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PubMed1989

Technique and countertransference in Freud's analysis of the Rat Man.

Freud's records of his treatment of the Rat Man constitute a unique document in the history of psychoanalysis. Through the years different analysts have used these records to support different theories about analytic technique. Certain non-interpretive interventions of Freud's have especially aroused their interest, and many reasons have been put forward to "explain" Freud's behavior. One reason never yet advanced and documented is that a countertransference tension may have been involved in one of these instances. This is surprising, since countertransference is a necessary part of every analysis. Evidence is presented that Freud's behavior may indeed have been under the sway of countertransference. Some recently discovered details concerning his early life are discussed as constituting a plausible background for ths countertransference enactment.

Countertransference↗
PubMedDate not supplied

Notes on countertransference in borderline conditions.

"When dealing with borderline or severely regressed patients, as contrasted to those presenting symptomatic neuroses and many character disorders," Kernberg (1975) observed, "the therapist tends to experience rather soon in the treatment, intensive emotional reactions having more to do with the patient's premature, intense and chaotic transference and with the therapist's capacity to withstand psychological stress and anxiety, than with any specific problem in the therapist's past" (pp. 16-17). The argument in the present paper contends that Kernberg's description of countertransference reactions to borderline patients is a caricature that applies only within a limited range of borderline conditions, specifically the most primitive or poorly organized level of borderline functioning or regressive borderline states. The description does not apply to the full range of borderline psychopathology, and in many cases can be misleading. It has generally been recognized that countertransference vicissitudes play an extremely important role in the therapy of borderline patients at one or another phase of the treatment. At critical points in the development of transference (TR) and countertransference (CT) and their interaction, the therapist's recognition of and capacity to deal with CT issues become crucial to the treatment progression. The present paper explores the dimensions of CT experience and provides a tentative model for the understanding of transference-countertransference (TR/CT) interactions. The central points emphasized are: (1) that borderline disorders form a spectrum of character pathology falling between the psychoses on one side and the narcissistic personality disorders on the other; (2) that these conditions reflect varying degrees of pathological disruption and varying levels of personality integration; (3) that, depending on the form of pathological organization, these conditions manifest a variety of types and degrees of intensity of TR involvement and elicit corresponding CT reactions; and, finally (4) that these forms and degrees of TR/CT call for corresponding modifications in therapeutic response.

Aggression↗
PubMed1994

Sexual excitement and countertransference love in the analyst.

The psychoanalytic literature has been remarkably silent on the subject of erotic countertransference feelings. The recent emphasis on transference-countertransference enactments in the analytic setting has resulted in increased openness about development of such feelings. Several key themes appear to be involved in the analyst's sexual excitement, including loss of the "as-if" nature of transference and countertransference, a measure of hostility and contempt, the perception of a deficit state in the patient, a defense against loss and mourning, and oedipal and preoedipal enactments involving a variety of gender configurations. These themes are illustrated with clinical material. The differences between those analysts who contain and constructively process erotic countertransference and those who destructively act it out are also discussed. The crucial role of consultation with a colleague is emphasized as a valuable recourse.

Countertransference↗
PubMed1993

[Countertransference as therapeutic instrument in analytic child psychotherapy].

In the process of psychoanalysis or psychoanalytical therapy countertransference plays a significant role: On the one hand still unconscious countertransference reactions of the therapist hinder the progress of the patient, especially when they lead to an acting-out of the countertransference resistance. On the other hand every analyzed countertransference reaction helps directly in understanding the patient and furthers of the process of therapy itself. This also applies to analytical child-therapy, which is demonstrated by means of some case histories.

Child↗
PubMed1993

Countertransference and the multiple amputee patient: pitfalls and opportunities in rehabilitation medicine.

Current psychoanalytic literature on countertransference broadly defines the term as a helping professional's overall response to an individual patient. Reactions of rehabilitation professional to their traumatically injured patients can significantly impact on the patient's treatment as well as the individual therapist's and entire rehabilitation team's effectiveness. In this paper, a case is presented illustrating a process of understanding countertransference toward a multiple amputee patient. Implications for the rehabilitation team are also described. The analysis of a single case demonstrates how countertransference interpretation might be used as a vehicle to enhance understanding the patient and promote team effectiveness.

Amputation, Surgical↗
PubMed1989

Countertransference and failure to report child abuse and neglect.

Though every state has laws requiring the report of suspected child abuse and neglect, failure to report remains a significant problem. Review of previous research on failure to report suggests that the reporters' anxieties about disrupting their relationship with the child's family as well as the reporters' gender, experience, and training affect willingness to report. Countertransference fear, guilt, shame, and sympathy are discussed as a basis for understanding the reporter's anxieties. We suggest that countertransference issues should be addressed in the training and ongoing practice of mandated reporters. The following mechanisms are offered to deal with this issue in training and practice: (1) teaching professionals about how countertransference reactions may arise during the reporting process (this training may include the use of risk management groups for private practitioners); (2) identification of a community child abuse expert for consultation; and (3) educating child protection workers about psychodynamics aspects of case management.

