Most training programs leave transference as a footnote. You identify here why teaching and learning deeply about transference is essential to doing a good enough job with clients and avoiding unnecessary harm. I urge any clinician who hasn’t received good training on transference and how to navigate in treatment to find a really good relational psychodynamic supervisor or trainer to at least support your practice. Even if it’s not a psychodynamic practice.
Thanks! Transference was big when I trained and left an impression on me despite me not going into psychotherapy in any formal capacity. I think the idea makes a lot of sense when applied to life more generally in how we interact with one another and even make first impressions.
Yes! I spent 13 years in community mental health and didn’t really learn how to apply the knowledge with the practice. Honestly, accidentally landing with a psychoanalytic supervisor changed everything. I understand how to use this in treatment to develop a new relational experience that I believe changes the brain over time. It’s really beautiful work but many avoid psychodynamic training because Psychoanalysts have historically done such harm. I really get it, but this way I do my work now is a different dimension and I wish we all knew more about it. Thank you for starting the conversation!
Thank you for engaging! Please share your thoughts as we move forward with the conversation. I’m by means an expert on this topic and just find it fascinating in explaining things I often introspect about.
Nice piece! Though tbh, one of my take-homes is that it seems we have quite a ways to go before neuroscience will really help us understand transference. Still, the first step towards any mechanistic understanding is a coarse mapping of spatiotemporal neural dynamics onto cognitive(/emotional/mental) process.
Agreed. Subjecting the phenomenon to cognitive science tools and doing a behavioral dissection can a good start. The neural stuff can always follow but a lot can already be done with a good behavioral model that makes falsifiable predictions.
This article comes at the perfect time, and thank you for so brilliantly laying out how our brains perform these immediate, often perplexing, substitutions that shape our reactions before we even fully process them, making me incredibly curious about the underlying neural mehanisms that enable such a fundamental human experience.
Yeah, it's fascinating, isn't it. We talk about transference all of the time in therapy (it's gotta be one of the most used words during therapy supervision) but I think we got so used to it that it became common place, something we don't look with novel eyes anymore, like a piece of furniture you see every day - you don't really look at its shape and colour anymore. Before Mike brought this perspective in, I never saw it as what essentially is a compression of experience for later use, which obviously is one great way to see it and lends itself to neuroscience framing. Thank you so much for reading and engaging!
Thanks so much for your input. We are keen on exploring the neural mechanisms and will hopefully be able to follow up on this exact point. Ana has far more developed ideas about how this relates to the practice of psychotherapy, which is also super exciting to explore.
Thought-provoking, but I have a few caveats. First, I don't see where the neurobiology is. Second, just because transference is neurobiological (much is), it doesn't begin to inform its meanings. Finally, confirmation bias doesn't begin to explain transferential phenomena. Biases can be automatic but aren't necessarily unconscious. In psychodynamic/analytic therapy, transference can often cause deeply ego dystonic emotions that don't confirm but fundamentally challenge. Only over time can these phenomena (transference and counter-transference) be acknowledged and understood and often only confirm something that was completely unconscious.
Thanks. Very reasonable comments and it’s something Ana and I discussed as we put the piece together. If one’s definition of neurobiology involves clear brain mechanisms, we’ve only set the stage at this point. But I have a more liberal view of neurobiology that includes cognitive mechanisms, which this piece engages with. For the rest of your comments, I’d let Ana respond as she is more qualified. All I can say is that it is reasonable to assume that cognitive learning styles shape how people handle social interactions and therefore how they engage with repeated themes in therapy. How exactly this relates to the rich literature on transference is a journey that we have just begun.
Hi Mark. You've got to admit that at least there are no typos and other embarrassing writing mistakes in this one - all credit goes to Mike for that (for context, Mark has been known to point over time some of the shocking typos and other mistakes I tend to leave in the text, for which I am very grateful). Now, to your thoughtful comment - I think you hit exactly those elements that are underdeveloped in this piece - Mike explains neuroscience side of things in his answer to you, so I have nothing to add there. I don't think we say that transference is all about confirmation bias, do we? Some confirmation bias can sometimes be involved, whether consciously or pre-consciously (these are loaded terms, so treading carefully). Also, some transference can be conscious too, or within awareness, right? Overall, I stand by the idea that some forms of structural learning could explain, possibly entirely, the phenomenon of transference. We don't know the details yet, we don't know whether it is the same mechanism for all types of learning: emotional, facts, people etc. But I think it is a good starting point. In psychotherapy, I feel, there is a certain mystique around the idea of transference, loads has been written about it and the concept has a life of its own, but what if it could really be reduced to this type of learning? That could give us some interesting ways to possibly turn upside down how we work with it - but it does not take away from its intrinsic complexity. What I take from your comment, we might not have conveyed this in the best possible way? Hope this makes sense. Thank you for reading Mark and for engaging, it's much appreciated.
Ana, great reply. As a therapist, you know much more about transference than I do. I’m fascinated by it. Perhaps, I “overread” the post and posited straw men where they didn’t exist. I will say that biology is an excellent tool for discovering causal mechanisms, but it is woefully inadequate when it comes to finding meaning. C’mon Ana, it’s been a long time since I said anything about typos.
