Transference: ABC – Awareness, BASIC ID, Checklists

Written by Prashant Bhatt

Write the story of your relationship, how it began, what are the concerns which bring you to therapy now and if your partner told this story, how would they tell it, what would be their main concern or complaint? This is a way to broaden the way we think (cognition). Being in health sciences since 1985 (Maulana Azad, Delhi), having been taught about family history, social history and how this impacts the care of clients, I see this play out in many immigrant families who come to Canada, North America.

Remembering Anthony Burns and William Ellery Channing : Worcester : On my trip to Barre Massachusetts for a Mindfulness Retreat- February 2024. As I finished my Masters in Counselling and the Academic requirements, I went a bit deeper into my Mindfulness practices. This led me to a journey to Worcester, Massachusetts and walk in the countryside, imbibe the spirit of thinkers like William Ellery Channing – who developed Unitarianism, and was one of the spiritual inspirations of the Transcendentalists. He did attend earlier meetings of the Transcendentalist club, but was older than the younger members.

Diaspora-in Africa

Having stayed in Libya for 13 years, I met and came to know the diaspora of Indian origin and also many other countries from other Arab , African countries and European countries. These experiences have made me consider the social and emotional factors, including relationships, identity, personal growtand faith. This is in alignment with Erikson’s stages which I had mentioned in my previous blog- Intimacy versus Isolation.

My family professional background

My father was a medical doctor (AIIMS-Delhi-1962 passing out)  who specialised in Anesthesia -Poona University 1972 and then in Cardiac Anesthesia (Christian Medical College, Vellore, 1974). 

One of my formative childhood memories was to see him keep flashcards of important drugs, their main actions, indications, contraindications and how they may interact with other powerful drugs. Having a checklist is very important when many important parameters are concerned, there are tense situations and if overlooked can have grave implications. Another lesson he taught me as I entered medical school was to give your 100% to each patient. “For you it may be one in 100 patients, but for the patient it is 100%. Always give your best to each patient.” 

Another lesson in self care he taught me was going for morning and evening walks and meditation. His duties to the Indian nation carried him to different areas where families could not go. He used to meditate at least 20 minutes in the morning, 20 minutes in the evening (sometimes more). Meditating in nature, by the banks of holy rivers, (sometimes even sitting within the river and meditating) were some of his more advanced practices. The priest in our ancestral village told me that he had seen him pray by the river Alaknanda in the mornings, when I went there with my mother to say prayers after he passed away-July 1999.

See: 2011-October:  Walks by Alaknanda

BASIC ID AND TRANSFERENCE

Imbibing the lessons of flashcards and check lists in counselling made me zero in on issues of transference, countertransference, resistance, rupture, repair and seeing the flight, fight, freeze, forget, fawn, faint, flooding paradigms and help chart client journeys through the BASIC ID multimodal therapy of Lazarus (B-Behaviour, A- Affect, S-Sensations, I- Imagery, C-Cognitions , I-Interpersonal, D-Drugs/Alcohol) (Lazarus, 2019; Van Der Kolk, 2020).

Transference: It is when one seems to have feelings, desires, thoughts, memories, sensations, interpretations related to an important figure in one’s life such as a parent, teacher, romantic partner, mentor towards someone who is not that person.

For example: In my case, from the flashcards and checklists which I saw my father make in my childhood, right from my preschool days, this has become a way of life for me. Later, as I entered medicine and specialised in Radiodiagnosis (KEM Hospital, Parel, Mumbai-1993 joining) , the need to have a checklist was important to me.

Applied in my work as a counsellor, I keep a checklist of whether the client is having any Behaviour which may be self-sabotaging and try to work on how these may be activated in certain circumstances, triggered by certain people, and then try to draw out with the client the emotional and life consequences of such behaviours on himself, his family, his outlook to future. 

Incorporating a self-care routine, I encourage persons with whom I work with to take time out in nature, do thought stop, develop a meditation prayer practice, journal about these aspects to refine them further, track their growth and imbibe them in an overview of one’s life. I use the DOCTOR acronym- D-Direction, O-Organization C-Cash or Time T-Tracking O-Overview R-Refine.

A psychotherapy counselling relationship will help create an alliance in which one can be more mindful of our conscious and subconscious thoughts, motivations, biases. One way to improve our awareness is to be aware of transference.

Here are a few examples

1. Therapeutic Transference: Persons with a difficult relationship with their father, may unconsciously project unprocessed feelings onto their therapist, either positively or negatively.
2. Parental Transference: Expectations from parents may be transferred to authority figures. Strict authoritative parents may lead to expectations of such behaviour from their work supervisor 
3. Romantic Transference: Qualities of a past partner (positive or negative) may be attributed to a new/potential partner. This can influence expectations, lead to exaggerations or extreme positions.
4. Countertransference: A therapist having their own unresolved issues may be overly protective or dismissive of clients, may enter the victim, persecutor, rescuer triad..
5. Cultural Transference: Stereotypes may lead to bias. Negative stereotypes about a particular ethnicity may lead to unconscious transfer of feelings onto an individual from that group.