Regina Miranda and Susan M. Andersen
Numerous studies have demonstrated that the therapeutic alliance that develops early in treatment predicts psychotherapeutic outcome (see Martin, Garske, & Davis, 2000). There remains limited research, however, on what factors influence the therapeutic alliance. Although we have not focused on therapeutic processes per se in our own research, we have focused on psychological processes in everyday interpersonal relations thought central to psychotherapy. In some form or another, classical theories have long suggested that the mental representations an individual holds about significant others are often influential in psychotherapy and that this may either facilitate or impede progress. Considering the process of transference may be helpful to understanding the formation of a therapeutic alliance.
In our work, we directly examine the ways in which a new person can be experienced as friend, not foe, or vice versa, in a matter of moments. Quite automatically, based on the social-cognitive process, this occurs in the process of transference. We examine this process in an experimental paradigm using the techniques of social cognition research. Even very early work on psychotherapy suggested that the therapeutic alliance might be important in psychotherapy outcome. Clients who are satisfied with treatment tend to like their therapist more and believe he or she is more friendly and involved, and by contrast, therapists with few (vs. many) premature terminations in their case histories are deemed more adept in understanding the client’s own issues, more accepting, secure and affectionate, and easy to get along with (see Beutler, Crago, & Arizmendi, 1986). Early researchers argued, as well, that a client’s “subjective feeling of change” may well be the best predictor of therapy outcome, associated as it appears to be with the client’s own involvement or engagement (Garfield, 1986). It is to this issue of establishing an effective working relationship, a therapeutic alliance, and what facilitates or disrupts this that we now turn our attention.
Our model of transference (and the evidence we have collected) is rooted in social cognition. The focus is on mental representations of significant others and on the relationship one has with those others. “Significant others” are family members, romantic partners, friends, or others whom individuals consider important and who have had an impact on their lives. This may include people whom they like or love (i.e., whom they regard positively), along with those whom they regard negatively, whether currently or no longer in their lives. We argue that transference occurs in everyday life, when such representations of significant others are triggered, and that it is thus a process by which people re-experience past relationships in their everyday social relationships and interactions. The research is conducted in laboratory settings and has amassed considerable evidence in support of this view, thus offering the first experimental demonstration of transference (Andersen & Cole, 1990; Andersen & Baum, 1994; Andersen, Glassman, Chen, & Cole, 1995). We believe this evidence has implications for the therapeutic relationship in a variety of therapeutic modalities – including cognitivebehavioral and psychodynamic psychotherapy.
Historical backdrop
Originally conceived by Freud (1912/1958), transference is regarded as an important part of the therapeutic relationship; indeed, perhaps the bedrock of psychoanalytic treatment (Greenberg & Mitchell, 1983). There could hardly be a more central psychological phenomenon in Freudian treatment. Transference was conceptualized by Freud as a process by which an individual displaced childhood fantasies and psychosexual conflicts onto an analyst (Freud, 1912/1958), and the process of psychoanalysis involved interpreting transference to bring to light the unconscious conflicts. Freud’s model of transference was based on drive-structure assumptions (Greenberg & Mitchell, 1983) with id, ego, and superego, and thus made no use of other kinds of mental structures, let alone mental “representations,” though he did mention the “imago” as a repository of parental material (he did not integrate it closely into his model, which was about the tripartite drive) (Freud, 1912/1958). Harry Stack Sullivan, by contrast, argued that “personifications” of the self and other (similar to mental representations) and “dynamisms” (i.e., the dynamics linking the self and other) play out in relationships with other people. He viewed transference as parataxic distortion, which involves relational patterns re-experienced with new people. Unlike Freud, Sullivan viewed transference, i.e., parataxic distortion, as rooted not in psychosexual conflicts, but rather in basic needs for satisfaction and security. Satisfaction needs are best met when developing one’s own talents and expressing one’s emotions while remaining connected with (or “integrated” with) others, and experiencing tenderness with them (Sullivan, 1953). This departure from the Freudian assumptions exemplifies the distinction between psychodynamic, drive reduction and relational theorists (see Greenberg & Mitchell, 1983). Our own conceptualization more closely resembles that of Sullivan (1953).
Another body of work relevant to our conceptualization of the relational self is the attachment literature, which grew out of behavioral, evolutionary, and psychodynamic theory, and focuses on the importance of internal working models of significant others and how they may be shaped through early relationships with primary caregivers (Ainsworth et al., 1978; Bowlby, 1969). Thus, there is interest in how attachment styles may influence current relationships (see Simpson & Rholes, 1998, for a review; see Liotti, Chapter 7, this volume). Our research is compatible (see Andersen & Berk, 1998; Andersen, Reznik, & Chen, 1997) but social cognitive in nature. Most work on the clinical notion of transference has been restricted to the client–therapist relationship. Transference has been regarded as interfering with, but perhaps also being essential to, the therapeutic relationship. The aim is to make it conscious and resolve it in order to move the therapy forward (see Westen, 1988).
Our social-cognitive model
Our social-cognitive model of transference presupposes that mental representations of significant others exist in memory, and such representations can readily be triggered by relevant cues in any context, which then leads people to view new others through the lens of pre-existing significant others (Andersen & Cole, 1990; Andersen & Baum, 1994; Andersen & Glassman, 1996). We further assume that the self and significant others are linked in memory as an inherent consequence of (or representation of ) their significance (Andersen et al., 1997). These linkages in memory obviously imply concurrent activation, such that when one is activated, the other will be activated too (see also Baldwin, 1992). Our model of the relational self lays out the ways in which this is particularly relevant to the self.
