Understand and Using the Transference

• The Case of Gary IV: Conclusion by Jim Pretzer, 12/1/97
  
  

Gary's treatment is a good example of how our patient's will work in many different ways to get better- Gary used the brief treatment modality for over four years and then continued to get pieces of help again later in his life. It raises some interesting questions for me about how our patient's find the best help for themselves. We might surmise that this mode of brief contacts over a long period of time provided Gary with a particular type of "holding" that suited his psychological make up. It might have, for example offered Gary protection against becoming overly dependent and attached to a therapist. 31 sessions is not a lot but Gary sure used them and seemed to gain help! It also be possible that Gary might have molded his style to that of his therapist- he may have had some idea that this was the way in which Jim worked.

Control Mastery Theory emphasizes patient's own style, need or pattern of getting help which will be reflected in their treatment. All theoretical considerations are case specific to an individual team's needs- the match of a therapist and the patient. That is where how one uses the transference comes into play. There is no question that the transference contains very important information for us. Most of our work involves understanding the meaning of the transference. I do not mean to dispense with the use of transference interpretations in general but rather to make their use dependent on the patient's ability to make use of them and likely reaction to them. There are many patient's for whom this method of exploration is a useful road to discovery but there are also those for whom it is not. For example an excessive focusing on the transference may be experienced as too intrusive and hovering an approach or can appear to be based on the narcissistic needs of the therapist. A patient may experience having to direct all, much or most of the material to how they feel about you as suggesting that you want them to worry abut you and make you very important. If a patient had a narcissistic parent with whom they had a similar relationship this could fail a test and re-traumatize them. A patient could be trying to leave you out in order to see your comfort with this.

There are many case in which the work is deepened and aided without the use of transference interpretations (as reported in the articles I mentioned) but this is not always true. All I was saying was that good, deep helpful work doesn't have to include any particular amount of transference interpretations. A deep understanding and use of the transference on the therapist's part - yes. In my own work I find it indispensable- it guides my every response. I do not always choice to bring it to my patient's attention. I am sure we would all agree that one must be aware of and adjust to the patient's capacity to make use of our interpretations.

Control Mastery Therapy suggests that you pay very close attention to the transference at all times but thinks a bit differently about what to with the feelings that are being generated in the room and how to discuss them with the patient. We try to assess the patient's plan and respond according to how we infer the patient will feels safest working with us. This may include transference interpretations or not, once a week to four times a week, on or off the couch, lots of breaks or a continuous long treatment. We believe that different ways seem to work for different folks. If anyone wants the article I was referring to above, our office would be would be happy to assist you in obtaining a copy. You can e-mail them at sfpsych@wenet.net. The author Polly Bloomberg Fretter will be presenting the next case so we can further discuss these issues with her as well.

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