Karen J. Maroda

Karen Maroda, psychoanalyst and author of The Power of Countertransference, Seduction, Surrender and Transformation, Psychodynamic Techniques, and The Analyst’s Vulnerability, talks with me about transference (in and out of the consulting room), what we might do with it, and some surprising research about the effectiveness of transference interpretations. 

Transcript

SPEAKER_00 0:01

Hello and welcome to What Comes to Mind, a podcast about psychoanalysis and how psychoanalysts think about the work they do. I'm your host, Allison Green, a psychotherapist with lots of questions. Which is probably why I started the show. Psychoanalysis is a unique profession in that we rarely get to see each other work. And when thinking about this show, I found myself longing for conversations with the people whose thinking was broadening my own. So in each episode, I sit down with the psychoanalyst to talk about their work. And much like in a session, we open ourselves up to wherever that conversation might take us. My guests range from foundational voices in the field to thinkers who are really pushing out its edges. What they share is a serious active engagement with the theory and practice of psychoanalysis today. For a debut episode, I sit down with Karin Moroda, a psychoanalyst and assistant professor of psychiatry at the Medical College of Wisconsin. She is the author of four books: The Power of Counter-Transference, Seduction, Surrender, and Transformation, Psychodynamic Techniques, and The Analyst of Vulnerability. Her work is long focused on what actually happens between two people in the consulting room the emotions, sometimes the missteps, always the mutual influence. In this episode, we begin with a new chapter on transference that she's written as an addition to her book, Psychodynamic Techniques. And then we find our way, as ever, into the consulting room. Here's my conversation with Karen. Hi, Corin. Hi, Alton. Thank you so much for joining me today. I'm really excited to be talking with you.

SPEAKER_05 2:08

Well, I'm happy to be here.

SPEAKER_00 2:09

So we'll start with you've you wrote this book, psychodynamic techniques. It's become, I'd say, like a classic text, and and now you're doing a new edition.

SPEAKER_05 2:18

Yes, actually, the new edition is completed and it's available for pre-order on Amazon. And it will be it'll be shipped on May 18th, 2026. So very shortly it'll be start shipping.

SPEAKER_00 2:30

Today we're going to talk about a new chapter that you've written. It's called Utilizing the Transference, an extra transference, bringing emotion from the past into the present. So I just thought we would start by talking about why you decided to add this chapter.

SPEAKER_05 2:45

I decided to add it because uh during COVID, I wasn't taking new patients. So I didn't want to start with people, you know, online. It was I thought it would be not as good in terms of therapeutically. So I would I had been getting a lot of requests to do supervision consultation, which I mostly wasn't doing, you know, I wasn't taking them on. And I thought, do what, you know, I think I would do that instead. And that would be, you know, a good way to use my time during COVID and in even after. So I got these people from all over the country and the world actually who wanted supervision and consultation. And I discovered they were really a cut above the some of the supervision I had done locally. Kind of made me less enthusiastic about it. But I was getting these people who were in there mostly in like around 30, early 30s. They'd been trained behaviorally, and they were bumping up against the limits of their training now that they've been out working for eight, five, six, seven, eight, even ten years, and didn't know. They said, I'm missing something in the bigger picture. And so they wanted something psychodynamic. And so they contacted me and I found these people delightful, you know, highly motivated, willing to take, even anxious to get uh balanced feedback, you know, both constructive negative feedback as well as, you know, positive feedback. And I was really invigorated by that process with them. And but I couldn't help but notice that their one of their greatest difficulties was dealing with the transference. And that they either they either deflected away from it, or many of the relational people, one of the unfortunate, I think, consequences of the relational perspective is that not only do we high consider very strongly what the feedback we're getting from the patient, many young therapists don't quite understand how to mix that with try understanding the transference. So they end up apologizing very quickly, which ends up, you know, or becoming very defensive. And each of those approaches really shuts down the possibility for unneeded conflict.

unknown 4:56

Right.

SPEAKER_05 4:57

So then I thought, well, if I'm going to do a second edition of psychodynamic techniques, I need to add a chapter on transference and extra transference.

SPEAKER_00 5:06

Right. Yeah, that's one thing I noticed in your paper is that there's sort of two common responses. One is either to say it's all the transference, and so it has nothing to do with me, or to take it on and blame oneself instead of thinking about what is going on right now. So maybe we could start with you provide a really helpful overview of the historical development of the term transference and then your own definition. So perhaps we could just start by talking about what is transference.

SPEAKER_05 5:37

Okay. Uh that's pretty easy. Uh, transference is Freud called it the stereotypic plate. And and meaning that we all have this kind of set of responses or expectations of other people in the world based on our early childhood experiences.

SPEAKER_02 5:53

Right.

SPEAKER_05 5:54

And initially it was believed to be mostly relationship with the mother or mother and father. So we were talking old psychoanalysts, was focused on maternal and paternal transferences almost exclusively. But now that's been expanded in many years over the research to include any significant person who was in a caregiving role. So that would include siblings, often older siblings, nannies, uh, grandmothers, you know, had so many grandmothers end up being care regular caregivers, especially these days. So anyone who was an important attachment and consistent attachment figure could would have necessarily contributed to all of our expectations of people in the world. So the transference is those set of expectations that we have that are really set in our brains. And recent neuroscience research has has very much validated that thought. Although I think we all know it. You know, that we all, you know, we all tend to have the same fears about people, the same expectations, the same skepticism. And uh one of the authors, I should have the name, talks about this as the core conflicts that we have, that we carry into life. Now, the good news about transference is that we also, many are all of our positive experiences are also transference. So the better childhood you had, the better nurtured you were, and the better, the more secure attachment you had, of course, sets you up for better relationships and experiences in adulthood as well. So we don't want to discount that, but it's not something that either classical psychoanalysis or current uh psychodynamic approaches really focus on because it's considered part of a positive therapeutic relationship. And Freud called this the unobjectable positive transference. In other words, we need this, you know, we need to have a good, he he recognized very early on, you need to have a good relationship with your client or patient. And so you don't want to be overly examining a positive relationship and putting it under the microscope.