Given the link between representations of the self and significant others, individuals develop unique representations of themselves as they are with each of their significant others. Thus, when relevant contextual cues are encountered – particularly cues coming from a new person – that are similar (even minimally) to the representation, this will activate the representation. This representation may then be applied in interpersonal perception in the process we have termed transference. Moreover, triggering a significant-other representation in this way can also shift one’s view of the self in the direction of the self-when-with-the-significant-other, while at the same time activating a host of affects, expectancies, motivations, and behaviors typically experienced in relation to the significant other. This is, in short, what this research has demonstrated in the process of transference. Hence, the emotional and motivational significance of the significant other is what enables the experience of transference, which is not dispassionate.
Our model is consistent with other social-cognitive models of the relational self and their associated empirical paradigms. For example, Baldwin’s (1992) model of relational schemas suggests that people represent relationships in memory via interpersonal scripts, or stereotyped relationship patterns, and a self-schema that defines the self within that interaction. Recent research on this model suggests that these relationship schemas can be activated and can impact the way people evaluate themselves even by cues that are not initially associated with the representation but that come to be associated through conditioning (see Baldwin, Granzberg, & Pritchard, 2003). Hence, there can be rapid, automatic responses to people that can begin before a person is even aware of them. Whereas Baldwin’s model emphasizes stereotyped and generic representations of relationships, however, our model emphasizes the unique and idiosyncratic aspects of the relationship and of the self within that relationship (see Andersen & Chen, 2002).
Why our model suggests that transference is not just cognitive
We suggest, then, that transference is not only cognitive, but also deeply intertwined with affect and motivation. Elsewhere we have argued that people may have a fundamental need for human connection (Andersen & Chen, 2002) – that is, for attachment, belonging, and relatedness (see also Baumeister & Leary, 1995). This assumption is drawn not only from classical theories (e.g., Horney, 1939; Sullivan, 1953), but also from more contemporary theory (e.g., Bowlby, 1969; Deci, 1995; Safran, 1990). It is relevant to attachment research (e.g., Hazan & Shaver, 1994; Thompson, 1998) and to models of relational schemas (e.g., Baldwin, 1992), both of which share assumptions with our model.
The paradigm: Assessing transference
Our paradigm for triggering transference involves a laboratory setting and a two-session research design with college-student participants (for recent reviews, see Andersen & Berenson, 2001; Andersen & Chen, 2002; Andersen & Miranda, 2006; Andersen, Reznik, & Glassman, 2005; Andersen & Saribay, 2005). In an initial session, participants are asked to describe positive and negative characteristics of two significant others using a series of freely generated phrases (as sentence-completions). The second session of the study is conducted at least two weeks later. In this session, participants arrive at a different lab for an allegedly separate study and are led to expect that they will interact with someone whom they have never met for a “getting-acquainted” conversation. They are told that an interviewer is next door with this person collecting some information about this other participant, and the experimenter goes next door to retrieve it. They are then asked to read a series of descriptions about the new person – presumably provided by the “interviewer” – and are asked to imagine interacting with the person.
Individuals are randomly assigned either to a transference condition or to a yoked control condition. In the transference condition, the descriptions of the new person that participants read consist of some of the statements that these participants provided in the first session to describe their own significant other. In the yoked control condition, each participant is yoked with one participant (at random) from the transference condition, and is then exposed to features of that person’s significant other. We perfectly control content across the two main conditions.
In addition, the descriptions provided about the new person contain both positive and negative features, regardless of how loved or disliked the significant other is, so that this overall valence of the description is not identical to the valence of the features. Filler items the participant had previously classified as irrelevant to their significant other are also included in the description of the new person to make the crucial statements less obvious. As noted, because each participant in the transference condition is paired with another person (a yoked control participant) who views exactly the same descriptions about the new person, resemblance (or not) to the participant’s own significant other is what accounts for any effects, not differences in stimulus content.
After participants learn about the new person, they are asked to rate such things as the degree to which they remember learning particular things about the new person (i.e., their recognition memory) and how they feel about (i.e., evaluate) the new person. They are also asked to indicate whether they are motivated to approach or avoid the new person and their expectations of being accepted or rejected by the person, as well as their various emotional responses. Beyond this, they may also offer self-assessments, by providing self-descriptive sentences about themselves at the moment – i.e., their working self-concept.
Our main index of whether or not transference occurs involves assessing the degree to which individuals “go beyond the information given” (Bruner, 1957), that is, assign characteristics of their significant other to the new person that were not actually presented when learning about the person. Differences between the significant-other-resemblance condition and the control condition show greater inferences and memory of this kind – colored by the significant-other representation when there is such resemblance. A difference in how participants evaluate the new person also arises, as does an overall difference in positive affect, in expectancies for acceptance vs. rejection, in motivation to approach or avoid the new person, and in behaviors elicited from this new person. Changes in how an individual views herself or himself arise as well, and are associated with a wide variety of emotional consequences, depending on the nature of the significant-other relationship.
