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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↗
PubMed1991

New uses of countertransference for the inpatient treatment of borderline personality disorder.

The author describes the uses of countertransference for the inpatient treatment of borderline personality disorder. Differences from usage in the dyadic outpatient situation are noted. In particular, the countertransference induced in staff may provide a crucial signal function reflecting the patient-ward system. Understanding these feelings provides information not only about the patient's inner world but also about general system features such as the staff's needs, therapeutic capacity and unresolved feelings from previous borderline patients. The signal function may also have diagnostic and treatment implications. A conceptualization of countertransference that encompasses the unique system aspects of inpatient psychiatry is helpful in the care of borderline patients.

Ambulatory Care↗
PubMed1986

The "dumb spot" a special problem in countertransference.

A special kind of countertransference which we call the "dumb spot," has been observed and described. We have delineated "dumb spots" which are the result of unlearned theory, the result of learned but not accepted theory, and the result of learned, accepted but not used theory. Those "dumb spots" resulting from unlearned theory, especially in those areas where psychoanalysis is widening its scope of diagnostic categories, age range, and socioeconomic status, are not considered countertransference errors. Those "dumb spots" resulting from learned, accepted but not used theory, we feel do represent special cases of countertransference phenomena. Theory which is learned but not accepted must be differentiated into that which is not accepted as a result of intellectual judgment and that which cannot be accepted because it would require an alteration in the analyst's self or object representations.

Adult↗
PubMed1995

Tangled in the web: countertransference in the therapy of factitious disorders.

OBJECTIVE: Patients who simulate or actually self-induce illnesses to assume the "sick role" present a number of imposing psychotherapeutic challenges. The purpose of this article is to discuss the countertransferential reactions that are mobilized in therapy with these patients. METHODS: Literature searches of the MEDLINE and HEALTH databases were performed using the term "factitious disorder." The resulting citations were examined for descriptions of the potential and actual countertransference responses in therapy with such patients. The few citations with relevant material were supplemented with other clinical literature on countertransference as well as observations from cases in which the authors have served as therapists or consultants. RESULTS: Once the medical dissimulation has been exposed, the most conspicuous difficulty is in persuading the patient to agree to therapy. When therapy does take place, both the patient's overt behaviors, such as actual bodily damage, and his or her underlying emotional issues can mobilize particularly intense reactions in the therapist. CONCLUSIONS: Recognition and management of the countertransference reactions likely to emerge in therapy with factitious disorder patients are particularly important if the therapy is to be maximally effective.

Countertransference↗
PubMed1991

Managing countertransference: what the experts think.

The present study attempted to assess the importance of five factors theorized to play a central role in managing countertransference: Self-integration, Anxiety Management, Conceptualizing Skills, Empathy, and Self-insight. 33 experts provided ratings of 50 characteristics of therapists as to the importance of each in managing countertransference. Analysis indicated that each factor is at least somewhat important to management of countertransference, with two of the factors, Self-integration and Self-insight, rated as playing a particularly important role. Clinical implications are discussed.

Adaptation, Psychological↗
PubMed1992

A peer supervision group: put countertransference to work.

1. As the nurse-patient relationship evolves through a series of ongoing interactions, both participants become "known" and stir in each other a range of positive and negative emotional reactions. 2. When working with severely psychologically disturbed patients, the nurse's affective and behavioral response can be valuable clues to understanding the patient's early experiences that contribute to the pattern of relatedness and to the formulation of change, enhancing therapeutic interactions. 3. The goals of the countertransference peer supervision group were to recognize unconscious countertransference reactions; unravel the origin and meaning of those countertransference reactions; and collaboratively develop therapeutic nursing interventions.

Countertransference↗
PubMed1976

[Role of countertransference in complex psychotherapy].

The psychotherapist has a key position in any psychotherapeutic situation, participating in the psychotherapeutic process with all his personality and responding both consciously and unconsciously to the patient and the entire psychotherapeutic system. Countertransference consists of those actions and emotional manifestations on the part of the psychotherapist, which originate from his unconscious strata as a reaction to the overall situation. The existence of countertransference and its possible interference with, and perhaps adverse effect on, the psychotherapeutic process require close scientific and social controls. Also, it will be necessary to make "self-experience" psychotherapy (educational analysis) a required subject. Countertransference also has important perception- and empathy-promoting functions.

Countertransference↗
PubMed1986

Countertransference, empathy, and the analytic ideal: the impact of life stresses on analytic capability.

