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PubMed2001

Enactments and amplification.

Advances in the understanding and articulation of enactments allow a reassessment of analytical psychology's method of amplification. Subjective and objective aspects of the amplificatory process, evolving notions of its role in analysis together with the use of countertransference phenomena provide the frame for reexamination of this method. Using a single analytic day, this paper explores the inevitable play of enactments with a focus on countertransferential components contained in the act of amplification. An internal examination of such an act is used to attempt to identify and differentiate the operative personal, interpersonal and collective aspects. The impact and traces of this act are followed through the workings of the day and demonstrate that the impulse to amplify is a suitable object for analytic scrutiny. This leads to a more general question of the mythic nature of enactments.

Adult↗
PubMed2004

Self creation and the limitless void of dissociation: the 'as if' personality.

The concept of the 'as if' personality has been used variously in analytic literature without having formed part of a clinically based theoretical development over time. The author discusses the bases of her notion of the 'as if' personality, as observed across a number of patients and supervised patients in intensive, long term analytic treatment. In this composite clinical picture, a grouping of elements that form a particular kind of defence of the self is identified in certain patients with an exceptional capacity for creative engagement in the world, surpassing expectations given their background. The picture includes the presence of physical breakdown and illness, as psychic suffering arising from early narcissistic wounding and from a physical, emotional and/or sexual abusive familial environment, was held for too long in bodily memory but not in mind. A distinction is made between the 'as if' personality, the persona and the false self. The 'as if' personality concerns the action of defensive dissociation deriving from very early experiences of internalizing the presence of an absent object, creating the sense of an internal void at the core of the self. At the same time, the self is capable of acts of self creation through a succession of identifications and internalizations with other sources of environmental nourishment, which substitute for, and are constructed around, the original sense of internal emptiness. Thus are restored, but only up to a point, the resources of the originally diminished self. Until these resources have been used up, the self is often able to excel in activities to an exceptional degree. The countertransference is shown to be the means of both useful but often perilously obtained clinical experience and information, supporting the work along the hazardous analytic journey.

Adult↗
PubMed1996

The animating body: psychoid substance as a mutual experience of psychosomatic disorder.

Starting from Jung's hypothesis of 'the psychoid', the author suggests that the concept can be extended and understood as a dynamic, relational and interpersonal experience-especially in regressed analytic relations. The author then defines his use of the term 'animating body' as having to do with primitive animal imagery and with psychosomatic symptoms stemming from disturbed pre-verbal and pre-whole-object stages of development. A case of a borderline patient is presented, whose projective identifications into the analyst infected him with her psychosomatic disorder, with her internalized Oedipal confusion and necessarily induced a mutually similar animal dream symbolism. If these embodied countertransference experiences (of desperate merging and sickening identification) can be lived through (tolerated and survived), thought through and interpreted, then they can actually become enlivening and lead to a therapeutic psychosomatic co-ordination.

Adult↗
PubMed1997

A view of the violence contained in chronic fatigue syndrome.

In this paper I ask whether there might be any one particular psychopathology likely to be linked specifically with the physical illness known as chronic fatigue syndrome (CFS) or myalgic encephalomyelitis (ME), and whether CFS/ME aids and abets and "fits' an original mental state. I think the question cannot yet be answered. However it is my hypothesis that in some personality structures the onset of CFS/ ME following a physical illness exacerbates negativity and is an aspect of ordinary depression where there is a lowering of energy levels and a loss of zest for life, or it may reveal the pathological aspect of unresolved rage. Depending on the degree of pathological disturbance, working with and through the rage may or may not result in a resolution of the symptoms of ME. In this paper I consider some of the problems in the transference and countertransference relationship, which make it extremely difficult to separate out reality from phantasy. There is then the further problem of the denial of the psyche by the patient as part of the violence inherent in the illness. One case is presented, an example of ME in a borderline male patient in whom resolution could not be achieved.

Adult↗
PubMed2006

The week the couch arrived.

