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At least 793 records · Page 44Linked to original sources
PubMed1975

Brief or crisis-oriented therapy in a city hospital setting.

The philosophy of brief therapy in a city hospital setting is outlined. Therapists frequently resist a brief and active approach and offer rationalizations against it. Most patients, however, seek only symptom alleviation or problem solving, and not insight psychotherapy. Specific treatment goals and foci must be established early when the treatment contract is formulated. Transference and countertransference play a significant role.

Countertransference↗
PubMed1976

The hard-of-hearing psychotherapist.

The hard-of-hearing psychotherapist is faced with special problems not faced by other therapists. This paper discusses these in a framework of reality, transference, and countertransference difficulties. Possible solutions are offered. The need of the therapist to work through his own feelings about his hearing deficit is discussed.

Countertransference↗
PubMed1977

The so-called boring patient.

This paper explores the affect of boredom with specific reference to its arousal in psychotherapists within psychotherapeutic sessions. Using Fenichel's classical psychoanalytic formulation regarding ego-defensive operations as a starting point, it explores the contribution of the more recently understood concept of narcissism, in particular the fluctuating states of narcissistic satiety and depletion within the therapist and their impact on countertransference.

Adult↗
PubMed1980

Problem patients or troublemakers? Dynamic and therapeutic considerations.

The article addresses itself to patients who are of above-average difficulty to deal with and who set up a variety of therapeutic obstructions. The scale of disruptive and counterproductive actions on the part of certain patients is extremely broad and represents a psychopathology per se rather than a specific psychiatric diagnosis. A grouping of ten categories covering clinical manifestations seen in problem patients is offered. Dynamic factors pertaining to the described symptoms are discussed. Brief reference is made to Sullivan's construct of malevolent transformation and Freud's tenet of the negative therapeutic reaction. Several case illustrations are offered indicative of a variety of problem-patient situations in the process of psychotherapy. Finally, a few general considerations about working with particularly difficult patients are added. Special reference is made to various ways of setting limits as well as to the particular role of countertransference in the broadest sense of the term.

Affect↗
PubMed1981

Pharmacotherapy as an intervention during the stages of psychotherapy.

Pharmacotherapy may be integrated into the process of psychotherapy by construing it as one of many interventions available to the physician-psychotherapist, rather than maintaining a strict dichotomy between verbal and pharmacological techniques. Each set of interventions influences cerebral electro-chemical processes and each takes place within an evolving therapeutic relationship which proceeds through different stages. Medications, like verbal interventions, may help or hinder engagement, resistance, transference, countertransference, and working through. One of the major challenges to current clinical psychiatry is the development of firm guidelines for combined therapy.

Adult↗
PubMed1982

The regressed inpatient group in a graded group treatment program.

This article describes the progress of severely regressed inpatients as part of a graded group treatment program. Leaders must actively initiate structure, formulate goals, and emphasize the eventual "graduation" of patients to higher-level groups. Essential qualities of the group leaders and countertransference issues are discussed.

Countertransference↗
PubMed1982

Court rulings on psychotherapists.

A review of court rulings on psychotherapists reveals that: privilege of communication may be overruled; lawsuits may be brought against psychiatrists because they were unable to curb their countertransference and because they had had sexual encounters with patients; psychiatrists were found not guilty if their patients committed suicide; involuntary psychotherapy might be ordered by the court; abusive language does not constitute malpractice; and psychotherapists, records are private material and should not be published.

Confidentiality↗
PubMed1982

Psychological testing of the borderline patient: a guide for therapeutic action.

The diagnostic ambiguity and difficulties of treating borderline patients call for refined idiographic understanding. Psychological testing can make a significant contribution to treatment of borderline individuals at all phases of the clinical process. First, during the initial consultation, an accurate taxonomical identification can be made which also elucidates the chaotic functioning of these patients. Second, choice of treatment modality and strategy can be made on a more informed basis as a result of test report inferences concerning ego functions and object relations. Third, the management of the ongoing treatment process can be guided by test-report elaborations of ego weaknesses, vulnerability toward particular transference distortions, and predilection toward inducements into specific countertransference traps.

