Case study examples of transference and countertransference

Transference And Countertransference Working With Children

Rescue Fantasies in Child Therapy: Countertransference/ Transference Enactments

Kerry L. Malawista, Ph.D.

ABSTRACT: When the focus of the child treatment is on the therapist being a ‘‘good’’ object, this can accentuate a possible countertransference dif- ficulty of the therapist becoming the protector of the child from the ‘‘bad’’ object. This countertransference can often resonate with rescue fantasies in the child. This paper will explore the topic of rescue fantasies in child treat- ment, while addressing the issue of coinciding fantasies existing uncon- sciously in both the therapist and child, leading to their enactment. A case of a nine-year old boy is presented which demonstrates how interpretation and resolution of rescue fantasies can lead to a deepening of the treatment.

KEY WORDS: Rescue Fantasies; Countertransference; Enactments.

Introduction

Transference and its ubiquitous counterpart, therapist countertrans- ference, are historical cornerstones of psychoanalytic treatment with adults. In contrast, the early days of child psychoanalysis, beginning in the 1930’s, focused less on transference and countertransference, but instead emphasized the ‘‘real relationship’’ between patient and therapist (Freud, 1936). Due to the immaturity of the child, transfer- ence was considered secondary to the ‘‘real’’ positive alliance with the ‘‘good object’’ of the therapist. By de-emphasizing transference, it

Kerry L. Malawista is a Training and Supervising Analyst, The New York Freudian Society and Teaching Faculty, George Washington University, D.C. for psy. D. Pro- gram.

Address for correspondence to Kerry L. Malawista, 9421 Thrush Lane Potomac, MD 20814; e-mail: kMalawista@AOL.com.

The author would like to thank Dr. Peter Malawista and Dr. Aimee Nover for their input and editing of this manuscript.

Child and Adolescent Social Work Journal, Vol. 21, No. 4, August 2004 (� 2004)

373 � 2004 Human Sciences Press, Inc.

is inevitable cohort, therapist countertransference, also remained relatively unexplored; both in the literature and in the consulting room.

This early view of child therapy and analysis was based on the understanding that the process of identification with important peo- ple is much greater in children than adults; and that since the child was living in the present with the significant objects of the past, therapeutic exploration could confine itself to the ‘‘real and current’’ objects, the child’s parents. The therapist could then serve as a ‘‘new, and real, and good object’’ for the child. Yet alongside the ‘‘real object of the present’’ is the inevitable transference representation of the therapist, distorted by the child’s past and current needs and conflicts. When the focus of the child treatment is based on the ther- apist as the ‘‘real and good’’ object, and parents as ‘‘real and bad’’ objects, a possible (if not probable) therapist/patient countertransfer- ence/transference configuration can manifest as corresponding (and correspondingly stubborn) rescue fantasies which can impede the process and progress of the work within the therapeutic dyad.

This paper will explore the topic of rescue fantasies in child treat- ment, while addressing the issue of coinciding fantasies existing unconsciously in both the therapist and child, leading to their enact- ment.

Rescue Fantasies

Early psychoanalytic literature traced the rescue fantasy, the wish to save and rescue the woman, to vicissitudes of the Oedipus com- plex, and studied it particularly in its relationship to the theme of incest (Freud, 1910). Ferenczi (1919) was the first to describe a par- allel phenomenon in analysis, when ‘‘the doctor has unconsciously made himself his patient’s patron or knight.’’ Fifty years later the term rescue fantasy was directly applied to analysts by Greenacre (1966). Esman (1987) provides an excellent review of the literature on rescue fantasies. He highlights Freud’s early emphasis on the ‘‘rescue of the fallen woman,’’ and the transformation of the ‘‘whore’’ into the ‘‘Madonna.’’