Hi Mark - I know, it is fascinating indeed. I am not sure, I think the underlying idea is good and provides one strand for explanation, but it might have not been conveyed in best possible of ways. True, you did not mention typos lately which does not mean that there are none - I always still find plenty in my text.
So many thoughts! I love the idea of individual differences in working memory applying to the way in which people think about their therapist. How some pattern match and others start anew and how always starting anew would make human relationships befuddling. I am bookmarking this one to chew on it some more. Thanks for sharing!
Thank you, Ana and Michael. This is a very nice piece. I'd like to add that the tough transference problems we encounter have an additional factor. They tend to be "frozen in time," particularly resistant to change because they are connected to existential challenges the person once faced and now can't let go of the imprint. Also related to your post, Friston in a 2022 article suggests that autism may be explained as an extreme of splitting, where every situation is taken as unique. I'm not sure that tells the whole story, but it's an interesting idea.
Hi Jeffery! Thank you for reading. How would you amend the story with that in mind? The whole story can go much further of course, this piece is just drawing the perimeters I suppose. So it’s really good to get your input. Would you say more abstracted the ‘rule’ more difficult to change? Mike is probably better for answering the autism question, I don’t really have a view on it.
I remember seeing literature on pattern learning in autism that’s broadly congruent with the sentiment. It’s an empirical question whether a Summerfield-type experiment would show that people with autism would be more likely to show a splitter phenotype. Would be nice to extend the paradigm to a social domain to know for sure…
“Frozen in time” means that transference is strong and persistent. Even more, it isn’t just a distortion of perception, but usually part of a very old plan to cope with a serious problem. For example, if the problem was not enough love & attention, then the transference is part of a plan to fulfill those old needs and we therapists are “it.” Letting go of that version of things may mean facing the pain of accepting the reality that the old deprivation can’t be fixed and it’s time to make peace with the love one can receive as an adult. That’s one example.
It is one of the most common and oldests concepts in psychotherapy and it is impossible to pull out THE reference for it. A thorough overview can be found in Weiner, I. B., & Bornstein, R. F. (2009). Principles of psychotherapy: Promoting evidence-based psychodynamic practice. The book is easy enough to find in pdf format. Hope this helps!
Most training programs leave transference as a footnote. You identify here why teaching and learning deeply about transference is essential to doing a good enough job with clients and avoiding unnecessary harm. I urge any clinician who hasn’t received good training on transference and how to navigate in treatment to find a really good relational psychodynamic supervisor or trainer to at least support your practice. Even if it’s not a psychodynamic practice.
Thanks! Transference was big when I trained and left an impression on me despite me not going into psychotherapy in any formal capacity. I think the idea makes a lot of sense when applied to life more generally in how we interact with one another and even make first impressions.
Yes! I spent 13 years in community mental health and didn’t really learn how to apply the knowledge with the practice. Honestly, accidentally landing with a psychoanalytic supervisor changed everything. I understand how to use this in treatment to develop a new relational experience that I believe changes the brain over time. It’s really beautiful work but many avoid psychodynamic training because Psychoanalysts have historically done such harm. I really get it, but this way I do my work now is a different dimension and I wish we all knew more about it. Thank you for starting the conversation!
Thank you for engaging! Please share your thoughts as we move forward with the conversation. I’m by means an expert on this topic and just find it fascinating in explaining things I often introspect about.
Nice piece! Though tbh, one of my take-homes is that it seems we have quite a ways to go before neuroscience will really help us understand transference. Still, the first step towards any mechanistic understanding is a coarse mapping of spatiotemporal neural dynamics onto cognitive(/emotional/mental) process.
Agreed. Subjecting the phenomenon to cognitive science tools and doing a behavioral dissection can a good start. The neural stuff can always follow but a lot can already be done with a good behavioral model that makes falsifiable predictions.
This article comes at the perfect time, and thank you for so brilliantly laying out how our brains perform these immediate, often perplexing, substitutions that shape our reactions before we even fully process them, making me incredibly curious about the underlying neural mehanisms that enable such a fundamental human experience.
Yeah, it's fascinating, isn't it. We talk about transference all of the time in therapy (it's gotta be one of the most used words during therapy supervision) but I think we got so used to it that it became common place, something we don't look with novel eyes anymore, like a piece of furniture you see every day - you don't really look at its shape and colour anymore. Before Mike brought this perspective in, I never saw it as what essentially is a compression of experience for later use, which obviously is one great way to see it and lends itself to neuroscience framing. Thank you so much for reading and engaging!
Thanks so much for your input. We are keen on exploring the neural mechanisms and will hopefully be able to follow up on this exact point. Ana has far more developed ideas about how this relates to the practice of psychotherapy, which is also super exciting to explore.