The evidence demonstrating transference
Inferences and memory: Going beyond the information given
The earliest research using this paradigm suggests that significant-other representations can be activated and applied to a new person, as revealed in biases in inferences and memory. For example, when participants are in a transference condition of an experiment (in which a new person is portrayed in a way that resembles their own significant other), they later show more biased memory in what they learned about this new person – relative to a control group exposed to no such resemblance. That is, when indicating how confident they are that certain phrases were presented to describe the new person, they report higher levels of confidence in having seen the features derived from their significant other but not actually presented about the new person. This is the case both when they learn about fictional characters (Andersen & Cole, 1990; Andersen, Glassman, Chen & Cole, 1995; Chen, Andersen, & Hinkley, 1999; Glassman & Andersen, 1999b) and when they learn about a new person with whom they expect to interact (e.g., Andersen & Baum, 1994; Andersen, Reznik, & Manzella, 1996; Baum & Andersen, 1999; Berenson & Andersen, in press; Berk & Andersen, 2000; Hinkley & Andersen, 1996; Reznik & Andersen, in revision). In the latter case, the effect occurs regardless of whether the representation is positive or negative. In the former, it was possible to rule out that just any cues that had been self-generated earlier by the participants themselves would produce the effect, or that just any activated mental representation would lead to the same level of the effect. While other representations (e.g., stereotypes and other social categories) function similarly, the effect is more pronounced for significant-other representations, which are chronically accessible (i.e., have a low-level tendency to be used willy-nilly) and are also readily triggered by cues in a new person.
Indeed, it has also been shown that the effect will clearly arise even when stimulus cues are presented entirely outside of conscious awareness. That is, the effect has been shown to occur non-consciously and automatically. For example, in one study, features of an individual’s own or of another person’s significant other were presented subliminally (in parafoveal vision for less than 90 ms and then pattern masked). Even under these conditions, participants who where presented with the relevant contextual cues subliminally were more likely to infer that a new person (with whom participants were presumably playing a computer game) had features of their significant other that were never presented, not even subliminally (Glassman & Andersen, 1999a). Clearly, then, the transference process can occur without awareness.
Using another measure altogether, a recent study (Miranda, Andersen, & Edwards, in preparation) assessed activation of the significant-other representation using a response latency index. Participants who learned about a new person in a transference paradigm showed faster reaction times to decide whether or not a given moderately positive adjective was a word – if it was highly descriptive of their significant other (vs. less so), and this did not occur in the non-transference control condition (see Andersen & Miranda, 2006).
Thus, the evidence demonstrates transference as a cognitive process, and is evoked by immediate cues in a situation, i.e., in another person (e.g., another person’s behavior, style or qualities), which become all the more probable because these representations also have a chronic tendency to be used. Moreover, the evidence shows that transference occurs automatically in that it is activated without intention or effort and also without consciousness (on automaticity, see Bargh, 1997), leading relevant inferences to be made about the new person (see Andersen, Reznik, & Glassman, 2005).
Incorrect assumptions a client makes about a therapist may thus derive from this process. For example, an individual may make a snap judgment about whether or not he likes, versus dislikes, or feels safe, versus threatened, in a new therapeutic encounter, depending on cues that trigger a particular significant-other representation. At the same time, this is unlikely to occur in a vacuum. The therapist’s own qualities (e.g., appearance, style of interaction, tone of voice, or other cue associated with the significant other) may trigger the process by activating the representation. Moreover, the therapist’s own inferences and mis-memories of a client may derive from the therapist’s own representations, again provoked in part by momentary shifts in what the person is saying and doing, and how (in addition to more stable characteristics). This process is automatic and largely unconscious, and we have no reason to believe it is different when it occurs in a therapist – commonly called counter-transference. This is de-pathologizing and may be illuminating for therapists.
More broadly, transference may be ubiquitous in people’s everyday interpersonal encounters and important relationships, in part as a function of contextual and expressive shifts in the other’s behavior in new situations. The implication is that it is just as possible to engage with a client about interpersonal encounters in his or her regular life and the ways in which prior relationships may be playing out in these present encounters – quite independently of what is going on in the therapeutic relationship. While some therapists find such work tangential to the immediate experience of the therapeutic relationship, it has the advantage of being “about” the client’s real life – his or her ongoing, regular experience outside of the therapeutic hour that brought him or her to treatment in the first place. Nevertheless, whether a patient feels safe in therapy may have implications for the type of information he or she may be willing to explore in treatment, particularly if the individual has a history of relationships in which he or she was made to feel unsafe (e.g., trauma history).
Automatic evaluation and affect
Our assumption has been that the overall evaluation associated with a significant other will come to be associated with a new person who is seen through this lens. That is, activation of a significant-other representation should lead to positive evaluation of a new person if the significant other is positive and to negative evaluation if the significant other is negative (in accord with the process of schema-triggered affect; Fiske & Pavelchak, 1987). In fact, the evidence shows precisely this. When a new person resembles a positive (vs. a negative) significant other, people come to like them considerably more, and this does not occur in a control condition (Andersen & Baum, 1994; Andersen et al., 1996; Baum & Andersen, 1999; Berk & Andersen, 2000).
Because the processes presumed to underlie this effect (activation, application of social knowledge) occur automatically (Bargh, 1997) and because evidence shows that automatic evaluation arises in response to any encountered stimuli (Duckworth, Bargh, Garcia, & Chaiken, 2002), we assume that our effects reflect automatic evaluations as well. This is further substantiated by research examining participants’ immediate facial expressions. Depending on whether they are learning about someone who resembles a positive versus negative significant other, the facial affect shown in immediate facial expression reflects the evaluation of the significant other, and no such effect occurs in the control condition. Individuals who read about a new person and are recorded by a hidden camera are assessed by independent raters as showing more positive facial affect when a new person resembles a positive versus a negative significant other (Andersen et al., 1996).
At the very least, these data provide further evidence that transference occurs and occurs automatically, while also showing its profound emotional quality. Thus, an initial encounter may set the tone of a relationship depending on which significant-other representation is activated. We also assume that relevant momentary responses may also be evoked midway in a relationship, depending on whether or not a particular significant-other representation is activated at that moment. An individual’s encounter with a clinician, whether an initial interview or a later session, will thus quite likely result in automatic evaluation of the therapist, depending on features the therapist exemplifies that trigger a significant-other representation. Likewise, the therapist may well have an automatic positive or negative evaluation of the client based on cues from that person that trigger his or her own significant-other representations. We thus assume that it can facilitate or interfere with a positive working alliance.