Contrary to Freud’s Oedipal focus (an underlying wish to rescue mother from father) of rescue fantasies is Berman (1997) who emphasizes the object of rescue as a projected version of the res- cuer’s own disavowed vulnerability, and the danger from which

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rescue is needed—as a split-off version of the rescuer’s aggression. Similarly, Grinstein (1957) points out that a significant element in some rescue fantasies is hostility toward the object. The rescue fan- tasy is a way to undo the unconscious hostile wishes. Sterba (1940, p. 505) states ‘‘we investigate here the rescue fantasy for its aggres- sive content although the life-preserving, love-affirming attitude of the individual producing the fantasy towards the object to be res- cued appears to contradict the prevalence of any aggressive inten- tion.’’ Thus, there is projection of hostility and then the reaction formation against it. When the expected change or ‘‘rescue’’ does not occur, helplessness and/or anger may ensue.

Rescue fantasies can and should be understood in the context of the family romance. Children often express the idea that they have been adopted, or the wish/fear of being kidnapped, and how wonder- ful life would be if he could be rescued by their ‘‘real parents.’’ Freud’s (1909) formulation of the family romance is the child’s rejec- tion of his own parents as his real ones, and the fantasy that he is the child of other parents who are of nobler origins than his own par- ents. Freud makes the point that the child endows these new parents with the idealized characteristics of his early childhood parents as a way to deal with the natural disappointments and apparent failures of his real parents. Deutsch (1945, p. 416) was the first to describe in detail how the family romance is a way for the child to deal with ambivalence towards the parent. These fantasies are evident in most children and may be even more powerful in children who were adopted, since the presence of other ‘‘real’’ parents is a fact. Both the rescue fantasy and the family romance are means of regaining the idealized omnipotent parent of early childhood (Frosch, 1959).

The treatment situation of children and adolescents, by its nature, provides an atmosphere where rescue fantasies would be prevalent. They seek in the therapist the idealized parent of the family romance. The child and therapist’s fantasies may become complemen- tary, where the child wishes to be rescued and the therapist wishes to rescue the child. Bornstein (1948, p. 696) has said ‘‘no one in con- tinuous contact with children can escape the danger of regression’’ which would include countertransference enactments such as corre- sponding rescue fantasies. The term countertransference can be used in many ways. For this paper, I am referring to Jacob’s (1986) defini- tion, ‘‘influence on [the therapists] understanding and technique that stem from both his transference and his emotional responses to the patient’s transferences (p. 290).

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Countertransference

For many in the ‘‘healing professions’’ the choice of being a therapist may be based on a powerful unconscious rescue fantasy. Volkan (1985) states his belief that the rescue fantasy is a universal deter- minant for therapists in their choice of career. Bernstein and Glenn (1978, p. 380) make the point that the ‘‘wish to be a child analyst frequently stems from the analyst’s maternal identification and an unconscious wish to have a child.’’

Frankiel (1985) wrote an interesting paper that looks at how the wish for a baby in early childhood and the wish to rescue can be revived by the intrinsic structure of the child treatment situation, arousing disruptive countertransference fantasies in some analysts, anxious fantasies and wishes in some parents, and potentiating riv- alry between analyst and parent in some cases. She gives examples from fairy tales and mythology that show this repeated theme of the wish to rescue or steal a child and how these fantasies are replicated in both the child and analyst during treatment. Bernstein and Glenn (1978, p. 385) caution that ‘‘however benign the analysts intention, an enactment of an adoption fantasy is inimical to the real purpose of analysis.’’ Anthony (1986) states that the countertransference gen- erated in analytic work with children is more intense and pervasive than any encountered in adult work. ‘‘The analyst may take the child as a transference object, or react to the child’s transference to him as manifested erotically or aggressively; or he may identify with the child’s parents and become controlling or oversolicitous. or he may find incestuous fears and fantasies stirring as a result of direct body contact with the child’’ (p. 77).

For the child patient, as well as with adult patients, the experience of the therapist as available and nonjudgmental is, of course, gratify- ing and therapeutic. Since this experience can be so satisfying to both participants, the therapist can focus too quickly on the external reality of the child’s problematic relationship with his or her parent, deflect- ing the child’s attention from the transference. Chused (1988) states ‘‘The real dependency needs of all children..., their potential for growth, their tremendous vulnerability to external forces, and the wish to have them grow successfully with minimum suffering, are all powerful seductive forces which lead to countertransference interfer- ences with the development of a transference neurosis’’ (p. 79).