Anger↗
PubMed1993

The hoarding habit, countertransference, and consultation anthropology in a Peruvian psychiatric hospital.

The 'hoarding habit' is the practice of collecting a large number of mostly useless objects by psychiatric patients. Countertransference consists of distorted perceptions by psychotherapists in their study of individuals, or social scientists in their study of human groups, which interfere with the pursuit of their therapeutic or research goals. A case is here presented from observations made by the author in one pavilion of the Hospital Victor Larco Herrera in Lima, Peru, of a 'bag man' who persisted in carrying his 'hoard' with him in large market bags. The practice of hoarding is related to the culture and social structure of the hospital, patients' use of physical space, the existence of trade networks, the smuggling of alcohol, and patients' needs to retain a feeling of selfness and personal autonomy as well as to maintain ties with the external world. In all these senses the hoarding habit is overdetermined: it is both a symptom of pathology and a sign of healthy functioning. However, its clinical construction may be expanded by an observer who can function as a 'culture broker' and who may be able to apply the dialectic of pathology and health to the operation of psychiatric services for more therapeutic ends. However, the observer, in a consultation capacity, is advised to go beyond the study of transference and countertransference in his or her subjects to focus on his/her own countertransference in order to consult more effectively.

Anthropology, Cultural↗
PubMed1986

Countertransference in cross-cultural psychotherapy: the example of Jewish therapist and Arab patient.

In the course of most psychotherapies, the cultural background of the therapist vis-à-vis the patient seldom emerges as a potential barrier to treatment. This is so for the simple reason that generally both participants share similar backgrounds. When this is not the case, however, divergent cultural values and assumptions may invade the treatment--sometimes undermining it altogether. The focus of this paper shall be on some of the countertransference issues in cross-cultural psychotherapy, with reference to one specific, and in some ways unique, therapist-patient dyad: the Jewish (Israeli) therapist and Arab patient. In the paper, I shall explore some of the more typical and troublesome countertransference issues that often occur in this particular example of cross-cultural psychotherapy. In addition, some suggestions will be made regarding the technical management of these countertransference problems.

Aggression↗
PubMedDate not supplied

The evolution of countertransference and its applicability to nursing.

While psychiatric nurses frequently use the term countertransference, the lack of a uniform definition may result in misunderstandings. In addition, some have questioned the applicability of countertransference to nursing. The author proposes that historical developments have led to a gradual expansion in the definition of this concept. However, some psychiatric nurses have also described countertransference incidents that are more intense and enduring than the transitory experiences described by the expanded views. The result has been conceptual confusion that limits nursing's ability to benefit from an increasingly valuable therapeutic tool. Modifications may therefore be required to make this concept applicable to certain nursing settings.

Countertransference↗
PubMed1984

Countertransference in focal psychotherapy.

The authors discuss the role and development of countertransference in brief psychotherapy. Factors inherent to the goals, setting and techniques of brief therapy appear to undercut the development of a regressive countertransference. The countertransference phenomena that seem to be more prevalent in brief treatment are those stemming from the reality-based response of the therapist to the patient. The impact of these factors on patient selection and treatment outcome in brief therapy are discussed.

Countertransference↗
PubMed1976

Countertransference: a neglected subject in clinical supervision.

As an acknowledged aspect of psychotherapy, countertransference would be an anticipated subject for discussion in clinical supervision. However, the authors' review of videotapes of 24 supervisors working with second-year residents revealed that 12 made no comments on the subject, 8 approached the subject directly, and 4 approached it indirectly. The authors discuss the reasons for this avoidance of countertransference issues and note that discussion of countertransference does not necessarily change supervision into therapy.

Countertransference↗
PubMed1980

Transference and countertransference in homosexuality--changing psychoanalytic views.

This retrospective review of the psychoanalytic treatment literature about homosexuals traces the development over the years of views of transference and countertransference. Shifts are identified in the dynamic understanding of transference phenomena, from an early emphasis on Oedipal issues to the contemporary focus on early maternal relations and how disturbances in these are recapitulated in the homosexual transference; this evolution parallels broader trends in clinical psychoanalysis. Against the background of rapidly changing social and professional attitudes toward homosexuality, and in light of burgeoning interest in countertransference among psychoanalysts, the absence of any discussion of countertransference in the treatment of homosexuals is considered significant. Further, the overwhelming attention given to male, compared to female, homosexuals is noted. Finally, some questions are raised about the implications of the contemporary status of psychoanalytic thinking about the treatment of homosexuality.

Countertransference↗
PubMed1987

The resident's countertransference: approaching an avoided topic.

The resident's countertransference to his/her patient may offer essential information about certain denied processes within that patient. It may also signal the existence of countertherapeutic scotomas within the resident. This paper offers a clinically based approach for directly identifying, exploring, and utilizing the information emerging from the resident's countertransference. This approach focuses on the "only or never" phenomenon, the parallel process, and introspective curiosity as modes of identifying the existence of countertransference responses. It highlights the importance of confrontation and clarification to explore the meaning of these responses in the context of that particular resident with his/her particular patient.

