Projection and Transference

Projection occurs when a person has a thought or feeling that he or she isn't comfortable with and then "projects" it onto others, or considers it the other person's issue. For example, if a practitioner feels sad, he or she may be experiencing the client's sadness, and ask about it. When a practitioner is unaware of feeling angry, he or she may perceive the client as angry, or angry with the practitioner. The primary danger of projection is that the practitioner may not understand what the client is truly feeling, and will fail to help him or her in an appropriate way. Instead, the practitioner tries to help the client with issues and in ways that the practitioner needs. Keep in mind that projection mostly occurs on an unconscious level.

Example 1: A practitioner has recently lost a loved one and has been grieving for several weeks. A client comes in for a session and isn't as animated as usual. The practitioner makes an assumption that the client is feeling sad, and begins to offer words of comfort, such as "Don't worry, everything will be OK," or "It's OK to feel sad." The practitioner gives the client a reassuring pat on the shoulder. The client responds by saying, "What do you mean? I feel fine." The practitioner then says, "It's normal not to want to admit it when you feel down or sad, but this is a safe environment for you." The client is perplexed and leaves, wondering, "What was up with that practitioner?" and feels uncomfortable returning.

Example 2: A practitioner with a great deal of unresolved anger about a recent relationship sees a client for a session. Throughout the session, the client makes several requests for a change in the manner in which the treatment is carried out. After each request, the practitioner feels uneasy and concludes that the client is dissatisfied and angry with the practitioner. The practitioner also feels hurt and uncomfortable after each request and begins to withdraw and become distant. As a result, the client becomes more demanding, and feels the practitioner is not present. The treatment ends with the client feeling dissatisfied with the quality of the practitioner's work and the practitioner feeling disrespected.

A client seeks treatment believing the practitioner knows best. Clients defer to the practitioner's judgment because they desire to be helped by an authority figure that possesses greater knowledge, healing ability and, therefore, power. Since a power differential exists in any health care relationship, the client may be inclined to respond to the practitioner as he or she would other authority figures, and in doing so, may recreate elements of similar past relationships. This situation is known as transference, a normal, unconscious phenomenon that appears during a therapeutic process. Professional helping relationships usually have a strong transference element in which the parent-child relationship is unconsciously re-established. In transference, unresolved needs, feelings and issues from childhood are transferred onto the helper. Whenever there is a power differential in a relationship, there is a strong potential for transference and counter-transference to arise. Transference also may occur in other relationships in which there is a real or perceived power differential, such as with a boss, teacher or clergy.

Learning to recognize transference in yourself and in others is essential for building a successful practice.  Creating and maintaining strong boundaries is essential in working with clients who are in transference with you.  When clients seek out therapy for specific reasons they are usually looking for an expert to help them with their issues.  They come to believe that we know more about them than they do themselves.  They come looking for answers to their pain and dysfunctions.  They come looking to get the unmet needs of early childhood attended to without really knowing it. The fact that clients take their clothes of to some extent creates a vulnerability that is unique to the massage profession. The power of touch also takes people to a deeper part of themselves where these unmet needs and repressed feelings live.  It is an unconscious process in all relationships.  

The power of touch in stimulating transference hasn't been formally studied, but anecdotal evidence suggests that touch, especially when it's intentional and done with care, can create regressive experiences. Clients frequently disclose personal information, talk about their emotional problems or demand special treatment. On an unconscious level, clients often expect practitioners to help them emotionally and in other areas, as well. These are transference reactions. Practitioners need to understand and deal with these situations in a gentle, appropriate manner. In mature adult clients, these feelings will likely be recognized and not control their behavior; however, in individuals incapable of handling these feelings, transference may become the dominant reality and cause frequent disappointment and feelings of rejection, often followed by anger and withdrawal. Maintaining clear boundaries is crucial for handling transference and ensuring it does not negatively impact the therapeutic relationship.

Signs of Transference

• The client frequently asks you personal questions.
• The client calls you at home, knowing that calls should be placed to your office.
• After only one or two treatments, the client is overly complimentary of you and your work.
• The client tries to bargain with you for a reduced rate.
• The client regularly requests that you change your schedule to accommodate his or her schedule.
• The client brings you gifts.
• The client repeatedly invites you to social engagements and feels rejected when you explain your policy of separating your work and social life.
• The client asks you to do "a little bit more" at the end of most treatment sessions and expresses disapproval if you don't comply.
• The client asks you to help him/her solve personal problems.
• The client frequently asks you questions in areas that you've previously explained aren't within your scope of practice.
• This client often mentions that you remind him/her of someone.
• The client has difficulty maintaining a physical boundary and attempts to inappropriately hug or touch you at the end of each session.
• The client has difficulty leaving after the session and tries to engage you in conversation.
• The client gives you intimate details about his or her personal life.

The Blending of Transference and Counter-Transference

Together, transference and counter-transference form a potentially volatile mixture within power differential relationships. Transference and counter-transference affect the answers to the questions we posed before: How is the person who holds the power using that power, and how is the person with less power responding? When both individuals in a relationship are psychologically mature, there is greater assurance that they will use or handle power in a healthy way; nevertheless, such maturity doesn't ensure that transference and counter-transference won't occur.

The practitioner working with psychologically immature clients has a serious responsibility, because such clients may be unaware of the transference they bring to the therapeutic relationship. The practitioner must cultivate his/her own awareness of both transference and counter-transference and consciously mitigate against their effects. Individuals more prone to transference include children or adolescents, needy clients, and clients that have been referred by mental-health professionals to assist in the processing of psychological issues.

A good goal for practitioners is to minimize the potential for unconscious "acting out" of power issues in the therapeutic relationship; nevertheless, the person who holds the power in a relationship may have difficulty recognizing transference and counter-transference. Getting supervision on a regular basis gives the practitioner the opportunity to explore these issues, gain clarity and learn methods for dealing effectively and ethically within the situation.