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PubMed1982

The role of the psychoanalytically oriented psychotherapist within a therapeutic community.

This paper presents a theoretical model for the psychoanalytically oriented psychotherapist working in a therapeutic milieu in which the standard psychoanalytic situation is altered in three respects: (1) the patient is borderline or psychotic and has difficulty participating in a verbal, insight-oriented approach, (2) the therapist is part of a treatment team, and (3) the patient is treated while in a community setting. These three factors can create difficulties in treatment, which will be reviewed with the goal of delineating a model to guide the therapist as he or she responds to the multiple stimuli of a therapeutic community. The role of the therapist will be examined from two broad points of view: the nature of psychotherapy with borderline and psychotic patients within the milieu, and the interaction between therapist, treatment team, and therapeutic community and its effect on the patient. Certain aspects of transference and countertransference in milieu treatment will also be discussed.

Countertransference↗
PubMed1984

Illness in the therapist: the eye patch.

During the second year of my psychiatry residency I began to experience an illness (corneal dysplasia) which necessitated the wearing of an eye patch for unpredictable lengths of time. I will use this particular even in the life of a therapist to focus on the array of feelings, reactions and meanings such an event stimulates in therapists, patients and colleagues. In addition to describing transference, countertransference and personal reactions, I will link the concept of such an occurrence as "special event" with the therapist's belief in his own specialness, which magically immunizes him against illness and death.

Adolescent↗
PubMed1989

Transference and the vicissitudes of medication use by borderline patients.

This paper discusses the psychodynamics of medication use by borderline patients who are involved in ongoing psychotherapy. Particular attention must be paid to the transference reactions that these patients have to the therapist and to the medication, and to countertransference responses as well. Shifts in the transference must be monitored, as rapidly fluctuating views of self and other may hamper borderline patients' abilities to use medication responsibly at certain points in treatment. Case examples are used to illustrate the complexities of the prescribing process in such situations. The implications for prescribing strategies are considered.

Borderline Personality Disorder↗
PubMed1990

Interaction regulations used by schizophrenic and psychosomatic patients: studies on facial behavior in dyadic interactions.

This paper is part of an extensive research project that is trying to examine transference and countertransference processes objectively. We have used a methodology that describes and analyzes interactive behavior patterns observed between different groups of patients with psychic disturbances and their interaction partners, who are uninformed about their problems. Thus far, we have completed several studies centered around the question of whether it is possible to identify specific interaction strategies in groups of patients of different nosological categories. Related to this question was the investigation of the specificity of the response patterns of their interaction partners. The patients consisted of stutterers (stuttering openly or not, Krause 1982a), schizophrenics (Krause et al. 1989), and psychosomatic patients (Sänger-Alt et al. 1989). This line of inquiry has rather severe consequences for the research strategies, which have been described elsewhere (Krause et al. 1989). In this paper, we will present for the first time a synopsis of patterns of facial behavior observed in different groups of patients and their healthy partners, and in healthy subjects interacting with each other.

Adult↗
PubMed1991

The homosexual analyst. Clinical considerations.

Some aspects of the work of the homosexual analyst with gay and heterosexual patients are discussed. The author examines the reasons most homosexual patients prefer to work with gay therapists, why it is usually beneficial for them to do so, and the related question of the appropriateness of revealing sexual orientation to one's patients. Manifestations and elaborations of transference and countertransference when the gay analyst works with homosexual and heterosexual patients are also discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Narcissistic disorders in children.

This paper discusses children who initially may seem suitable for psychoanalytically oriented treatment but who do not respond in the anticipated manner. Such difficulties in treatment may suggest the presence of a narcissistic disorder. Clinical material from a latency-aged girl is presented to demonstrate the typical difficulties encountered in maintaining a working relationship with such children, and the special frustrations and countertransference issues that are apt to arise. A set of criteria is proposed to help in the diagnosis of a narcissistic disorder, and a treatment approach is suggested.

Child↗
PubMed1992

Rescue fantasies and the secret benefactor.

The concept of rescue fantasies is traced from Freud's earliest idea of the rescue of the mother as the fallen woman to later ideas of ambivalent rescue of the father, siblings, and children. Clinical vignettes from work with children and adults illustrate these points as well as reparative rescue fantasies in response to trauma and narcissistic hurt. The contemporary family romance myth of the secret benefactor as rescuer is described. An analytic case presentation explores the narcissistic-masochistic and the positive and negative oedipal meanings of the secret benefactor rescue fantasy. Application to countertransference enactments in the analyst is suggested.

