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Psychiatric nursing entails its own particular hazards, specifically patient suicide and patient assault on staff. The reactions to these occurrences are manifested in the symptoms of PTSD and grief, which often are exacerbated by administrative reactions and the staff's own countertransference issues.
1. Because of the positive and negative therapeutic insights gained by mental health professionals who have family members suffering from mental illness, an ongoing evaluation of one's practice must be balanced with careful introspection. 2. Therapeutic insights that may be gained from family experiences include letting go of the shame; remembering the particular strengths in the psychiatric nursing role; knowing when you have regressed; learning when to get support; and learning to appreciate your talents as a mental health professional. 3. Mental health professionals who have family experiences with mental illness may bring a bias or suffer from countertransference; however, these individuals bring to work a unique perspective that is born from shared suffering and shared hope.
Transference is a process in which individuals displace patterns of behavior that originate through interaction with significant figures in childhood onto other persons in their current lives. It is a powerful determinant of patient behavior in medical encounters. Transference can affect the kind of physician-patient relationship a patient seeks and his or her response to interventions prescribed by physicians. The relationship is also strongly affected by the physician's own transference or countertransference. Rather than approach every patient in a uniform way, tailoring the approach to fit the relationship needs of the individual patient is advocated. Such tailoring would affect whether the physician is collaborative or prescriptive, how much personal information he or she shares, and how close or distant he or she is. Transference issues can also affect level of somatization and patient adherence to medical regimens. We discuss other problems with transference, such as the seductive patient and gift giving. By paying attention to the transference needs of patients, physicians can enhance the therapeutic alliance in which patients optimally participate in fulfilling their medical needs.
AIM: Analysis of some anxious and aggressive features stemming from the highly traumatic war experiences and having as a consequence chronic posttraumatic stress disorder (PTSD). METHOD: Group psychotherapy was applied as a therapeutic approach of choice. RESULTS: During the psychotherapeutic process, the possibility to name and express anxiety and aggressiveness was uncovered not only as the sequels of highly traumatic war experiences but even the transgenerational transmission of frustrations and aggressive feelings. These features have constantly very strong influence on the therapist's countertransference. Some of the most prominent characteristics of these processes are described through clinical vignettes. CONCLUSION: Longer group psychotherapy is required for patients suffering from serious PTSD to develop the possibility to externalize their deep traumas and to work them through in order to reestablish connections with everyday life. During that process, the countertransferential issues disclose the most important traumatic features and encapsulations, and indicate the main topics to be addressed in patients and the therapist as well.
The relationship between projective identification and aggression is explored through case material in which the psychotherapist felt strongly influenced by the patient's projections. Through a variety of interpersonal and intrapsychic dynamics, the patient evoked an unconscious and conscious sense of hate in the psychotherapist that emerged in a countertransference dream.
An effort was made to provide emotional support during the terminal phase of leukemia in a 20-year-old woman. Notable were the patient's own ways of coping and the responses of her family and the hospital staff. She first denied and then recognized her own dying. Her anger was prominent, and she withdrew from objects toward the end. The intense stresses in the doctor-patient relationship, transference, countertransference, and reality factors are described.
Defensive psychiatry refers to any act or omission that is performed not for the benefit of the patient but to avoid malpractice liability or to provide a legal defense against a malpractice claim. Defensive practices that produce deviant treatment boundaries usually take the form of clinically unnecessary prohibitions that disturb the therapist's position of neutrality. A distinction is drawn between boundary violations, boundary crossings and boundary issues. Typical clinical issues that provoke defensive treatment boundaries include managing patients with sexual transferences and potentially violent patients that may require the therapist to warn and protect endangered third parties. Defensive boundaries are usually created by unrecognized or uncorrected therapists' countertransferences.
A new international standard of editorial policy calls for written informed consent by the subject of every case report. Although this appears to be ethically appealing, the authors posit that in some situations, requesting informed consent may be unethical, can harm patients, and may erode the use of case reports as a valuable teaching method in psychiatry and psychotherapy. The authors discuss concerns regarding this new policy for mental health publication based on issues of transference, countertransference, best interest of the patient, and practicality.
This paper explores aspects of the psychopathology of the patient-therapist relationship, and specifically defines and illustrates the concept of therapeutic misalliances. After a review of the relevant literature, two extended clinical vignettes are presented in order to explore efforts by both patient and therapist to create and modify conscious and unconscious misalliances. A tentative effort is made to delineate attempts on the part of the patient to "cure" his therapist of countertransference difficulties that have contributed to a therapeutic misalliance. Such efforts are based on the patient's extensive unconscious perceptions of his therapist's difficulties and these are documented in detail. In discussing this clinical material, the following are considered: The means of recognizing therapeutic misalliances from the therapist's subjective awareness and from the patient's associations; the interfering and therapeutically helpful aspects of the creation and analytic resolution of misalliances; the techniques through which therapeutic misalliances may be modified; the motives in both the patient and therapist or analyst that prompt the creation of misalliances; the curative aspects of the patient's positive introjective identification with the therapist and the damaging aspects of incorporative identifications with a therapist who is in difficulty; the importance of the adaptational-interactional framework in understanding the patient-therapist and patient-analyst relationships; and the importance of the therapist's personality and behavior, in addition to his role in providing the patient with well-timed and meaningful interpretive interventions.
