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Transference: supporting and safeguarding people with learning disabilities who are vulnerable to exploitation

Transference is a form of ignoring reality by placing one’s wishes on to another person – and service users can be particularly susceptible to this type of encounter   

Transference is a form of ignoring reality by placing one’s wishes on to another person – and service users can be particularly susceptible to this type of encounter   


Picture: iStock

Mr A, a man who has a mild learning disability, had been duped into giving away a large sum of his savings to a person he had never met. He had been told he had won millions in a foreign lottery, but some fees had to be paid before they could release the funds. He paid these fees believing he would receive his winnings a few days later and was told the delays were due to bureaucracy. 

No one could convince Mr A that it was not real and that it was a con. In the end his support team had to get the police involved, who told him it was all a hoax. Mr A was referred to psychotherapy to get some support. Even then, he was sure, positive, he was a winner.

‘Transference is one of the most important concepts in psychoanalysis, which is at the heart of the therapeutic encounter between the psychotherapist and the service user’

Hoax

While we can recognise that service users are particularly vulnerable to this kind of hoax, what was interesting was his state of mind, his certainty – in the absence of any evidence – that he was a winner.

An important aspect of this was the ‘transference’.

Mr A transferred his own wishes about his life situation and ignored the reality of this encounter. He has transferred and made the person offering the money to be a good figure. This is an example of transference. Transference is one of the most important concepts in psychoanalysis, which is at the heart of the therapeutic encounter between the psychotherapist and the service user.

But it is a concept, which can be used outside the therapist’s consulting room. The difficulty is that, while many learning disability professionals know what transference means, it is important they recognise it in patients.

‘Often professionals can have close and powerful relationships, but they do not think about this in terms of the transference’

Repressed feelings and desires

The term means ‘to carry across’ from the Latin. It originated from the work of neurologist and founder of psychoanalysis Sigmund Freud. He described the way the person transfers repressed feelings and desires from childhood onto the therapist in the here and now. Freud discovered this in his work with women who sought help from him. 

He noticed that they experienced him as a father figure and they felt he could cure them of their unhappiness. Freud believed that this was to do with their own wishes and desires rather than the reality of the situation, as in Mr A’s case.

Freud believed that we always carry with us our early experiences. Transference can be positive, negative or erotic. Positive is essential for forming alliances for community-based staff. Often professionals can have close and powerful relationships, but they do not think about this in terms of the transference.

Stronger recovery

Several studies have shown that if the patient feels positive about the medical staff their recovery is stronger. The more challenging transferences are negative or erotic. 

An example of a negative transference is when I saw a female service user with her mother. She told me that her father ‘had never accepted me from birth’. She then went on to give painful details of his conduct towards her, some of which were shocking and upsetting.

‘He was never a happy man, never smiling,’ she said. She had been referred to me because he had recently died. Since then her hatred and grievance had come to the surface, in effect she had repressed this while he was alive.

Far from sleepy

She had a couple of sessions with me before making a complaint that I was not listening to her and was always yawning in the sessions. The truth was I had found her interesting and was far from sleepy. 

It was an example of the negative transference and, while I was conscious about this due to her history, I did not get a chance to discuss it.

Understanding the transference can remove the ‘personal’ from the relationship so, although it was difficult for me to be on the end of a complaint, I could understand what it was about and work with it.

It is useful to remember a saying attributed to the Talmud, the source from which the code of Jewish Halakhah (law) is derived: ‘We do not see things as they are. We see things as we are.' 


About the author

David O'Driscoll is visiting research fellow at the University of Hertfordshire, Hatfield

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