Benefits of dealing with Feelings and Resistances in the transference

In a past video we discussed the vital importance of dealing with feelings, impulses and fantasies arising in the transference as soon as they appear, in order to facilitate a rapid and reliable unlocking of the unconscious. In this process, a clear link is made to the genetic figure you have come to represent. The past becomes present, where it can be faced and resolved.
This is in stark contrast to an approach in which the transference is allowed to develop into a transference neurosis, which often proves difficult, if not impossible to successfully resolve.
The other reason this is so important is because transference is a defense that distorts the patient's perception of who you are. By dealing with these feelings in a timely fashion, the link to the past is made clear and, in the process, you become distinguished from past figures. Increasingly you are viewed realistically and without distortion - as someone there to help.

[@rod4530]

So much shared in 8.34 mins. Thank you.

[@patriciacoughlinphd1852]

Glad it was helpful to you.

[@jonz9296]

Patricia I would love for you to talk about how often and reasons why the facing of feelings in the transferences DOES NOT cause a transference of images, even when all 3 signals are online in the transference.

[@patriciacoughlinphd1852]

What do you mean by three signals? If there is no unlocking, with a transfer of images and depression of fresh material you must consider that you were either dealing with conscious feelings of anger (as opposed to accessing unconscious rage) or that the patient was complying with you. Of course the only way to know is for me to see the video, so take this feedback with a pinch of salt.

[@emmapinn5216]

Argh, so frustrated I didn't receive any of this information in my cbt training program. Thanks Patricia

[@patriciacoughlinphd1852]

I'm so sorry if that's all you got. CBTs effectiveness has been waning over the past 50 years. Human beings are not driven by conscious thoughts, rather unconscious feelings and conflicts. Even David Barlow conceded, in a famous paper published in the American Psychologist, that there is no neuroscientific evidence that thoughts create feelings. Feelings are registered far before conscious thoughts have a chance to form. Brave of him to acknowledge that. You will have to get your own post graduate training to enhance effectiveness. Good luck!

[@LPchief]

Great timing! Topic of Tomorrow 's course. Thanks a lot dr Coughlin

[@patriciacoughlinphd1852]

What course?

[@ZoeGeorge84]

I've fround that this can be particularly challenging to do (to distinguish oneself from the past figure) when that past figure was constantly affirming to the patient that everything they did was in the patient's best interests - "this isn't easy for me to treat you in this way, but I am doing it because it is what you need". It's harder for the patient to see the reality that the genetic figure was in fact serving their own needs and ignoring the needs of the patient, despite what the genetic figure was saying / how the genetic figure was explaining it. I think a good place to start in these cases is to be clear that I don't know what the patient needs. That only the patient can know that, and to be curious to that.

[@patriciacoughlinphd1852]

The perception of parents and others should clear up once they face their own mixed feelings. Patients distort reality of genetic figures if they cannot face their feelings toward these figures. Trying to clear up these distortions prior to unlocking is difficult indeed.

[@ZoeGeorge84]

Thanks so much Patricia. Are you able to explain your process / timing of the initial sessions, and then subsequent sessions? Ideally, how do you structure the timing of these? You mentioned you do a trial therapy over 3 consecutive days which involves several sessions each day? I'd love a breakdown of the duration of sessions etc. I don't do the intensive trial therapy component, and I have noticed that it is difficult to gain momentum in a standard 50-minute session. I'd like to change the way I go about initial sessions / trial therapy to increase momentum, so I'd appreciate any outline you can give around how you structure timing and duration. Thanks as always.

[@patriciacoughlinphd1852]

ISTDP was designed in a particular way for a reason - beginning with a 3 hour trial therapy. This gives you time to get through the central dynamic sequence, to assess the patient's capacity and facilitate a therapeutic experience in the first encounter. Doing so accelerates and condensed the process. If you don't begin this way the whole process will be affected.

[@kevinnaidu3713]

Hi Patricia. I absolutely agree with what your saying here believe I do as it makes perfect sense logically and theoretically. I'm very envious that your patients are able to come twice a day for three days. I would love to be able to work in this way. My reality is I see patients who are unemployed, referred by third parties, highly medicated at times and really unmotivated for treatment at the outset. I might only have one session with them or two. Can I package istdp into a single session format. Is that possible or not really?

[@patriciacoughlinphd1852]

I no longer do block therapy. That used to be the only alternative for patents who lived at a distance. Now patients who are at a distance can be seen remotely. Of course you are limited by only having one session, but learning to deal with resistances to treatment, finding ways to boost alliance and inviting the negative feelings toward caretakers and helpers who have not helped, will also increase your effectiveness. Have you trained in ISTDP or read up on the model. It could be very useful to you.

[@nirahamvidrohin5266]

Thank you so much for the wisdom you're sharing. Your videos are immensely helpful. I've got a request to do a video about so called "rotating fronts". I heard this concept in one of Allan Abbass'es lectures but I find it quite difficult to grasp. Maybe you could illustrate it with a vignette and describe it in your own words. Once again, very grateful for your channel. Thanks.

[@patriciacoughlinphd1852]

This is not a concept I use or teach. I believe he is talking about whether anxiety, defense or feelings are in the front of the system. This can change or rotate very rapidly. Rather than singling out one aspect of the patients conflict, I like to keep the conflict in view. While the patient may experience a sudden spike in anxiety, which certainly has to be down regulated, that is happening in the context of a conflict. For example, When you even acknowledge feeling anger toward your mother, your anxiety spikes and you cannot think straight. Here we have the triggering feeling toward an attachment figure that evokes high anxiety. The patient defends by getting confused. So, again, while we might see one aspect standing out in any moment, it is of the utmost importance to keep the conflict in mind.

[@nirahamvidrohin5266]

@@patriciacoughlinphd1852 Thank you very much. 🙏

[@B_27]

I've been working very hard to bring up any feelings that arise in the transference and in doing so I have noticed that my feelings towards my therapist have become less obsessive and less "desperate" (for lack of better words). Despite being aware that this is a good thing, I feel as though I am not ready to lose that idealised version of my therapist. I can only assume that fantasy is filling some need that I have yet to find a way of meeting elsewhere. If my therapist isn't the most important person in my life then my life feels empty. Do you think there is a grieving process involved in the transition from "fantasy therapist" to "real therapist"? How does one navigate this without sabotaging progress?

[@patriciacoughlinphd1852]

I am glad to hear you are being open and honest with your therapist - and that that has resulted in a decrease in obsessing about him or her. The goal of therapy is to heal, create a full and satisfying life and leave treatment! I would urge you to invest in your personal relationships which are real and lasting.

[@B_27]

@@patriciacoughlinphd1852 Thank you, I am trying to do that 🙂