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PubMed1992

Countertransference and clinical choices in public-sector treatment of a patient and her family.

Clinical decision making in the treatment of families of individuals with prolonged mental illness can be affected by countertransference that is stimulated by the context of treatment as well as by the family being treated. For clinicians, psychoeducation, the current intervention of choice for such families, can serve defensive functions that are motivated by counter-transference; a case example illustrates how such defenses led a clinician to avoid deeper therapeutic work. The authors believe that clinicians must strive to understand their motivations for whatever clinical decisions they make; to facilitate this awareness, intensive psychotherapy should be required as an adjunct to training.

Activities of Daily Living↗
PubMed2000

Countertransference enactments informed by cancer in an analyst's child.

The author's son was diagnosed with Hodgkin's lymphoma in the spring of 1997. She traces the impact of this trauma on her practice, with specific emphasis on her experience as both analyst and mother, and on the related countertransference feelings and enactments. The paper discusses in detail the analyst's effort to determine for each patient whether or not to disclose the fact of her son's illness, the internal conflict she experienced over those decisions, and the effects of her decisions on her patients. An extensive case discussion focuses on a patient who appeared to intuit in a dramatic fashion the traumatic events in the analyst's private life.

Adult↗
PubMed1982

Serious illness in the analyst: transference, countertransference, and reality responses.

Serious illness in the analyst has a disruptive effect on the therapeutic process. Transference and countertransference responses are highly idiosyncratic and variable, but must be dealt with effectively when the therapeutic process is resumed. Some effects are relatively brief and immediate; others become manifest only after a significant delay. This paper uses the experience of such an illness to call attention to this topic which has been relatively ignored in the psychoanalytic literature.

Aggression↗
PubMed1986

Freud, Dora, and the maid: a study of countertransference.

Early advances in psychoanalytic knowledge, profound though they were, were incomplete structures to be built upon, modified, and partially discarded. In addition to errors due to insufficient knowledge, Freud's difficulties with Dora stemmed from countertransference. Dora's transference included an identification with a governess/maid. Important oedipal role played by a nursemaid in Freud's life made him vulnerable to being left by Dora. The maid, Monika, "the prime originator" of Freud's neurosis, seduced him, chastised him, and taught him of hell. In his self-analysis she was associated with Freud's mother who left him when she gave birth to his sister. When he was two and a half years old, Monika was discharged and jailed for stealing. I suggest that Freud's attraction to Dora revealed itself in his libidinal imagery of the treatment and his premature sexual interpretations, the effects of which he misjudged. Defending against his attraction, he pushed her away from him, did not act to keep her in analysis or allow her to reenter analysis later. In addition, since Dora had left him as he must have felt his childhood nursemaid had, he reacted as if she were that maid. Hurt, saddened, and angered, he used reversal and deserted her, thus damping his feelings.

Adolescent↗
PubMed1989

Negativism and countertransference.

The purpose of this work is to explore the phenomenon of negativism and the analyst's response to it during the course of analytic work with a patient in whom negativism is a central behavioral pattern. Melville's short story, "Bartleby the Scrivener," describing in telling detail the response of a sympathetic lawyer to profound and pervasive negativism in his legal scribe, is discussed as a literary analogy to the analyst-analysand dyad. Aspects of the concept of negativism within psychoanalysis are discussed. The potential usefulness of understanding certain unexpected countertransference responses to pervasive negativism is explored, as this is a relatively neglected area of psychoanalytic technique. A case is presented describing the analysis of a patient whose character, like Bartleby's, is a mixture of profound negativism along with schizoid, obsessional, and masochistic elements.

Countertransference↗
PubMed1995

The analytic role: a mediating influence in the interplay of transference and countertransference.