Analysts' emotional attitudes toward countertransference issues are influenced by unduly perfectionistic ideals that are partly derived from the early period of psychoanalytic theory. Analysts' unconscious receptivity, whether of the beneficially empathic kind or the disadvantageous countertransference variety, is a reflection of a dynamic internal state. This fundamental relationship between empathy and countertransference is illustrated with examples. Important events that occur in the life of the analyst, by virtue of their impact on his own central compromise formations, cannot but affect his analytic functioning. Minor disturbances in analytic capability are commonplace and do not significantly handicap effective work.

Countertransference↗
PubMed1985

Some technical problems of countertransference.

There are several aspects of the psychoanalytic interaction that foster the emergence of countertransference. First is a persistent identification with the patient, based primarily on the sharing of unconscious fantasies. Then there is the evocative power the patient's material may have upon latent unresolved conflicts in the analyst. Finally, the analytic setting itself may evoke a broad range of countertransference responses. Particular attention must be paid to those interventions of the analyst which represent attempts to divert his own and the patient's attention from emerging derivatives of the conflicts. There are many clues that should alert the analyst to the possibility of interfering countertransference.

Countertransference↗
PubMed1994

Countertransference to parents in child psychotherapy.

The author refers in this paper to countertransference to parents of children in treatment, within the conceptual framework of Racker's (1) terms concordant and complementary countertransference. In the second part of the paper the author demonstrates that the use of the concept counter-transference to somebody who is not the actual patient has theoretical basis. It is then hypothesized that the simultaneous analysis of the types of countertransference to the parent and to the child might reveal important information regarding the developmental place of the child, and thus, help the therapist in the child's treatment.

Child↗
PubMed1995

Countertransference effects of absence.

In this paper the author aims to refine and explore some aspects of the clinical use and understanding of countertransference. Emphasising that countertransference is unconscious, the author proposes a specific approach focusing on the nature of the ongoing countertransference work that is required to unravel its meaning. Using a clinical vignette in which the analyst had to understand feeling impatient, irritated and then discouraged, the author describes how she was able eventually to understand what had been happening following insights she gained when she mistakenly understood how long a patient was going to be away and the function of the patient's response to her surprise on his return. This leads the author on to a wider consideration of the countertransferential work that may be needed when the analyst decides to take even regular breaks from patients, or when patients decide not to come. General aspects of the decisions analysts make about how and when to work as well as the specific opportunities presented when the occasion arises to inform patients of holiday arrangements, are considered. Finally, the author turns to possible countertransferential responses and the work that may be required when patients return to their sessions, whether they come back having suffered or acted out following the analyst's absence, or after having taken an absence of their own.

Adult↗
PubMed1995

Analysing forms of aliveness and deadness of the transference-countertransference.

The sense of aliveness and deadness of the transference-countertransference represents a critical dimension of the analytic experience and may be the single most important measure of the moment-to-moment status of the analytic process. In this paper the author presents four clinical discussions that illustrate the importance of analysing the experience of aliveness and deadness in (of) transference-countertransference. In each vignette particular emphasis is placed on the use of transference interpretation derived from experience in the countertransference to address the defensive and expressive role of the dynamic movement of aliveness and deadness at a given juncture in an analysis. The role played by the experience of aliveness and deadness in the structure of the patient's internal object world and quality of object relatedness is examined.

Adult↗
PubMed1995

Countertransference in court interpreters.

Transference and countertransference are important concepts in the therapist-patient relationship in psychiatry. They are also important elements of the courtroom setting and the court interpreter's verbalizations. Transference and countertransference are defined and illustrated in both the psychotherapeutic setting and the courtroom setting with interpreters. The role of the forensic psychiatrist as consultant in interpreter countertransference is discussed in this article.

Countertransference↗
PubMed1997

On receiving the patient's transference: the symbolizing and desymbolizing countertransference.

This is an empirical study of the therapist's experience of the patient delineating the boundaries between empathy and constructive and destructive forms of countertransference. The unique step was taken of focusing a video camera on the therapist in order to trace the therapist's nonverbal behavior during listening. The same therapist was observed first in a "not-so-difficult" and then a "difficult" session; the sessions could then be distinguished along dimensions of rhythmicity or arrhythmicity of nonverbal behavior. These observations suggested three modes of experiencing the patient: empathy marked by rhythmicity, a symbolizing countertransference marked by a transitory arrhythmicity, and a desymbolizing countertransference marked by continuous arrhythmicity. The congruence of these formulations based on direct observation of therapist behavior and ones derived from retrospective reconstructions of analysts in sessions (Schwaber, Jacobs, and Laskey) was explored and was found to enhance the validity of the proposed formulations.

Countertransference↗