Countertransference: The Body of The Therapist As A Space For Reflection
Countertransference: The Body of The Therapist As A Space For Reflection
Countertransference: The Body of The Therapist As A Space For Reflection
Abstract:
(…)
RGG, 1999
1. Why the body of the therapist?
This poem marks a moment of awareness that both my personal development and the
way forward in my clinical practice were a journey of return to the body. My
professional practice as a psychotherapist has developed for the past ten years – with
many detours and periods of apparent stagnation – intertwined with my personal growth
and the development of a creative and embodied approach to life. What I bring to
therapy, my personal one as well as the one I am able to provide to my clients,
encompasses all the complexities and levels of such developments.
The body of the therapist has been a major interest for me as I discover new pathways of
awareness, challenges and creative responses that the body can bring to the therapeutic
practice. The experiential learning of the Sesame course has been a continuation of many
of the aspects I came to see as fundamentals to psychotherapy, the need to develop a self-
reflective practice and the importance of the therapeutic relationship being two of them. I
consider in this review that the process of transference/ countertransference lies at the
core of these two aspects thus justifying its relevance as a subject of study.
I understand the practice of psychotherapy, and perhaps even more of the Sesame
approach to dramatherapy, to be an embodied and dialectic encounter between the
therapist and the client. I see myself as a therapist as I see my clients, as a whole person
with its own complexities, yet being able to influence and be influenced by the other
through an embodied encounter in the space defined by the therapeutic relationship. This
embodied aspect means that the therapist is working in the present moment with his own
spontaneous emotional responses and sensations as well as with the techniques he may
have acquired beforehand. Using my whole embodied experience as I started my first
placement in the course led me into questioning what was the place of my body in the
therapeutic relationship and how I could use it in the service of my clients’ therapeutic
needs.
Conger (1994:19, 20) poses a similar question ‘How do our bodies inform and enlighten
our work with our clients?’ He continues by stressing the importance of knowing our
own bodies for the understanding of what is happening with our clients, stating that
through this awareness of his unique distortions and deep fragilities the therapist can
‘become the fine bone flute’ that is meant to be; his body ‘the stream always available,
educating [him] about the client, the therapy, [their] interaction and [his] own being’.
This, I believe is very much in line with the Jungian perspective of knowing ourselves
better in order to better understand our clients. Another author that stresses the
importance of looking at the phenomena around the therapist’s body is integrative
psychotherapist and osteopath R. Shaw. In his work on the embodied psychotherapist he
suggests that ‘the embodied experience of the therapist is a significant aspect of the
intersubjective nature of therapeutic relationship’ (2003: 32).
The intersubjective nature of the therapeutic encounter means that the therapist is also
being transformed by participating in the therapeutic relationship. But what exactly
means this transformation? At what levels do we understand this transformation when we
consider that our work as Sesame practitioners involves some sort of contact with the
unconscious aspects of the psyche?
Sesame approach views the therapeutic relationship as a dynamic process, drawing on the
work of Jung and Winnicott, as well as contemporary Jungian analysts and
psychoanalysts such as Casement and Clarkson, among many others. The importance of
the unconscious phenomena in psychotherapy is paramount to the Jungian psychology,
in itself an important part of the Sesame approach. According to Sedgwick (2001) Jung
was pioneer in regarding the mutuality of the therapeutic relationship by suggesting that
the personal influence that client and therapist exert on each other, both consciously and
unconsciously, is the central dynamism in psychotherapy.
According to Conger (2005: Preface) both Jung and Winnicott provided ‘the foundations
of a body-oriented psychotherapy: a kinaesthetic awareness of oneself and the impact of
others, an attention to the psyche-soma correspondence, an appreciation for the character
of physical presence, for gestural language, for the vibrant or dulled energetic boundary
between therapist and client, and an imaginative awareness of the client having bulk in
the world he or she describes’. I believe these are all important ingredients for the
Sesame approach: kinaesthetic awareness, atunement, psyche-soma correspondence, and
imagination, and refer to the pre-verbal and unconscious aspects that can be facilitated
within the therapeutic relationship. I would add to this the symbology of unconscious
images and material that can be expressed via the art form.
3. Countertransference
If transference is an important aspect of psychic life and can be seen in the relationship of
the client towards the therapist then the process of countertransference, simply put the
therapist reaction to the client’s transference, should be seen as important.
After what Samuels (2006: 185) calls the ‘countertransference revolution’ of the 1950’s
psychoanalytic schools, both Freudian and Jungian, started to look more attentively at the
phenomena of countertransference and incorporate it as an inescapable and valuable part
of the therapeutic work. Since then there seems to be an increase in the literature
concerning the phenomena thus transforming the analyst/therapist in a subject of the
clinical narrative (along with the client). More recently there has also been an increase in
research on these questions across the fields of psychology and psychotherapies. This
trend is also present in the disciplines of body psychotherapies and dance movement
therapy especially the ones influenced by analytical and depth psychology. It seems that
post-Jungian analysts were the ones who pushed this subject into deeper and perhaps
most controversial considerations (Schwartz-Salant and Searles, being two of them).
