Variations on the Theme of Transference & Counter-Transference in the Treatment of a Ten Year Old Boy*

There are, inevitably, certain patients in our professional lives who affect us more than others. Not only do they affect us more, they actually have a very profound emotional impact on us. As a consequence of this, in order to help these patients, the therapist has to struggle to understand, and not become defended against, the powerful feelings that they experience towards the patient. It is these feelings that are the pathway to being able to understand the urgent, non-verbal communications that the patient is desperately projecting into the therapist (Heimann, 1956; Racker, 1957).

Transference and counter-transference are at the heart of any psychoanalytical therapy and are, ideally, flexibly utilised in every therapy undertaken, according to the receptivity of the patient to such an approach. Transference interpretations may be very rare in some therapies, but frequent in others. The likelihood is that regardless of frequency of transference interpretation, the therapist is using their understanding of the transference/counter-transference process to guide all their responses, verbal and nonverbal, to the patient. There are, however, some patients who enter therapy with an intensity of feeling and need that affects the therapist much more deeply and on a more personal level than others do. The anxiety that is immediately raised is that this is possibly unprofessional over-involvement and due to some neurotic pattern in the therapist which the patient unwittingly fits into. And of course this may well be so. In the best interests of the patient, we must therefore always be prepared to think long and hard about such emotional responses, both on our own and in discussion with colleagues. But when it becomes sufficiently likely that this is not a neurotic response on the therapist's part, we are left with a phenomenon that is very clearly related to the patient, which we are just going to have to learn to live with during the course of their therapy. In such cases w