What would therapy look like if therapist followed this protocol?

How to reduce the risk of adverse idealising transference

Inform clients about the phenomenon at the beginning of the therapy.

Carry out regular reviews in which the potential for AIT is monitored.

Maintain consistent professional boundaries and refrain from personal disclosures that could encourage idealisation.

Refrain from making the client feel special.

Be clear that the relationship can only ever be professional.

If the potential for AIT becomes apparent, discuss it with the client in order to work out the best way of tackling it.

Take it to supervision and seek external consultation if it persists.

Take responsibility for any actions that contributed to the idealisation.

Refrain from acting defensively by blame, rejection and sudden rigid boundaries, or terminating the therapy without the agreed notice period.

Very interesting. Does idealized transference always have to be bad?

With babies/toddlers, there might be an evolutionary purpose for the idealization and attachment, even if the parent is subpar in reality. Can I.T. in therapy serve as a “good enough” replacement for a missed attachment opportunity from a time when idealization was a critical driver behind survival mechanisms — one that a client can experience reparative socioemotional development in, and more importantly through, with a properly trained therapist?

Agree, idealization in infants or toddlers serves a purpose.

I think what happens is that the function of idealization can sometimes get messed up, due to trauma, etc. Here's something I think might be useful as a "stage model" to help people move beyond the messed up idealization and other things.

http://relational-integrative-psycho...ry-handout.pdf

But how to get the clients who might benefit to the therapists who might know how to help? Most of us clients have no clue until regular therapy becomes "adverse". And the therapists I've seen had no clue either.

I really like Moxie's idea of putting the possibilities out there to begin with, rather than waiting until an adverse transference just "happens".

If I would number the items in your protocol then based on my own experience I would say that the items 1, 2 and 6 are not really necessary when other points are fulfilled.

I.e. if the therapist is acting professionally, is not fuelling anything but is not backed of anything and does not become defensive either, then there simply is no need to explicitly initiate the review of these topics by the therapist. He would just maintain a stable and consistent presence and company to the patient while the transference storm is going on - not making the storm stronger, not trying to flee into inside leaving the patient alone in the storm.

If these other points are not fulfilled, then I'm not sure the points 1, 2 and 6 would accomplish anything per se.

Sure, if the patient is initiating the discussion of these items, then they must be discussed, of course.

Your T's problem is that unfortunately he seems to have no clue how to be a dependable, stable and consistent presence to his patients, so that his patients could truly rely on him when working with their vulnerable and intense feelings. This is precisely what incompetence means. Heck, he wouldn't even have to do much - just be present, try to understand as best as you can, don't take it personally, don't judge. But I think the problem might be that therapists who haven't had any specialised training about working with transferences and who haven't had the experience of being the originator of the transferences, even if not that intense, actually start taking things personally and then things go awry.

This!

Transference comes from the client. A good T will do as described above.

I think people see mental health workers more than skilled therapist and think that's therapy.

[I]Idealising transference – Then, as infants grow and explore their world, they look up to their
parent/s as strong, powerful and confident; they learn to count on their parents to provide a sense of
safety, security and freedom. Thus the child admires (idealises) this all-powerful caregiver and
absorbs these admired qualities into their own values and ambitions (internalising the parent). The
process is similar in therapy, where – in transference - the client may initially idealise the therapist.
Eventually clients come to develop a more realistic picture of the therapist’s limitations and
fallibility. If this process involves small ‘optimal frustrations’ (such as the therapist being late for an
appointment) rather than dramatic, unmanageable disillusionment (forgetting the client’s name and
history) causing a rupture in the relationship, the client’s narcissism is thought to follow a healthy
pattern of development.[/I]

Exactly when do I develop a more realistic picture of my therapist that will help me overcome idealizing transference? Yeah he is being an jerk now but it is not helping it is making me feel like I am bad and have done something wrong to make him not want me around anymore.

You make some good points here. I know you're talking about Moxie's T here, but I think some of it applies to my T as well. Where he tends to take some of my transference and attachment stuff personally. And assumes it's entirely about *him* when much of it is more what he represents to me. And he lets his own feelings out in the room and gets defensive at times. I like the term "transference storm"--it's an evocative description. I think it fits for me, too, because at times it's quite strong and other times not really there at all--perhaps a few transference clouds, but that's it. Other times, it's like a tornado or hurricane.