Adolescent↗
PubMed1994

Analytic abstinence and preoedipal disturbance.

Analytic abstinence entails a technical frustration that may have different meanings for those with primarily neurotic disorder and those with significant preoedipal pathology. It is posited that the greater the degree of preoedipal disturbance, the greater will be the tendency to experience the frustration of the technique itself as transference-laden: conflicts related to frustrating experiences in early childhood are revived owing to the abstinent form of psychoanalytic treatment. Ramifications regarding the analyst's work-ego, countertransference, general strategic considerations, and technical difficulties are discussed.

Countertransference↗
PubMed1995

Erotic transference in the male adolescent-female analyst dyad.

Erotic transference involving female analysts and adult male patients has received increased attention in the past ten years. Absent from the literature, however, are any clinical reports concerning erotic transferences of adolescent male patients with female therapists. This paper presents a fragment of a treatment involving an adolescent male patient who developed an erotic transference. The vicissitudes of the transference, as well as his relationship to his mother and father, are discussed from the perspective of developmental conflicts and tasks of adolescence. The countertransference dimensions of this particular gender constellation are also examined from the standpoint of intrapsychic and cultural factors.

Adolescent↗
PubMed1995

Post-traumatic stress and coping in an inner-city child. Traumatogenic witnessing of interparental violence and murder.

Violence today appears to be ubiquitous: it even enters the clinical session, deeply internalized within child victims who were exposed to often unspeakable horror. Violence and its pernicious, horrific effects are observed in the streets, schools, parks, playgrounds, and homes of some inner-city communities. This article introduces the use of Anna Freud's Diagnostic Profile system with an inner-city child who, at the age of four, witnessed his mother fatally stab his father with a kitchen knife and at age eleven was assessed and treated by the author. Clinicians may wonder whether any kind of therapy could ever undo the serious fixations, regressions, developmental arrests, and integrate trauma-shattered ego functions observed in children exposed to visual horror and affective terror. Application of the Profile may offer some direction with these children: a panoramic view of their painful mood, their hypervigilance and distrust, fears, separation and annihilation anxieties, nightmares (with murder imagery), developmental anomalies and arrests is presented with clarity and force. The therapist uses countertransference responses to monitor the affect tolerance in the child and to determine the appropriate dosages of awareness the child can integrate from one moment to the next. The therapist also serves as the child's external stimulus barrier and explores feelings about media-driven portrayals of violence, stereotypes, and inner-city children and youths. The unsurpassed utility of the Profile as a diagnostic system that documents vital economic, dynamic, structural, genetic and adaptive-coping information about the child is discussed in detail as is the Profile's added benefit of possibly guarding against misdiagnosis and charting a course for psychotherapy in difficult city-violence trauma cases.

Adaptation, Psychological↗
PubMedDate not supplied

Erotic horror: desire and resistance in the psychoanalytic situation.

The emotions experienced during a sexualized transference are, though genital, hardly pleasurable. The phrase erotic horror describes something of what most patients find the experience to be like. Accordingly, I set forward the hypotheses that in direct proportion to the intensity of its need, the erotic transference is a form of negative transference deriving from past object relationships with exciting but frustrating objects; genetically, erotic transferences can be related not only to the oedipal phase but also to preoedipal phases of development, can refer to actual or fantasied seductions by either or both parents, and can involve both sexual and aggressive drives; the patient can also be an exciting but frustrating object to the analyst, evoking inevitable countertransference feelings in the analyst pertaining to both contemporary and past objects; the factor that most limits the elucidation of the patient's erotic transference is not the desire of the patient but the desire of the analyst; and only the correct interpretation, whether spoken or silently understood, mitigates the frustrated desire and resistance of both patient and analyst.

Adult↗
PubMed1992

Psychoanalysis and child and adolescent psychiatry.

This report describes psychoanalytic advances in theory and practice as well as changes in knowledge about determinants of behavior from infancy through adolescence. These changes influence how dynamic psychotherapy is conducted. Mother-infant research, affect development, object relations separation-individuation theory, and newer concepts of regulation of self-esteem are explored as they affect treatment strategies. The authors also review countertransference transference and psychoanalytic reconstruing of adolescence as a stage and their influence on how therapy is conducted. Finally, the authors propose using a dynamic formulation as a means of determining where or when the therapist intervenes.

Adolescent↗
PubMed1985

Group psychotherapy with multiple personality patients.

