The Psychodynamics of Transference—A Virtual Reality Model

Introduction

In the new, high-tech world, psychodynamic therapy may find its theories and practices reinvented, and psychoanalytic theories may acquire a new vividness and real worldliness. There is increasing interest by mainstream psychiatry in what life on the Internet can show us about ourselves (Allison, von Wahlde, Shockley, & Gabbard, 2006; Bickmore & Gruber, 2010). Newer concepts from computer simulated virtual reality can be conceptualized by analogy to older concepts from psychoanalysis and—conversely—computer simulations may illustrate and revivify traditional treatment theories. A body of literature dating back several decades had already seen similarities between psychoanalytic constructs and some of the goings-on in the virtual world (Turkle, 2005). Sherry Turkle (1995, 2005, 2009), for example, reported on such notions as introjection, gender construction, self representations, Kleinian models of development, attachment, and the vicissitudes of self-esteem related to virtual worlds. Unexplored (or mentioned in passing) were other object relations concepts, such as splitting, projective identification, the “depressive position,” narcissism, and transference.

Especially useful in understanding translations from the traditional to the technological are notions from object relations theory and ego psychology. In object relations therapy human beings are seen to relate to one another through the intermediation of mental images, that is, people connect by means of proxy transactions using representations of self and other (Kernberg, 1987). In ego psychology (Gabbard, 2004), by contrast, the impact of ego mechanisms of defense are understood to impede or facilitate relationships.

From Reality to Virtuality

“It’s not personal,” says the supervisor to the trainee analyst, “it’s transference, it’s a defense.”

The supervisor is a 60-year-old analyst. The therapist is a 28-year-old, third-year resident; his patient is a divorced, 41-year-old software engineer, working for an information technology consulting firm.

The weekly psychotherapy started 10 months ago. The patient’s neurovegetative symptoms are better on selective serotonin reuptake inhibitors (SSRIs), but he complains bitterly that he’s “not any better.” The patient is obsessed with his wife having left him for another man (“What does she see in him, that nebbish!”). The resident has a recurrent fantasy the patient might kill the wife and lover, although there is no evidence in reality for it. In this session the patient is again vaguely suicidal. In the previous session he was scathing toward psychiatry and threatened to quit treatment.

For her part, the supervisor has been trying to help the resident see the underlying meaning of the patient’s communications. She struggles to keep impatience out of her voice, “Suppose you get a letter in the mail full of vicious insults, ‘I hate you, I HATE you, I HATE YOU! But then you look at the envelope and see it’s marked ‘To Occupant.’ That’s transference: it’s addressed ‘To Occupant.’”

The therapist regards this information dubiously. The therapist, despite being an exceptional resident—smart, intuitive, well read—is constantly knocked off balance by the patient’s “digs” about the resident’s age and inexperience.

In the previous session the patient had reported his boss reprimanded him for using the Internet at work for non-work purposes. The boss called him an “Internet addict” and ordered the patient to see someone in the firm’s employee assistance program about the problem.

“The guy is an idiot! It’s that simple,” the resident complains to the supervisor. The resident adds that the patient admitted he spent four or five hours a day, some of it at work, playing World of Warcraft® and Second Life®.

The supervisor asks about these “games” and listens carefully as the resident explains these virtual worlds. She immediately gets the concept of “avatar” as a narrative representation of a human personality. Listening to the resident explaining online gaming, she hears underlying fear and guilt in his voice—a lot of it. Earlier in the year, she had wanted to be more involved in the case and asked the resident to bring process notes. Now, she wonders whether she should ask for audio recordings of the sessions.

She suddenly says, “Don’t you think you better tell me the truth—about what’s really going on?”

“You are so going to hate this,” the resident says and opens his laptop.

Old Wine, New Bottles

Freud’s heuristic of labeling mental processes and functions as “structures” proved useful in theory building and for clothing psychoanalysis in more scientific garb. But in fact, the “mind” is only what the brain does, not a structure. In many contexts, working with Id, Ego, and Superego as if they were actual things rather than figures of speech is not only useful, but also lends a kind of humanism to the philosophy of mind that is psychoanalysis. This is well and good when psychoanalysis is the basis of literary criticism. But as neuroscience advances and computer metaphors replace such constructs, younger trainees in psychiatry and psychology are more difficult to reach because, as “digital natives,” (Prensky, 2001), they are born into a world where the Internet is as omnipresent—and as taken for granted—as the air they breathe. Computer analogies and information technology metaphors are far more natural to them than figures of speech based on 19th century Helmholtzian assumptions about the mechanical functioning of the nervous system.

