Transference and countertransference as interindividual cathexis.
Explore the source record for details and available documents.
Classification↗
SEARCH · Search PubMed
Results for “Countertransference”
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
[Transference and countertransference or masochism in the economy of the analytical situation].
Explore the source record for details and available documents.
Female↗
[Not Available].
Although treatment selection in psychotherapy can be conceptualized as an interactive process, as yet there is few empirical research that aimed at addressing the significance of therapists' emotional reactions to their patients when selecting appropriate psychotherapeutic treatments. The present naturalistic-observational cross-sectional study investigates therapists' countertransference which was assessed after the completion of the intake interview. 13 psychotherapists rated their countertransference feelings regarding 237 patients who presented at a psychotherapy outpatient university department, using a 17-items feeling word checklist. By means of factor analysis, three dimensions of the countertransference ratings could be found: 1. sympathy; 2. helpfulness; 3. anger. Clusteranalytically, patients could be assigned to four groups that are characterized by specific countertransference patterns: 1. positive countertranference (n = 82); 2. weak countertransference (n=124); 3. ambivalent countertransference (n=16); and 4. negative countertransference (n=13). The frequencies of both diagnostic categories and selected treatments proved to differ between the clusters. In the positive countertransference cluster, patients with depressive disorders were more frequent and patients with somatoform disorders less frequent. In the positive countertransference cluster, the indication of cognitive-behavioral therapy was especially frequent. Regarding the combination of positive countertransference and selection of cognitive treatment, the result of a previous study could be replicated. This finding proved to reflect different countertransference attitudes and indication preferences of therapists with different therapeutic philosophy orientations (psychodynamic vs. cognitive-behavioral).
Countertransference↗
Induced emotional reactions and attitudes in the psychoanalyst as transference in actuality.
The long hiatus between Freud's seminal paper on countertransference in 1910 and the contributions of the 1950s on totalistic countertransference is analyzed in terms of historical factors and others intrinsic to psychoanalysis. Induced reactions in the psychoanalyst as transference in actuality is differentiated from classical countertransference and the growing literature on totalistic countertransference, as well as from transferences involving the usual displacement and projective mechanisms. Several cases are discussed to indicate the wide range of psychopathology in which induced reactions occur and their value in reconstruction. The reasons for the confusing use of the concept, countertransference, for a variety of psychological processes in the analyst are cited, and a new model of five categories centering around modes of communication are posited: empathic transitory identifications, preconscious associations and imagery, induced reactions to transferences, induced reactions as transference in actuality, and classical countertransference. The relationship of induced reactions to classical countertransference is discussed, as well as implications of induced reactions as transference in actuality for internalization theory, and implicitly for the psychology of the self. Finally, some clinical issues in the use of induced reactions are eluciated.
Adult↗
[The emotions of physicians. Significance of physicians' emotional reactions to the patients].
During the last thirty years there has been a growing interest in research into physician-patient interaction. This article highlights the research which concerns the physician's countertransference feelings. The concept of countertransference is described and a classification with relevance for physicians in general is explained. The existing research into the incidence and consequences of countertransference is examined. Examples are given of categories of patients, who often evoke specific countertransference feelings in the physician. The consequences of the countertransference feelings for the physician himself are discussed and examples are given of particular situations where countertransference feelings could be of importance. Finally, the existing possibilities to learn about handling countertransference feelings are surveyed and the authors emphasize the need for more research in this particular field.
Countertransference↗
Supervising the therapy of patients with eating disorders.
Supervising residents, fellows, and interns conducting psychoanalytic psychotherapy with eating-disorder patients presents special problems and opportunities. The authors explore specific countertransference issues in the long-term therapy of patients with anorexia and bulimia, and describe how these issues in the therapy are often mirrored in the supervisory process. Countertransference phenomena include being secretive, intrusive, shaming, overcontrolling, overindulgent, or overidentified. Experiences associated with countertransference impasses include power struggles, despair, helplessness, and boredom. The wide range of transference and countertransference manifestations represents the difficult domain of long-term therapy with anorexic and bulimic patients, whose relationship with their eating symptom is so complex and ambivalent. Therapists in training benefit from a supervisory attitude of respect and empathy, with specific attention to countertransference difficulties as they arise. While unaddressed countertransference poses the risk of disrupting the supervision and/or the therapy, appropriate recognition and exploration of its meaning in the supervision is an especially valuable training tool in the teaching of psychodynamic psychotherapy, and a source of learning for the therapist in training, the supervisor, and ultimately the patient.