If and when a problematic transference occurs in the therapeutic relationship, it may interfere with effectively working with outside-of-treatment material. Of course, such a negative transference in therapy can also become pronounced enough to destroy the therapeutic relationship, leading the client to quit, and it is thus important to watch for this impediment to nip it in the bud, though obviously not all negative responses from a client are transference. In some instances, anyone would respond that way to the actions or expressions of the therapist.
Expectations for acceptance and rejection
We also assume that the love, acceptance, dislike, or rejection experienced with a significant other translates in transference into expectancies about how the new person will respond, i.e., with acceptance or rejection. Indeed, when individuals encounter someone who resembles their own positive (vs. negative) significant other, they report expecting this new person to be accepting of them and not rejecting, and this differential expectation does not occur in the control condition (Andersen et al., 1996; Berk & Andersen, 2000). Other research has also suggested that expectancies for rejection can have profound consequences in their own right (Downey & Feldman, 1996) and may be stored in memory as part of relationships with significant others or, more broadly, relational schemas (Baldwin & Sinclair, 1996). Research on relational schemas has also shown unconscious activation of significant-other representations using a priming methodology, and it does so in part through effects on self-evaluation (e.g., Baldwin, Carrell, & Lopez, 1990).
The evidence again demonstrates transference while also showing that it includes assumptions about the significant other’s presumed feelings. That is, what is stored in memory contains not only how one feels about the significant other, but how one believes one is evaluated by that other.
In therapy, this might be reflected in the client feeling liked or well-regarded by the clinician, or disliked/rejected, or alternatively as the client disliking and rejecting the therapist. Likewise, if the therapist views the client as especially liking or adoring him or her, or as being rejecting of him or her, this may also be a reflection of the therapist’s own transference of a prior relationship(s) that is now experienced with the client. Indeed, such expectancies as they arise in the client’s everyday life may have this same source, and the corrosive effect of rejection expectancies on interpersonal relations in everyday life is well understood.
Motivation to approach or avoid a new person
Our model of the relational self assumes that people have a basic need to be close to or connected with others and, as such, that this motive should be triggered when a significant-other representation is activated, because motives and goals are associated with significant-other representations in memory (Andersen et al., 1996) and are stored in memory as cognitive representations (Bargh, 1990; Bargh & Barndollar, 1996). All things being equal, people are motivated to approach those they like or love and to avoid those they dislike, and are more disclosing with the former than with the latter. Our evidence has shown that when a new person resembles a positive versus a negative significant other, individuals report greater motivation to approach and to be close to this new person (versus wanting to avoid and be emotionally distant from him or her; Andersen et al., 1996; Berk & Andersen, 2000). This does not occur in a control condition. Other research has also shown that activating a significant-other representation activates goals automatically (Fitzsimons & Bargh, 2003; Shah, 2003).
In psychotherapy this may involve the degree to which a client wants to come to therapy sessions and to disclose about deeply personal matters. Motives to reveal hopes, dreads, and fears can be evoked in a client based on a positive transference, which can facilitate therapeutic work, even if it is, in a sense, illusory. This evidence also suggests that a negative transference can (if unaddressed or resolved) be an impediment, perhaps even bringing authentic disclosure to an abrupt halt. In a therapist, the desire to be “closer” to the client, to enable the client to “know” the therapist better, to fully grasp the therapist’s own feelings and perceptions, may arise in the same way. The process may occur as well in the desire to be distant and withholding with a client.
Triggering behavioral patterns consistent with significant-other relationships
We have also examined affectively-laden processes in overt behavior in an interpersonal encounter with a stranger. We focused on the interactional behavior with the new person in transference – by focusing on the new person – to see if the effects of transference could be observed in a self-fulfilling prophecy (also known as “behavioral confirmation;” Snyder, Tanke, & Berscheid, 1977). Participants learned about a new person, as usual, who did or did not resemble a positive or negative significant other and then engaged in a brief telephone interaction with a naïve participant who had been randomly assigned to be paired with this perceiver (Berk & Andersen, 2000). The results showed that independent judges rated the conversational behavior elicited from the new individual as more positive in the context of a positive vs. a negative transference (i.e., when a positive vs. negative significant-other representation had been triggered in the perceiver). Thus, participants actually elicited the same behavior from the naïve individual – expressed in this new person’s behavior – as was typical of the significant other.
The evidence showing the relational self in transference
Views of the self in transference: Shifts in working self-concept and self-evaluation
Given our proposition that one’s views of the self are constructed in the midst of important relationships, and that self-representations are thus “entangled” with significant-other representations (Andersen & Chen, 2002), it stands to reason that triggering a particular significant-other representation should lead to changes in how a person views the self – as the self-when-with-the-significant-other. One becomes a particular version of oneself, depending on the significant-other relationship that is active. This is what our research has shown. In one study (Hinkley & Andersen, 1996), participants not only described a positive and negative significant other in advance of the experiment but also characterized how they viewed themselves when with each significant other. In a later session, when they learned about a new person resembling either their positive or negative significant other, they were also asked to list phrases characterizing their working self-concept – i.e., how they viewed themselves at that moment.