Recognition of the analyst's subjective involvement has led to profound reconsideration of the nature of mutative process. How is it that the analyst can be personally involved in an unconscious way, yet also be an "objective" participant in the relationship? The paper proposes that the analyst's subjectivity is mediated by his or her role. The analytic role conditions how the analyst listens, experiences, and behaves, leading to interactive outcomes different from that expectable from unmodified subjectivity. The paper describes the analytic role in terms of contributions from metapsychology, clinical theory, and tactics. Each affects the function of the analyst-at-work in a different way. The analytic role, learned during training, is maintained by a combination of internalization and ongoing involvement in psychoanalytic activities. A clinical illustration demonstrates how a typical transference-countertransference enactment is influenced by the analytic role. The vignette suggests ways in which the concept of role modifies the effect of subjectivity. Three recent viewpoints--those of Renik, Ehrenberg, and Hoffman--that challenge previous theories of mutative process are discussed in terms of the analytic role. In each case, consideration of role clarifies the nature of the innovative technique or view, and seeming contradictions between it and existing clinical theory.

Adult↗
PubMed1976

Utilizing reflected countertransference Applying the reflection process as a teaching tool in supervision.

There are times when teaching cannot proceed through the abstract presentation of content and must progress by the demonstration of what is to be taught. This is true whenever a student is unable, for whatever reason, to appropriately apply such abstract material to the concrete task before him. This may be due to a number of factors, one of the most common of which is the lack of qualitatively similar experiences to which to refer. The teaching of complicated processes such as psychotherapy is an example, especially when the trainee is relatively unsophisticated and/or seems unable to abstract from discussion of blocking phenomena, where it may become necessary to "act in" the feeling tones which are to be the cues for the behaviour to be learned, instead of persisting with abstract interpretations. When, in supervision, a supervisee recreates the conditions existing in the therapeutic situation, this procedural behaviour is called the "Reflection Process". This process often appears to be unconsciously motivated by the need of the supervisee to solicit from the supervisor a practical demonstration which he does not know how to solicit otherwise. Even if the Reflection Process is due mainly to unresolved, unconscious conflicts of the supervisee, it can be a useful clue as to what transference-countertransference problems he is having difficulties with. The fact that such behaviour on the part of the supervisee may arise out of unresolved unconscious conflictual material should not become a reason for dismissing it. Instead, supervisors should become proficient at recognizing the countertransferential feelings in themselves, which can be an accurate reflection of the feelings troubling the supervisee in his dealings with this patient; and they should recognize the distress signal on the part of the supervisee, which can often be responded to constructively. In the supervision, the supervisor at times can, almost unwittingly, come to play the role which the supervised therapists plays in the supervised therapy and, if not aware of the Reflector Process, he may not realize that the countertransferential feelings which underly his assuming that role may not be primarily a response to the character of the therapist he is supervising but rather to that of the patient. They may also be a reflection of the process problem in the supervised therapy. It is not essential that this process be labeled in the supervision; what is essential is that its ramifications be recognized by the supervisor.

Allied Health Personnel↗
PubMed2003

The patient's material as an aid to the disciplined working through of the countertransference and supervision.

The author argues that the patient's largely unconscious observations of the analyst's functioning are, at times, communicated in the patient's material and that this can impart a sense of clinical relevance to the countertransference. The concept of 'understanding work' is used to provide a psychoanalytical model of this phenomenon. This is illustrated in a clinical case and it is argued that a selective consideration of the patient's material can provide a proper discipline which steers the analyst between the twin dangers of megalomania, on the one hand, and involvement in a symmetrical, self-disclosing relationship, on the other. The author then applies these ideas to supervision and uses them to distinguish psychoanalytic supervision from a practice that also derives from an intersubjective paradigm but which, to the author's mind, is not distinct enough from personal analysis.

Adult↗
PubMed2003

On the countertransference of the patient: Transformations of the psychoanalyst's 'theoretical self' and their possible articulations with the vicissitudes of the analytic relationship.