A therapist’s countertransference can take many different forms. A therapist, upon hearing of parents that sound unempathic, or

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seem to cause suffering in the child, may have the fantasy of rescu- ing the child from the ‘‘villain who caused the illness’’ (Gillman, 1992, p. 283). The therapist can become overidentified with the child and unable to see the intrapsychic components of the child’s difficul- ties. Bernstein and Glenn (1978) point out that the analyst’s ‘‘own oedipal involvements are often revived. As a result, he experiences an inner pressure to identify with his patient’’ (p. 379). The thera- pist may enact a competitive countertransference toward the par- ents. This form of countertransference, where the therapist has an unconscious competition with the parents may be particularly pow- erful when it coincides with a child’s own rescue fantasy that the therapist would be a better parent to the child.

Greenacre (1966) portrays the analyst’s rescue fantasy and the analyst’ self-image as substitute parents: ‘‘In such rescue operations, the analyst’s aggression may be allocated to those relatives or thera- pists who have previously been in contact with the patient and are, in fact or in fantasy, contributors to his disturbances. The analyst then becomes the savior through whom the analysand is to be launched’’ (p. 760). The danger of grandiosity and omniscience with our patients is present when there is a mutual rescue fantasy enact- ment that remains unconscious, or is denied.

Enactments

The concept of countertransference enactments was introduced in the literature by Jacob’s (1986). Chused (1997, p. 265) states that an ‘‘enactment is an unconsciously motivated behavior of the analyst (verbal or nonverbal) provoked (usually unconsciously) by the patient.’’ Chused makes the point that in essence the concept of enactment joins together the concepts of ‘‘countertransference’’ and ‘‘acting in’’; but adds the component that it was a ‘‘jointly created interaction’’ (p. 265) fueled by unconscious psychic forces in both patient and analyst. The concept of enactment recognizes that trans- ference may be represented, not only on the verbally symbolized level, but also on the enacted level in the treatment. Chused (1991) distinguishes an enactment from acting out, in that the former involves the analyst as a participant rather than as an observer. ‘‘Enactments occur when an attempt to actualize a transference fan- tasy elicits a countertransference response’’ (p. 629).

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The countertransference that occurs with rescue fantasies could be thought of as an enactment when the behavior of the therapist has been distorted from its conscious intent by unconscious motiva- tions. Enactments involve the actualization of an unconscious fan- tasy in the treatment. Child therapy and analysis would be fertile ground for enactments, since much of the child’s communication is through nonverbal means and child therapy involves an active inter- personal relationship. Also, by virtue of the child’s natural immatu- rity, the therapist does perform some caretaking tasks, e.g., tying a shoe. Norman (1989) writes about how the child is bombarding the analyst with urgent demands which can reach beyond the analyst’s defenses and actualize those infantile phase-specific problems and feelings that were left behind. There is a pull for actualization of countertransference feelings in the therapist, which can lead to an enactment of a rescue fantasy in treatment.

Case

The following is an illustration of a session that followed several months of twice-a-week psychotherapy around a child’s rescue fan- tasies. The work was able to proceed productively, partly because I became conscious of a rescue fantasy with this boy, and was able to take extra care to not allow it to become enacted. Early in the treatment, I had a dream in which I was taking Tommy on an out- ing with my own children. I recognized in the dream an explicitly represented wish to rescue Tommy from his parents whom I had, at times, perceived through Tommy’s communications as possibly somewhat punitive and, at least at times, unempathic. By analyz- ing this countertransference, I was able to understand the personal meaning in myself and begin to empathize with the mother and her feelings of frustration and guilt for feeling like a ‘‘bad’’ mother to Tommy, The mother had described wishing she only had one child, her daughter Jane, not Tommy, who she felt was difficult to handle.

Tommy is an 8-year old boy currently in the third grade. The ther- apist (author) is a 40-year old mother of two children. Tommy came for treatment because of a history of ADD (treated with Ritalin) and troubles at home and school related to his inattention and impulsiv- ity. His parents also expressed concerns about his fear of dogs. Tommy has one younger sister Jane, who is five. The parents

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described Tommy as a caring older brother with only mild feelings of rivalry towards his sister.