As the vignette above (and its continuation below) shows, it is possible to redefine psychoanalytic terms from examples found in virtual reality. This deductive approach—redefining terms from virtual reality—lessens the need to come up with translations from “thing” to “function.”

Virtual Reality and Object Relations Theory

Although it is against her better judgment, the supervisor agrees to sit with the resident at his laptop as he logs into Second Life® and “teleports” to an “island”—a virtual location created by participant “engineers.” He explains that those who inhabit or visit this island have agreed to permit violence and combat, and he points out his own avatar, a young man much like himself, named “Amleth,” but here the resident blushes: His avatar, his virtual self, is a street fighter.

The resident then runs a search through a list of avatar names, and easily locates “Morlok,” a muscular space pirate of some notoriety in this particular island who leads a crew of lawless intergalactic buccaneers. The resident reveals that “Morlock” is the avatar of his real world patient.

The supervisor is stunned! “How did you know he’d be online? How can you tell he’s your patient?”

“He’s always online, that’s why he’s in trouble at work. I know it’s him by the avatar—he told me his avatar is named “Morlock” two sessions back. I’d already fought him online a couple of times before—then I almost freaked when he said the name of his avatar. I’d been gaming with my own patient.”

“Small world—how do you know he won’t guess ‘Amleth’ is your avatar?”

“Same way I didn’t know that Morlock’s his avatar’s name; he’s got no reason to ever recognize me,” the resident says, typing rapidly, “and look—you see him there with my avatar—he sees me as a total wuss. Look at the chat window—there’s his thread, he’s challenging me again.”

“What just happened?” She asks squinting at the screen. “Looks like he just had a stroke. He turned gray and froze.”

“He’s ‘away,’ hasn’t logged off but he’s away from his computer.”

“Turn this off, it’s creepy. And a violation of his privacy.” She moves her chair back.

“I know,” the resident nods numbly, “I feel horrible, but it wasn’t intentional: When Amleth first met Morlock I had no idea it was him. I had no idea. What do I do—call the Legal Department? That’s what they told us in orientation, do that first thing.”

“Legal will have to be told at some point. But go to your training director first.”

Teaching Trainees a New Language

As an educational model, concepts from contemporary psychoanalysis are well suited to illustrations from interactions within a virtual world. But first, trainees have to learn a new language from a lexicon whose definitions changed over time as the field developed. Whereas classical theory posited a dual-instinct system, the signature concept of object relations theory was relationship through “representations.” Rather than being controlled by drives, as posited in classical theory, in object relations theory, human beings preserve attachments to one another through their mental images— they relate by means of symbolic interchanges between self representations and object representations. In ego psychology, human interactions are seen to be distorted by more primitive mechanisms of defense and facilitated by higher-level defenses rather than “fixations” at developmental nodes causing repetitions of maladaptive patterns. Especially difficult for fledgling psychotherapists to learn about and even to “believe” is the slippery concept of transference—how can it be both a distortion of reality and a defense mounted by the ego in relationships?

To illustrate, take the characters in the vignette above. Imagine the resident and the patient are negotiating a transaction in their “real world” relationship. The resident has a mental image of himself. The patient has a mental image of the resident different from the resident’s self-image. (This difference the resident would be taught to call “transference.”) The patient’s own image of himself may also differ greatly from how the resident sees him. According to object relations theory, what is happening in the exchange is never direct but always done by proxy for each party, self, and object representations as mental stand-ins for persons out in the real world. And for reasons of defense and short-term mental homeostasis, each party distorts the object representation to meet the demands of expectations that every human being brings to a relationship (the defensive nature of the transference). But in real life exchanges, the resident and the patient each assume that their representations of self and other are correct. Each believes his perception is the true interpersonal reality. In this live two-person relationship, there are, in a sense four self- and object representations interacting: the resident’s representation of the patient’s in his mind (1) plus the resident’s picture of his own “self” (2) in his own mind—or to say it slightly differently, on his mental “screen.” For the patient, there is the patient’s picture of himself (3) on his “screen” plus his object representation (4) of the resident seen on his (the patient’s) mental “screen.”