Thought-provoking, but I have a few caveats. First, I don't see where the neurobiology is. Second, just because transference is neurobiological (much is), it doesn't begin to inform its meanings. Finally, confirmation bias doesn't begin to explain transferential phenomena. Biases can be automatic but aren't necessarily unconscious. In psychodynamic/analytic therapy, transference can often cause deeply ego dystonic emotions that don't confirm but fundamentally challenge. Only over time can these phenomena (transference and counter-transference) be acknowledged and understood and often only confirm something that was completely unconscious.
Thanks. Very reasonable comments and it’s something Ana and I discussed as we put the piece together. If one’s definition of neurobiology involves clear brain mechanisms, we’ve only set the stage at this point. But I have a more liberal view of neurobiology that includes cognitive mechanisms, which this piece engages with. For the rest of your comments, I’d let Ana respond as she is more qualified. All I can say is that it is reasonable to assume that cognitive learning styles shape how people handle social interactions and therefore how they engage with repeated themes in therapy. How exactly this relates to the rich literature on transference is a journey that we have just begun.
Hi Mark. You've got to admit that at least there are no typos and other embarrassing writing mistakes in this one - all credit goes to Mike for that (for context, Mark has been known to point over time some of the shocking typos and other mistakes I tend to leave in the text, for which I am very grateful). Now, to your thoughtful comment - I think you hit exactly those elements that are underdeveloped in this piece - Mike explains neuroscience side of things in his answer to you, so I have nothing to add there. I don't think we say that transference is all about confirmation bias, do we? Some confirmation bias can sometimes be involved, whether consciously or pre-consciously (these are loaded terms, so treading carefully). Also, some transference can be conscious too, or within awareness, right? Overall, I stand by the idea that some forms of structural learning could explain, possibly entirely, the phenomenon of transference. We don't know the details yet, we don't know whether it is the same mechanism for all types of learning: emotional, facts, people etc. But I think it is a good starting point. In psychotherapy, I feel, there is a certain mystique around the idea of transference, loads has been written about it and the concept has a life of its own, but what if it could really be reduced to this type of learning? That could give us some interesting ways to possibly turn upside down how we work with it - but it does not take away from its intrinsic complexity. What I take from your comment, we might not have conveyed this in the best possible way? Hope this makes sense. Thank you for reading Mark and for engaging, it's much appreciated.
Ana, great reply. As a therapist, you know much more about transference than I do. I’m fascinated by it. Perhaps, I “overread” the post and posited straw men where they didn’t exist. I will say that biology is an excellent tool for discovering causal mechanisms, but it is woefully inadequate when it comes to finding meaning. C’mon Ana, it’s been a long time since I said anything about typos.
Hi Mark - I know, it is fascinating indeed. I am not sure, I think the underlying idea is good and provides one strand for explanation, but it might have not been conveyed in best possible of ways. True, you did not mention typos lately which does not mean that there are none - I always still find plenty in my text.
So many thoughts! I love the idea of individual differences in working memory applying to the way in which people think about their therapist. How some pattern match and others start anew and how always starting anew would make human relationships befuddling. I am bookmarking this one to chew on it some more. Thanks for sharing!
Thanks Arturo. Always good to get your input! Our conversation about bilingualism has been on my mind and I definitely see parallel threads here.
So many parallels. Still chewing.
Thank you, Ana and Michael. This is a very nice piece. I'd like to add that the tough transference problems we encounter have an additional factor. They tend to be "frozen in time," particularly resistant to change because they are connected to existential challenges the person once faced and now can't let go of the imprint. Also related to your post, Friston in a 2022 article suggests that autism may be explained as an extreme of splitting, where every situation is taken as unique. I'm not sure that tells the whole story, but it's an interesting idea.
Hi Jeffery! Thank you for reading. How would you amend the story with that in mind? The whole story can go much further of course, this piece is just drawing the perimeters I suppose. So it’s really good to get your input. Would you say more abstracted the ‘rule’ more difficult to change? Mike is probably better for answering the autism question, I don’t really have a view on it.
I remember seeing literature on pattern learning in autism that’s broadly congruent with the sentiment. It’s an empirical question whether a Summerfield-type experiment would show that people with autism would be more likely to show a splitter phenotype. Would be nice to extend the paradigm to a social domain to know for sure…
“Frozen in time” means that transference is strong and persistent. Even more, it isn’t just a distortion of perception, but usually part of a very old plan to cope with a serious problem. For example, if the problem was not enough love & attention, then the transference is part of a plan to fulfill those old needs and we therapists are “it.” Letting go of that version of things may mean facing the pain of accepting the reality that the old deprivation can’t be fixed and it’s time to make peace with the love one can receive as an adult. That’s one example.
Sure, I get you. In TA we would call that script and injunctions/drivers (I am a TA therapist). I guess attachment styles fall into that category too.
Thanks. I completely defer to @Ana Lund on the literature re: transference.
It is one of the most common and oldests concepts in psychotherapy and it is impossible to pull out THE reference for it. A thorough overview can be found in Weiner, I. B., & Bornstein, R. F. (2009). Principles of psychotherapy: Promoting evidence-based psychodynamic practice. The book is easy enough to find in pdf format. Hope this helps!
Very cool thank you