As a psychodynamic therapist, supervisor and lecturer, Myira Khan is used to paying particular attention to the pre-transference, transference and countertransference. Here, she observes how closely tied her modality is to her spirituality and explains why this makes such a difference to the depth of the therapeutic relationship.
The relationship starts before you meet
There is an element of pre-transference that happens before you have even met the client. It can be a ‘gut’ feeling you have at any moment up until you meet them, from when you read an assessment or take a phone call, right up until the morning you are meeting them, when they turn up on your doorstep.
As you are reading a client assessment, take some time to ask yourself: how am I feeling? What is my countertransference response to this client?
It is not linear
You may not know, at the time, why you are behaving a certain way before meeting a client, but then once you have met the client, you might think, ‘Oh yes, that feeling I had, or that thing I did that I don’t usually do, makes sense now that I have met the client. It fits with the blueprint for their internal world’.
You will only know about it once it has happened. You can’t prepare for the pre-transference or think, ‘I’m going to look out for it’. It relies on a process of self-reflection and the use of hindsight.
Draw upon your self-awareness and make a mental note of what you are doing and how you are acting in the days and hours before you meet your client.
It involves a tracking process
Right before the session, I always ask myself how I am feeling because I want to know how that changes throughout the session. Then I ask myself how I feel straight after the session. For me, that is quite an intentional conscious process. I track my experience so that afterwards I can make sense of it.
Therapy is about timelines. It is part of a story with a beginning, middle and end; a before, during and after. And that happens on both a macro and a micro scale: for each session, and for the therapy itself.
Very often, there won’t be a specific moment, or session, when everything changed. There aren’t always dramatic, life-changing sessions. Each week, it can perhaps feel like nothing much happens, but then you zoom out and look at the whole thing and you think, actually, everything happened and it all changed. It can feel cumulative.
And the whole process is the work. It is not just the 50-minute session but the entire time you are in contact with the client.
Spend some time directly after the session unpicking the pre-transference, transference and countertransference. Ask yourself: how has the client left me feeling? Has the client stayed with me? Some clients linger in the room, energetically speaking.
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Relationship enables change
When you look at the process, there is an awareness that an evolution has happened over time, but it is also clear that a client needs to do that in relationship with somebody else to enable that metamorphosis. And that is always beautiful to see.
When you do a review with a client, or an ending session, it can be empowering for clients to reflect on and acknowledge how far they have come. During therapy, it can be difficult for clients to acknowledge progress.
Everything is rich data
A key part of working psychodynamically is recognising that everything that is said, whether consciously or unconsciously, is a communication. As practitioners, our countertransference provides rich data about the relationship that the client is trying to set up, and also about what they are trying to say about themselves. With that in mind, nothing is a coincidence. Turning up late, turning up early, missing sessions and anything else that we would consider a break to the frame, offers information.
When the client makes changes to the frame, ask yourself: what is the client trying to tell me?
The client’s spiritual beliefs offer another form of communication
When you ask the client about their faith, belief or spirituality in an assessment, their answer tells you something. It tells you how they have interpreted the question. For someone to say, ‘I’m an atheist’ tells me that they don’t subscribe to a religion, but that they are sharing a belief that they have with me.
Just the idea of asking that question in an assessment is so rich because it tells you something about their worldviews, their lived experience and their sense of self. Straightaway, it opens up the question of what life means to this person.
Recognise that a question about faith can get minimised into a binary, closed, ‘Are you religious or not?’ question. There is a difference between being a religious person and being a spiritual person. How you practise your spirituality may not look exactly the same as a religion – and it won’t because it’s individual. You may have a faith or belief, but your spirituality involves going for walks in the country, for example, or experiencing solitude or silence.
On the assessment form, you could follow up a question about faith with more curious, invitational questions such as: how does that show up in your life? How do these practices support your wellbeing, mental health and self-care?
Countertransference can be spiritual
For me, countertransference feels very intuitive. I might have a fleeting thought about something and then wonder, ‘Well, how on earth could that be related to my client?’, and then, later on, it will be there in something that emerges.
Intuition bypasses the conscious, logical part of our brain and sinks straight down into our gut, which is also where our empathy is.
We can consciously hear our clients and we can think about them from a very thinking, theoretical, modality-based perspective, but the ‘gut brain’ can provide such richness about how a client is coming across and what they are communicating.
As spiritual beings, we are connected to one another. Working psychodynamically speaks to our sense of self and our sense of being souls because we have to accept that we have a conscious and an unconscious and that we are communicating with one another all of the time.
Can I bypass, or override, what my logical, conscious brain is saying and attune to what my soul is hearing and listening to and picking up from this client? It may not be very tangible, but there will be something there and it is a good idea to make a note of that.
Empathy is a muscle
From day one of week one, I get my students to practise listening to their intuition and empathy because they want to ‘get it’ up in their brains, but I like them to ‘get it’ down in their bellies.
I do believe that you can teach this, because this is the process I have gone through myself. I have always been incredibly intuitive, but you have to match that up with a real practice of empathy. I talk about empathy being a muscle. You go to the gym to strengthen physical body muscles, so why are we not doing that with empathy when empathy is one of the core muscles that we use as counsellors?
When you practise, you become more attuned to it, but also it’s more precise, so that when you are sitting with a client, your empathy muscle is working.
Give your empathy a workout by practising feeling into it when you read a book, watch a TV show, or listen to a piece of music.
Give yourself five minutes
Before the doorbell goes or you’re jumping on Zoom, give yourself time to just sit and listen to yourself and ask how you are feeling. When people first start training, they tend to need more time because it takes them longer to tune into themselves or feel grounded.
Take five minutes to identify what’s going on in your gut so that you can be grounded in who you are and how you are feeling right now.
Think of yourself as a washing machine
I like to use the washing machine metaphor. As counsellors, we are a washing machine, and we are taking in our clients’ laundry. Our client loads the machine and, when we take on board the laundry, we will use our empathy muscle to literally feel what that laundry is.
If, prior to a session, we are still fully loaded with our stuff, and we haven’t emptied ourselves of it, we do not have the emotional capacity to be loaded up with the client’s laundry. It is the equivalent of going to load up the machine and realising that the last load is still in there.
Use your five minutes to ask yourself: what's in my washing machine? Can I metaphorically put it in a basket and put it to one side? If there is something I am thinking about, do I need to bookmark it for later? Having emptied my own washing machine, can I then sit with how I am feeling?