SPEAKER_00 7:58

Yeah, I think that that that feels like something easier to identify when you are in the idealizing transference, when your clients are reacting to you in this sort of idealizing way. And often it's it's sort of egosyntonic, so it feels good and it's not hard to notice. But in your paper, you talk about we don't necessarily need to interpret the idealizing transference. But but you do say that sometimes you do.

SPEAKER_05 8:25

Yes, and and I agree. Uh Kernberg talks about this. And uh I think there was a tendency in the time during the period of time where I got my early training, cohort was very big, self-psychology. And he, you know, said you should not really interrupt the idealizing transference, that it's a positive, you know, for the therapeutic relationship. But I I write in this chapter that I became increasingly uncomfortable with that. And at first I thought it was just, you know, my difficulty in being, I it was maybe idiosyncratic to me. But over time I realized that it I didn't think it was that healthy for the patient over time to always put themselves beneath me. I was always better than they were. And and Otto Krimper very much agrees with that. And you know, he's a he's a was an old school, you know, analyst. And he said, he said, it's a good idea if it persists too long to start introducing the idea that perhaps there's over-idealization, even just in something as innocuous as, you know. So well, I'm wondering I'm wondering what makes you think that somehow I've had the perfect life, you know, or that I have no flaws. I'm curious, curious about that. Because ultimately, as you move toward termination, I think all of us see that our clients will de-idealize us, right? That's part of any growth process. As long as you're idealizing someone, you're the child. Right. So at some point that has to be resolved so that the patient does not feel so you know unequal or inferior. So, but anyway, the in classical analysis, the transference was considered, you know, analysts. I and I couldn't believe this when I was a young uh graduate student. Analysts truly believed, and and even people who'd social workers, anyone who'd been analyzed, actually believed that they were now free of all pathology. It was very common. Wouldn't that be wonderful? Oh yeah, wouldn't it? So it was like it was the magic cure. I mean, you'd be amazed at how many people believe that.

SPEAKER_02 10:29

Wow.

SPEAKER_05 10:29

So there was this sense of superiority, of course, that went with that over not only over patients, but over uh anyone who hadn't been analyzed. And uh it was quite amazing. And and so there was this belief that now being uh pathology free, you could listen to the patient and you could know automatically what was transference and what wasn't. And and also you would always attribute it, you'd you believe that you were an objective person observing and you were not really that much in the mix. Transference really wasn't delineated and used applied clinically as in early analysis. So it would be like if the patient got angry with you, you would say, Well, I wonder if this if you're really angry with your mother.

SPEAKER_03 11:16

And this would make patients crazy, of course.

SPEAKER_05 11:18

And that's why that's why if you read the old literature and you read the case examples, you see so many examples of patients being inordinately frustrated, angry, acting out in the sessions, because they're the their analysts or or therapists would not acknowledge them, their reality.

SPEAKER_00 11:38

Right. Can you talk about that as a way that the analyst can defend themselves by just saying this is this is the transference, this has nothing to do with anything that I've done. But you talk about the way that that there will be something in the person and the behavior of the therapist that is going to stimulate the transference.

SPEAKER_05 11:58

Yes, I I absolutely agree with that. But it's and it's a delicate balance. I mean, how do you, I mean, I think it is possible to do over time, but how do you try to differentiate, you know, in in collaboration with the patient? To what to what extent like have I stimulated a conflict by you know, overtly by my behavior that wouldn't have been as strong if I hadn't stimulated it? To what extent am I bringing this out in this person? You know how some people will push our buttons and bring out the worst in us, and other people bring out the best in us, and that's true in therapy too. So am I bringing out the worst in my patient? Or, you know, is this their pattern of responding to most people? But I I don't think that you have to be omniscient to figure that out. I would disagree with people to say that that's largely unknowable because patients themselves will say, you know, this is what happens in all my relationships.

SPEAKER_00 12:55

Yeah, and I've certainly had the experience where patients will say, you know, I have this, for example, I have this fear that you're gonna find me too needy and you're going to fire me. And I know that's not you. I know you won't do that, but I still have this really strong fear. So they are aware that they're bringing something to the relationship that is not really to do with their experience of me as a person or as a therapist, but that there's something else happening that's coming out, which is really useful to be able to talk about.

SPEAKER_05 13:26

Yes, and I think that's true. It's less true with uh agitated, you know, borderline patients, who Karnberg talks about and based his transference focused psychotherapy on. But everyone has experienced where, you know, we feel like the patient's being completely irrational and is not does not have that absorbing ego, you know. But most people do. And when when people, even with more severe borderline personality disorder, when they're out of the emotion in the moment, often they can reflect on it too and say, you know, I know this this happens with everyone and they'll want to explore it and know why.

SPEAKER_00 13:59

Yeah, I so one of the questions that I've been thinking about, you know, we talk about transference, counter-transference, and then projective identification. And they're all separate phenomena, but they often feel pretty entangled. And I'm just wondering how you think about projective identification, if that's something that you you think about, or how that fits in with your framework.