By analogy, two individuals interact in the online virtual world of Second Life®, their two avatars, as viewed on their respective screens, are analogous to the self- and object representation of the two people described above. And, of course, each individual perceives the avatar of the other not only in terms of images, but also through the lens of expectations of the other’s beliefs and desires. Each is remembered from experience, and is perceived in a certain way. From these basic representational elements are constructed the infinity of transactions that characterize human relationships. The concept of distortion between sender and receiver defines the very nature of transference (Bird, 1972; Westen & Gabbard, 2002) and virtual reality can vividly teach how the distortion works, as is demonstrated in the conversation between the resident and the supervisor:

“Since I hadn’t given anybody else patient information, Legal didn’t see it as problematic—no more than if I had bumped into a patient at a social event. They did want to get on record it was an accident online, that I had no idea it was my patient—in case he claims ‘pain and suffering.’ At least it wouldn’t be intentional.”

“But this is more than just bumping into somebody. I’m no lawyer, but ethically you’ve still got to inform him, and tell him you’ve closed down ‘Amleth.’ And do this as soon as possible. The question is how to do it with the least damage to the therapy—look, we all make mistakes, certainly I have. But this is a new one on me. Let me think. Let’s review the case, try to understand him so we can minimize the trauma. Do you have your notes from last session?”

“Well, he sat down and immediately told me the human resource people from work are going to call me about the ‘Internet addiction.’ I’m supposed to say he doesn’t have one. He said he’d signed a release allowing them to talk to me.”

The resident let out a long breath.

“The boundaries are all shot to hell,” the supervisor replied, shaking her head. “It’s an inappropriate request—for you to deal with an issue that’s the patient’s responsibility—and he set you up. On the surface, this looks like a problem in the psychotherapy frame—his involving you with his boss—but it’s also the process of therapy. It’s not just a problem interfering with the treatment—it is the treatment.”

She sat back and let the situation sink in, finally noting: “People don’t come to us with their problems, they come to us with their solutions. Only the solutions don’t work anymore.”

“It’s not a glitch, it’s an enhancement.”

She nodded. “What do you think you should have done here?”

“I didn’t say anything, I didn’t know what to say. I just listened.”

“When in doubt, that’s best. But what you would do here—if we weren’t in this virtual reality debacle—is to hand back the dilemma to him. Make him take responsibility. You say, ‘There are two courses of action here—either of them is harmful to you as my patient: If I intercede in what may be an addiction, that potentially makes the addiction worse. If I don’t, then I abandon you and you get to feel sorry for yourself. You pick which you want me to do, I wish there were a way I didn’t have to do either.’”

“And I wish I had a do-over, but as it’s left now, the human resources people from his company are going to call me.”

Transference and the Assumption of Shared Reality

The “Dora” case is Freud’s first full, coherent description of transference in relation to treatment. Fully psychoanalytic interpretation really begins with a transference that Freud came to understand too late. He had already, “stumbled on the concept of transference while desperately casting about for an antidote to the epidemic of iatrogenic lovesickness that had spread through his practice in the 1890s” (Malcolm, 1984). It is this distortion of interpersonal reality that constitutes transference both in and out of the treatment situation. It is not an exaggeration to blame this distortion for a large share of the psychopathology related to intimacy in relationships. And the necessary condition for transference to function as a defense is the assumption one has the True perception of reality. This assumption is also a key fact of “life” in virtual reality, as shown below.

To continue the example from above, imagine the Resident and the Patient again, but now as two gamers online in a virtual world such as Second Life® (Linden Lab, 2008). In virtual rather than “actual” reality, the resident sees on his computer screen an image of his avatar (Amleth) and an image of the patient’s avatar (Morlock). The patient sees on his screen the resident’s avatar and an image of his own. These two real-life people looking at two screens are watching a total of four avatar images: the resident view of his own avatar, the resident’s view of the patient’s avatar, the patient’s view of his own avatar, and the patient’s view of the resident avatar. Because of the intrinsic property of computers and the Internet, an avatar on the patient’s screen is always assumed to be identical to the corresponding avatar on the resident’s screen. The resident assumes that the scene he sees is the same scene that the patient sees. Seeing identical screen images is something the resident and patient take as a given because the identity of images is an intrinsic property of the electronic set up.