Gelso and Hayes talk about countertransference as a therapeutic tool with the twist of the
‘wounded healer’ (2007: 110): ‘the therapist’s wounds need to be sufficiently healed to
be drawn from usefully. We would argue that one’s vulnerabilities and conflicts are never
fully resolved, nor do they need to be. In fact, a therapist’s issues probably need to be
alive enough so that they are available to be drawn upon in the work. Conflicts that are
dormant or sealed of cannot be used to relate to the patient.’ This is very much in line
with Jung (1954: 116) when he calls upon the Greek myth of the wounded physician.
Gelson and Hayes define Five Factors in the ‘Management of countertransference’ in
order for the therapist to be able to refocus on the client after the impact of
countertransference: self-insight; self-integration; anxiety management; empathy and
conceptualizing ability.
Often countertransference feelings and emotional states overwhelm the therapist who then
takes those issues to personal therapy and/or supervision in order to gain consciousness
and understand them in the light of his own material (complexes, past relationships and
feelings towards the client, etc.). As we recognize these phenomena as
countertransference we start a process of turning into consciousness what once belonged
only to the unconscious realm. Yet, it seems that this process is far from being a linear
one. In the context of my training I have learned from my own experience, from the
exchanges with colleagues and supervisors and through the literature, that this is indeed a
dynamic and probably never finished process. The fact that countertransference
phenomena can happen in different and simultaneous client-dramatherapy trainee
relationships (in a context of continuous assessment in an accelerated mode), not to
mention the parallel process that can occur in supervision and personal therapy, just
seems to add layers of complexity to this already intricate phenomena.
Whether or not we follow Sedgwick and other authors of the post Jungian school, and see
countertransference as an essential condition for the work of the therapist as a wounded
healer and perform a countertransference-based work, it seems that learning from this
phenomenon is an important aspect of becoming a Sesame dramatherapist.
4. Somatic countertransference
Somatic countertransference in the way of certain feelings and body sensations that linger
in our body after the work make this process of analysing and separating the client’s and
the therapist’s material particularly difficult. Occasionally we may feel so drained,
agitated, overwhelmed, frightened, excited or numb, that we can hardly do anything else
besides trusting our own self-regulating bodies/ psyches. Persistent and unfamiliar
symptoms may tell us something about the client’s world but until we discover or make
sense of it they stay in our bodies with their undeniable truth. I believe this is where a
self-reflective practice becomes crucial. For me this ongoing and self-focused learning
process has necessarily to go through my embodied self and in that sense the somatic
countertransference is an invitation to look attentively at, to care for, and to learn with
my own body experience.
Somatic countertransference has a particular interest for me in the sense that you cannot
escape it. One is confronted with the authenticity and imminence of the body and the first
thing we might be able to do about it is to accept it and breathe; the same acceptance that
we encourage in our clients but may sometimes lack towards ourselves. Acceptance here
is understood as prerequisite to awareness. Only if we accept our own body
vulnerabilities and capacity to be influenced, will we be prepared to see other’s
vulnerabilities and our own influence on them.
Shaw (2003:149) argues for the necessity of the therapist to own his bodily and physical
reactions rather than always seeing them as countertransference to the client’s material.
He talks about the ‘reification of the subjective experience’ stating that: ‘these somatic
phenomena are therapist responses, which, through a layer of psychotherapeutic
interpretation, become located within the body of the client. However what is possible is
an exploration of therapist embodiment; this may have something to say about the
therapeutic encounter, and I am sure that it is of importance in the process of the
therapeutic relationship. It can though, unless discussed with the client, only ever mean
anything to the therapist.’
I agree with the importance of therapists to own their body reactions and that this analysis
can sometimes lead to a ‘reification’ of the subjective account of the therapist, at the risk
of attributing to the client complexes and situations that in fact belong to him and were
until that moment unconscious. However, I also believe that a lot can be done through
this self-analysis even if it is not conveyed to the client directly. To do so, would be
perhaps possible in a type of person-to-person relationship, but could be detrimental in
other situations.