Adult↗
PubMed1987

Conceptual trends and issues in the psychotherapy of schizophrenia.

A review of the theoretical principles of exploratory, insight-oriented psychotherapy of schizophrenia shows three major trends: drive theory, object-relations theory, and ego-psychology. These trends follow the development of psychoanalytic theory and may relate to symptom clusters of the illness. Current considerations of countertransference follow similar lines.

Conflict, Psychological↗
PubMed1988

A preschooler in a disaster.

A search of the literature of children in disasters showed no case of individual therapy with such a child. The absence may be related to a specific countertransference. In the case of the preschooler presented here, the child's particular situation and developmental stage were significant aspects of his reaction and therapy.

Abreaction↗
PubMed1990

Referral issues in psychotherapy and psychoanalysis.

The authors consider the complex decisions involved in the initial consultation of a person looking for treatment when this person must be referred to a professional colleague. They explore the way decisions are made in the referral processes and the complex practical and transference-countertransference issues that arise at the outset and whenever second opinions are sought during an ongoing psychotherapy. They present four clinical examples in varying detail to emphasize how readily misunderstandings can develop when even experienced consultants are not sufficiently alert to the complex conscious and unconscious motives and messages being expressed in the exchanges. They make recommendations on how to conceptualize and respond to them.

Countertransference↗
PubMed1991

Psychotherapy of an Arab patient by a Jewish therapist in Israel during the Intifada.

Fragments of a psychotherapy of an Arab patient by a Jewish psychotherapist in Israel, during an exacerbation of a historical political conflict, are presented. In addition to the delineated characteristic difficulties embedded in a cross-cultural/ethnic/national psychotherapy, an Arab-Jewish dyad evokes a complicated interaction between external political reality and the therapeutic space, confusing and obscuring the discourse, the transference, and the countertransference. We believe that the complex and intricate relationship between external reality and inner psychic reality, as it appeared in the therapeutic space, endangered the psychotherapeutic process by blurring the boundaries and creating a fertile ground for projective identification. Both the use of political reality as a defense, or its denial may preclude the possibility for a real dialogue. Implications for emphasizing the differences between patient's and therapist's ethnic affiliations, guarding sensitively the authenticity of interaction, and strengthening both participants' identity in all the relevant levels are pointed out to facilitate the dialectic process of the psychotherapy.

Adult↗
PubMed1992

Clinical consequences of a formal mode of science of psychoanalysis and psychotherapy.

The paper has presented some ways in which existing formal-mode science results are of importance to the practicing clinician. Stress was placed on the quantification and mathematical identification of countertransference difficulties. Formal science results allow for deep insight into the effects of various approaches to doing psychotherapy that have not been previously available. By adding a new dimension to psychoanalytic observation and understanding, formal science studies of the deeper nature of the human mind and of the therapeutic interaction should help in time to lead to major revisions in clinical theory and practice.

Communication↗
PubMed1993

Treatment of patients in the borderline spectrum: an overview.

My purpose here has been to provide no more than a brief overview of an approach to the therapy of borderline patients in the framework of a spectrum view of this complex pathology. While the perspective, generated within a tripartite framework of alliance, transference, and countertransference, allows the therapist a sense of orientation and direction in pursuing the therapeutic work with these patients, it can provide little more than guidelines, a theoretical context for thinking about the therapeutic vicissitudes that challenge and frustrate all of us. Within this perspective, I would emphasize the importance of flexibility. The complexity of therapeutic interactions and the wide scope of variation, seen not only in the borderline spectrum itself but in individual patients, calls for an unusual degree of flexibility and therapeutic adaptability to the immediate demands of the ongoing therapeutic interaction. If therapists, as they are being buffeted about by the storms and unsuspected undercurrents of the therapeutic ocean, can at least keep their bearings and know when they are being pulled out of their therapeutic role and function, their ability to deal with and help their patients will be immeasurably enhanced. I would hope that these few guidelines would provide a workable compass for the task.

Borderline Personality Disorder↗
PubMed1993

The psychotherapy of core borderline psychopathology.

