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PubMed1991

Observing countertransference in brief dynamic psychotherapy.

Six cases treated with Brief Dynamic Psychotherapy were studied. Initial countertransferential reactions were identified, and expectations were determined concerning the evolution of the patient-therapist relationship. The existence of a basic pattern of emotional response to the patient in the therapist throughout the treatment was observed, and the authors propose to denominate it countertransferential focus. Three clinical vignettes are reported.

Adult↗
PubMed1997

The impatient therapist: managed care and countertransference.

The conduct of therapy is particularly vulnerable to the influence of impatience. External pressures on the therapist to work quickly intrude on the session. When therapists are unconscious of their own impatience, it is more likely to reduce their ability to listen fully, to understand the extent of the patient's problems, and to participate in the rapidly shifting dance that makes therapy effective. Since the external factors that encourage this impatience are unlikely to abate, therapists need to become more aware of these influences and to consciously develop coping strategies. Impatience can arise from a number of places-the departure from any plan or timetable we have set for therapy, a desire to satisfy third parties, worry that the work is not progressing quickly enough, doubts about our ability to help, fear of "failure," confusion of process with "product," and attachment to favorite treatments. Aversion, attachment, and confusion have been well charted by Buddhist writers as hindrances to clear perception. The solution they propose is to face these obstacles directly, by noting their appearance, development, and passing away. While frequently an unpleasant process, such self-examination maximizes our chances of listening carefully and compassionately to each person who consults us.

Adolescent↗
PubMed2002

Under the influence of unconscious process: countertransference in the treatment of PTSD and substance abuse in women.

PTSD and addiction are a marriage made in the avoidance of unbearable affect; an avoidance that is costly in the resulting traumatic reenactments experienced by patients whose attempts to escape the past keep them evermore tightly bound to it. Rather than "difficult patients" a more dynamic and intersubjective conceptualization emphasizes the notion of a "difficult treatment dyad." Vicarious traumatization, unconscious affects about addiction, and pressures within the treatment surround conspire to pull the therapist out of connection with the patient at critical points, and toward sadistic abandonment or collusive indulgence. The concomitant desires to rescue and desert patients create forces for action in the therapist, precisely when what is needed most is the ability to tolerate and contain one's own and the patient's affective experience. The pull for action is also felt by treatment systems, eager for "action" that can be measured in "behavioral observables." Support for the therapist in the form of process supervision can assist the therapist to contain, identify, and acknowledge his/her affective responses evoked in treatment. The therapist is called upon to "grow one's own heart" through a confrontation with the undeveloped parts of self that are vulnerable to the dynamics of the treatment.

Adult↗
PubMed2003

New mother/old therapist: transference and countertransference challenges in the return to work.

Psychodynamic psychotherapists are not generally accustomed to discussing with patients the impact of their own personal experiences on their clinical work. Psychotherapists who return to work postmaternity leave, however, have both a rich opportunity and a clinical mandate to explore the effects of their new parenting on the treatment field. Pregnant therapists have addressed their pregnancy with their patients; however, the experiences of both therapists and patients postmaternity leave are often not discussed to the same extent. Using the author's own experience following her return to clinical work following the birth of her child, this paper explores the ways that the psychodynamic work is affected when the therapist has become a parent, including: changes in transference work; problems of separation and abandonment; and expanding boundaries.

Adult↗