That's a good question. It's similar to how I reacted with my former marriage counselor, when we had ruptures. I just felt like I was doing something wrong and just wanted him to accept me again. But eventually, with the final one, it was like he didn't look the same to me. I didn't get the same feeling when I looked in his eyes. So I think that may have been the transference going away. But that took a bit of time, it wasn't immediately after he was a jerk to me.

I took this to Quora.....take answers with a grain of salt but someone posted this:

It sounds like he made a clinical decision regarding your treatment. He thought you needed fewer sessions.

Sit back with that feeling of being “punished.” Unpack it. How much of it is the emotional attachment? Could his sternness just be a professional demeanor? How much of your reaction feels like emotional rejection? A fair bit, I expect.

That’s the attachment. Your side is emotional. His is not. You are being forthright and so is he. He is doing what he is trained to do, which is support you to the point that you need it. He is guiding you toward your therapeutic goals.

Most of what you wrote sounds fine and like what the therapist should be doing anyway (maintaining boundaries, using supervision, etc.). These two, though:
I think can cause problems rather than avoid them. Some people are very suggestible and if the therapist tells them "X is a possible outcome," then the client will be more likely to have that outcome rather than less. Other people might go the opposite way and reject those feelings without working with them. And then some people will just find the whole thing scary or think the therapist is an arrogant jerk ("Oh, I might idealize you? Yeah right") and leave therapy. I think it is better for a therapist to just see what happens and deal with problems as they arise.

I think you are overlooking the enormous, harmful consequences to those of us who would have been better served by knowing the possibilities in advance. So -- a balancing act, maybe, in terms of the therapy-seeking population as a whole?

From my perspective though -- are you just not hearing about the harm that NOT addressing the possibility of an AIT has done to people on this forum? Or do you just not believe it?

A decent, different viewpoint.

Seems to me that you still need some help in dealing with the (feeling of) emotional rejection. And punishment. Maybe that's from the past but just contrasting that with the present, as your T has suggested, does not seem to help much?

I certainly believe that the OP and others on this forum have suffered a great deal of pain. I just think that a warning can have its own adverse effects, and in addition, I'm not convinced that it would actually prevent anyone from developing transference feelings anyway.

As one who has experienced the pain, I do think it would have helped to have known in advance and gotten my cognition engaged at the beginning of the process, and to have had that be a part of a "therapeutic alliance".

Since you have not experienced this kind of pain and harm I can understand if you are not convinced. But can you see that it is perhaps because you just don't know what the experience is and is like? How can you be convinced that something will help if you don't know what the situation is like?

Alternatively, do you have any suggestions to offer which would help to prevent the kind of pain and harm which, some of us know from personal experience, can happen in therapy?

Look at it this way. You are considering the OP's questions from the perspective of one set of experiences. I am considering it from another. What might be a good "protocol" for you would have been, at best, irrelevant and unnecessary for me, and quite possibly inhibiting and detrimental to therapy.

I am not sure why I would bother offering suggestions when, in your second paragraph, you have already discounted my opinion as being based in ignorance. However, I will say that if a person is predisposed to experience a certain type of transference in therapy, they are likely to experience that transference in other relationships as well.

Yes, that's what I was saying, too, or trying to. We agree on your conclusion.

I am not discounting your opinion, for yourself and your experience.

I said that I don't think you know what the experience of harm and pain is like, for those of us who have experienced it, and so your opinion does not speak to that experience. Do you disagree?

The OP has made some suggestions that she thinks would work for her and I think they would have worked for me, too. You don't think they would work for you, and so don't want them added to the protocol.

But that still leaves the question -- what to do to try to prevent the horrible pain and harm that some of us have as a result of "therapy". I am concerned about that. Perhaps you are not?

I, for one, did not experience anything like the problems I had in therapy relationships with any relationships in real life. So, once, again, our experiences seem to have been different.

This list does not seem very realistic.