Transference arises when this assumption—that both screens images are identical—is not true. For example, suppose that the resident and patient are online through their two respective computers. But suppose that, unbeknownst to the resident and the patient, there is an unseen, unsuspected computer expert on a third computer who is able to manipulate the images on the resident’s computer screen and the images on the patient’s computer screen. The resident and the patient can see each other’s avatars, but the secret hacker can distort the computer images.

There is the potential for splitting their shared reality into two different realities. Rather than being correct in the assumption that each player sees the same avatar image, the two “gamers” (the resident and the patient) are deceived by the distorted avatars. Yet they believe that the avatars each see are identical and that each is seeing the “true” image. The resident and the patient have their own preconceived assumptions that blind them to the mischief caused by the hidden hacker. They are dupes but do not know it, victims of unseen splitting.

This suggests an important analogy: A virtual reality avatar functions like a psychoanalytic object representation.

The deceptions and distortions of the unseen hacker owe their power not just to the disinformation in the system but also to the unexamined assumptions the Resident and the Patient make that they see an identical, un-split reality. The hacker is unseen and unsuspected (unconscious in other words), which allows for almost unlimited sabotage of transactions between the patient and resident. Analogous to the mischief of the hacker in virtual reality are the distortions in real reality that have come to be called transference.

Winnicott pointed out stable attachment first depends on mastering the developmental task of ambivalence and mastery depends on a capacity for mutative play (Winnicott, 1971a, 1971b). Maturation entails integrating the all-good and all-bad images of the infantile world, it depends on melding black-or-white images into a picture that also has shades of gray. This is achieved by overcoming primitive splitting and reconciling contradictory positive and negative images of self and other. This is achieved through a specific type of creative play in which aggression is neutralized without loss of creative power. One of the major ironies of the cultural divide for which the Internet is both a cause and effect, is a tendency for some to undervalue or even fear various forms of video games, which may well serve as a maturational arena, one no more sinister than Winnicott’s Squiggle game (Allison et al., 2006). Reality testing depends on a type of aggression aimed at destroying certain images, to see what is real and what is not. Without this process, the individual remains a false self in an imaginary world, a world of transference. Distortions of intimate relationships are one cause of psychopathology, thus suggesting a second analogy: The hacker’s impact on virtual reality is analogous to what transference is to intimate relationships.

Transference in Virtual Reality and “Real Life”

The resident hands the supervisor the copy of a letter. She skims it.

The supervision (Anne Alonso, 1985; A Alonso & Rutan, 1988; Anne Alonso & Rutan, 1978) of real-life psychotherapy is as much about the trainee’s shame, guilt, and anxiety as it is about the conceptual framework of psychodynamic therapy. As the vignette shows, seeing these concepts in virtual reality helps metabolize the shame and anxiety of the resident and positions the supervisor in the position to show and tell. In the above vignette, the avatar in a game of Second Life® gives the therapist a view of a patient’s representation of self and other, which might be a better view of the patient than one simply discussing a personal situation (Allison et al., 2006). Since an avatar is a character representing oneself in virtual reality, how someone constructs an avatar may echo the way dreams are constructed. Presumably avatars are made up of wishes and fears, disguised not only from others but also the gamer/author by displacement and condensation. In a fundamental sense, only in disguise can desire reach its satisfaction (since desire is at root supposed to be about infantile incestuous aims) (Winnicott, 1971a). Desire must be hidden in an encrypted message that has to be decoded, the avatar being (among other things) a decryption key and a transitional object (Winnicott, 1971a, 1971b).

Because mental representations, defenses, splitting, and transference are distinctive of psychoanalytic theory, individuals—rather than interacting with each other through drives and defenses—interact through images, a self-representation and an object representation of the other person. Here we have explored one of several psychoanalytic constructs, but other potential areas of focus are splitting and primacy of attachment; activation of primitive defenses, such as projective identification; progression from paranoid-schizoid to depressive position; failure of mirroring and false-self formation; and the function of libidinal and aggressive drive derivatives. Each has an educational analogy within the virtual world.

A century after Freud’s early descriptions, transference is still a difficult concept for trainees to grasp or even believe. If placed under the lens of evolving computer-based technologies, might transference reveal its reason for being? Might transference actually turn out to be a necessary ally of human relationships? It is a fascinating question, but perhaps one best asked in virtual reality.