Responding to an Immediate Negative Transference

• A Cold Opening
• Are You Orthodox?
• A Transference Blooms
• Fits and Starts

A Cold Opening

When my friend and colleague, Jessica, called to make the referral, she said, “She’s an analyst, really smart and a great person. You’re going to love her.”

Sally arrived in my office about ten minutes before her appointment began. When I opened the door to the waiting room to invite her in, I saw a tall, thin, woman with gray hair. She was dressed simply in a gray wool skirt and black turtleneck sweater, but there was something elegant, almost aristocratic in the way she carried herself when she got up from glancing at a magazine and entered my office. I felt instantly inferior to her.

I greeted her: “Hello Sally, why don’t you come in.” I invited her to sit wherever she was comfortable. Then I sat in my chair and faced her silently. I thought about the fact that she was a more experienced analyst than I was. If she had never been in treatment before, I might have waited a minute and if she was silent said, “So tell me what brought you to see me.” But since she was an analyst herself, I just waited for her to tell me why she came.

“You’re pretty cold, aren’t you--silent and cold. But maybe that’s not bad. Maybe that will be more analytic and help the transference come out faster than if you were warm and fuzzy.”

I was taken aback because I don’t imagine myself as silent and cold. I thought I was warm but giving her the space to present herself. Indeed, this was the first thing I learned in my first class in analytic training. So I was speechless when Sally accused me of not knowing how to begin a session properly; but before I had a chance to respond, she continued.

“Let me tell you about my history.” Her face was expressionless as she pulled aside her long gray hair that was partially covering her right temple and continued. “When I was five years old, I was in front of my house waiting for the school bus with my younger brother. A car ran me over and I almost lost my right eye. I was in the hospital for months. They saved the eye, but I have this scar.” She pointed to a slightly indented grayish patch of skin that started at the edge of her eye socket and extended to her hairline. I made an inaudible noise and grimaced to express my understanding that this was a traumatic experience. But she continued before I could utter a sentence. “Then when I was 15, my mother, brother, sister and I were going to California to see my maternal grandmother who was dying. My father dropped us off at the airport in Chicago and then before we got on the plane, a policeman came and told my mother that my father and his driver were in a car accident and my father was dead.” Again I gasped, this time in disbelief that so much tragedy had befallen her at such a young age. But she continued telling the story without affect as if she were giving me a chronology of what she did over the weekend. I wanted to say something empathic to her, but I would have had to interrupt her to do it. So I just decided to listen until she gave me an opportunity to speak.

When Sally finished telling me the history she thought was relevant for me to know, she turned to telling me about her present life. She told me she had a husband, son and daughter. Then she got around to why she came.

Are You Orthodox?

“I’ve come because I’m depressed. I was terribly depressed a few years ago and went into couples’ therapy with my husband John. It helped, but I’m depressed again and I’m also worried about my son. He doesn’t have a job and I’m afraid he’s not doing the right things to get one. Also, I’m going to be 60 and I feel terrible about it…”

I was about to ask her what was so terrible about being 60 when she continued;

“The thing is that I think there’s something wrong with my brain.” She started to get teary for the first time. “I used to remember everything. But now I take notes on every single session because I’m afraid to forget; I walk into a room and forget why I came. I go to get the car and realize I forgot the keys. I know something is wrong with me.”

I thought to myself, I constantly forget what I’m looking for and where I put my keys.

My impulse was to reassure her. I wanted to blurt out: Oh, that’s nothing. I do that all the time. If she were a friend, rather than a patient, that’s what I would have done.

Sally continued in a voice that sounded frightened. “I think I may be getting Alzheimer’s. I always remembered everything and now I have to make lists to remember things.”

I have to make lists to remember things too. I resisted the impulse because reassuring her might seem to her that I wasn’t really hearing her. I didn’t want to trivialize her anxiety. And, after all, there could be something wrong with her brain.

“I went to a neurologist and he said there was nothing wrong. But I heard about this cognitive test regimen you can take and I’m going to do it.”

