By Ariola Vishnja Zjarri

Date Posted: Monday, 13 December 2010

 

Ariola Vishnja Zjarri lives in London where she worked for a number of years as first a senior worker and then as a manager in a home providing residential care for young adults. She is a member of the goodenoughcaring Journal’s editorial group.

 

Transference and Counter-transference : their therapeutic value in residential work with young people.

 

Readers of this journal may be aware of the significance of the unconscious in the psychodynamic approach to working with children and young people. Our task in providing therapeutic residential care to the young people we look after is to interpret the unconscious (Bateman & Holmes,1995). This is a huge task, and it requires continuous efforts and energy as well as insight and skills from us in getting to know the young people, finding out about their lives, their problems and most importantly their feelings in order to better understand them and where they come from. In doing this, we have to be aware of our own feelings, fears and expectations as well as those of the young people. In this earticle, I argue that an informed practice based on the psychodynamic concepts such as transference and counter-transference can be very helpful as they provide invaluable insights into the world of the young people as well as into our own inner world as residential care workers.

When I first started work in residential care with young people I remember finding a young person, 16 years old Mark, particularly challenging to work with. He had drastic mood swings and one minute would be very happy and the next would be shouting the worst things at me. Sometimes he would come back from college feeling very low and would refuse to talk. Then, suddenly with no apparent reason he would get angry and start shouting at me that he did not like me, that I never did anything for him, and that he’d rather do things on his own rather than ask me for help. These outbursts would usually happen when he was upset for some reason at college or work and often he would come and talk to me afterwards and apologise for his behaviour. At the time I was training, for better or for worse as I thought at the time, to adopt a psychodynamic approach to my work.  As I gained more knowledge of this way of thinking about how human beings relate to each other, I was able to understand that Mark was transferring into me feelings related to his parents . A great deal has been written about “transference” in psychodynamic literature but in terms of my relationship with Mark what helped me with my understanding of how this “transference” could be used therapeutically was Winnicott’s suggestion that it is through transference that unbearable unconscious anxieties, fears and terrors can be gradually made conscious and with the right kind of parental containment can be made tolerable(Winnicott 1986). Mark unconsciously “used” transference to deal with his suppressed feelings from the past. Mark had been placed at a boarding school from a very young age, and therefore had to learn to do things for himself without support from his parents. He was not happy there and blamed his parents for leaving him at the school on his own and not being there for him. His outbursts were re-enactments of his feelings about their abandonment of him  which he placed into me. With experience, and a lot of support in supervision I was able firstly to take in his outbursts and anxiety and understand where they came from, and secondly to assure him that whatever he felt about me I would be there if he wanted to talk. Eventually, through containing and processing anger and fears and returning them to him in as non-threatening way as I could it gradually became possible for us to have what might be described as “normal” conversations. He became able to tolerate my responses to his expressions about the unfairness of life that he often cloaked in fantasies he had created, which, though they were a kind of defence, could not in reality be sustained. For instance he would insist that his teachers, my colleagues and I were determined to obstruct everything he wanted to do.  As he began to feel that he could survive without exercising these defences, he seemed to become able to tell me how he felt about his parents and how alone he had felt all his life.

I should also make mention here of “positive” transference because as we were going through the process I have been describing we moved slowly towards having a relationship which was more satisfactory for both of us. Mark’s feelings towards me began to change from the negative ones which I have described above to very positive ones. During this phase Mark would talk to me about how good he felt to be in our children’s home, how good everybody was to him, how all staff were so helpful, idealizing every little thing we did for him. In some ways this was trickier to deal with than the negative transference as everyone loves to hear good things about themselves but it was impossible to live up to them.  Again, I found the best thing to do was to reflect on what was happening and to consider how much of what Mark was feeling was valid and how much was not. I think we should always keep in mind that it is our task  to bring young people gently towards being able to deal with their reality. I found that by taking in his unrealistically positive expectations of me – for instance that I was going to take him home to live with me – by assuring him that though this would not happen, my colleagues and I would not be abandoning him and Mark became able to accept this. What I had to work through about this however was that there were times when I felt Mark was so needy that I should take him home. I came to understand this as my own counter-transference. I felt powerful maternal feelings towards Mark but I was not his mother.