Changes in the therapeutic environment can elicit intense and unpredictable responses from patients, who then react to the new elements with their own unique thoughts, fantasies, emotions and behaviours. When the change is very specific, and when it entails implications for the treatment itself, these patient responses can coalesce around more profound experiences of the transference as well as of the countertransference. The author, as a candidate or analyst-in-training, purchased an analytic couch for his office and observed the unfolding of what this new couch meant for existing treatments. Using clinical examples, he describes the three most common patient responses that occurred: rejecting, ambivalent, and embracing. The richly variant ideas and fantasies related to the analytic couch are described, and the couch's history within Freudian and Jungian contexts is reviewed. Personal determinants that could lead to the decision of whether to use a couch as part of analysis are considered from the standpoint of the analyst's preferences and own experience with the couch. The couch is discussed as a signifier of the analytic process with cultural meanings alluding not only to familiar stereotypes, but also to psychological healing and self-development.

Countertransference↗
PubMed1981

Challenges and promises of training women as family systems therapists.

The structural/strategic family therapy model has drawn increasing numbers of women practitioners attracted not only by its effectiveness but by the opportunity to function in an active, orchestrative, flexible role. Traditional sex-role training, family and supervisor expectations, and patriarchal institutional structures pose particular challenges to the female family therapist and trainee. This paper explores several critical problem areas for women learning to function in this role, including the expression of authority, countertransference, sexual politics of supervision, and boundary issues. Particular content areas of focus for didactic training and common sex-role difficulties in the supervision process are delineated. The discussion underscores the need for assessment and intervention skills not only in small family systems but in larger institutional structures as well in order to enhance the professional development and effectiveness of women in the family therapy field at all levels.

Countertransference↗
PubMed1998

Nurses, indirect trauma, and prevention.

PURPOSE: To begin examining the nature of vicarious or indirect trauma and to discuss risk factors and prevention strategies. Despite the fact that many nurses are traumatized indirectly, few recognize the insidious development of such trauma. The dynamics of indirect trauma are relevant to nursing as are risk factors and prevention strategies. SCOPE: Brief review of the literature (1974-1997) on vicarious trauma, compassion fatigue, secondary traumatic stress disorder, and traumatic countertransference using short vignettes for illustration. CONCLUSION: Nurses who are informed about vicarious trauma and who actively maintain a balanced personal and professional life are in the best position to bring themselves and their clients through the many hazards of trauma work. The implications of vicarious or indirect trauma for nurses and clients are serious and complex requiring thoughtful analysis and research to clarify its effects.

Anxiety Disorders↗
PubMed1990

Finding the borderline's border: can Martha Rogers help?

The psychodynamics of the client with a borderline personality disorder are reviewed within the context of Martha Rogers' Model of Unitary Human Beings. Emphasis is placed on the phenomena of transference and countertransference, which are viewed as resulting from the continual mutual interaction of human and environmental energy fields. Nursing interventions are postulated based on recognition of the fact that the nurse constitutes a significant part of the borderline client's environmental energy field.

Adolescent↗
PubMed1991

Working in psychiatric research: answers tomorrow, dilemmas today.

Implementing research protocols with critically ill psychiatric patients sometimes creates professional dilemmas. It almost always intensifies countertransference issues. Working through the process assisted staff at this hospital to reaffirm their commitment to clinical research.

Adolescent↗
PubMedDate not supplied

The pregnant therapist.

The therapist's pregnancy and subsequent maternity leave affects treatment by stimulating many transference and countertransference reactions. Many clients will feel abandoned and rejected, and experience sibling rivalry and oedipal strivings. The therapist's pregnancy can be an opportunity for clients to work through issues of separation and loss, and to make significant progress in treatment. Case examples from the author's experience during her first pregnancy are used to illustrate how such reactions can be managed in treatment.

Adult↗
PubMedDate not supplied

The nurse, the patient, and the illness: an object relations approach to nursing.

TOPIC: An object relations approach to the patient's experience of illness. PURPOSE: To explore possible unconscious meanings of illness to patients, and antecedents to the meanings. SOURCE: The author's clinical experience. CONCLUSIONS: Nurses can work more effectively with patients when they have an understanding of early object relations theory, the defenses of projective identification and splitting, and their own countertransference reactions to patients and their illnesses.

Attitude of Health Personnel↗
PubMed1977

Individual psychotherapy with the institutionalized aged.

