time with busyness working tirelessly against disorder while also hoping to arrange our lives in some order that we find a sense of safety or security in – at the very least, a sense of familiarity. We crave normalcy and, to some degree, we cling to the delusional notion that someday our lives will be suspended in some abstract fixed state of continual satisfaction; we desire a state of being where all of our needs are met, so we conjure goals from our hopes, dreams, and role models to develop some plan of action for setting out on this quest.

However, the undertaking is tricky for two main reasons: first, future goals have a way of branching off into additional goals and/or dividing themselves into numerous subgoals that serve to continually postpone our attainment of the initial goal we set as our target; second, even when we have attained a particular goal, inevitability dissatisfaction and tension finds us once more, and we are left feeling as if we’ve drifted back to the shore from which we’d initially set sail. The cycle repeats once more.  

Many people convince themselves of their eventual conquer of this journey and spend their lives committed to this belief, even until their last day. Others, also convince themselves of thoughts more comforting than the truth and pretend that all their needs are already met, so there is no need for them to strive.

It is challenging to confront these distorted beliefs held within ourselves because to do so requires some degree of both acceptance and humility. Both of which are praised as virtues, when viewed from a distance, such as abstractly, but seldom do we genuinely wish to adopt and embody these virtues in the experiential realm. Rather, we decide that an intellectual appreciation of these virtues will suffice and, once more,  dodge the actual challenge presented to us by life.  

We spend most of our lives trying to avoid the realities of life by either convincing ourselves or allowing ourselves to be convinced by others’ fictions about life. This cognitive maneuvering allows us to sidestep the discomfort experienced when life’s challenges are indeed acknowledged as an obstacle. We prefer to become like Sisyphus destined to exert effort toward a task that never ceases in the rest of completeness but provides the illusion of progress by conflating motion with progress. Unlike Sisyphus who the repetition of his task to be his punishment, we harness our creative powers of meaning-making and allow our imaginations to construct grand narratives of how our work and task-pursuit are in fact of the utmost significance.  

There is real meaning to be found in the tasks we choose to undertake in our lives. However, issues tend to arise when we choose to deny the reality that we will never arrive at the fixed permanent state of satisfaction, which we so crave.

This issue resides within ourselves. We lack the sufficient self-knowledge necessary for us to properly identify what tasks, goals, and pursuits provide us with the meaning, purpose, and satisfaction we seek.

Consequently,  if we haven’t allowed ourselves to succumb to the illusion of pursuing tasks like Sisyphus, then we may find ourselves aimlessly wandering from place to place searching for others to tell us about where we should look within to discover answers to what propels our internal restlessness. This movement of outsourcing may even be taken so far as to alter how we perceive our inner world as to align ourselves more fully with the direction we’ve allowed others to corral towards. 

Yet, this too is fruitless and leads to feeling stifled or as if one were an imposter. Nevertheless, many choose this path because it supplies more comfort and security than embracing the alternative; that is, the recognition of what an incredibly challenging, ambiguous, and arduous task it is to become an individual.

A word of caution feels warranted here because of our proclivity to gravitate toward extremes. To be an individual is to understand, appreciate, and embrace the inherent uniqueness of oneself and others; it does not necessarily entail that one must become solely an individual concerned only for oneself and own self-interests.

This is an example of how often we take a particular point about a specific matter and then run ahead with it, applying it to a whole host of other ideas. Quickly, and often subtly, the result of this type of hasty generalization is a product that has lost its connection to, or hardly even resembles, the initial point from which it was derived. Consequently, this too leads back to another method of deceiving ourselves.

How significant must this force be that we try everything within our powers to wriggle our way out of having an encounter with it by means of avoidance, suppression, denial, and the list could continue ad infinium. Nevertheless, despite any of our attempts, like Sisyphus, we are not capable of such a maneuver, as to sidestep or bypass this force that imposes upon us, since, to succeed in such an endeavor would be to contradict our essential quality of being. For what confronts us is the task of becoming something with the being that is inherent to our existence. 

While the temptation to delegate the contemplation of the topic of being to the domain of the philosopher is an enticing way to, once again, duck our responsibility, we are nonetheless incapable of escaping the task placed upon us by life itself to discover what it is that we are, both as an individual and within the context of society.  

We know that we are something; we know that we exist and can quickly provide a list of identifiers to prove our existence within a societal context; that is, by utilizing the tool of language to articulate the ways by which we identify, or distinguish, ourselves from that of others. However, does this articulation of an inventory of individual identifiers truly resolve the task placed upon us by life? Is there not more to our existence and to who we uniquely are than merely that which can be articulated in a manner as to communicate it to others?

However, since these aspects to which I refer are definitionally ineffable, their existence becomes easy to merely dismiss as sophistry and continue navigating through life operating purely from what can be explicitly stated or objectively shown. Moreover, science and empiricism offer further validation that it is only the manifest, the quantifiable and the qualitative, that our existence is justified. Consequently, that which is unable to be spoken nor seen must then not actually exist. Yet, how much of our life is undermined and/or dismissed if our sole criterion for evaluating existence requires some sort of external or externalizable proof before being eligible to be deemed as being something “real”?