SPEAKER_05 14:23

Oh, for sure. I mean, I I actually I've written on I've written a couple, I've written a chapter and I wrote a paper way back in '98 on projective identification. And it's part in uh enactment. So yeah, I mean, Klein, you know, Melanie Klein coined that term, and of course, she was naming a real phenomenon. I would think we all know that we start to have the feelings that other people are having, particularly if they're not expressing them. Right. You know, right? We start having like a person comes in and says, Oh, well, you know, I my I do all the housework. You know, my husband, he likes to watch video games when he comes home, and he doesn't really talk to me very much.

SPEAKER_03 15:05

Go on and on and on. And then we start to feel really frustrated and angry for the patient.

SPEAKER_05 15:12

Yeah, that's right. I mean, that's clearly projective identification. I think we don't spend enough time uh for all the talk of mutuality, understanding that there's mutual projective identification.

SPEAKER_00 15:23

Yeah, that's something we think about more in couples therapy, the mutual projective system among couples, but yes, not so much in the in the therapy client relationship. Well, I asked about I asked about the projective identification because as I'm as I'm reading you and thinking about the transference and understanding what is happening, I think about okay, I'm paying attention to what it feels like for me to be with this client. And I have to think about, let's say if something is being evoked in me, if I'm feeling angry, for example, is this my feeling? You know, is this coming from my own self? Or is it um something that's happening in the transference? Is it a disavowed feeling that the client is having that they don't that they're communicating to me? Is it something that is could help me understand what it felt like for that client to be with their mother, for example? You know, there's all these different ways of thinking about what is the meaning of the feeling that is coming up in me. And I'm imagining you you you will say this is something to be explored with the client, but I'm I'm just wondering your thoughts.

SPEAKER_05 16:32

I think that very often it is, I don't rush to do that immediately for the for the very reason you stated. Because I'm not if I don't, if I have no idea where what the source is, and I suspect that it's my feelings are too intense. Meaning, right, excessive reactions tend to be it isn't credit to that person. So is it really, is it the client, is the client that frustrating, or are they suppressing that much anger? Or am I responding to something from my childhood or my own experience that was negative and really upset me? So I think I don't respond immediately with some kind of a discussion or interpretation. I always say, uh Donald Strike, be curious. The thing I I try to teach my supervisees the most is try to contain your affect, don't suppress it, don't ignore it, but explore it in your own mind and explore it after the session. When you go home, think about that session, think about what how that person might be stimulating something in you. Sometimes uh I see that therapists just feel angry because they get frustrated because the patient isn't moving. Or they get uh the anger is defensive in response to basically being invited to sit in despair for long periods of time.

SPEAKER_02 17:51

Right.

SPEAKER_05 17:52

And so is it that I can't bear, and Crystal, uh Crystal has he wrote, I don't know, in the 80s, a long time ago, but K-R-Y-S-T-A-L. He says that the biggest resistance in treatment is the therapist's resistance to what the patient is feeling. Right. And I think we again we don't give quite enough credence to how difficult it can be to sit in a room for days and weeks and months and years with someone who needs to be in despair a great deal of that time. Right. And needs for us to just quietly accept that and be with them in that. I think that's an that's an enormously difficult thing to do.

SPEAKER_00 18:30

Yeah, that's making me think about beyond and the container function and like a refusal to to serve as a container for the client's despair in that in that moment that it can be, you know, coming from a place within the therapist of not wanting to feel that, but what it's like for the client to have that refused.

SPEAKER_05 18:49

Yeah. And and you will see, I mean, that's the other thing. It's not that difficult to see that you're getting a negative response from the patient. I remember one patient who came in just session after session, and I was, and he was my last patient of the day. And it was like, oh, and on the last my last day of the week that I practiced. And I just thought, I am so tired. And I I and this is the end of my day, and I really do don't want to go there. And I can remember, and I would, of course, as we all do, I would fall into trying to, you know, help him get out of that state and try and intervene in some way. And he just got very frustrated. And he would look away from me, turn away from me. He would start talking about people who can't bear his feelings, right? I just thought, oh my god, that's me. Wow. And so, and so I just at one point, you know, at a session, I just thought, wow, this is this this is uh part of the treatment he's going through right now. He did because he could also be enormously entertaining and interesting, super bright guy. And when he started going into the nonstop despair, I thought, gee, where's this entertaining guy I used to treat at the end of my day? But I realized I was just gonna have to take a deep breath and expect that this was gonna keep occurring for some time, and it did. Right. But there was a positive. He did eventually emerge from it, of course.

SPEAKER_00 20:19

Well, this is something that so many people don't have the experience of, right? Which is somebody being willing to just be with them in really difficult feelings, like I'm thinking about in their childhood, you know, to not have somebody that can just sit with them and bear those feelings and help them bear those feelings.

SPEAKER_05 20:38

Sure. And I I think at any time that's a that's a very difficult task. I mean, where can a person get that? I mean, I mean, virtually everyone, people cannot bear those intense feelings. We just don't have the there's a natural defense against that, I think. Plus, socially, we're not ever groomed to understand and approach other people that way. We just don't. And people who come to me say, you know, even my best friends, they just couldn't bear it anymore. And they they just give me advice, they try to point out the positive things, they just and they're just not getting it. But unfortunately, a lot of therapists do that as well.

SPEAKER_00 21:17

Yeah, they're trying to get rid of the feeling instead of just being with it. And yeah, I agree. We all try and do that in our in our different ways, but learning to just actually bear it is very difficult to do.