In this paper the author examines one of the many levels of the analyst/analysand relationship: the possible interaction between the analyst's mental routes in relation to theories (also meant, but not only, as internal objects) and the vicissitudes of the psychoanalytic relationships with his patients. The author assumes that an important variable affecting the transformation of certain therapeutic relationships is the change that takes place in the relationship between the analyst and that part of his internal world where his theories find their place. He names this part of his internal world 'theoretical self', and 'precipitates of the analyst's theoretical self' those complex formations, akin to more or less cohesive conglomerates, that are formed by his relationship to theories and to psychoanalytic institutions, and by the various, 'personal' internalised objects. The psychoanalyst will relate to these precipitates in a variety of ways, and he will make use of them mostly at an unconscious level in his analytical work; and his patient is likely to 'react' to them, almost chemically. The author also offers some working indications: the psychoanalyst, despite his knowledge of some aspects of his own countertransference, is in fact lacking in knowledge, unless he constantly does some extra work focusing on how his mental position (i.e. the relationship with the precipitates of his theoretical self) may intervene in any of the therapeutic relationships that he establishes--not necessarily in the same way in each of them. The author also illustrates his reflections and conceptualisations by reporting dreams and excerpts from sessions taken from three psychoanalytic treatments in the course of several years.

Countertransference↗
PubMed2006

Buried treasure: money, ethics, and countertransference in group therapy.

Exploring money in the context of group therapy highlights the powerful way that groups can magnify the most intimate and charged aspects of our patients as well as ourselves.A thorough self-examination that includes an ethical framework for decision-making about money matters can safeguard against problems resulting from therapists' and patients' unconscious relationship to money. This paper addresses the setting and raising of fees, pre-group evaluations, third-party payers, handling of payments and statements, as well as combined treatment. Special attention is paid to countertransference with an exploration of the particular difficulties inherent in reconciling one's identity as a healer with the business of clinical practice.

Countertransference↗
PubMed2003

Primary process and peer consultation: an experiential model to work through countertransference.

Various models exist for peer supervision and consultation of group therapy. This article documents the authors' experience using an experiential group consultation of group therapy model that relies on primary process to overcome countertransference dilemmas. A review of group therapy supervision and consultation models is followed by vignettes from the authors' experience. Discussion of the vignettes highlight critical issues in group consultation and expound upon the strengths and challenges of using an experiential model.

Countertransference↗
PubMed1994

Incest: transference and countertransference implications.

It has not been the attempt of this paper to discuss the overall treatment of adults with a history of incest, but rather to elucidate and identify the various transference and countertransference implications that are emergent in psychoanalytic therapy. Despite this, some statements can be made regarding the analysis of these themes and the overall effectiveness of treatment with these patients. Analytically oriented treatment with adults with a history of incest concerns itself with three intertwined aspects. They are the reconstruction, integration, and validation of a past history of trauma (Alpert, 1991; van der Kolk, 1987), the analysis of its impact on self-identity and its effect on the person's object relations. This last component is deeply connected with the analytic relationship. This relationship is initially consciously and/or unconsciously consciously constructed by the patient as one that can typify his or her past and will be characterized by fears of abuse, neglect, and exploitation, as well as wishes and fantasies of merger, idealization, and reparation. "In the patient's psychic reality, the experience of the analytic situation then becomes the trauma, be it seduction or failure to protect" (Levine, 1990). The concept of projective identification explains how the patient may attempt to reenact his or her history and how this may be used as a vehicle for empathy and change. Throughout treatment, the analyst attempts to contain, understand, and make timely interpretations regarding herself, reactions to the patient, and their mutual interactive processes. Even when acting out inevitably occurs, it is hoped that it will be reflected on and eventually understood. At times, this process is shared with the patient and becomes a mutual endeavor. Individuals with a history of incest have been abused and exploited by those on whom they were dependent. The development of a realistic intimacy with the analyst that takes into account and respects each other's boundaries is a therapeutic goal in the treatment of adults who have been sexually abused. This can occur through the successful identification and analysis of transference/countertransference themes and the various projective identifications. Through this, the patient who has been a victim of incest is able to develop a new object relationship that is not characterized by deliberate abuse. As Horner (1987) states, the analyst and patient create a new history together, a new object relationship.(ABSTRACT TRUNCATED AT 400 WORDS)

Acting Out↗
PubMed1994

The impact of psychoanalytic values on transference and countertransference: a study in transcultural psychotherapy.