Speech behaviour of the patient and the analyst is considered with regard to the psychoanalytic situation and its regulating factors such as transference and countertransference. It appears that the scientific viewpoint of the researching analyst determines the conception as well as the interpretation of a possible connection between verbal behaviour and neurotic personality structure. If the psychoanalytic situation is regarded as a means to investigate the patient and his symptoms, his verbal behaviour seems to depend on the unconscious motives forming his neurotic structure of personality. On the contrary, if the psychoanalytic situation is regarded as a communicative situation, the verbal behaviour of the patient as well as of the analyst depends rather on their 'here-and-now' transference relationship in a certain phase of the psychoanalytic process.
This paper is based on the concept that, instead of neurotic conflicts as studied and treated by Freud, Earlier ego-disturbances e.g. psychotic and borderline reactions have nowadays become prominent and need a very different technique of treatment. These so called archaic ego-illnesses are due to an unresolved symbiosis complex, a disturbance which arises already in very early childhood before the development of speech. On a sample of a female borderline patient the author tries to show that in such cases active use of countertransference often provides the only technique with which the psychotherapist may recognize on an averbal plane the needs of the patient and may be able to make them available to her verbally.
This paper describes the relationship between medical staff and HIV-1 patients. Important mechanisms can be used by individuals with HIV-1 infection in order to accept their seropositivity to HIV-1. Among them, regression and negation are well-known. These mechanisms are related to countertransference lived by the medical staff. They are various as well as rejected by medical staff to avoid anxious reactions. On the contrary, the medical staff has to accept the experiences of the patients and to be ready to listen to the problems of HIV-1 infected people.
In some cases a gratifying transference fantasy is the subject of progressive analytic work, while in other cases the same type of fantasy eludes investigation, and its enactment causes treatment to become an unproductive endless task. One cause for the latter difficulty can be that the patient uses his or her analyst as a fetish, permitting the distinction between reality and fantasy to remain inconclusive, so that relinquishment of magical expectations does not take place. The particular form of thinking involved in use of the analyst as a fetish is described. The role of illusion, its various clinical manifestations, the countertransference reactions they can evoke, and the technical problems posed are discussed. Special attention is given to the crucial issue of termination. By considering extreme instances in which use of the analyst as a fetish predominates, the author hopes to call attention to a phenomenon that appears to some degree in many, if not all, analyses.
Understanding the analyst's work and its vicissitudes has been a major focus of recent psychoanalytic writing. This study on slips of the analyst represents an attempt to advance our understanding of analytic work. The slips described support the view that slips reflect not simply contributions from instinctual life, but active work-related goals of the analyst in carrying out the analytic tasks. Countertransference is discussed as reflected in the disturbance of intentionality betrayed by the occurrence of a slip. The essential role of the analyst's understanding his or her own reactions is emphasized.
The turning point is defined as the sudden change of quality that plays the part of a forerunner or prerequisite to the slow structural change in psychoanalytic treatment. Turning points have two common elements, confrontation and surprise, that lead to the centre of the turning point experience -- the feeling of having an inner life--which leads up to the interpretive working through process that corresponds to structural change. To restore or create the feeling of having an inner life runs parallel to restoring the psychoanalytic process from acting-out temptations. Harold Stewart's agents of change are discussed as having the characteristics of turning points and clinical vignettes are described to show the main points. Finally, the countertransference aspect of allowing turning points to happen is discussed.
The author looks at the question of psychic change from the viewpoint of difficulties involved in this change, starting with a short historical overview. He discusses 'the difficult patient as a specialist in resisting change' and describes the clinical characteristics of such patients over and above their psychopathological diagnoses. Some specific clinical cases are described to clarify the theoretical ideas. The author then covers the nature of changes best studied within the field of transference and countertransference. Finally, he examines change as a process of change and suggests that qualitative differences exist between psychic functions relating to 'traumas' in narcissistic constraints. These differences are apparent in psychic content. The connexions between interpretation, insight, anxiety and change are described. The nature of the negative therapeutic reaction is discussed. The notion of an underlying deficiency in the development of genuine egoistic resources required to bring about psychic change is examined.
Understanding the effects of prolonged contact, in a professional role, with trauma victims has led to conceptualizations of helper stress. Various terms such as compassion fatigue, vicarious traumatization, secondary traumatic stress reactions, empathic strains, burn out, and Type land Type II countertransference have been proposed These terms required conceptual classification to make a proper diagnosis and classification of their impact on the helping process. It is proposed that Traumatoid States is a more inclusive and accurate term to define sub-types of occupationally-related stress response syndromes (OSRS).
The question of what is genuine maternal love was posed by a mother struggling to understand and value the nature of her bond with her small baby. The question surfaced time and again in the context of this dyad's long-term parent-infant psychotherapy and has challenged me to examine my thinking and, indeed, has produced impassioned discussions within the Parent Infant Project team at The Anna Freud Centre. In this paper I will address this question through sessional material of this mother and baby and discuss issues of technique in response to it, including my countertransference and conceptualization.