SPEAKER_05 21:30

It is. And I think too that we'd uh I I'm planning to write a paper on this, that it's natural too to become defensive when uh switching a little bit to when like when you're being criticized by a patient. It's natural to be defensive in those in that situation. But acting defensively is countertherapeutic, right? So I think that uh oft ignored part of our training should be focusing on how we can internally deal with. The defensiveness that will arise. We can't create a situation where we're never defensive. That's just not realistic. It's a survival-based coping mechanism.

SPEAKER_00 22:10

And you need you need to let your clients make use of you. If you're too defendant, like you said, of course, you can't really avoid it. But if you act from that place, then you're going to interfere with their ability to make use of you in the way that they need to in that moment.

SPEAKER_05 22:28

Yeah. So they so you don't want to be defensive and you don't want to say, you don't want to make it go away. So then what do you do? Is you explore, right? You stay with their feelings and just keep exploring and exploring and trying to dig deeper and deeper and get to more emotion and allow them leave room for that experience. It sounds so obvious, you know, when you say it, but yet it's it's much more difficult than it sounds.

SPEAKER_00 22:56

Do you I'm wondering about the role of sort of psychoeducation for you with clients? And I I say that because often when I start a treatment, I will say, you know, I will ask you questions some from time to time about how you're feeling about me and the relationship. And that is because the way that you relate to people is going to show up in our relationship. And it's a place where we can actually get really curious about it. And I find that that that helps people when I do make a transference interpretation, not react like, why are you making this about you? You know, um, and can sort of it they've almost been sort of primed for that type of a question and understand uh maybe that it's not coming from a place of defensiveness, but curiosity. So I'm just I'm just wondering how you talk to clients if you do talk to them about transference.

SPEAKER_05 23:52

I'm glad you brought that up because uh again, in the days when psychoanalysis was extremely popular and in the culture, people expected to have a personal relationship with the therapist. People would make jokes about being in love with their analysts, you know. And it was assumed that you would have feelings toward your analyst or therapist. But that has gone out of you know, the culture. It's not in the current psychics. In fact, I've had people who come and if I make a transference interpretation, uh, they say, Well, I'm not supposed to have feelings about you. Am I? That just seems really inappropriate. They feel like it's the same as like going to a lawyer on an account.

SPEAKER_03 24:36

We wouldn't bring up your feelings about that person.

SPEAKER_05 24:40

That would be uh it wouldn't be, she said, Well, that would be rude. So, so no, I have taken to uh introducing that very notion that you mentioned to every patient when they start. And people do often ask, how does this work? What are we what are we going to focus on here? How are you going to work with me? And I I tell them about the transference and I tell them that I want them to be free to say, express any feeling they have, positive or negative, and that it's my job to facilitate the treatment, but it's their job to help me understand them so I can make a judgment about what they need and how to proceed. And that for them to be as honest as they can be uh with their feelings is is paramount. And I again I always tell them about the neuroscience literature that these patterns of feeling and igniting feeling and behaving were all laid down in the brain when we were young, and that it takes a lot of repetition, which is why long-term therapy is proven to be better than short-term therapy. It takes a lot of repetition repetition to create those new neural pathways in the brain. And so we have to work on uh there's an interesting article too that I cite in that chapter called changing emotion with emotion. You have to introduce, you know, either a new, a different feeling, help them understand that will create a feeling, but more often than not, a modified feeling. So that feeling, so you're you're really working toward affect regulation. And I will explain all of that to my patients. And I also do goal setting and revisit that throughout the treatment. And I'm I am grateful for my my master's degree was mostly behavioral, and I am grateful for that training and do incorporate it into a psychodynamic approach. But but I, along with my colleague Nancy McWilliams, we're both very big on having goals and educating our patients, you know, about the process. Because you you really need to do that if you're if you're going to have a collaborative treatment, which I think is by far the most successful, where you're making decisions and exploring issues, including impasses with the client, that you have to be educating them as to the process as an essential part of that.

SPEAKER_00 27:00

I found that so helpful in in your book, talking about um setting goals, because it's not something that I often I would have patients come with a presenting problem, but then a year later, that's not really such an issue anymore. And and then therapy can sort of like, well, what are we doing now at this point? And being able to bring it back to them and say, okay, what do you want to actually work on? has been really helpful when I've done it because often people it it gives them pause. They haven't actually really thought too much about it. Um, they're just carrying on with the therapy. And so it's allowed for a lot of useful conversations and also for us to take a certain kind of direction.

SPEAKER_05 27:42

Absolutely. I agree. Yes, I think, and people really appreciate it. People appreciate that you're thinking about the treatment, you know, that you're assessing it along the way, that if you didn't understand something, you'll come back and say, you know, I was thinking about our conversation. And it's like, oh, really? You think about me?

SPEAKER_00 28:00

Yeah, you're holding me in mind. Yeah, yeah.

SPEAKER_05 28:02

And and it really is uh it inspires collaboration and you know, and mutual curiosity and a desire to set goals. People think, wow, so progress is important to you, you know. My progress and my you know, growth is important to you. And again, it helps them to think about it. Yeah, okay, now I've got my my grief under control. I, you know, I was seeing a patient who was great unprocessed grief from losing her husband. And okay, now the grief's under control. What else do we want to do? You know? Mm-hmm.

SPEAKER_00 28:38

Yeah. So you you had brought up something that is sort of um a through line in your work, I think, which is the sort of the experience of emotion in therapy as kind of the engine for change, that that that is what precedes change, not cognitive insight, that the insight may follow from the emotional experience, but not the other way around. And I wondered if you could talk a little bit about that, because that seems pretty critical.

