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PubMed1982

The exit line: heightened transference-countertransference manifestations at the end of the hour.

Final comments in many contexts have privileged positions among the many communications we make to one another as human beings. Deathbed pronouncements are treasured for their alleged profundities. "Famous last words" are catalogued. As we listen to political debates, we are particularly attentive to the closing statements of the candidates in the belief that something of superordinate importance will be revealed in these final words. Patients who come to us for psychotherapy and psychoanalysis also convey special messages in their parting comments. Final words are heavily invested because they bear the feelings deriving from earlier separations, complete with the longings to fuse with the earliest objects. Moreover, the cathexis belonging to the object may indeed be displaced onto words. In this paper I have sought to delineate and to describe certain patterns of exit lines which may provide useful information for the clinician. These "last words" are saved for the hour's end to keep them out of the therapeutic process and to render the therapist impotent and unable to respond. However, the therapist need not despair because he can bring these comments into the following hour as the focus of much productive work. After all, as Scarlet O'Hara would say, "Tomorrow is another day."

Adult↗
PubMed1984

Countertransference and supervision: a discussion of some dynamics from the point of view of the supervisee.

Although the important role of supervision in the training of psychotherapists is generally well recognized, it does remain a neglected topic in daily psychiatric practice. An overview of the abundant literature written on the subject shows the paucity of papers that take the perspective of the supervisee and subjectively describe the experience. A common difficulty of the supervisory process appears to be the management of the therapist's feelings both in his relationship with the patient and with the supervisor. This problem is approached from the point of view of the supervisee, using a group perspective. A clinical vignette, from a supervised individual psychotherapy process illustrates how supervision is a mourning process where frustrations and losses abound. The difficult task of working through these conflictual feelings is fundamental for the supervisee if he wants to learn from the experience. Within this painful process (and to avoid it) many defensive mechanisms are often used and are described by the author along with some of their possible psychodynamics.

Adult↗
PubMed2006

Countertransference reactions in therapeutic work with incestuous sexual abusers.

The study was a qualitative investigation aimed at therapists' responses to working with a population of incestuous sexual abusers. Semi-structured interviews were conducted with nine therapists who were recruited from psychotherapy, psychology, and forensic psychology services in the National Health Service (NHS) in the UK. The predominant therapeutic model was psychodynamic; however, cognitive-behavioural and integrative approaches were practiced by some therapists. The data were analyzed using interpretative phenomenological analysis (Smith, 1996). Results suggested that the therapists experienced a considerable amount of negative and difficult feelings and that they tended to experience feeling controlled and deceived, which seemed to influence their ability to create and maintain the therapeutic relationship. It was suggested that the dynamics of incestuous sexual abuse played a part in these difficulties. The results are discussed with reference to the clinical therapeutic literature.

Adult↗