Young (2001) identified that a key component of this process is interpreting the counter-transference. I first became aware of my counter-transference when early on in his stay in our home Mark’s emotional outbursts would leave me with a feeling of despair and hopelessness, although I might have been in a very good mood before his outburst. Initially I felt confused by my feelings but over time it dawned on me that this was how Mark was feeling : hopeless, sad and confused as if  there was nothing he could ever do would make things better for him.  I came to realise that he was unconsciously projecting his fears and anxieties into me and that I was now experiencing how he was feeling. This form of transference is described by psychodynamic  theorists as projective identification. After  discussing this in my supervision I decided to try to deal with my feelings by using them to help me show Mark that I empathised with is despair. I think taking time to interpret our counter-transference is important because I think reacting immediately to it may be harmful. I could not say to Mark that he was making me feel useless just as I  could not ask him  come to live in my house and that  I would become his mother.

I want to make it clear that the processes I have been describing were unconscious. The counter-transference is our unconscious response to the feelings of a child. We do not deliberately think “Oh ! this situation has developed and so this is how I intend to feel about it.”  Our counter-transference feelings come upon us without our consciously drawing them up. What emerges whether we wish it or not are our own deep feelings from our own past, which the present situation arouses. It may be the young person reminds us of someone we know, or that something a child says to us hits a painful spot  within ourselves which relates to our own childhood with  which we haven’t dealt. Why it is important to recognize this is that if we are to be effective caring adults we should not act out our unresolved issues from the past. This is why supervision plays a key role for staff in residential care, as it gives us opportunities to reflect on what has happened, how the young person was feeling and what we were feeling.  In my relationship with Mark, it was often difficult for me to be immediately aware of how my own feelings, and unresolved conflicts  were being aroused. This made setting aside time, either a brief moment when difficult events were unfolding and also for a fuller consideration during my supervision.

Another danger of acting immediately on our counter-transference feelings is that sometimes, we believe that by drawing on our own experience we will help the young people. For example, if we say to a young person “I know how it feels, I have been a teenager myself”, what we are actually  doing is saying “I know better than you.” In other words our counter-transference feelings are telling us “I am anxious about this situation. I need to get control of it before it gets out of hand”(Sharpe, 2006). Also, by using our own experience of difficult situations and saying that we “got over it,” and implying  “It’s not a big deal”, we are denying the child’s emotional pain.(Sharpe, 2006).  I think we have to take great care to communicate with our young people in a way that is genuinely two-way and which respects their feelings as much as it does their words.

I have been trying to argue that using psychodynamic concepts such as transference and counter-transference as well as an understanding of projection can aid us in our work with young people in residential care but while it is helpful it also presents us with difficulties. It can be helpful for the children if we, the workers, become aware of the transference feelings which flow to and fro between the young person and the worker which results in us providing more informed and sensitive support to a child. At the same time, it can be difficult because engaging with young people in this way involves a lot of searching and sometimes painful introspection and self-containment for the worker. It demands that we receive skilled supervision and management, and requires insightful supervision and skilled management to help us deal with our feelings as well as with those of the young people. Most importantly it helps us understand that we don’t always have to stamp a foot down every time we sense there is a possibility of losing control of  young people. A knowledge and awareness of transference in our work can assure us that we can emotionally contain situations without recourse to drastic action because we understand that by not acting on transferred feelings, but rather by acknowledging them we can help a young person like Mark explore their behaviour and feelings with us with us by comparing their  feelings from the past with their current reality. It is only by doing this that we can eventually help them prepare for a better future.
References

Bateman, A and Holmes, J. (1995) Introduction to psychoanalysis. Contemporary Theory and Practice  Routledge,   London.
Sharpe, C. (2006) “Study notes” from the Eagle House Graduate Diploma Course in Care and  Development of Children and Young People
Sharpe, C. (2001) In Care in Therapy ? A consideration of the usefulness of psychoanalytic theory for the care of young people living in children’s homes  accessed on November 12th, 2010 athttp://goodenoughcaring.com/Writings/Writing31.htm
Winnicott, D.W. (1986) Home is where we come from    London, Penguin Books
Young, R.M. (2001) Mental Space   London,  Process Press