I have been particularly interested in looking at the moments of apparent stillness in the
work with the clients, the moments during the session but also the ones before and after
the session. The sessions when the client does not come, and especially those moments
just after the client has left and I return or stay in the empty room still with the client,
what just took place minutes ago, myself and how all of this is relating, in my mind. That
moment when I can still feel that special substance, for which I do not have a name but
which is the substance of the therapeutic encounter; when this substance begins to land
gently or abruptly, in shapes and images or in a turmoil of affects. Paying a particular
and consistent attention to these moments has been important to develop my sensitivity
and awareness, not only to the clinical work, but to myself as well. It has helped by
teaching me a patience and tolerance towards what I do not know and cannot grasp. This
substance is mysterious, and this might be why Jung himself chose the alchemical
metaphor to write about the ‘Psychology of Transference’. The therapist’s own
development is happening as a parallel process. Is it essential to try to separate the two
processes – what is from the client and what is from the therapist? Or is it the possibility
of a merging between the two that enables a deeper change to take place?
But the body, psychologically speaking, is the expression of our individual and
conscious existence, which, we then feel, is in danger of being swamped or
poisoned by the unconsciousness. We therefore try to separate the ego-
consciousness from the unconscious and free it from that perilous embrace. Yet,
although the power of the unconscious is feared as something sinister, this feeling
is only partially justified by the facts, since we also know that the unconscious is
capable of producing beneficial effects. The kind of effect it will have depends to
a large extent on the attitude of the conscious mind.
Jung (1954:290)
I am interested in that moment when separation is not yet achieved, when the subtlety of
the phenomenon evades from the session and finds home in the therapist’s body, forcing
him to acknowledge the existence of something that might have been unconscious until
then. Somatic countertransference seems to be the translation of participation mystique in
the body of the therapist. Whichever the way in which these experiences are analysed
further, and how skilfully the therapist is able to track down the path into the client’s
reality, it is in his body that they are manifesting. Is analysis and interpretation the only
way through? And need this be urged? As Sesame practitioners we do not interpret the
client’s images or symbols, or give direct feedback on them, so why should we rush to do
it in the client’s absence? Only in consciousness would we be able to analyze and bring it
back to the clinical work; in analysis this could be achieved by making sense of the
analyst’s responses in the light of what the client had projected onto him – transference –
and using interpretation to help the client towards some understanding of his own
process. But what happens when we do not interpret? When at least we do not verbalize
to the client the impact of his projections?
Surely the feelings and bodily felt sensations that the therapist is experiencing can be
valuable sources of information for his work with the client, helping in the assessment
process and in the choice of appropriate material/ interventions to meet the client’s needs.
My learning on this, however, has been more on how to be able to sustain the moment of
separation. Before attempting to differentiate the client’s material from our own (it may
not even be possible at times), using our analytic skills or our supervisor’s, I consider
important to dwell a bit longer in that ‘mutual unconsciousness’, allowing it to become
conscious in a gradual, creative and embodied way.
Looking into the theories around the psychoanalytic concepts of countertransference and
projective identification I came across a rather different type of book that I remembered
to be very popular some decades ago – an image book with stereograms. I decided to
look at it and try if I could still see the 3D shapes from each image. I was then struck by
the analogy between the process of seeing the picture in 3D and the way I understand the
experience of countertransference: in both you need to experience a sense of loss, of not
knowing, and some confusion, and only by allowing yourself to stay there long enough
do you get to see the ‘hidden’ shapes. You need to allow yourself to see a blurred image
before you can see the multidimensional one appearing like an instant picture. This
moment can be quite difficult and strenuous, because our mind is somehow designed to
make sense of what it sees and experiences. Sue Jennings gives a personal account on
waiting for the meaning to emerge:
It was in the waiting with, and being attendant to, that meaning began to emerge.
It was from these experiences that I developed some advice for myself to `stay
with chaos' and allow meaning to emerge. Advice I have found very useful since
then, when working as a therapist. (…) What I learned most about being with the
Temiar was that in waiting I had to make use of myself in the process of
understanding the other. (…) Therefore, in order to be in any way effective in the
healing process, the therapist needs not only to be aware of the client's
experiences of crisis and chaos but also to make use of his or her own comparable
experiences. It is only in the space between the therapist and client that the
possibility of eventual understanding can take place. If the therapist cannot make
use of his or her own liminal experiences the communication will be one
dimensional.
Using the same expressive techniques that we encourage our clients to use, we give time
to listen to our body talk. In my experience I have used mainly authentic movement and
drawing as ways to achieve that. Using my own body movements – in the space and
projected in the paper – in order to integrate the complex experience of
countertransference. This research question has enabled me to find precious time to focus
on my own process during the tight schedule of my placements.
Authentic movement is a unique and complete way to be in touch with our symbolic
bodies and arrive at new levels of embodied consciousness. But it requires a privileged
and contained space where the caring and holding gaze of a witness enables us to be lost
and found inside our own moving experience. These conditions were reunited in the
monthly movement sessions provided by one of our previous tutors in the Sesame
training. Meanwhile I had to encounter a way that could be available at the moments
between sessions when I was able to enjoy some solitude and breathing space. I used
mainly drawings to be able, in a condensed time, to project things that felt stuck in the
body and that I needed to look at with some distance.