During the early months of treatment Tommy repeatedly played out a rescue fantasy of a man saving a girl from a multitude of calamities: a burning building, an attacking dinosaur, or a car that had crashed. Gillman (1992) terms these types of fantasies as ‘‘ambivalent rescue fantasies.’’ Gradually this fantasy play in the hour switched to one in which there is an older brother rescuing a younger sister from similar dangers. Tommy would frequently put the sister into dangerous situations in which the older, stronger brother would need to rescue her. One favorite scenario was a burn- ing house and the big brother would jump on the fire truck, climb the ladder, and pull the little sister to safety.

With Tommy one could see what Sterba (1940) described, that the object of the rescue fantasy is very often the person against whom there existed aggression.

After several months of addressing this concern and reworking his feelings Tommy became conscious of the reaction formation. Gradu- ally his hostility became outwardly evident and he spoke openly of the hate and rivalry he felt towards his sister.

The following is an excerpt from a recent hour that followed sev- eral months of interpreting Tommy’s rescue fantasies in the dis- placement, and the ambivalence and the reaction formation against hostility towards his sister, inherent in his fantasies. For example we were able to comment that he played out a fantasy of rescuing a ‘‘little sister’’ from a fire after the siblings had a fight.

In this hour, Tommy entered the room and immediately took out a game of checkers. For the first time he began to make up rules as he went along, all of which were in his favor. As the game preceded the rules became increasingly more wanton to the point that his pieces could jump my pieces anywhere on the board and in any direction. After a complicated jump he would laugh with pleasure. I made several comments such as ‘‘You’re pieces are sure getting mine,’’ ‘‘My pieces don’t have a chance,’’ ‘‘Seems exciting to be able to make up the rules. You can do anything.’’ Tommy replied ‘‘It’s great. I’m sick of rules! Everywhere I’m told what to do. Can’t do this or that (while imitating a grown-up voice).’’

Therapist: That sounds like a grown up voice. Tommy: Yeah, when I go to bed, when I can watch TV, when I

can hold the guinea pig.

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(With his voice rising in anger, Tommy continued to describe all the things that he is told he can and can’t do, things which are nota- bly proscribed by parents. In the moment, I found myself feeling a certain sense of pride in my work, which I recognized as related to the rescue fantasy I had previously recognized having towards Tommy and his parents.)

Therapist: Seems like it makes you pretty mad when you’re told what you can and can’t do.

Tommy: I get really mad. You know when my uncle comes to visit. He always wants his way. He’s the one always like that! He is hard to be around. My Mom gets really mad at him, she loves her brother but he makes her furious.

Therapist: How can you tell? Tommy: You can see it in her face. He drives her crazy. She tries

not to show it, but you can see how mad she is getting. (demon- strates her face). She could kill him she looks so mad. (More about the uncle). But he knows she still loves him.

Therapist: I guess he’s glad to know she still loves him, cause he could worry when she looks so mad that she doesn’t love him.

Tommy: Yeah, he might think that, but he knows she does. It’s her brother. You always love your brother. But I think after he’s there a while she wants him to leave.

Therapist: She gets so mad she’d like him to leave. Tommy: Yeah, cause he always wants his way. He can be such

a pain. (He is talking with an annoyed voice about his uncle. Gradually he begins to talk about other hypothetical brothers and sisters).

Tommy: My sister drives me crazy too. I could kill Jane. I’d like to kick her in the butt. (This is the first time Tommy has expressed anger at his sister. As he made this statement he looked cautiously at my face to see that I didn’t react disapprovingly. He continued with a long list of things Jane does that make him mad, especially that she won’t let him touch her guinea pig when he doesn’t want to play with his own pig). But I know how to get back at her. I say I am going to sit on it or strangle it, because she makes me so mad. I say those things cause it really upsets her. I say ‘‘I’ll kill Silky.’’

Therapist: Then you feel so powerful to watch her get upset, rather then her upsetting you.

Tommy: Yeah, I hold it up (demonstrates) and say I won’t give it to you. I can torment her back since she torments me. I hold the gui- nea pig up by her neck, like this. She is so annoying. I can’t stand

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her. (At this point I considered wondering with him about how the guinea pig might feel, but I decided to wait to not inhibit his anger or increase his guilt).