In transcultural psychoanalytically oriented treatments, the therapist must consider differences between the cultures of origin of both patient and therapist. The therapist also must be aware of a third relevant culture that affects the patient-therapist dyad: the psychoanalytic culture. The effect of the psychoanalytic culture and its values on the development of transference and countertransference is illustrated in three clinical vignettes from transcultural treatments. The authors offer suggestions for dealing with problems that arise because of discrepancies between the psychoanalytic cultural values and the patient's cultural values.

Adult↗
PubMed2004

Studies in countertransference and gender: female analyst/male patient in two cases of childhood trauma.

The paternal transference and the erotic transference have been singled out in the literature as more problematic for women analysts with male patients. Two clinical cases provide evidence for their appearance indicating that the reactions they trigger in women may explain the difficulties in their recognition and interpretation. In these particular cases, the author analyzes her counterresistance to a projected narcissistic, cruel father object and her defense of masochistic submission, following more stereotypical gender lines. And in the case of an eroticized transference, the fears of a symbiotic and incestuous merger made more difficult the elucidation of the complex transference reaction. The hypothesis is forwarded that cultural prohibitions are partly responsible for the lack of recognition of these transferences and for the challenging countertransference that they elicit.

Adult↗
PubMed2004

The place of erotic transference and countertransference in clinical practice.

Patients who express intense, erotic attraction to their therapists pose special treatment challenges that may not respond well to the interpretative effects of the therapist. The wish that the therapist demonstrate love for the patient and the therapists' own erotic feelings toward such patients can create misalliances as well difficult technical moments. Furthermore, some patients expressing their love for their therapist may have physiological manifestations while others would not. At the same time, therapists may not experience erotic feelings toward the patients' expressions of love. The purpose of this paper is to try to answer the following questions: How do we conceptualize our patients' erotic manifestations? Are those expressions of Oedipal or preoedipal pathology? What are the countertransference reactions of the analyst? Two clinical examples will highlight these issues.

Child↗
PubMed1990

Countertransference in the movies: effects on beliefs about psychiatric treatment.

This study examined the effect of viewing the movie Lovesick on college students' beliefs about countertransference and psychiatric practice. Consistent with the concerns of Gebbard and Gebbard (1985) that the public may develop erroneous beliefs about psychiatry from watching such movies, after seeing the film subjects were more accepting of sexual behavior between analyst and patient and were cynical about the motivation of the mental health professions in prohibiting such behavior.

Adult↗
PubMed1993

Countertransference: a typological expansion.

Countertransference was viewed from the perspective of a 2 x 2 x n factorial typology (source x degree of consciousness x depth). This typology incorporated the conscious and unconscious influences of nonpsychological variables and their theoretical schema upon the analyst's therapeutic recommendations.

Countertransference↗
PubMedDate not supplied

Team approach to working through transference and countertransference in a pediatric/psychiatric milieu.

The principles of transference and countertransference are essential to understanding and working through the intense pain and anger that often dominate the emotional field of the pediatric/psychiatric milieu. Using Winnicott's model of the maternal/infant relationship, this milieu can be seen as a holding environment where transferential phenomena can be expressed, interpreted, and worked through. Anger and pain are common elements of the transference/countertransference relationship matrix of the milieu. Staff often have a strong bias regarding anger and hostility. If they are willing to examine their bias, and are given the forums within which to do so, then patients' anger and hostility can be viewed and interpreted in an adaptive and facilitative manner. Working through in a milieu setting is accomplished by both verbal processing and the lived experience.

Child Psychiatry↗