Anorexia Nervosa↗
The ill therapist: therapists' reactions to personal illness and its impact on psychotherapy.
This paper examines the potential countertransference problems therapists face when they become ill. Personal illness creates conscious and unconscious dilemmas for therapists, and the psychotherapy relationship may be strongly affected by the ways in which the dilemmas are managed. Psychotherapy is a relationship based on trust. A therapist's illness does not necessarily damage the trust that has been developed; however, the handling of the illness and interruption can create a major rupture in the relationship. Alternatively, the therapist's illness can create a useful opportunity for therapeutic work. Successful management of countertransference is a crucial ingredient for the latter outcome. Relatively little has been written until recently on countertransference aspects of therapist illness. Available literature has noted such defenses as denial, omnipotent fantasies, and reaction formation against dependency and weakness. Illness has been seen as a problem for "older" therapists, but, in fact, illness can occur at any age. Illness may cause a defensive withdrawal from one's patients and in its most serious instance lead to total empathic failure. Clinical concerns for the ill therapist fall into two categories: how much (if any) information to give patients about the illness and how to work therapeutically with patients' reactions. While there are no clear guidelines, we recommend a flexible, common sense approach with the central focus always on the patient's reactions to information or to changes in the therapy. The foundation for decisions about information and for subsequent processing of reactions must be the therapist's own awareness of countertransference. We recommend consultation with trusted colleagues or supervisors. In addition, we emphasize the ethical responsibility every therapist has to provide for patients in the event of an emergency ahead of time. Finally, we surveyed a small number of experienced therapists who were known to have had personal experience with illness. The results indicated that decisions about giving information were not difficult. However, the countertransference reactions of anxiety, denial, sadness, and avoidance (of patient anger) were often troublesome. We recommend that psychotherapy training include management of therapist illness. We also recommend that supervisors be familiar with the countertransference aspects as they may be called on suddenly to give consultation. Our conclusion is that therapist illness is as big an event for the therapist as it is for the patient, and we hope that a body of literature will be developed on this important topic.
Adaptation, Psychological↗
The perverse subject of analysis.
In this paper I suggest that the analysis of perversion necessarily involves the elaboration and analysis of a perverse transference-countertransference. Both analyst and analysand contribute to and participate in the perverse transference-countertransference which intersubjective construction is powerfully shaped by the perverse structure of the patient's unconscious internal object world. In the fragment of an analysis that is presented, I illustrate the way in which the analyst makes use of his experience in (of) the transference-countertransference in gaining understanding of the perverse scenario that the patient is utilizing as a form of psychic organization, defense, communication, and object relatedness. I discuss the analyst's use of his own unobtrusive, mundane thoughts, feelings, fantasies, ruminations, sensations, and so on, in the service of understanding the perverse transference-countertransference, which understanding is utilized in the formulation of transference interpretations. The perversity of the transference-countertransference is viewed as deriving from the patient's defensive use of particular forms of sexualization as a way of protecting himself or herself against the experience of psychological deadness. Compulsive erotization is understood as representing a method of creating an illusory sense of vitality. The subversion of the recognition of the experience of psychological deadness is achieved in part through compulsively enlisting others in the enactment of exciting, erotized, and often dangerous substitutes for the experience of being alive.
Adult↗
Professional attitudes to requests for secondary facial reconstruction in patients who have attempted suicide.
Two patients sustained multiple facial fractures after a suicide attempt. After a period of convalescence, both wished to undergo secondary reconstructive surgery to improve the cosmetic appearance and function. On the ward, patients induced strong emotional reactions in medical staff and nurses. It should be realised that in most cases suicide attempts are not fatal. It is essential that a psychiatrist is consulted who establishes a psychiatric diagnosis and has an active role in further treatment. What may interfere with the indications for operation is countertransference from the surgeon to the patient who consciously injured himself. Five types of countertransference hatred are distinguished and described; repression of countertransference, projection of countertransference, reaction formation, reversion, and distortion or denial of reality. Failure to recognise this mechanism will result in undertreatment of these patients. A good professional understanding between the consultation liaison psychiatrists and the surgeons may facilitate a positive outcome of consultations in this area.