Therapist: When you get so mad and frustrated you want to find a way to be strong and get back at her.

Tommy: Yeah (As he continues talking he begins to take out the collection of trucks, including the frequently used fire truck of his res- cue fantasies).

Tommy: Where do you get these? I never see these any- where—these really are great trucks. (He continues with more anger and grievances at Jane; I noticed here the shift in my thinking where I no longer felt pride in being the superior parent who supplies ‘‘great trucks’’ to play with). I think I saw one of these when I was three. Yeah, I think it was this one; that was when Jane was born. I think Jane gave me one of these trucks when she was born. They are cool. Had real lug nuts (describes many details about the truck, and links it so nicely to the ‘‘good’’ in his home environment: parents, sister, and all).

Therapist: You remember a lot about the truck. Tommy: I think it was the 1992 one. The truck was from Jane.

Well I guess my Mom actually bought it, but it was from her when she was born. I think they also gave me Busy Town, cause I got her.

Therapist: They bought you something cause Jane was born. Tommy: Yeah, what a trick. I wanted to bite her I was so mad.

Before I got all the attention. I got whatever I wanted. I got way more as an only child. Now everything has to be fair. I hate fair. I don’t want her here. I don’t want it fair. I hate having a sister.

Therapist: Felt like things were spoiled for you when Jane came. (This is unusual in our sessions to be speaking directly about his feelings, especially towards Jane; previously this material had been in the displacement through play, and usually onto the ‘‘bad parents’’ that Tommy oered up as objects to be rescued from; objects from whom I had experienced the urge to rescue him).

Tommy: Yeah, and they don’t take her allowance when she does something wrong. I hate her. I really hate her. I hate having a sis- ter. They kept saying its nice to have a little sister. How lucky I am (sarcastic laugh). I didn’t want her. I didn’t ask for her. It’s not nice. I always wanted a brother though. A brother my exact age. Always someone to play with. Never be lonely if my friends aren’t over. We would like to do all the same things. I’d like that. Or an

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older brother could help me, teach me things. Even a younger brother would be okay. I could teach him things. But instead I got a sister. Instead I got her, Satan’s daughter (laugh). I got that line from a movie (describes the movie).

Tommy: Oh Yeah, I got my violin today. I’m going to be in an orchestra at school. (He tells me who else will be in the orchestra and what instrument they will play. He then begins to play with the space shuttle).

Tommy: Did you know the space shuttle goes around like this (shows it straight up spinning; an obviously phallic object) It has black tiles all on the bottom so that when it comes back down into the atmosphere it won’t burn up. If it didn’t the spaceship and crew would burn up. (He describes other safety devices on board)

Therapist: Good to know the engineers put so many things in place to keep them safe.

Tommy: Yeah. They always replace all 3,047,000 tiles after each trip. (more details). My Dad and I are going to go to Florida for a space launch. (He gives me exact details of how the trip will go). Just me and my Dad.

Therapist: Nice to be just the boys together. Tommy: Yeah, not my Mom or Jane. It will be great. I like it with

just my Dad and me. When Tommy came the next session he began telling me about

‘‘Club Friday’’. A club for 9- to 12- year old children at the recreation center where they can play games and dance. He stated that he was not going to go because his parents and he talked about how he gets ‘‘revved up’’ at Club Friday and then can’t settle down when he gets home and can’t get to sleep.

Tommy: They said if I had good behavior for the whole week I could get a toy on Sunday. And Club Friday gets me stirred up and I can’t calm down. So I decided not to go this week. It was my deci- sion.

Therapist: Feels good that you decided. Tommy: Yeah. Instead my Mom is taking Jane to a party and my

Dad and I are going to have dinner and watch a DVD, The Mummy. I don’t think it will be scary this time because I’m older and I’ve seen it before so it won’t be scary this time. The toy I’m going to get is Cubics Robot (Tommy excitedly described these robots and who the ‘‘good guys’’ and ‘‘bad guys’’ are and what super abilities they have. The rules each robot had to follow became increasingly confusing to follow).

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Therapist: Must be hard for the good guys to keep track of all these rules. Sounds like it gets confusing.