A psychodynamic formulation of borderline psychopathology includes the understanding of the borderline patient's aloneness problems, need-fear dilemma issues, and difficulties with primitive guilt. The aloneness problems are at the core of the disorder, and involve an inability to maintain an evocative memory, and holding and soothing introjects of significant people when under stress of separation. The possible childhood origins of these difficulties are explored and related to the ways these issues emerge in psychotherapy. The psychodynamic formulation is crucial in the psychotherapeutic approach to the aloneness problems. It helps the therapist work with the aloneness difficulties and understand the options as the therapy continues. Since rapid therapeutic decisions are often necessary with borderline patients, the formulation provides the necessary framework, and helps the therapist process and utilize countertransference feelings. Projective identification is an important concept that helps explain the complex transference/countertransference experiences, and is used in defining the resolution of the aloneness problems of borderline patients. Finally, limit-setting and the use of transitional objects are explored, utilizing the psychodynamic framework that has been defined.

Adult↗
PubMed1993

The outpatient psychotherapy of the borderline patient.

This paper discussed common problems in the outpatient psychotherapy of borderline patients, especially their rage, seductiveness, and abrupt negative shifts. The definition of "borderline" is not settled. Even DSM-III-R mixes it up with other personality disorders. There are no pathognomonic symptoms, no specific personality constellations, and no compelling evidence for a definitive stage in infant development when this disorder is fixed; all stages are involved, from faulty foundational to oedipal periods. It is a descriptive diagnosis and typical presentations of such patients are reviewed. In the psychotherapeutic approach, limits must be set first, but these must be flexible and reasonable. Medications are used rarely and with care. We attempt to form an alliance by (a) getting the patient to join us in a study of himself or herself, especially a study of when rage and maladaptive behavior emerges, and (b) providing a consistent and reasonable ambience. The ultimate aim is uncovering and interpreting when the patient is ready for it, more and more approximating psychoanalytic treatment as the patient's pathology permits. The special phenomena of the self-object (Kohut), transitional object (Modell), and disruptive extreme erotic or raging (Kernberg) transferences were reviewed, as well as the pitfalls of therapist anxiety and impatience in dealing with them. While archaic transferences predominate, we serve as an auxiliary microscopic ego and appeal to the rational adult part of the patient's ego in a phenomenological investigation. We interpret early only if we cannot get the patient to examine what has led to the explosions and when distortions or projection without insight continues to predominate. The dangers of early transference interpretations are discussed. Therapy is long, tedious, and requires the willingness to patiently catalyze the patient's resumed development and endure the periodic disruptions. Countertransference problems and what to do about them are reviewed.

Ambulatory Care↗
PubMed1993

The interaction between pharmacotherapy and psychotherapy in the treatment of posttraumatic stress disorder.

For patients with PTSD, the effective initiation of additional therapeutic modalities to ongoing individual psychotherapy is challenging. When pharmacologic agents are added, the therapist must carefully consider and monitor the impact of medications on PTSD core symptoms and on adjunctive symptoms such as depression. Further considerations include issues of countertransference, the possible symbolic meaning of medications for both the patient and the therapist, and the appropriate staging of medications. When nonphysician treaters work together with a medical back-up, both parties should frequently communicate with one another in order to avoid unnecessary treatment distortions and disruptions.

Combined Modality Therapy↗
PubMed1993

The context of transference interpretations in analytical group psychotherapy.

Transference interpretation varies with the underlying understanding of the concept of transference. We view the phenomena of transference in its multiple connections; its relationship to countertransference, its relationship to a particular kind of remembering that unfolds in sequence rather than in representation and its relationship to working through. The transference is expressed in the context of a "total situation" and in order to unfold, requires a time-space frame which variation will modify the nature of the transference available for interpretation. The analytical frame applied to a group situation creates an environment that promotes rapid and sometimes massive regression. We have introduced the notion of levels of transference to account for the state of self/object differentiation present in the group. This varies with the amount of regression, and depends on the severity of splitting, projection and projective identification. In terms of transferential objects available in the group, we recognize the analyst, other members and the group as a whole. The latter carries the more primitive transference and the underlying phantasy structure of the group transactions. We briefly described some possible errors in the interpretation of transference and their potential consequences.

Countertransference↗