SPEAKER_05 29:03

Yeah, I think uh actually I started exploring the neuroscience literature, you know, like decades ago, because of my own theories about counter-transference and expressing it, you know, judiciously. And I thought, and I could see that at certain times, if I could express emotion and give emotional feedback, it was just enormously therapeutic. So I always like to back things up. You know, I do my little end of one experiments, I like to say so, and you know, and I would repeat it with the patient and other patients. I think, nah, this really works. But uh, there must be some literature somewhere that talks about it. So I just started exploring and and discovered the neuroscience literature and the importance of the role of emotion. And to me, that was very confirming about our established patterns, about how those patterns change. And you you can't change an exaggerated or I would say a maladapted response, right? Some of our responses based on the past are maladaptive. You can't change that without getting to the emotion in the moment in the here and now. Now, that's been determined to be most important, is to for the patient to get to the emotion and then also often to get some emotion feedback from the therapist. That's the most important aspect. Now, some patients do change with that without insight. Not most, but some do. They're not interested, they don't want to talk about their childhoods, they don't want to talk about the past, they're very vividly in the here and now. But again, the research shows, which I quote in the transference chapter, is that if you combine the two, that's the winning combination.

SPEAKER_02 30:49

Right.

SPEAKER_05 30:50

That's that's the winning combination because it helps you to be more in control when you understand, yeah, here's this pattern. This comes from way, you know, many years ago. I've enacted it many times throughout my life. And so when I'm having an intense reaction that I don't feel good about, it's like, yeah, that's what that is.

SPEAKER_00 31:10

Another thing that you've talked about in the book that I find so helpful is this idea that you can actually assess your interventions, that that that's a sort of a teachable skill to start to learn what interventions are working and what aren't with this particular patient. And this is making me think of that. That you know, when you make a say a transference interpretation, but any other any kind of intervention, and all of a sudden the emotion hits the client and they and it surprises them, and they're like, Oh, okay, this must this must be something because I suddenly felt this surge of emotion. And then we start to think about it and be curious about what that might be about.

SPEAKER_05 31:48

Yeah, I I I literally tell every person I treat that it's all about emotion and that that before they commit to treatment, are they on board? I literally ask them this are you on board with having expressing intense feelings, letting all your intense feelings come out here because that's how you will get better.

SPEAKER_00 32:09

Right. Well, how do you handle it when you have a patient that won't go there?

SPEAKER_05 32:16

Well, if they really don't want to go there, then they we don't they they say, Well, I guess this kind of treatment isn't for me. Or sometimes they will say, Oh, I think I want to go there, but after a few months, it's like uh and they're you know, and they they've they're past their the crisis they came in with. Most people come in with some kind of crisis, right? And when they're they get symptom relief, they'll say, you know what, I don't really want to go there.

SPEAKER_02 32:44

Right.

SPEAKER_05 32:44

And I think I always respect that. I say, well, that's absolutely your choice. And uh then we just mutually agree to end the treatment.

SPEAKER_00 32:54

But some some patients are so intellectually defended that they will talk and talk and talk about things, but you cannot get to the emotion. They are just they just don't allow it to come up. And I guess that is that is an example of a moment where as the therapist you might feel frustrated because you cannot get to them.

SPEAKER_05 33:18

Absolutely, yeah. And then you have to ask, is this is this possible? And ask them too.

SPEAKER_02 33:24

Right.

SPEAKER_05 33:24

Ask them, you know, and talk to them about their defenses, you know. I asked you a question about what you were feeling, but I got this kind of response, you know. Is there any way? And I'll say too, is there is there a better way for me to approach you? Right. Is there something I could do differently that might help you to get to those feelings? Because I hear the feelings, you know, it I see the expression on your face, or you know, I understand that inherent in the situation you would naturally be and you might even use the words, oh yes, I was frustrated and angry. But but we're not that's not getting to that feeling.

SPEAKER_02 34:03

Right.

SPEAKER_05 34:04

How can we, how do you think we could can we talk about how we could make that happen together?

SPEAKER_00 34:10

I had somebody recently who was in quite a lot of pain because of something that was happening in his life. And um I noticed this, you know, he wasn't really talking about it, but I said, I can I can see that you are in a lot of pain right now. And he literally was this this is one of the few patients I see online, but he had a moment of of feeling that with me. And then he said, I have to, I have to end the session. And he logged off. And it was it was quite intense for him. And then in our next session, you know, it was something that could be talked about, which was like, I I noticed how difficult it was for you to to feel that feeling with me that you had to you had to go. And um, we'll see where it goes. This is recent.

SPEAKER_05 35:00

Yeah, but you know, I think it's it's I'm glad to hear that, you know, you respected that that he had to go. And and I think often I've had patients who, especially with some more severe traumatic experiences from their childhood, they will say, Okay, I I can't talk about I'm done now. I can't talk about this subject anymore. And they won't necessarily leave the session. Sometimes they say, I think I want to leave. But uh they will say, I could I can't talk about this anymore. And I go, Okay, all right, I get that. So let's see, maybe what what else could we talk about today?

SPEAKER_00 35:35

Because you you do talk about in this chapter the importance of stimulating manageable emotion. Correct. Which feels key. Yes. That you don't want to try and take your patient to some state of uh too much emotion where they become it's unbearable for them.

