By Stephanie Newman, PhD
Dear Psychoanalyst: Can a positive transference be more problematic than a negative one?
—Dr. S., Clinical Psychologist
Hello Dr. S.,
Good question—this is one of our field’s greatest hits, right up there with couches and dreams about teeth falling out.
I see you’re a clinician, but you’re also likely a patient. Working with the transference can be a challenge on both sides of the couch. Intensely positive emotions towards a therapist can feel burdensome for patients and prove to be a handful for even the most seasoned clinicians. The sudden incursion of, say, adoration or erotic desire may make discussion difficult. You might find it hard to bring up intensely admiring feelings or erotic fantasies about your therapist or analyst. Or you might be skeptical about whether idealizing or erotic transference is an issue that needs attention at all.
Let’s start with a definition. Emotions and fantasies about significant people or experiences from the past are often transferred onto present day people and experiences. This is what we in the therapist’s chair like to call transference. Think of it as emotional time travel: The patient’s thoughts and feelings hitch a ride from the past and arrive with you in session. These can be negative (“you don’t give advice, why don’t you care about me?”) or positive (“I finally feel seen!”). Warm and fuzzy, loving, erotic, and admiring feelings routinely develop during the course of a treatment and land squarely on the person of the therapist. All this because the patient has cast you in a familiar role (or more than one role!) that may have little to do with you in reality.
So, what could be so bad?
Psychoanalysts have been discussing the pitfalls of positive transference for years—about one hundred, to be exact. An old guy with a white beard (you know the one) noticed a young female patient’s intense response to their sessions, which felt like a distraction from treatment. Then it happened with other patients. Eventually, understanding he was not that attractive, he realized it wasn’t about him; it was a relic from the past, one that could be interpreted. While he cautioned against prematurely interpreting the transference, he did come to see transference as the stuff of therapy, not an impediment to it. When our man’s model of the mind shifted to conflict between Id, Ego, and Superego, clinicians began to recognize a kaleidoscope of thoughts, feelings, and defenses against them, alongside fantasies about the therapist-patient relationship. These transference fantasies, positive and negative, were a tool to aid in analyzing.
Fast forward a few decades and theoretical approaches to transference emphasized what was happening between therapist and client, the “here and now transference” (Merton Gill we mean you!), a relationship built in real time that does not merely recapitulate the past. Some took this idea a step farther, positing that struggles in the consulting room would be best addressed by untying present day knots between patient and therapist—no need to go back in time and revisit “old feelings” to shed light on current day struggles. Maybe the feelings come from the past, according to this view, but the way to deal with them is in the present relationship. Here it’s less about watching reruns of the patient’s life and more about shooting a new season.
Theories of transference are a-plenty, and most modern psychodynamic approaches agree that a combination of developing insight and experiencing a new relationship is what makes people better.
It’s clear that negative transference is a problem worth reflecting on. There’s reticence and defensiveness at play. Embarrassed or ashamed people can become tongue-tied, judge themselves, and put their self-criticism onto others, especially their therapists. But you might remain unconvinced that positive feelings are a problem. If so, consider two scenarios: (1) idealizing, intensely loving feelings and thoughts and (2) powerful erotic experiences and fantasies. If idealizing and erotic transferences lurk, treatment can stall.
Silence is not always golden. Here’s how. Some go to all lengths to avoid whatever is taboo in their eyes: sexual, angry, vulnerable feelings are commonly uncomfortable. So, someone who grew up in a home full of conflict, angry blowups, extended absences of a parent, or use of the silent treatment may have learned that anger is toxic and may avoid conflict by being nice and pleasing others, including the therapist. Some might aspire to be the “perfect patient,” striving to be likeable, complimenting the analyst, putting them on a pedestal. Piling compliments on your analyst might feel polite, but it can be a red flag: Somewhere under all that sugar there’s probably a little vinegar. Looking at idealization, allowing a full range of feelings (even negative and critical ones) into the treatment room helps integrate them into the patient’s awareness, allows for authenticity, and helps us feel more comfortable in our own skin.
Naming the elephant in the room—an elephant called erotic transference—turned out to be healing.
Like idealizations, feelings of desire can be difficult to know and discuss—even with a therapist. I once supervised a female clinician whose male client made progress by talking about career concerns. He was positive about treatment and asked to see the therapist four times a week. He decided spontaneously to lay down on the analyst’s couch. Next session he came in ready to argue, railing against a female boss who had “misled” him about a promotion and speaking about a romantic partner who had “led him on” and “hurt “him. He yelled that treatment was not helping. He shouted, “This is what it’s like to be married to me!” and stormed off. The patient did not return my supervisee’s follow-up calls but wrote a note apologizing for the outburst and ending the treatment. After some time he was able to return and connect intense feelings of attraction for the trainee therapist to his need to storm out of the treatment and leave on angry terms. The patient later began to explain the source of his pain: In his community sexual attraction outside marriage was taboo. In his family love was stormy and full of ups and downs. Naming the elephant in the room—an elephant called erotic transference—turned out to be healing.
In my view, progress is deterred by what is left unsaid or unlabeled because it is too threatening or shameful or taboo. Talking it through, feeling it, tolerating what is scary or dangerous, allows a person to integrate frightening thoughts and emotions. If a feeling or topic feels unspeakable, all the more reason to label and address it. I agree with the many psychodynamic clinicians who believe that whatever doesn’t get discussed gets acted on, often emerging when we least expect it. What isn’t understood and labelled comes back to bite us.
As clinicians we open up a path to progress by showing we are comfortable with whatever patients put onto us. If we can take it they see it must not be so bad, and they can integrate it and feel less overwhelmed and anxious.
If you are seeking advice about your own treatment and how to approach “positive” fantasies and feelings, I’ll reiterate: I hope you’ll communicate your emotions and concerns to your analyst. Understanding transference opens doors. It might not be easy, but it will likely open up new areas of exploration in your treatment.
In Ask a Psychoanalyst, Stephanie Newman, PhD, responds to reader questions about therapy, relationships, and psychopathology of everyday life. Submit your questions to advice@tapmag.org. Your identity will be kept anonymous.
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This column is for general educational and informational purposes only and is not a substitute for professional advice, diagnosis, or treatment. Always seek the advice of your own therapist, physician, or other qualified health provider with any questions you may have regarding a mental health condition. Reading or submitting to this column does not create a therapist-client relationship.
Happy to contribute an anecdote and counter weight to the red flag of positive transference. . .
If your therapist returns these feelings of admiration and putting them on a pedestal. If they act out on these feelings, from the past, as if they are to do with the here and now - it’s time to change therapist.
I agree wholeheartedly with your preference to talk through these intense positive emotions. Not always easy for a client to do, especially if they have a desperate need to keep the connection.
However, a therapist should be talking them through in supervision too. Not with the client?