Contrary to the predisposition of many mental health professionals, this paper contends that insight-oriented, dynamically-based, individual psychotherapy is an effective treatment modality with the institutionalized elderly. Issues such as dependency, transference and countertransference, contrasts to psychotherapy with younger patients, and methodological modifications are discussed, and clinical examples are offered.

Adjustment Disorders↗
PubMed1980

Brief group therapy with offspring of holocaust survivors: leaders' reactions.

The authors, themselves children of Holocaust survivors, discuss their reactions and experiences in leading nine short-term awareness groups designed for this population. They evaluate their role as leaders, and examine countertransference, personal motivation, and the establishment of goals within the group context. Preparation for therapists leading short-term homogeneous groups of which they are not members is also explored.

Adolescent↗
PubMed1981

On being seen as a "Chinese therapist" by a Caucasian child.

Reactions of ten-year-old Caucasian boy to his Chinese therapist, and his use of this racial difference to express his acute alienation, are described. Stages include the boy's initial projection of aggression and evil onto the "Chinks," subsequent ambivalence and anxiety as attachment to the therapist increased, and eventual trust and alleviation of his loneliness. Aspects of the therapist's countertransference are explored.

Aggression↗
PubMed1986

Challenges of research with the borderline patient.

Clinical research of the borderline personality disorder can be difficult and challenging for the investigator. The core psychopathology and characteristic defense mechanisms of the borderline research subject often make the completion of research protocols with these patients problematic. The researcher may also be plagued by issues of 'classical' and 'total' countertransference. Psychopharmacologic investigations are especially likely to bring these issues to the forefront. Some of the psychologic challenges in completing research with the borderline patient, with special emphasis on psychopharmacologic investigations, are reviewed.

Borderline Personality Disorder↗
PubMed1980

On the subject of handling hostility in therapy.

This paper focuses on the subject matter of handling repressed or expressed hostility within the context of the psychotherapeutic situation. The emphasis is on the importance of permitting the patient to express hostility, and/or help him become aware of the fact that he is repressing it. To achieve this insight on the patient's part, the therapist has to be aware of his own countertransference reactions and has to maintain an objective attitude at all times. Some difficulties in attaining this attitude are explored. Brief vignettes from the author's and others' experience are given.

Adult↗
PubMed1990

Questions of guidance and supervision at the beginning of psychotherapy in children and adolescents.

Firstly, the significance of the establishment of a positive working alliance in children and adolescents at the beginning of a potential psychotherapy is described. Secondly, questions of supervision by means of psychodramatic treatment of transitional situations are discussed. (1) Children and adolescents are mostly presented by the parents and initially have no or hardly any motivation for psychotherapy. The author therefore recommends inter alia a ten-wish phantasy game at the first encounter with the child or adolescent irrespective of the reason for presentation by the parents. The possibility of being able to express ten wishes or changes which a fairy or a magician would fulfill for the child encourages the patient to name the most diverse levels and dimensions of his/her psychological reality and to reflect it in the form of wishes. The therapist thus provides space for yearnings and compensatory 'counterworlds', frequently leading to a positive contact in a subsequent dialog about the wishes. (2) In training, the young psychotherapist is often not aware of his transference and countertransference relationship. Psychodramatic role play in a supervised colleague group or in the development of a psychodramatic 'family sculpture' may frequently clarify the situation quickly by own experience and by 'psychodramatic reflection technique'.

Adolescent↗
PubMed1975

Psychiatry and the elderly: an overview.

The author notes that the elderly in our society have not been provided with treatment, research, and services commensurate with their needs. These needs are reflected in the increasing incidence of psychopathology, suicide, and poverty with increasing age. The psychiatric profession's therapeutic nihilism toward the elderly may reflect unresolved countertransference issues that result in a form of prejudice called "ageism." Many of the conditions labeled "senility" are actually manifestations of socioeconomic or medical problems that could be resolved with prompt, appropriate treatment. The author makes several recommendations--the creation of a multidisciplinary nongovernmental commission on mental health and illness of the elderly, reexamination by psychiatrists of their attitudes toward the elderly, and proportionate representation of older individuals in psychiatric services, training, and research.

Aged↗