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A return to Freud's broader concepts of transference and psychic reality as general psychological principles would include applying both concepts to the analyst as well as to the patient and thus obviate the need for the concept of countertransference.
We attempted to extend two findings obtained at private university clinics to a heterogeneous community outpatient population: an under-representation of male patients in the case loads of beginning female therapists and longer treatment of female patients by beginning male therapists. Data from professional and preprofessional psychiatrists, psychologists, and social workers partially replicated the first finding but not the second. The results thus leave open the question of subtle sex role-related countertransference in a large urban community mental health setting.
Eczema in the first year of life results in a basic disturbance of the earliest mother-infant relationship, a disturbance that is renewed with every transitional phase of the life-cycle. The pervasive fear of disintegration or loss of the self, and the need to be contained and held, affects subsequent character formation. Infants who experience extended periods of bodily soothing learn to translate psychic pain into visible bodily suffering and so arouse concern and care. This is illustrated by direct observation of women patients suffering from skin diseases and their interaction with women doctors in hospital. In the analysis of patients who have had such an infantile experience, whether they know it or not, a disturbance in concepts of the self linked with narcissistic difficulties and acute sensitivity to object relationships may be anticipated. The mother's human disappointment in her baby's appearance gives rise to an unsatisfying and unsatisfactory self image which remains unaltered in the true self. Transference and countertransference problems derived from the analysis of a female patient are described in order to illustrate these themes.
A paradoxal clinical case is described. First paradox: a patient borderline concerning personality, I.Q. and height involves all the medical and paramedical staff in her ambivalence. Second paradox: few members of the staff built with her a strong therapeutic link which allows to overcome the majority's negative countertransference. Third paradox: from a defensive behaviour, the patient succeeds to express her deep humanity through her drawings and poems. She is now taking the way of the autonomy.
The concept of countertransference (CT) reaction has undergone dramatic changes in definition since its inception at the turn of the century. No longer viewed as a hindrance to effective therapeutic interventions, it has become central to building the therapeutic alliance. However, CT can interfere with the therapeutic task, and this is especially true in forensic settings in which one must help particularly difficult clients. In these cases, the CT must split into two parts in order for the therapist to be clinically effective. The therapist reacts to the individual as both an offender who has violated a societal law and as a client who needs help, separating the client from the behavior. Although not recognized explicitly in the forensic literature, the effects of the dual CT underlie investigations of therapist-offender relationships. This article reviews the concept of CT with specific reference to forensic settings and develops the concept of dual CT.
The verbal material of religious individuals in psychotherapy is laden with metaphors, folkloristic themes, and literary allusions whose meanings are generally deemed adequately elucidated by analysis of their symbolic content, generally in terms of the classic psychosexual conflict model. Contemporary psychoanalytic models demand that such material be further examined in terms of the level and quality of object relations and representation that characterize such content, and with an eye toward the influence of early, preverbal intersubjective factors that, by nature, tend to attain a minimal amount of psychic representation. These factors add richness and complexity to our overall understanding of the religious personality. The expanded role of countertransference as a tool for comprehending prerepresentational states, and the modes in which these are communicated, helps to outline new dimensions of religious object experience.
This paper deals with the nature and function of transference and countertransference, with respect to transference love. After a summary of the major views on the nature of transference and its function in the analytic process, the paper presents a case in which this issue of transference love was pertinent and how the therapist dealt with these feelings.
The author describes some similarities in the psychoanalytic literature between the conceptualisation of the dream space and that of the analyst's function as a container of the patient's projections. He also notes the correspondence between the creative use of a dream and the use of an analytic session to further understanding. Detailed clinical material is then presented from the analysis of two male patients, both of whom were unable to complete a dream about a particular emotional dilemma. The way in which they created severe disturbance in the countertransference at the same time is reported. The analyst's struggle to work through this difficulty and the beneficial consequences of this for the patient are described. It is argued that this demonstrates the way in which patients may project into the analyst dilemmas that they are unable to dream about in order that the analyst's functioning may transform the dilemmas into ones that can be thought and dreamt about. It is further argued that some patients have a developmental need to engage the analyst in this way.