SPEAKER_05 35:52

Right. Because hype, yeah, either too little emotion or too much is non-adaptive, right? I mean, it we're defeating ourselves if we're if we stimulate our patients into hyper-arousal. Because our goal should be affect regulation, which is like Crystal says, is like it's the capacity. Uh he said something interesting, you know, like decades ago. He said, he said, you know, we used to call mental health issues emotional problems. Yeah, so-and-so has emotional problems. And I remember that from my childhood. And he said, that's because he said, I would defy you to think of a diagnosis that doesn't involve a problem with emotions. And that inherent in most maladaptive, you know, patterns of behavior or diff problems in living is a problem with emotion. Either recognizing it, knowing it, being able to identify it, being able to accept it without shame or guilt, being and being able to express it and being able to control when and how that happens. Sounds easy. Yeah, I know. Sounds easy, but it isn't right. Yeah, sounds too easy. Right. And and of course, the people who uh stimulate the most affecting us are the people who are emotionally out of control. And that's why, you know, borderline patients get such a bad rap because they're stimulating us all the time and uh in ways that make us uncomfortable.

SPEAKER_00 37:16

Right. Well, in your paper, you talk about this research around um who benefits from transference interpretations, which I thought was really interesting. Maybe you could speak to that for a moment.

SPEAKER_05 37:27

Yeah, now we now when you read it, were you so I'll I'll talk about the research. Were you surprised by that research?

SPEAKER_00 37:34

I was surprised by it, but as I thought about it, it made a lot of sense to me, actually. So maybe I'll say more. Maybe you can explain it and then I'll say more.

SPEAKER_05 37:44

Yeah, yeah, that sounds good. So, yes, I was surprised actually, is that and there this is this isn't just one study. Uh then the references are in the chapter, but this isn't just one study. This is numerous studies that show that people who are more disturbed and have more problems in relationships respond better to transference interpretations than people who are higher functioning and have positive relationships and attachments. And I think that speaks to you know, invalidating or to validating uh Kernberg's transference focused psychotherapy because it centers on working with borderline personality disorders. And that those people respond well to transference interpretations. Higher functioning people do not, they think it's it's an interference because they come in with their already established relationships that perhaps they're having issues with, or they're having issues with a boss or or with their own achievement and different problems in living. And basically establishing relationships is not one of their problems. So they don't really need a relationship, they don't need to discuss in depth the relationship with us, and they often resent it, find it irritating, and consider it a distraction and frankly like narcissistic on our part. And and often it is, by the way. There was an there was an article I read recently where uh an analyst was talking about in her youth you were supposed to fall in love with your male analyst, and she and all of her friends you would get that feedback from the analyst. Oh, so are you aren't you, you know, aren't you feeling you know in love with me or whatever? And how they would placate that, you know, our patients track us and will try to please us, right?

SPEAKER_03 39:36

And how all these women used to pretend to have or indulge, especially like these old guys, right? And women, and it's like, oh yeah, sure. I yeah, I think you're really cool and but not really.

SPEAKER_05 39:51

And so, you know, you you risk that and you know, trying to create uh an erotic transference or an excessively positive transference that that really isn't there, and I think that you can never assume what the transference is. And you can't assume, even if you have a sense of it, that the patient wants to talk about it and will benefit from it. And even more interesting, I thought, was the research that showed that even with the patients who benefit from it, it should be done uh it should not be done often. That the optimal, the the one study showed that the optimal number of transference interpretations was like two to three in a session and max, one would be fine. And that you shouldn't do it too early in the session, again, which makes sense. You have to warm up with the person first and get into a topic. Don't just, you know, blurt something out from a previous session that you noticed. And you shouldn't do it too close to the end of a session because you're not leaving enough room and time to explore it.

SPEAKER_02 40:55

Right.

SPEAKER_05 40:56

So approximately midway, one to three transfer interpretations. More than that, it would be overstimulating or unwanted.

SPEAKER_00 41:04

Right. I mean, I thought three sounded like a lot.

SPEAKER_05 41:06

I did too. But some people, you know, again, it would be that patient who really wanted to do that.

SPEAKER_00 41:13

Yeah. I I mean, I was when I was thinking about that study or those studies, um, as I said, I was surprised. And then as I thought about it, I thought, okay, that uh not having read the actual studies, but I thought that makes sense to me because borderlines need help. They need help understand like the uh my experience has been that they just often don't understand how they affect people. And so it is really helpful for them to hear in in the kind of therapeutic environment how they actually affect people. And they can often make good use of that and are surprised by it, but it's helpful. Whereas, you know, we call like a nice normal neurotic, um, you try and make it in a transference interpretation sometimes, and and they look at you like, what, why are you making this about you? Like I'm trying to tell you about my husband. Right, exactly.

SPEAKER_04 42:05

And he's way more important to me than you are. Right. Why would I want to talk about you when I can talk about it?

SPEAKER_00 42:11

Yeah. So when I was saying that I I educate my clients a little bit ahead of time, I I do say to them, like, when I if I mention this, it's not because I'm a narcissist. I mean, maybe I'm denying too much at the outset, but just because I do, I do know that people can can have that reaction of like, why are you making this about you? But but I will say that I when I was thinking about the study, I was thinking there is also, though, sort of the other end of the continuum, I think, which is people that are in the sort of nice neurotic or normal neurotic whatever category. There are people that I find are deeply interested in like the the people that are deeply interested in their unconscious and very curious about it, they often do like to have some or are at least willing to talk about the transference and appreciate those interpretations because they sort of have a sense that there is something maybe outside of their awareness that is going on. And if they can respond just with curiosity, then it can be generative for them.