As expected, the working self-concept of individuals in the transference condition shifted to reflect the self-when-with-the-signif-cant-other, even after adjusting for baseline self-concept descriptions. Their self-concept features listed after learning about the new person showed a greater degree of overlap with how they described themselves as they were when with that signficant other (compared to the non-transference condition) – for both positive and negative significant others. In addition, participants classified the newly overlapping features (with the self-when-with-the-significant-other) more positively in the positive transference condition than in the negative transference condition, and this did not occur in the control condition. Both effects have also been found when only positive significant-other representations are activated – and these involve an individual with whom one experiences a desired self or a dreaded sense of self (Reznik & Andersen, 2004). Thus, significant others with whom people have positive self-views appear to lead people to view themselves in positive ways in transference, while significant others with whom people hold more negative views of themselves lead to corresponding negative shifts in the self-concept in transference. Such shifts in self-views in transference may have implications for the experience of a variety of self-conscious emotions, such as shame (see Gilbert, 2003), in new interpersonal encounters. For example, if one experiences a negative, “shame-self” with one’s father, then another man who may resemble one’s father could reactivate that shame-self representation or experience. Not only may one tend to think/feel that a new person will look down on the self but also one’s own experience of the self-when-with-the-significant-other is affected. The experience of self and of other are woven together. It may be valuable in therapy to know it is entirely “normal” for a client’s sense of self to shift as a function of which significant-other representation is activated. Self-evaluation and one’s sense of worth may vary in tow. That this happens for the therapist, as well as in the context of daily life, can also be illuminating.
Self-regulation in transference
SELF-PROTECTIVE SELF-REGULATION
We have found that in addition to shifting their views of themselves in transference, individuals also shift their self-regulatory responses. When significant-other representations are triggered, this leads people to regulate their views both of themselves and of loved ones accordingly. Despite negative shifts in the self-concept involving the self-when-with-the-significant-other, in a negative transference, people also show an overall shift in their self-views that is far more positive when with their negative significant other. Individuals thus appear to show compensatory self-inflation or self-enhancement (see Greenberg & Pyszczynski, 1985), a kind of defense, in a negative transference. This is self-protective self-regulation and does not occur in a positive transference, or in the control condition (Hinkley & Andersen, 1996).
OTHER-PROTECTIVE SELF-REGULATION
In addition, people show regulatory responses indicative of a desire to protect their views of their significant others in transference. When reading positive and negative descriptions of a new person who resembles a positively-toned significant other, individuals demonstrate especially positive facial affect when exposed to negative features of a positive significant other as descriptions of a new person. The effect does not occur in negative transference, nor in the control condition. Thus, individuals appear to exhibit what we have termed other-protective self-regulation in positive transference, and they may use regulatory strategies to maintain a positive view of an important other who is liked or loved (Andersen et al., 1996). Such self- and other-protective regulatory responses may be adaptive in enabling people to maintain an overall positive view of themselves despite a threat to self-esteem and to maintain positive views of important others, and relationships of trust. Clearly, if a client expresses “puffed up” views of the self in treatment, this may be due to an insult to the self through the self-when-with-the-significant-other activated in the transference. This may also make the client less willing to address (or face) directly the experienced insult. Protecting the self from experienced insult may likewise render a therapist less fully self-reflective or self-honest. The process may be off-putting to others, in everyday life as well as in therapy, although this is speculative. It may also be highly adaptive self-regulation (reflected in affect), and this is known to sustain relationships and yet may bind one to problematic relationships as well.
The self and affect: Disruptions in positive affect in positive transference
We now turn to the ways some positive experiences may break down even in a “positive transference” and may thus become problematic – potentially leading to disruptions in positive mood states and even to the induction or exacerbation of negative moods. We have found three conditions under which pleasant mood is disrupted in a positive transference: when a new person violates the interpersonal role associated with the significant other (Baum & Andersen, 1999); when there is a chronically unsatisfied goal associated with the significant other (Berk & Andersen, 2004); and when the significant-other representation triggered is that of a person around whom one tends to become a dreaded version of the self (Reznik & Andersen, 2004).
CONTEXTUAL ROLE VIOLATION
Given that knowledge about significant others is stored in memory, information about the relational role the other person usually takes in relation to the self should also be stored with the significant-other representation. There is evidence that the violation of roles is disruptive to interpersonal relationships (e.g., Sheldon & Elliot, 2000). We thus expected (and found) that when a representation of an important other who held a particular type of role was activated in the context of an anticipated interaction with a new person, individuals would experience mood disruptions when they learned that the new person somehow violated this interpersonal role. In our research, we found that when transference involved a representation of a positive authority figure, the positive mood that participants would usually experience in a positive transference was disrupted if the participant also learned that the new person whom they expected to meet was a novice (i.e., thus unable to fulfill the interpersonal role associated with the significant-other representation; Baum & Andersen, 1999).
CHRONICALLY UNSATISFIED GOALS
Our work has also demonstrated that positive mood is disrupted and hostility increased when one has experienced chronically unsatisfied (vs. satisfied) goals for acceptance and affection with a positive significant other (Berk & Andersen, 2004), and this significant-other representation is triggered in relation to a new person. The activation of this representation is even associated with overt behaviors designed to solicit acceptance from the new person under the circumstance that the significant other is a family member.
THE DREADED SELF
Disrupted positive mood also occurs in relation to a positive significant-other representation with whom one tends to experience a dreaded sense of self. When individuals expect to meet a new person who resembles such a significant other (i.e., one associated with experiencing a dreaded self ), they also come to experience a decrease in positive mood and an increase in negative mood relative to when they expect to meet a new person who resembles a positive signif-cant other with whom one tends to experience a desired sense of self, which results in positive affect (Reznik & Andersen, 2004).