Clients also have to do their research prior to engaging in therapy and be informed of what it entails. Similar to choosing a doctor or a mechanic or a hair salon where people do their own research and know what they are getting into, as well as what to expect. Hence, the onus ought not to be solely on the therapist.

Moreover, some of the points listed are also ambiguous and a matter of subjective perception. Issues such as disclosure, idealisation, responsibility.

How much is too much disclosure? We are dealing with human beings, not robots or blank slates. As such, how to avoid revealing anything personal? That is not realistic. Should that be avoided at all costs? That is one major aspect of psychoanalytic therapies anyway, whereby the clinical coldness of the disengaged analyst is majorly criticised and deemed *not* to be beneficial.

As for making clients feel special, that is also a matter of perception. What one client assumes is special treatment might not be. So, where to draw the line? Some might misinterpret benign gestures/behaviours as special. Is that also the therapist's fault?

Same with idealisation. Why should therapists take sole responsibility for someone else idealising them? What about the clients’ personal agency. Clients share the responsibility for their own therapy and as such, ought not to be abdicated of responsibility themselves.

I agree that Ts ought to have regular supervision and adhere to ethical and professional boundaries. But then again, therapy is not 'done to' clients. The latter play an active part in their own therapy, or ought to. However, I find this list infantilises clients. Most, if not all, of the responsibility is placed squarely on the T’s shoulders. What about the clients' responsibility?

I am not sure how AIT is potentially more harmful than any other kind of transference, or indeed other psychological phenomena which emerge in the therapy room. Should therapists have different warnings and protocols for each type of transference and phenomenon?

It doesn't seem very realistic and I wonder how much time would be left for the therapeutic work amongst all the checklists and procedures.

same....this is exactly what happened in my therapy and what ex-T struggled with. and he was seeking regular fortnightly private supervision with a supervisor he had worked with for many many years. in fact, his super, at the time i was seeing T, was the head of the psychotherapy accreditation association in my country. so, not quite sure what to make of that, because even regular supervision with a quite prestigious supervisor didn't calm the transference storms that regularly kept brewing.

I think those guys need to spend a lot more time warning clients about the dark side of therapy and the side effects, the lack of real studies, and the fact that they are just guessing at it.

I completely disagree with this. I think those people are already condescending patronizing enough without giving them this sort of pass. Clients deserve informed consent. And they deserve to be warned about the harmful parts of therapy BEFORE they happen.

and because 'those guys' probably won't ever do that anytime soon, that is definilty one reason why i continue to come to these forums and share my story.

Yeah, I agree that informed consent is something that should be covered to a much higher degree than it is. And I think the argument that people shouldn't be informed about risks because we are suggestible or may back out is bogus. I mean, that's not an acceptable reason to not disclose the risks for other things, so why therapy? For example, when we take over the counter or prescription medication, we are given information on the possible side effects, contraindications, etc.

For me personally, if I look at the list of side effects and see weight gain, I don't want to take that medication. If my doctor/pharmacist/drug manufacturer just withheld that information and waited until a possible side effect "arose" for me personally and I was wondering why I had gained 100 lbs and developed type II diabetes, nobody would think that was ok.* Same with any sort of physical medical procedure. You wouldn't want a surgeon letting you know that you might require a second surgery only once the necessity "arose." So why would it be ok to just address things as they come up in therapy? If we accept the idea that people have a right to autonomy in making decisions about their own care, then you can't just address situations as they arise. That's just paternalistic.

* Yes, I realize that drugs are a dicey subject since usually not all of the side effects are known for many years, let alone prevalence rates. My point is that compared to the therapy industry, the pharmaceutical industry is downright transparent about known risks of undergoing any treatment.

What could be more infantilizing, and more unethical, than shielding the client from the truth on the basis that they might be scared away.

Either you treat the consumer like an adult (rather than a helpless toddler or moron) and have an honest discussion about the transference game, or you don't and you are unethical. Choose one.

The other problem is that many therapists probably cannot give a clear breakdown of the risks because they avoid looking at that side of things.

My therapists treated me like an adult and never had discussions with me about transference and they were highly ethical.

Therapy isn’t as black and white as you make it out to be. It isn’t that simple.