Adult↗
The revival of "Dora": advances in psychoanalytic theory and technique.
For nearly six decades after its publication in 1905, Freud's remarkable case of Dora remained untouched by critical comment. However, beginning in the early 1970's, an abundance of articles began to appear, which focused exclusively on the Dora case. The present paper reviews the literature of this so-called "Dora revival" in order to explain the historical and theoretical reasons leading to this extraordinary burst of research. Above all, two vital developments in the psychoanalytic discipline created the climate that fostered the Dora revival. First, there was a revolutionary change in attitude toward the phenomenon of countertransference: in contrast to the classical view of countertransference as a disruptive interference in treatment, analysts increasingly regarded countertransference as a pervasive and natural process, which could be potentially utilized to enhance understanding of the patient's unconscious conflicts and defenses. Second, there was enormous and rapid growth of a comprehensive psychoanalytic theory of adolescence and its treatment. Thus, based on a more favorable attitude toward countertransference, and a much improved understanding of the unique problems of adolescence, psychoanalysts could reexamine and better understand the decisive events that contributed to Freud's abortive analytic treatment of Dora.
Adolescent↗
Love in the analytic setting.
In the context of viewing the analytic setting as a "clinical laboratory" to study the nature of love relations, this paper starts by outlining the relationships of transference love, "normal" love, neurotic love, and oedipal love. After a description of the vicissitudes of transference love when patient and analyst are of the same sex and of opposite sex, developments of transference love regarding homosexual and heterosexual longings in neurotic and narcissistic pathology are considered. Countertransference reactions in response to transference love are explored next, with emphasis on conditions under which erotic countertransference may become particularly intense. In describing the technical management of erotic countertransference, the analyst's ability to explore his own feelings and fantasies without constraint is stressed. The usefulness of understanding the erotic countertransference in arriving at transference interpretations is illustrated by a clinical case of a female patient with a neurotic personality structure and predominantly masochistic conflicts.
Adult↗
Thick- and thin-skinned organisations and enactment in borderline and narcissistic disorders.
In this paper the author argues that enactment is any mutual action within the patient/analyst relationship that arises in the context of difficulties in countertransference work. Such enactment is common during the treatment of borderline and narcissistic disorders. In order to delineate different forms of enactment, which in his view may be either to the detriment or to the benefit of the analytic process, the author describes a patient who was identified primarily with a sadistic mother and who threatened the analyst with a knife during treatment. Three levels of enactment involving countertransference responses are described of which two, namely a collusive countertransference and a defensive countertransference, were detrimental to the analytic process. The third level of enactment was beneficial but only because the intervention by the analyst was independent of the analytic process and yet in response to it. The author uses Rosenfeld's distinction between thin-skinned and thick-skinned narcissists to illustrate how enactment is most likely when a patient moves between thick-skinned and thin-skinned narcissistic positions. Nevertheless the move between thin and thick-skinned positions presents an opportunity for effective interpretation, allowing progress in treatment.
Acting Out↗
Interactional behaviour as a marker for screening patients with environment-related complaints.
BACKGROUND: Adequate assessment of symptoms of patients suffering from environmental illnesses requires appropriate procedures such as psychological and psychiatric diagnostics, medical screening and a thorough analysis of noxious environmental factors. The Basel pilot research project established a multi-methodological assessment procedure that meets these criteria. However, an exhaustive three-fold analysis is very costly in terms of both equipment and personnel, and hence the need for a heuristic approach and pre-screening persists. METHOD: The three-fold diagnostic approach was preceded by a structured psychodynamic interview; the findings were used to construct a new profile of the patient's interactional behaviour (IB) in conjunction with the interviewer's countertransference. The extent to which this new profile could predict the results of the multi-method assessment was then assessed. RESULTS: A low level of IB on the part of the patient significantly predicted the degree of stress and the extent of the psychiatric diagnosis, including personality disorders. A negative IB was associated with negative personality traits. Furthermore, a high level of IB implied more medical, but not more environmental, findings which could plausibly be related to the patient's complaints. CONCLUSIONS: Assessment of patients' IB in conjunction with one's own countertransference is very helpful as a preliminary heuristic approach and may lead to consequences for treatment and therapy. Therefore, the training provided for experts who deal with patients suffering from environment-related complaints should place more specific emphasis on assessing patients' behaviour and on incorporating information gathered from countertransference. Nevertheless, an interdisciplinary assessment including medical, psychological/psychiatric, and environmental expertise remains mandatory for adequate and satisfactory diagnosis of patients with environment-related complaints.