PHYSICAL AND PSYCHOLOGICAL ABUSE
The experience of physical, sexual, or psychological abuse at the hands of loved caregivers should sensibly disrupt positive feelings in a positive transference, and perhaps lead to distinctive affective experiences. Empirical evidence suggests that a history of childhood maltreatment (Shields, Ryan, & Cicchetti, 2001) and sexual abuse is associated with greater interpersonal problems in both childhood (Shields et al., 2001) and adulthood (Classen, Field, Koopman, Nevill-Manning, & Spiegel, 2001), and also with holding more maladaptive parental representations (Cloitre, Cohen, & Scarvalone, 2002; Shields et al., 2001). Research examining the mood states evoked by triggering representations of abusive family members in transference among females with a history of such physical and psychological abuse by this attachment object is revealing (Berenson & Andersen, in press). It suggests that when women with an abuse history expect to meet someone who resembles the relevant parent and are also told that this new person is becoming increasingly tense and irritable, they report disliking the person, mistrusting him or her, and expecting to be rejected by him or her (relative to non-abused participants). They also reported being more indifferent toward this new person, suggesting disengagement.
Indeed, in terms of mood, abused individuals actually report decreases in dysphoric mood in transference after being told that this person is becoming irritable, while the latter cue spiked their dysphoric mood in the control condition, and no such differences arise among non-abused participants (Berenson & Andersen, in press). Thus, despite explicit dislike and mistrust of the new person, women with an abuse history showed dampened negative mood in transference based on the target-irritability cue, which may be a kind of “emotional numbing.” In fact, the affective responses among these individuals are even more complex in that they display the same immediate positive facial affect in transference as do nonabused participants (compared to the control condition) when first reading descriptions of a new person resembling their parent and when encountering the irritability cue, revealing very mixed emotional reactions in implicit vs. explicit affect. In short, a client’s varying mood states may result from far more nuanced processes than immediately meet the eye.
Evoking specific emotions in transference based on the relational self
We now turn to considering the conditions under which discrete negative affects might be triggered in transference.
SELF-DISCREPANCIES
Early relational models of psychopathology and psychotherapy emphasized the importance of the ideal self as contrasted with what is true of the self (Horney, 1939) or measured self-reported ideal and actual selves (see Rogers, 1951). These constructs have been reconceptualized in social cognition within a theoretical framework that makes predictions about discrete emotional states. That is, self-discrepancy theory (Higgins, 1987) suggests that a discrepancy between a standard held in memory and one’s actual self creates emotional vulnerability. Such a discrepancy can be held from one’s own viewpoint or from that of a significant other. For example, discrepancies between one’s ideals (hopes and aspirations) and one’s actual self lead to dysphoric affect while discrepancies between the actual self and one’s duties and obligations (“oughts”) result in anxiety. In our examination of self-discrepancies in transference (Reznik & Andersen, in press), we found that people who have an ideal self-discrepancy from a parent’s standpoint show increases in dysphoric mood when the parental representation is triggered. Similarly, when a representation of a parent from whose viewpoint one has an “ought” self-discrepancy is triggered, more agitation-related affect arises, along with decreased relaxation and increased resentful, hostile mood (Reznik & Andersen, in revision).
ATTACHMENT STYLES
Attachment theory assumes that early interactions with caregivers shape the mental models of the self and other that a person develops (Ainsworth et al., 1978; Bowlby, 1969). The assumptions of our theory are thus quite compatible with attachment theory (see Andersen & Berk, 1998; Andersen et al., 1997). In fact, we have evidence that individuals experience specific emotional reactions in transference that involve the particular attachment style they have with their significant other. Recent evidence suggests that people can differ in the attachment styles they hold with different people (Pierce & Lydon, 2001), and that attachment styles can be triggered by contextual cues (Mikulincer, Gillath, & Shaver, 2002). Research on transference has examined differences in emotional states evoked by the activation of representations of parents with whom the individual has a secure, anxious-ambivalent, avoidant, or fearful attachment.
Differing affective states are triggered in transference involving a parent, depending on the attachment style held with that parent, as assessed by self-reported mood (Andersen, Bartz, Berenson, & Keczkemethy, 2003). Transference involving a parent with whom one has a secure-attachment relationship results in increases in positive affect (relative to the control condition), but this did not occur for anxious-ambivalent, avoidant, or fearful attachment. In addition, transference involving a parent with whom an individual has an anxious-ambivalent attachment is associated with more anxiety (relative to the control condition), and this was not the case for secure, avoidant, or fearful participants. Finally, transference involving a parent with whom one has an avoidant attachment style results in decreases in self-reported levels of hostility (compared to the control condition), which does not occur for other individuals, suggesting a lack of emotional expression, and even suppressed hostility, as one might expect. Given the purported importance of internal working models of primary caregivers to the attachment system, this work contributes to the literature by providing evidence that transference may be one mechanism by which attachment styles are triggered in everyday living (see Liotti, Chapter 7, this volume).
Increases in dysphoric mood and self-concept shifts among depressed persons
There is increasing evidence that depression is associated with impairment in interpersonal relationships (Hammen, 2000). In our work we thus assume that depressed individuals may have experienced more problematic interpersonal relationships than non-depressed individuals (Davila, Hammen, Burge, Paley, & Daley, 1995). Triggering a significant-other representation associated with a problematic relationship may lead mood regulatory capacity to break down (see Nolen-Hoeksema & Corte, 2004).
For example, encountering a new person who is similar to a loved one with whom one has experienced rejection may lead to increases in dysphoric mood. We examined this hypothesis in a recent study using a college-student sample of individuals pre-selected for high versus low symptoms of depression on the Beck Depression Inventory (Beck, Rush, Shaw, & Emery, 1979). Participants learned about a new person who resembled or did not resemble a positive or negative significant other with whom they had not experienced the level of acceptance that they would have preferred in the past (or, viewed differently, with whom they had experienced rejection) (Miranda et al., in preparation; see also Andersen & Miranda, 2006).