I wanted to say: That sounds like a good idea. But she continued without skipping a beat.

“I don’t want anyone who knows me to know about this. Some analysts talk about their patients with each other. But I think that’s terrible. I came to you because you’re not involved in my circle. I won’t tell any of my friends except Jessica and I’m terrified of them finding out.” I felt stung by her pointing out that I wasn’t “in her circle.” But I knew I had to let that go. I knew what I should say was: “What’s the terror?” But I didn’t want to cut in. I looked at the clock and the session was over, but I would have had to interrupt her to tell her. But then, as if she knew the session was over, she said,

“You haven’t said anything all session. You just sat there like a silent analyst. I guess you’re quite orthodox or maybe you’re just inexperienced.”

I felt “put down” and misunderstood. I needed to say something, but the session was over and I was feeling furious at her. I was afraid I would blurt out something angry. I dug my nails into the palms of my hands to try and get control over myself. “Well, we’re going to have to stop in a minute. But I think it’s a good thing that you’ve come because it sounds like you’ve experienced a great deal of trauma and loss. Turning 60 seems to be a catalyst for re-experiencing those feelings again.”

I sat in my chair for a few minutes after she left and thought about what I was feeling about her and what my friend Jessica had said about her. “You’re going to love her.” But I didn’t love her; I was struck by how controlling and critical she was during the session. I wondered about the disparity in our perceptions of Sally. What’s was going on here?

A Transference Blooms

When Sally returned the following week, she seemed calmer and less frightened. My back relaxed. But then she began the session by noticing that my chair seat was higher than the other chairs in the office.

“No therapist has a chair higher than her patient. It’s such a basic thing.”

I felt like my mother had slapped me across the face. I could feel the sting in my cheeks. I wondered if my cheeks were red and if she could tell. It had never dawned on me to consider the height of my chair in comparison to the other chairs in the office. Sally’s criticism made me feel like a fool. Once again I dug my nails into my palms to try and get control of myself. I spoke very quietly:

“What does it mean if my seat is higher than the others in the room?”

“You must be insecure and need to be higher than your patient. I have never been in a therapist’s office with seats of different heights.”

I bit my lower lip, trying to control my rage. “You seem to equate the height of the chairs with differences in status.”

“Yes, I feel like you’re trying to be superior to your patients.”

After what felt like a long pause during which I was trying to tamp down my anger, I said: “To my patients, or to you?”
“Yes, of course, to me.”

Trying to keep my composure, I spoke slowly and quietly: “Are we competing?”

“Yes, I guess we’re competing. I don’t want to feel lower.”

There was silence for a moment. She seemed to immediately understand that her feelings about the chair were more about her than me. Then she went back to the story about her father’s death that she had told me about the prior week which indicated to me that we had come to some transferential understanding of the importance of the height of the chairs in my office. I could feel the muscles in my back relax.

“My father had a driver. They drove Mom and me to the airport because we were visiting Grandma in California. The driver hit a truck and my father wasn’t wearing a seat belt so he was thrown from the car. He was probably decapitated.”
I felt stunned and I’m not sure if I gasped. Part of what staggered me, aside from the inherent horror of what she was saying, was that Sally said it without affect as if she were saying: “My father was probably wearing his blue suit.” That amplified my shock because I was completely unprepared for it. I had an image of her father’s bloodied head flying onto the highway while his disheveled body was thrown to the side of the road. I was speechless and Sally went on to another topic.

“I’m really angry at John because he keeps saying my anxiety about losing my cognitive capacity is silly.” She's worried about losing her head, I thought.

“That must feel like he doesn’t understand how frightening it is for you…" I said. "Unfortunately, we are going to have to stop for now.”

The next session I was afraid to open the door to my office and invite Sally in. I could feel myself tightening up in expectation of her criticism. She was consistent.

“You know it’s really odd that your magazines are old and you cut off the address label on the magazines in the waiting room.”

I felt exposed. What did this mean about me?

“I’ve never seen such a thing.” She continued, “You must order the magazines for your house and then bring them here!” She was outraged at the idea.