SPEAKER_05 43:13

Yeah, I think that's a good point, Alison, is that these this these studies are generalizations and and the things that my conclusions are generalizations, and I I freely say that, and that you have to make an assessment of what's going on with each particular patient. And there are vast differences, and people can surprise you in either direction, right? And that you need to go with that, and based again, based based on assessing the intervention, as you noted earlier. Did this fly? Was it helpful? Did it, you know, did the person go deeper, or did they become irritated and you know, accuse you of changing the subject? So I say if that happens, if you get a negative response, and when I say negative, I don't mean you got a negative emotion. If the person I when I say negative, I mean the person. Disenges. If they want to engage in conflict with you, great, you know? But if they dismiss you and dismiss the what you've said and find it irritating and disengage from you, that is not something you should ignore. Even if you feel confident that your transference interpretation or any interpretation was accurate, I say I always say there are more important things than being right. And the real maintaining the relationship is certainly one of them. Right. So so it put it aside. Either even if you're right, even if you're convinced you're right, the patient clearly isn't ready to hear that. Put it in your pocket and save it for another day.

SPEAKER_00 44:42

Yeah. And well, and you said it. So you've already said the interpretation. And if if the if the client has a negative reaction to it, why pursue it? I mean, it's already been said, maybe it will generate something down the road, who knows? But if not, sticking with it is is just going to irritate uh the patient, I think.

SPEAKER_04 45:03

Yeah. Absolutely.

SPEAKER_00 45:04

Yeah, or shut them down, as you say, cause them to disengage.

SPEAKER_04 45:07

Yeah.

SPEAKER_00 45:08

I wondered if we um, because you touched on it, but I wonder if we could talk about the extra transference, because that's that was something that I I haven't really thought about it in those terms as like extra transference. Yeah. Um, but I thought it was really helpful your discussion of it. So could you talk a little bit about that?

SPEAKER_05 45:23

Sure. So I take it then you've before I start with that, I take it you have experienced that in in with patients, right? Yeah. There's the person who, for whatever reasons, uh sometimes in part it's interesting. People don't want to explore the transference or they don't want to build on those feelings because they're going to leave one day, you know. And people who make strong attachments sometimes don't want to explore the transference with the therapist because it will only deepen their attachment and and the ending will be all that more painful. Other often there's other reasons too. Like uh, I found that uh women who get very strongly attached to heterosexual women don't want to are uncomfortable and think it's weird to have intense feelings about another woman. So then they will create an attachment, a new attachment to a man, even if they're married, which was the case I gave in the chapter, is a woman I was seeing who was married not too not terribly happily, but uh committed to staying in the marriage. And she started clearly developing a strong attachment to me. And when I tried to transfer its interpretation, it just you know fell to the ground. It's like absolutely not. And uh she was in a uh uh I'm trying to identify something with you know, without identifying her, she was in a chat group with her occupation, and and she met this man who lived in another part of the world. They would never meet, they would never be together, and she developed this intense attachment to him instead. And it used to be and when if that happened, the patient was considered classical analysis, the patient was acting out, they were refusing to be present. But see, the question always is are they emotionally present? Not are they fixated on you? So I soon began to see over time that the patients who formed these attachments outside, via you know, if they were single, a romantic attachment or a close friend or mentor or a boss, you know, it could be a lot of different people who they started having all these intense feelings about. I realized that it didn't matter. What mattered was could they bring that emotion into the room and could they talk about their issues with that person with emotion that I could help them process? And that that was almost as good or as good as a transference. They don't have to have it with me, they just have to have it with someone important during the process that I can help them, I can facilitate them, their curiosity, their affect management, their their acknowledgement of it being somehow a repetition or the satisfaction of a longing from childhood. If we can do all that processing, it doesn't matter. And the term that was coined for that process is extra transference. Why extra? I don't know. It's really like outside external transference.

SPEAKER_00 48:29

Yeah. Yeah. And it's it's uh it's such a helpful concept or way of thinking about it. Because I actually find it to be um very common with with patients, especially those that come once a week, that they want to talk about their relationships, their key relationships outside of the consulting room. And if we're interested in transference and these ways of relating, um, as well as ways of defending and everything else, you can see it in those relationships. Like you said, it doesn't have to be how is it showing up in our relationship? It's like, how is it showing up in your life? And can we, you know, get to the emotion that is connected to that in our session, which often we can in a way that uh feels less vulnerable for them to drop into a feeling, say, of deep despair or hurt about somebody in their life than it might be to actually drop into that in a feeling in in relation to me, if that makes sense.

SPEAKER_05 49:31

Yeah, absolutely. And and I think again, that's not really discussed, it's not considered transference unless it's with the therapist. And as we both would beg to differ.

SPEAKER_00 49:40

Yeah, well, that's why I I find it so useful because it's sort of like you think, well, it is certainly there are supervisors that I've had that are like, you have to be in the transference. You always need to be working in the transference, as if there's the transference in the room, and then everything else in the in the patient's life is not transference. So this has been really useful for me to think about okay, we are working in the transference. It's not our relationship and how it's showing up here, but we are definitely in the transference.

SPEAKER_05 50:11

Yeah, absolutely.

SPEAKER_00 50:12

So that's been really helpful.

SPEAKER_05 50:14

Yeah, and and how did you feel when when your supervisors were telling you that?

SPEAKER_00 50:18

I mean I think, you know, I I've had I've had wonderful supervisors, but I think mainly Kleinian Neoclinian supervisors in a way that um historically, well, I'll speak freely and think that maybe we'll edit this out.

unknown 50:39

Okay.