Tommy: Yeah, it is. Then the next time I can get something I’m going to get the other robot so David and I can play it together. They can go against each other. (Tommy takes out the Hess trucks while he continues to describe the robots fighting).

Therapist: What do they fight about? (Tommy describes evil Dr K, who is the bad guy and the robot he is going to destroy. Of course, one could wonder about the transference connection to Dr. K and keep this in mind with the material, but not interpret pre- maturely). He’s cute. Well I guess cute depends on who is the per- son saying it (ironically said). For example, I find snakes and lizards cute (laugh). You know snakes are easy to tame, as long as they’re not poisonous. (He tells me facts about snakes). At least they don’t poop or pee.

Therapist: They don’t poop or pee? Tommy: Yeah, they don’t have a hole for it to come out. So I have

no idea how they lay eggs! But I’d want a boy one anyway. Therapist: Better to stick with boys, easier to understand. Tommy: Definitely! And boys don’t shed as much either. The boy

snake does the hunting. The mother nurtures the babies for four months, and then at four months its more like they’re teenagers and they go off. But the boy snake can also feed the babies, cause they also have what the mother has. Whatever that is! But its kind of dis- gusting for a 9-year old boy.

Therapist: Can be kind of confusing for a 9- year old boy, what’s different and the same that they have.

Tommy: Yeah. You can learn a lot of this on the Discovery Chan- nel. I’m like the only kid in my class that watches different kind of shows other then cartoon network. I like shows like Discovery or History Channel where you learn stuff. So I like to watch stuff that’s interesting. I’m just not a sports kind of guy!

Therapist: Good to know what kind of guy you are, what you like, ways that your different then other kids.

Tommy: (looking at a truck) You know this truck (Playing with the fire truck with ladders; putting the ladders up) You know this truck in real life would fall over if it didn’t have these stabilizers (demonstrates) These trucks are so heavy...the ladders are so big they would literally fall right over. Since the trucks are so long they have a driver in the back part to do the steering. But they really are connected to the front wheel so they could still be turned (again I

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think, may be some of these restrictive safety devices that adults come up with aren’t all bad).

Conclusion

When the focus of treatment with children is based on the thera- pist as the ‘‘real and good’’ object, and parents as ‘‘real and bad’’ objects, a therapist/patient countertransference/ transference con- figuration can emerge in the form of rescue fantasies within the therapeutic dyad. This configuration, which I assert here may be relatively common, may frequently lead to enactments which can undermine the effectiveness of our work with children. My recog- nition of a wish to be a better mother to Tommy became con- scious in a dream where he was represented as one of my children. I recognized the beginning of a mutual countertransfer- ence/transference enactment in the material from Tommy’s hours in which he was the rescuer of an ‘‘endangered sister.’’ My awareness of my countertransference allowed me to interpret Tommy’s displaced rescue fantasies, which in turn brought about conscious awareness of Tommy’s anger about his sister Jane’s birth (deepening and furthering the treatment). Together we became aware his wish to be rid of his sister was heightened by his fear that his aggressive behavior at home somehow ‘‘caused’’ his mother to love his sister ‘‘more’’ while similarly ‘‘causing’’ his mother to wish she could ‘‘be rid’’ of him. Once these thoughts were conscious he and I were able to see how he sought safety by moving to thoughts of wanting to be with just the men. These themes continued in his confusion about the sexual differences between males and females. Again he sought the protection of staying home with his Dad, rather than confronting the boys and girls at the club that ‘‘stir him up.’’

Tommy began expressing disappointment in his play subsequent to the material documented here, with the ‘‘grown-ups’’ who don’t make cars, or the shuttle, or other vehicles ‘‘safe’’ for the passen- gers. For Tommy the disillusionment with his parents, particularly his mother, seems to relate most clearly to the arrival of his sister. While his sister’s birth is unambiguously something his parents caused, it by no means makes them bad, merely human. Had I been seduced (as would be so easy) into forming a helpfully sup- portive alliance with Tommy against his ‘‘bad’’ parents, I would

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have continued to be ‘‘all good’’ for my patient; a comfortable posi- tion certainly, but not nearly so helpful as I can be by retaining my neutrality.

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