It was true; she was right. I didn’t really understand what was wrong with doing that.

“What is it about taking the mailing labels off the magazines," I asked, "that is upsetting to you?”

“It means that you don’t subscribe for the office, you subscribe for your house.”

“What is it about that, that’s upsetting?”

She took a breath; she was trying to figure it out. “My parents had a very romantic relationship. Every night they had a cocktail in the living room together when my father came home from work and we weren’t able to talk to them or even go in the room during cocktail hour. I think it feels the same to me. Your patients are secondary to your real life. We get the magazines with the label torn off.”

I felt that something important was happening. Each week she came in criticizing me and I felt exposed and inadequate. Each time we were able to understand what these criticisms meant to her, but we had not talked about what it meant that she was always criticizing me. I felt a dread that reminded me of how I felt when my mother came home from work. There was always something I had done wrong. I wondered what it meant that I was dreading Sally’s next criticism of me. Was this my countertransference or was this what she felt about her mother? Or both!

Fits and Starts

The next session Sally came in saying she felt very depressed. She realized that she forgot to put on make-up or comb her hair before she came to my office. She analyzed it herself:

“That’s very interesting. I’ve never done that before. I seem to want you to see me without any decoration.”

I thought that was a great breakthrough; she wanted me to see how she really feels underneath her façade. I decided to take a risk and make an interpretation.

“You’re critical of me, but I think you’re hyper-critical of yourself.”

“You mean you think I’m projecting my own feelings of inadequacy on you?”

“Yes exactly. I think you’re treating me the way your mother treated you.”

“I feel so relieved. Yes, that’s right.”

I felt that was an important moment in our work together. I finally addressed how critical she was of me. I was much happier to see her when I opened the door to my office the next week.

Sally handed me the check to pay the bill for the prior month. I took the check and crossed off her name in my book to indicate she paid.

“What are you doing that for?” She said in an outraged tone.

“Doing what?”

“Writing down that I paid you. I’ve never heard of anyone doing that.”

“I don’t know what you mean.”

“You mark it down after the patient leaves, not while I’m here.”

I was feeling speechless once again. I never noticed what Anna did after I gave her a check because I always turned around and walked over to the couch to lie down. I was barely able to utter: “What does it mean that I’m marking down that you paid while you’re here?”

“It’s unprofessional that’s all. Anyway, I’ve been thinking about whether I want to see you or not. It’s a big trip from where I live to get here.”

“Do you think there might be something more to it?”

“Well, I liked what you said last time. It made me feel much better to think that you’re not inadequate; I’m just projecting. But I think I liked you better when you didn’t talk. I want to know what you think, but when you tell me what you think it’s what I’d say if I were you.”

“Is that good or bad?”

“I don’t know. When you were silent it gave me room for my own associations.”

I felt damned if I did and damned if I didn’t. It felt just like my situation with my mother—whatever I did it would not be right.

“Do you think not wanting to see me might be related to my saying something that was helpful to you?”

“Yes, I think I’m competitive with you. I want you to help me, but I don’t want to feel you can help me. Especially because you’re so much younger than I am.”

Well, I thought, she’s certainly not like my mother. Sally’s able to consider my questions and look at her own behavior.

The next time I saw Sally she told me she was feeling much better about herself and about me. She realized that her family was very focused on status differences. Her parents were contemptuous of blacks and Jews.

“Do you think that’s related to your feelings about me?”

“Well, you’re probably Jewish and I seem to be competitive with you.”

In the next few sessions Sally told me she felt I was “too nice” and “not analytic enough.” Once again I felt like she was poking a finger at me. It took energy to find something to say to her that wasn’t defensive and angry. Finally, I was able to remove myself and see what this was about. I suggested that “analytic” was her term for cold and uncaring. I was the first female therapist she had and she was ambivalent about whether she wanted a mother who was cold and critical like her mother or warm and “too nice.” Of course, Sally continued to criticize me, but we had developed a working alliance and now the work could continue.  

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