Hiller (1998:452)
This activity of drawing can be understood as Bion’s alpha function in which the mother
is capable of receiving the beta elements from the baby and translating them back in a
more digestible form, so that the baby is then able to reintegrate his own contents – the
beta elements being my countertransference responses that were contained by the
maternal function of the art form. The drawings also suggest the Winnicott concept of
transitional phenomena – at the same time subjective, as products of my inner world and
objective, through their material existence; ‘not separate enough to be fully fledged
symbols, they become nevertheless more than mere objects, having been endowed with
personal meaning’ (Wright: 1998: 467); they linger in that intermediate area between
what is from the therapist and what belongs to the client, containing the flavour of the
substance of the encounter between them. They are also dynamic, for if one drawing
were to be made a moment later it would become something different. In this sense they
do not attempt to explain the countertransference phenomenon but simply to witness its
passage. Like a footprint in the sand that soon will be vanished by the waves, or a lost
poem.
6. Final reflection
Dramatherapy approaches, being part of the arts therapies, share these humanistic and
holistic traditions and therefore assume the importance of the therapeutic relationship and
the role of the therapist in the outcome of the therapeutic intervention as well as the
techniques and methods used. Accounts of therapeutic work are very often written in a
lively and personal style, giving important contributions to the field where review of
theory is contrasted and enriched with clinical material. Nevertheless, the dramatherapist
as a subject of research seems to be still in the shadow of the backstage while the main
focus lies on the client, its needs and the appropriateness and effectiveness of the
methods. This can be due to the fact that Dramatherapy is still an emerging discipline in
terms of research (contrasting greatly to the thousands of years of an inherited practice,
going back to the first uses of drama and arts as healing aspects of many human societies)
and thus being naturally concerned with validating its effectiveness and appropriateness
of different methods to a variety of client groups.
In the Sesame approach there is a great focus on the therapeutic relationship as a dynamic
process in which the therapist as a whole person participates. Looking at some of the
Sesame dissertations that focus directly on the therapist’s own process or on his place in
the therapy there is a sense of the importance of a self-reflective practice during training.
The experiential type of learning, along side individual and group therapy, where the
student goes through a very personal journey of self-discovery, and paraphrasing Jung of
‘confrontation with the unconscious’, aims at providing the student with the opportunity
to encounter his own themes, complexes, emotional responses, feelings and hopefully
also his own creative responses to work through some of those. This, we soon realize, is
only part of a greater journey, the acknowledgement of the depth of an individuation
process, as a return to the Self.
This process seems to be intensified in the training context as the student’s personal
process, anchored in his individual and group therapy, happens at the same time he is
facing the demands of meeting new clients in placement. This parallel process continues
and the ability to recognize and capitalize countertransference responses becomes vital. I
believe this type of inward looking continues to be a strong component in the activity of
most practitioners and perhaps it would do no harm to the profession to formalize this
importance by creating more research on the subject of the dramatherapist.
The understanding of the client is dynamic, involving body and mind, intellect and
feeling, intuition and senses. The art form enables us to access the non-verbal, the hidden
and the unconscious; with its transformative potential, as a therapeutic technique, it can
also be used as a tool for understanding the therapist’s process. Using the art form and
my own embodied experience as a therapist to reintegrate the phenomena of
countertransference became a natural pathway to my self-supervision. I discovered that
specifically the drawing – that could be made in the much needed, though sometimes
difficult to keep, space of solitude after a session with a client – could provide me the
space to reflect without necessarily arriving at any particular conclusions.
7. Bibliography
Bonaminio, V. 2008. The Person of the Analyst: Interpreting, Not Interpreting, and
Countertransference. The Psychoanalytic Quarterly. 2008. Vol. LXXVII, 4.
Caroll, R. The subtle Body and Countertransference. From: Thinking Through the Body
http://www.thinkbody.co.uk/body-psych/subtlebodyctr.htm 02/05/08
Conger, J. P. 1994. The Body in Recovery: Somatic Psychotherapy and the Self. Frog
Books
Conger, J. P. 2005. Jung and Reich: The Body As Shadow. Berkeley: North Atlantic
Books.
Gelso, C.V. & Hayes, J. A. 2007. Countertransference and the Therapist’s Inner
Experience. Google Books 4/11/08
Hiller, S. 1998. Dream Maps. The British Journal of Psychotherapy. 1998. Vol.14, 4
(448-452).
Hougham, R. 2005. Track the Deer, Catch it and then let it go. Dramatherapy Vol27 No3
Autumn 2005
Jennings, S. 1988. The Loneliness of the Long Distance Therapist. British Journal of
Psychotherapy, 1988, Vol. 4, 3.
Jennings, S. et al. 1992. Dramatherapy Theory and Practice, vol. 2. London, Routledge.