Transference & Countertransference Positions when working with Survivors of Sexual Abuse: 1) The Unseeing, Uninvolved Parent and The Unseen, Neglected Child.

We have found that there are eight relational positions, expressed within the four relational matrices, alternatively enacted by therapist and survivor in the transference and countertransference that repeatedly recur in psychoanalytic work with adult survivors of sexual abuse (p.167)

The Unseeing, Uninvolved Parent and The Unseen, Neglected Child

Whenever a child is sexually abused, someone’s eyes are closed […] One aspect of the internalized world of the adult survivor, then, is a relationship between a neglectful, unavailable parent and an unseen, neglected child.[..]. Within the transference-countertransference, the patient enacts either side or both sides of the relational matrix sequentially, while the therapist protectively identifies with and enacts the complementary role. 

Manifestations of this paradigm are varied.

A) At times the patient identifies with her parent and enacts the latter’s coldness, unavailability and rejection in the therapy sessions. The patient may be profoundly withholding, remaining silent for long periods, or she may respond minimally to queries or overtures from the clinician. When identified with the uninvolved parent, the patient may appear bored, disdainful, narcissistically preoccupied, hostile to the interpersonal engagement sought by the clinician. During these periods of identification with the neglectful parent, the patient treats her own vulnerability, emotional needs and affect states with the same cold neglect that she heaps on the therapist.[…] The clinician frequently countertransferentially takes on the role of the patient’s disowned self- representation of a neglected, unseen child. The therapist experiences herself as unwanted, unimportant, and utterly bereft of vital connection with the patient. The clinician may begin working very hard to reach the patient and when these efforts fail, as they once did for the child struggling to make contact with her parent, the therapist sequentially may feel frustrated, inadequate, enraged, and ultimately depressed. 

B)   In another enactment, the patient identifies with herself as a child and responds to the clinician as she once did, at least initially, to her parent. Here, the patient denies her own needs and feelings in order to care for the therapist. Certain that the only way to obtain emotional supplies from the clinician is to tend to latter’s perceived needs, the patient is solicitous of and, at least superficially, compliant with the therapist and the demands of the therapeutic situation. Associations may appear to flow freely, but, in fact, the patient “protects” the clinician from her deepest pain, rage and bereavement. She also is quite likely to “protect” the therapist from the memories of her abuse, much as she once shielded her parent from the reality of the sexual victimizations. During this period the therapist may collude with the relational matrix being enacted by not seeing the “false self” (Winnicott, 1960) aspects of the patient’s presentation. If this transference-countertransference configuration extends for some time, the patient is likely to become enraged at once again not being truly seen or heard. As she did when she was a child, the patient may split off rageful responses in order to maintain a tenuous attachment to the therapist/parent. Instead of expressing them in session, the patient may act out her rage in extra-therapeutic relationships or by engaging in self-destructive behaviours such as cutting, substance abuse, or promiscuous sex or she may become increasingly depressed. Within this relational matrix at play, the therapist may feel bored, annoyed, increasingly angry as she senses that the treatment is mired in apparent superficiality. […] 

C)  Finally, an overt to the therapist transference as an unseeing, uninvolved parent may develop, which the patient experiences the clinician as neglectful. Sometimes, the patient angrily and repetitively berates the therapist for somehow “missing” her; for not noticing, hearing, correctly interpreting, remembering feelings, behaviours, facts, dreams, memories the patient considers crucial. Here it seems that nothing the therapist does or does not do is “right” In this case the therapist is once again identified with a hostile parent who expected to be cared for by the child and who berated the patient for her ineptness in meeting the adult’s needs perfectly. […] Countertransferentially, the therapist, much to her or his chagrin may enact stupidity, forgetfulness, inadequacy. It is with such a patient that therapists uncharacteristically double-book a session, miss an “obvious” connection among associations or forget dream material. The clinician, again identified with spit-off aspects of the child feels panicky, stupid, frozen, and inadequate. She may begin to dread sessions with the patient. Once again it is important for the therapist to use the countertransference experience to gradually help make explicit the split-off terror of the patient and to refrain from self-protectively emotionally abandoning the survivor.

 The relational matrix of the uninvolved parent/neglected child is frequently the first transference-countertransference paradigm to emerge in the treatment.

Davies, J. & Frawley, M (1994) Treating the Adult Survivor of Sexual Abuse: A Psychoanalytic Perspective, United States of America: Basic Books