Startling affect in therapeutic relationships: Relational formulation of experience*

Abstract

Open internal boundaries allow therapists to receive patients’ unconscious communications and to hold disavowed affects and self states, thus making possible new relational and affective development. Such deep engagement with patients inevitably stirs intense feelings that may be difficult for therapists to bear. Unwanted affect and unconscious points of identification with patients may stimulate therapists’ shame and guilt leading to states of disequilibrium. A therapeutic stance which is fluid and open to intrapsychic and interpersonal influence, allows for the experience and elaboration of complex unconscious affects, points of identification and self‐other configurations. Clarity concerning intrapsychic and interpersonal boundaries in the therapeutic relationship is most helpful. Relational formulations of case material focusing on startling affects are offered.