As such, depressed individuals show increases in dysphoric mood (adjusting for baseline levels of dysphoria) in the positive transference condition (that is, where the representation triggered was of a family member who was liked or loved by the individual), compared to the control condition, i.e., when the significant other was positive and still rejecting. Their freely listed self-descriptors, moreover, are rated by independent judges (adjusting for baseline self-concept) as characterized by a feeling of being rejected, while those of non-depressed individuals are not. These findings suggest that depressed persons are more vulnerable to a transference involving a positive but rejecting significant other than are non-depressed individuals. Depressed individuals may thus be particularly pained by rejection in their relationships with people whom they like or love a great deal, and this emerges in a relevant transference.
This body of work has important implications for treatment. It underscores the importance of the relational self both for facilitating the therapeutic encounter and relationship in emotional terms, and for disrupting it. The individual’s current emotional and interpersonal functioning in any relationship will depend very specifically on what particular cues are perceived and experienced in the encounter, which shifts their own mental state. Our research tracks this and thus offers a precise, cue-based way of seeing the texture of an encounter, through its evoked relational meaning for the person, rather than merely identifying abstract differences in trait predispositions or generalized cognitions, such as dysfunctional attitudes about the self. Understanding transference in these terms thus provides useful information to the therapist.
We do not mean to suggest, however, that transference should necessarily be a central and explicit focus of therapy in the therapeutic encounter, as is often the case in psychodynamic treatment. Instead, we argue that the focus of attention in therapy should be on the client’s meaning-making in his or her life across varying contextual cues. This may best be accomplished by being directed to the client’s daily life, ongoing relationships, and interpersonal encounters. At the same time, our data suggest that understanding a person’s relationship history – not only the “here and now” – might be important when working with someone who presents with interpersonal difficulties. This offers a window on the transference processes occurring there – if one knows something about the content of the individual’s significant-other representations and his or her relationship with each one. Since much human suffering is located in the relational nexus of people’s lives, we argue that this can be invaluable.
Modifying interpersonal schemas and relationship patterns in treatment
Over the past two decades, interpersonal relationships have received increasing attention in models of psychotherapy. Interpersonal psychotherapy for depression (Klerman, Weissman, Rounsaville, & Chevron, 1984), for example, which draws on the theories of Harry Stack Sullivan (1953) and John Bowlby (1969), is a time-limited treatment that addresses the interpersonal context of depression. A major part of this treatment, which has been shown to be efficacious for both adolescent and adult depression (Mufson, Weissman, Moreau, & Garfinkel, 1999; Weissman, Klerman, Prusoff, Sholomskas, & Padian, 1981; see Markowitz & Weissman, 1995), is the identification of interpersonal problem areas that may exacerbate or maintain symptoms of depression and then helping clients develop strategies to address these problem areas.
To take another example, Cloitre and colleagues (Cloitre, Koenen, Cohen, & Han, 2002) developed a cognitive-behavioral treatment for posttraumatic stress disorder (PTSD) that involves skills training in affective and interpersonal regulation prior to an exposure component in which the individual is exposed to components of a trauma narrative. The skills training component of the treatment includes identification of maladaptive interpersonal schemas and patterns of interaction and identifying ways to modify these interpersonal patterns. This treatment has been shown to be effective in reducing symptoms of PTSD and in maintaining symptom improvement as long as 9 months after treatment (Cloitre et al., 2002).
In our view, interpersonal perception and relations are profoundly influenced by the mental representations of (and relationships with) significant others that one brings to a situation. In considering what is “maladaptive” about the otherwise normal, nonpathological process of transference, it is useful to distinguish process and content (see Andersen & Berk, 1998). The process of transference appears to be quite general. The basic process is that once a significant-other representation is triggered, it is likely to lead to certain thoughts, feelings, motivations, and behaviors. What is distinctive to the person and more relevant to human suffering and dysfunction is the content of an individual’s significant-other representations and relationships. And this is what can be assessed in psychotherapy. A first step in our own research is to ask participants to name and describe important others in their lives using free-form sentence completions. By having individuals in psychotherapy describe important others in their lives, including the person’s qualities, quirks, preferences, interests, ways of relating, as well as the nature of the relationship, much can be learned about the individual, especially as experience varies across significant others. This is analogous to the initial phases of existing treatment models that focus on the interpersonal relationship as the unit of analysis (see, e.g., Weissman, Markowitz, & Klerman, 2000). The emotions evoked by these others in these relationships, as well as the motives and expectancies with these others, may be experienced anew in new contexts with new people (both you, the therapist, and other people in the individual’s daily life).
Once these representations are identified, the therapist may be able to see when they have been activated (or infer when they may have been activated) by looking for comparable patterns of response to you (or to another person) as experienced in the pre-existing significant-other relationship. The therapist may also be able to ask the client if these seem to be the same responses that the individual had in the other relationship (see Leahy, 2001). This can provoke a dialogue about whether or not there were aspects of your response (or a new person’s response) that reminded the client of dealing with the significant other. Presumably, such experience can help the client to identify relevant triggering cues himself or herself – potentially learning over time to expand the “moment of freedom” between the occurrence of these cues and having the typical response, perhaps permitting a choice as to how to respond, instead. That is, therapy can thus be directed, in part, to helping the individual modify old patterns in new relationships as instigated by activation of significant-other representations and relationships. This may help the individual to process information about new people in more conscious and effortful ways – and in more diverse terms rather than in the simpler automatic ways that otherwise occur, allowing alternate ways of responding to be considered, tried out and practiced over time in changing patterns in small ways, step by step.