Adult↗
PubMed1994

Variations in countertransference reactions in psychotherapy with children.

This paper has further developed and argued for a broadened concept of countertransference in psychotherapy with children and adolescents. The model presented here emphasizes that countertransference difficulties may result because of therapist reactions (1) to the child that are acted upon directly in the child's treatment, (2) that are stimulated by the child and displaced onto parents, or (3) that are stimulated by the parents themselves, while still being acted upon in the treatment of the child. In all of these situations, the therapist unconsciously may alter the treatment of the child or the guidance offered the parents about the child. Supervision and consultation in therapy, as well as therapists' examination of their own reactions to all members of the family system (including to those who are not present) are helpful in understanding and managing these complicated countertransference reactions. Finally, it is highly recommended that therapists see parents of a child in treatment regularly to decrease distortions of them and to appreciate them appropriately as ordinary human beings.

Adolescent↗
PubMed1994

Countertransference issues in staff caregivers who work to rehabilitate catastrophic-injury survivors.

Countertransference reactions experienced by caregivers who work to rehabilitate victims of catastrophic physical lesions arise from the fundamental characteristics of catastrophic lesions: they are life threatening, life altering, anatomy altering, and restoration to pre-illness normalcy virtually never occurs. No true preparation is possible: Major physical and psychological work is required to rebuild a traumatized personality and a damaged body so that a life of quality is possible. Countertransference refers to (therapist's) unconscious reaction to patient transference, i.e., to aspects of the patient's behavior that are the product of unconscious factors in the patient's personality, as well as the meanings attached by caregivers to patient's impairment and rehabilitation struggles. Countertransference reactions arise in caregivers from two sources: (1) Socially universal sources: the demands posed by patients' regression; patients' misplaced aggression; patients' thwarting of staff's (narcissistic) professionalism; the threat of obligatory identification; staff disgust at patient's body damage. (2) Individualized sources: individual residues of caregivers' own developmental experience (conscious and unconscious) with issues such as dependency, aggression, sexuality, self-esteem and autonomy. Solutions involve understanding and mastering the distinction between feelings and actions, and sparing patients from two actions: Assault or abandonment. Suggestions for management include better knowledge of basic psychodynamics; working toward continuous self-awareness; special group meetings; and selective use of educationally oriented psychiatric consultations. Three case examples are offered.

Activities of Daily Living↗
PubMed1993

Treatment by a psychotherapist and a psychopharmacologist: transference and countertransference issues.

Recent surveys suggest that collaborations between psychiatrists acting as medication consultants and therapists providing psychotherapy are an increasingly common form of treatment. Complex transference and countertransference reactions can arise in these "therapeutic triangles." Risks include splitting by the patient, conflicts between the two practitioners, and premature termination of either the psychotherapy or pharmacotherapy. The authors discuss typical transference and countertransference reactions that can lead to these problems and present case examples of productive and unproductive collaborative efforts. The authors describe a collaborative approach based on mutual respect, trust, and openness that, along with an awareness of typical transference and countertransference issues, can increase the likelihood of a positive treatment outcome.

Adult↗
PubMed1983

The analyst and the patient's object world: notes on an aspect of countertransference.

I have discussed an aspect of the problem of countertransference that has received little comment--the relation of the analyst to objects in his patient's world. Emotional reactions stimulated in the analyst by his perception of such objects can have a profound effect on the course and outcome of his analytic work. Such responses are a product of complex interactions between the impulses, affects, fantasies, and defenses evoked in the therapist by the mental representations he has formed of these objects. Such objects, in fact, can have a variety of meanings for the analyst. Not only are they related to self-and object representations past and present, but they may, in his imagination, be part of a network of interactions involving the patient, his family, and other of his objects as the result of the reawakening in the analyst of fantasies, memories, and expectations derived from his sibling and family relations. Emotional responses aroused in the therapist by the patient may also be displaced onto objects in the patient's world and not be recognized as countertransference phenomena. Finally, I have commented on the way that reconstructions can be influenced by the analyst's perceptions of his patients' objects, and I have made some note of the special situation when an object in the patient's life is also known to the analyst. While awareness of his conscious attitudes and feelings toward such objects can serve a useful function for the analyst, too complacent an attitude regarding the protective value of such self-awareness may make difficult his recognition of the link between the image of the object known to both patient and analyst and the reawakened self- and object images of the analyst's childhood--a link that, in fact, constitutes the deepest source of countertransference difficulties.

Adolescent↗
PubMed1986

Countertransference and the theory of technique: discussion.

Historical, clinical, and conceptual remarks are presented regarding countertransference and the theory of psychoanalytic technique, preliminary to and in the context of discussing the contributions to the panel, "Countertransference in Theory and Practice" (Tyson, 1984; Loewald, 1984; Jacobs, 1984; Dewald, unpublished). In addition, special emphasis is given to problems of countertransference in training and supervision which may be prototypes for later difficulties in analytic work.

Countertransference↗