Group psychotherapy with multiple personality patients is an infrequently utilized technique. In a homogeneous group composed of multiple personality patients, the technique of group psychotherapy is examined in detail. The group setting, selection of patients, and group composition are described. Therapeutic issues involving group process, intrapersonal dynamics, transference, countertransference, co-therapy, and termination are examined. Finally, psychotherapy with the group of multiple personality patients is contrasted with group psychotherapy with borderline patients and incest victims.

Adolescent↗
PubMed1995

Therapists' attitudes about treating patients with eating disorders.

The attitudes of 90 therapists toward patients with an eating disorder were explored by questionnaire. Topics included therapist's treatment desires, countertransference, treatment approaches, and prognosis. Twenty-eight respondents (31%) desired not to treat such patients. Analysis of those who did not desire to treat these patients showed that (1) more of them were male, (2) individual therapy as the sole treatment method was more common, (3) feelings of empathy were less common, and (4) more of them believed the prognosis for anorexia nervosa with bulimia to be poor. Overall, therapists considered cognitive behavioral therapy to be the preferred treatment method, though subjects who desired to treat these individuals tended to use more diverse (dynamic, supportive, interpersonal, eclectic) approaches. Twenty-nine percent of both groups believed female therapists were preferred. Therapist frustration, treatment resistance, and comorbid conditions were found problematic. This study revealed several factors that distinguish therapists by desire to treat individuals with eating disorders.

Attitude of Health Personnel↗
PubMed2005

Boundary issues and personality disorders.

The author first presents an overview of the basic elements of boundary theory and clarifies the distinction between boundary crossings and boundary violations. The concepts of context dependence, power asymmetry, and fiduciary duty as they relate to boundary problems are also discussed. The intrinsic and extrinsic consequences of boundary problems are reviewed. The extrinsic consequences fall into three major categories: civil lawsuits, complaints to the board of registration, and complaints to professional societies. The author then reviews types of boundary issues that arise in relation to histrionic, dependent, antisocial, and borderline personality disorders. Countertransference issues that arise in working with patients with personality disorders are discussed, as well as cultural differences that may affect the perception of boundary problems. The article ends with a list of risk management principles and recommendations for avoiding boundary problems in the therapeutic relationship.

Countertransference↗
PubMed2005

Psychodynamic perspectives of collaborative treatment.

In contemporary psychiatric practice, collaborative treatment between a psychiatrist and psychotherapist is very common. Much attention has been devoted to the fiscal, ethical, and legal issues relevant to this treatment modality. However, such collaboration had been proposed long before the advent of managed care, which has accelerated the trend to separate the dynamic and the biologic. While fiscal considerations have been highlighted of late, the underlying tension between the dynamic and biologic remains and with it the complexity and potential pitfalls that directly and indirectly affect patient care. These issues are often neglected or kept in the realm of the unconscious. The key issues of transference, countertransference, and dynamic issues related to medication are discussed from the perspectives of the psychiatrist, the therapist, and the patient. In this article, the authors review the literature in order to revisit and reframe psychodynamic issues, as a timely reminder for clinicians to look at patients in different frameworks, and as a means of enhancing the effectiveness of collaborative treatment.

Countertransference↗
PubMed1998

Under the volcano: varieties of anger and their transformation.

This paper seeks to illustrate the ambiguity of the affect of 'anger' which masks a number of subtly different emotions observable in clinical work. The author differentiates between anger, rage and hatred in terms of the dialectical relationship between ego and self and pays particular attention to why it is that for some patients, experiences of anger may be harnessed creatively into development, whereas for others, they remain self destructive. Using illustrations from work with two patients in analysis, the author describes how a persistent grievance originating in the earliest stages of life is linked with hatred and can lead to a defensive self structure. It is suggested that the clues to the presence of a grievance and to its potential transformation are likely to be observable first in the analyst's countertransference in the form of an all-embracing emotional strait jacket. Analysts' capacity to tolerate their own hatred is crucial to the transformation of a patient's grievance.

Aggression↗
PubMed2001

His mother-tongue: from stuttering to separation, a case history.

This paper delineates the transference and countertransference experiences in the analysis of a patient whose presenting symptom and main concern was his stutter. I suggest that oral-sadistic rather than anal-sadistic hostile elements may be identified in this patient's particular stutter. I focus on its significance in terms of object relationship: my patient's struggle to 'get born', to emerge as a separate other. I argue that early symbiotic fusion needs in conflict with the need to separate produce his stutter. Speech and language are seen as the vehicle for separation and the stutter as a flight from separateness back to an illusion of fusion with mother.

Adult↗