Significant-other representations and the therapeutic alliance
While transference has been the crucible of psychodynamic thinking, and there has been much discussion of the therapeutic alliance in most thinking about psychotherapy, there has been less research on the actual relationship between therapist and client in psychotherapy than would be valuable. On the one hand, research has certainly begun to suggest that the matching of client and therapist on a variety of dimensions of preference and expectancy and style facilitates a therapeutic alliance (Beutler et al., 1986). On the other hand, very little research examines the process of client-therapist interaction in precise terms, perhaps because it is so labor-intensive to conduct.
One exception is research on therapeutic relationships showing that positive therapeutic relationships contribute to positive treatment outcomes (see Horvath & Luborsky, 1993). The ability to engage a client in treatment and to maintain that bond and the trust it usually requires will be affected by the response a client has toward the therapist – and this is likely to manifest itself relatively early in treatment. It is also likely to have an impact on the client’s ability to acquire new skills in cognitive-behavioral therapy. For example, in PTSD treatment among women with a history of childhood physical or sexual abuse, the client’s rating of the therapeutic relationship in the first few sessions of treatment predicts improvement in symptoms through changes in the client’s perceptions of her own ability to regulate her emotions (Cloitre, Stovall-McClough, Miranda, & Chemtob, 2004). Such findings argue for the need for a richer, more comprehensive understanding of relational processes in psychotherapy, and we believe our work on interpersonal perception and interpersonal relations can inform this development.
Whether a client has an initially positive or negative response to the therapist matters, and is likely to be determined, in part, by the mental representations triggered in therapeutic interactions with the therapist. For instance, an individual who experiences mistrust of the therapist and a motivation to avoid engaging openly may well experience this based partly on cues that the therapist himself or herself gives off that happen to trigger a prior significant-other representation and relationship. Approach motivation can be diminished and anxious or dysphoric mood can also be evoked, as the client perceives that she or he has failed to meet the therapist’s expectations. This can occur based on a positive significant-other representation, not only a negative one, and so can be relevant even when the apparent alliance is strong. Furthermore, even attempts by the therapist to act in role-specific ways (e.g., trying to be understanding and getting to know the client, to be empathic, or to place boundaries and act as a containing authority) may be alarming to a client, particularly when this behavior violates role expectancies – as when in a client’s history, closeness is associated with abuse (see Gilbert, Chapter 6, this volume). Indeed, it is likely that even a relapse in symptoms can be evoked by the transference process. Moreover, if the client is experiencing other difficulties or there happens to be a relapse for other reasons, such a transference involving rejection expectancies can then interrupt secondarily the very trust and bond needed to help the individual through the difficult times.
Our data suggest that an individual’s initial response to a new person can be gauged non-verbally – in fleeting facial expressions (Andersen et al., 1996). A client’s initial non-verbal expressions of affect during early therapeutic encounters may thus be informative about his or her reaction to the therapist. Just as positive facial affect may reflect a positive transference, the opposite – when observed in a client – may reflect a negative transference. Our work suggests, then, that clinicians should remain attentive to clients’ facial expressions and other non-verbal expressions of affect (body posture, etc.), particularly during early phases of treatment, as these may help predict how well the individual will engage in treatment over time. It is also worth noting that beyond the initial sessions, it is quite likely that subtle variations in what the therapist is giving off and communicating can trigger variability in the kind of transference evoked, even if these happen not to have been observed in early sessions, as they can perhaps be an indicator of such processes during any stage of therapy.
The evidence we have presented showing that disruptions in mood and self-regulatory responses occur in transference offers both a warning to clinicians about the potential deleterious impacts of the process of transference and some encouragement about when it can work well for therapy. It perhaps offers some grist for humility both about the well-organized and well-practiced (automatic) aspects of what clients bring to psychotherapy and the fateful question of effective or problematic match with a therapist at a given time.
We have presented a model of the social-cognitive process of transference and of the relational self. We have suggested that one’s sense of self is constructed through significant-other relationships. Mental representations of the self, held in memory, are tied to representations of significant others. Transference is the process by which such mental representations are triggered by social contextual cues and applied to new individuals. These are often responses that arise automatically in a variety of domains – in cognitive inferences, biases and retrieval; core affective responses (e.g., like/dislike, positive/negative); evaluative responses and expectations (of being accepted/rejected); motivations (to approach or avoid), and the feelings, thoughts and behaviors evoked in the recipient of the transference. Even views of the self, held in relation to each unique significant other, will come to define the self, depending on whether or not that significant-other representation is activated. This line of research is the first experimental evidence of transference, and it demonstrates it in everyday interpersonal life.
While our research has been restricted to settings outside the therapeutic encounter, and to non-clinical samples, even Freud assumed that transference occurred both inside and outside of analysis, and Sullivan and most other early theorists concurred. Our work has clinical relevance for what transpires in psychotherapy in a variety of ways. Using basic behavioral science research in the field of social cognition, it shows that the longstanding clinical assumption that “transference” occurs in psychotherapy is correct. Our research does not address how a therapist should (or should not) deal with transference in therapy, but illuminates how it can occur – in the client and from the client’s point of view.
We also suggest that the same processes can be applied to the understanding of transference and counter-transference experiences in the therapist. We show how this normal process operates in everyday interactions among “ordinary” people and how it can lead to emotionally painful consequences or, conversely, to feeling connected, bonded, and comfortable. The key message is therefore that in deepening our understanding of “normal” social psychology we can throw light on therapeutic relationships. There is no reason to assume that the evolved conscious and non-conscious social processing systems that make our complex social life possible are not also key to psychotherapy.
This research was funded in part by a grant from the National Institute of Mental Health (#R01-MH48789).
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