This essay introduces the reader to some basic self psychological concepts that have useful applications to couples therapy. Two points are highlighted. First, the therapist must be constantly aware of the narcissistic vulnerability of each of the participants. Second, the working through of transference and countertransference-like experiences within the marital dyad is just as central to an understanding of the curative process in couples treatment as it is within the patient/therapist dyad in individual treatment.
Multiple external life events and vicissitudes can impinge upon the traditional privacy and isolation of the usual psychotherapy situation and relationship. Among these are major illness and disability in the therapist, which will activate conscious and unconscious responses in both patient and therapist. If worked with and well handled by the participants, such events may stimulate therapeutic growth and working through of multiple issues related to illness, separation, death, anxiety, and fantasies of omnipotence and idealization. However, multiple factors in both patient and therapist may combine to foster avoidance of the conflicts that have been activated. To the extent that countertransference responses in the therapist interfere with his/her ability to bring conscious attention to these issues, a potentially valuable therapeutic opportunity may be lost. It is important for therapists to therapists to anticipate such situations, and to make use of colleague consultation to assist in managing them.
A relational/constructivist view incorporates contemporary trends toward viewing countertransference and co-transference as results of mutual intersubjective influence. It moves toward a view of the socially constructed nature of human reality, toward recognizing the therapist's as well as the members' irreducible individuality and initiative taking, and toward therapy as about meaning-making rather than scientific discovery of The Truth. General clinical examples, and examples of working specifically with trauma, are given.
The authors discuss their work together in a consultation process. One author led many groups that were created to facilitate recovery for persons directly impacted by the terrorist attacks on September 11, 2001; the other acted as consultant to the therapist/leader. The leader was a resident of New York City at the time of the attacks; the consultant lived in a distant Midwestern city and the two had never met prior to the work. They describe their experience of working together and the role of this collaboration in the lives of the leader and the groups. Well aware that little exists in the literature about groups led by leaders having experienced the same trauma as group members, the authors pay special attention to the countertransference that each underwent and raise questions about the effects of that on the group process.
Trauma affects the conductor of the group as well as the group members. This identificatory countertransference of the group conductor is a resultant of the coming together of the conductor's internal and external worlds, the interplay of introjections, projections, and empathy. It is inconceivable that a conductor of a group can project a "blank screen" of technical neutrality when trauma impinges upon everyone. From a psychodynamic perspective, this article explores groups under the throes of trauma, the interplay of that trauma with the conductor's feelings, and the effects on his or her role in the group. The article also explores the effect of trauma upon the affective process within the group and upon the cognitive processes of the conductor and group members.
The treatment of choice for traumatized and difficult patients is psychoanalysis or psychoanalytical therapy followed by intensive group analysis for an unlimited period of time. The group is able to help the analyst make therapeutic use of inevitable difficulties in countertransference processes. Also, traumatized and difficult patients are likely to create the basic assumption of Incohesion: Aggregation/Massification, and to personify the roles associated with it. These processes can be used in order to provide such patients with appropriate therapeutic attention involving both containment and holding, and interpretation. Extensive clinical data from psychoanalysis and group analysis are used to illustrate both this clinical approach and the author's theory of Incohesion.
Interactions between therapist and patient are influenced by the feelings and impressions that develop during the therapeutic relationship. The terms transference and countertransference are used to describe this process. However, attention must also be paid to the possible effects that events in the personal life of the therapist can have on therapy. The therapeutic interchange can be disrupted when this factor is ignored.
Relationship violations have been documented in all service professions, particularly those involving a power differential in the relationship. Although the coach-athlete relationship is not a typical therapeutic interaction, there should be professional and ethical boundaries. Boundary violations, including sexual abuse of a minor, do occur. Five clinical cases of relationship disturbances are presented. The authors use the paradigms of transference, countertransference, and achievement by proxy distortion to discuss these worrisome vignettes. Colleagues are encouraged to collaborate in an effort to develop awareness and prevention programs through research and education. Developing an enlarged workbook of similar case studies for use as a stimulus for seminars and discussions in training environments is an immediate goal.
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