SPEAKER_00 50:41

That, you know, uh in my early days, they would, you know, I take take a client to supervision and they would say, you know, here's what you should say. And I would think, um, if I say that, my client is gonna look at me like I'm crazy. Like they just will not, it won't do anything. Um, so I had to try and find my way into what is, you know, what is my way of talking about the transference with a client that is going to be something other than, you know, um, you are giving me all of your goodness, you know, for example. Like I'm just thinking about um ways that I've heard heard things phrased. Um so yeah, trying to find a language that made sense for me, that felt natural to me, but that also clients could work with. So I'm cognizant of your time. I I wonder if there's anything else that you wanted to say about this chapter before we end.

SPEAKER_05 51:37

Well, I'm glad you brought up the Kleinian perspective because I did mention that in the chapter, is that uh the two major approaches that really emphasize transference are transference-focused therapy, obviously, uh the Kernberg group, and Kleinians who are still very much everything is in the transference. And that continues to this day. And uh Rachel Blass, I quote her, she she's a prominent Kleinian who's written recently about the transference is everything. But I state in the paper, I said from my perspective, you know, that goes in the face of the research. It flies in the face of the research. And also the Kleinian approach heavily relies on the analyst as an objective uh observer. And it's it's not considered a mutual exploration in the Kleinian approach. It's I know what's going on with you and I'm going to interpret it. Right. And at least that's how I read it. And uh I think that that's that requires that goes back to like almost a needed omnipotence on the therapist part that I think we can't achieve. But I think the other interesting point to make here is that uh I always explore the research, like the behavioral research, the neuroscience research, all the all the social science research on any topic I write about, because there are so many things that therapists do not uh explore or do research on. And they just keep promulgating a certain uh thought that is not supported by the research that our colleagues are doing. And I think that I think the transference approach is greatly the decline approach is greatly at odds with the research that we talked about earlier on on how much transference interpretation is helpful.

SPEAKER_00 53:26

Right. Yeah, I mean, there's much in the Kleining approach that I find really useful, but I do find that those types of interpretations often just fall flat if I uh because I think that they it it takes it into a different realm for clients that they they just can't relate to. And so, like I said, trying trying to come back to a way like how can I make how can I say this in a way that might make sense to you? And then as you say, assess, right? If the intervention falls flat, it falls flat.

unknown 54:00

Yeah.

SPEAKER_05 54:01

So I'm curious, what do you I know what I find uh interesting about the Klein approach and I think why it's gaining somewhat in popularity recently. What are uh having had probably more training in that, what are your thoughts about that?

SPEAKER_00 54:15

I mean, I what I find most useful, and I and I I guess I'll preface it by saying that I I did a my own analysis for about five years, and I I think probably my analyst was Kleinian. We didn't actually talk about that, but certainly. Um one of the things that I found useful to understand about myself as well as with patients is this movement between the paranoid schizoid position and the depressive position, and recognizing like, okay, I this is I'm I'm in the territory of black and white thinking right now. You know, all of the all of the good qualities in my friend have gone out the window right now, and all I can think about is how terrible they are. I actually don't think that way about my friends because they're wonderful, but um, you know, being able to recognize that that is happening and that the way out of the paranoid schizoid position is to be able to think about it, which is actually really hard to do when you're in it, and move back into the depressive position, start seeing those shades of gray. So for me in my own interpersonal relationships, it's been helpful to notice in myself. Um, and I I like the idea that you know this is not a developmental stage that we reach and move past, that we can all move in and out of this. Um, but also seeing that in my clients, being able to recognize when they are in that state can can be helpful. And that is also something that um that kind of an interpretation I actually think can be helpful, especially for borderlines. Um, being able to say, like you, that is really hard for you right now to see anything other than you know, all the bad qualities in your partner. And just notice that and and then they start thinking about it, and then suddenly some of the good can come back in.

SPEAKER_05 56:06

Yeah. What I find helpful is uh the they they never jettisoned sex and aggression. You know, the Kleinians, you know, and I think a lot of people are attracted to that notion, you know, that that uh you know they're into and I think that's why you Jung is uh very popular now too. You know, people are like we've ignored the dark side of humanity, ours, our patients for so long. And I think people are saying we're suffering from that. And it makes people ashamed of their own dark side, right? If everything's supposed to be positive and helpful, and you know, it's just like that's not real life.

SPEAKER_00 56:42

Right. Well, and so and then we what do we do? We project it. Like if we think about everything that's happening right now, think about the paranoid schizoid position and the all good and all bad. We see this in so much in our politics, this this these extremes. And um yeah, this this sort of I also I love the concept of um persecutory objects, you know, because I I do um have clients that you can they just feel persecuted all the time. And um being able to think about that in the context of aggression and guilt can be really really helpful.

SPEAKER_05 57:20

I I I read an interesting book uh the nature of aggression, and it talks about it's a very compelling argument that people who are highly aggressive almost always portray themselves as victims. From Hitler, it's well documented, from Hitler all the way up to our current, you know, autocrats. It's it's they, you know, we've been, you know, we're we need redemption. We've been uh wronged, we are being persecuted. And that's the justification for uh aggression.

SPEAKER_04 57:52

I find that I find that very interesting. It is, yeah.

SPEAKER_00 57:58

Um, well, thank you so much for your time. I really it was very generous of you to come talk with me today. I really appreciate it.

SPEAKER_01 58:05

Well, it's it's been a pleasure and thank you for the invitation.