Behavior↗
The relational treatment of dissociative identity disorder.
The intent of this paper is to review the literature pertaining to the transference and countertransference components in the treatment of dissociative identity disorder. Aspects of transference and countertransference are presented and discussed within the relational psychoanalytic model. The functions of empathy, enactment, projective identification, and transitional objects are reviewed. Specific attitudes in the transference and countertransference are illuminated and major transference themes are discussed. Finally, a case vignette illustrates some of the central issues involved in the treatment of dissociative identity disorder.
Countertransference↗
Therapist anger in group psychotherapy.
Countertransference anger serves as a defense against the experience of shame, which occurs when therapists fail to live up to jointly created idealized expectations. The author describes ways of changing these expectations in order to reduce the transference-countertransference resonance, which is based on narcissistic needs. The author distinguishes countertransference anger (which should not be disclosed to group members) from realistic therapist anger, which has therapeutic value. Realistic anger can be used as a therapeutic tool to dispel distortions, provide an interpersonal connection, help members trust the reality of the situation, and provide a balance of good and bad between the members and therapists.
Anger↗
Art within analysis: scapegoat, transference and transformation.
Through clinical example and pictorial illustration, the author examines ways in which art offers a particular means of psychological transformation in states which may otherwise be in expressable. A transference to the art work itself is proposed. It is submitted that, mediated within the transference/ countertransference dynamic, this 'scapegoat transference' facilitates a particular process of psychological differentiation. The aesthetic qualities of art presented within analysis will resonate with other countertransference affects. Clinical material demonstrates how observation of this--aesthetic countertransference--leads to a distinction between the 'diagrammatic' and the 'embodied image. The process of integration of shadow material is furthered by the temporary safe-keeping of the art work by the analyst.
Adult↗
Desire and the female analyst.
The literature on erotic transference and countertransference between female analyst and male patient is reviewed and discussed. It is known that female analysts are less likely than their male colleagues to act out sexually with their patients. It has been claimed that a) male patients do not experience sustained erotic transferences, and b) female analysts do not experience erotic countertransferences with female or male patients. These views are challenged and it is argued that, if there is less sexual acting out by female analysts, it is not because of an absence of eros in the therapeutic relationship. The literature review covers material drawn from psychoanalysis, feminist psychotherapy, Jungian analysis, as well as some sociological and cultural sources. It is organized under the following headings: the gender of the analyst, sexual acting out, erotic transference, maternal and paternal transference, gender and power, countertransference, incest taboo--mothers and sons and sexual themes in the transference.
Acting Out↗
High holidays 2000 and aftermath: doing psychotherapy with Holocaust survivors and the second generation in Israel during the sudden eruptions of violence.
The potential for countertransference complications in trauma work is generally known by now. "A priori" countertransference demonstrates that thoughts, emotions, and prejudices are evoked by preliminary information about a client even before the first meeting. Insufficient awareness is likely to put both therapists and clients at risk. The literature about therapy with Holocaust survivors amply illustrates this. Less is known about what happens to the therapeutic process at times of armed conflict. Must additional aspects of countertransference be taken into account? Can psychotherapy continue as normal? The outbreak of violence in Israel on Rosh Hashanah 2000, when peace seemed realistically near, provided an opportunity to explore the impact of therapists and clients sharing real-time, potentially (re)traumatizing conditions. This small qualitative study with therapists who work with clients traumatized by the Holocaust focuses on how they cope with the additional personal and professional challenges, and suggests answers to the above questions.
Adaptation, Psychological↗