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[Sexual abuse of minors].

The author gives a definition of sexual abuse on minors, emphasizing its more frequent occurrence inside the family (incest) than outside. He describes the countertransference reactions induced by this type of abuse, especially in professional teams who tend to put each other in a position of rivalry. Next, he sketches the pathogeny of sexual abuse, the clinical signs and the long term effects. The author deduces what should be the first signs of sexual abuse and proposes a pattern of diagnosis. Finally, he explains a management model, of the crisis and the follow-up of this difficult situation.

Adolescent↗
PubMed1991

Neglected fathers in the aetiology and treatment of sexual deviations.

Current researches in sexual deviations have rightly stressed deficiencies and faults in the mother/child relationship, fears of annihilation and an inability to achieve separation and independence. As a result of this the role of the father in the patient's family structure and in their psychotherapies and psychoanalyses has been somewhat neglected, also because the fathers are usually described as cold, distant, uninvolved, etc. The author believes that the obliteration of the father figure, whether accidental or deliberate, is an important part of the psychopathology. It follows that in the late stages of a therapy there should be a careful examination of the original establishment of the father as a second object, as its internalization is essential for a healthy sexual development. The obliteration of the father figure can cause serious problems in terms of the understanding of the transference and countertransference. The paper includes a clinical description of a case where such problems were much in evidence.

Countertransference↗
PubMed1991

Analysing the matrix of transference.

In this paper, the background experiential states forming the matrix of transference are discussed in terms of the interplay of three modes of generating experience: the autistic-contiguous, the paranoid-schizoid and the depressive. Portions of three analyses are discussed in an effort to illustrate clinically some of the ways in which analytic technique is shaped by an understanding of the predominant mode or modes of experience forming the context of the transference-countertransference at any given moment. There is a focus on the ways in which the analyst's interventions must often be directed to the contextual level, or matrix, of transference (for example, the significance of the way the patient is thinking, talking or behaving) before it becomes possible to address other interrelated aspects of transference (for example, the unconscious symbolic meanings of what the patient is thinking, saying or enacting).

Adult↗
PubMed1991

Technical approaches to transference hate in the analysis of borderline patients.

Transference hate presents a major obstacle to effective analytic work with borderline patients. In a subgroup of these patients, the analyst is hated relentlessly in a manner that seems unresponsive to interpretation. The persistent projective identification of hated aspects of the patient's internal world may erode the analyst's ability to maintain his analytic posture and lead to various forms of countertransference acting out. A prolonged period of containment is required for both patient and analyst before they are likely to converge in an 'analytic space' where interpretation will be effective.

Adult↗
PubMed1991

Suicide in old age: psychotherapeutic intervention.

Psychotherapy with suicidal patients can best be planned and conducted after the specific narcissistic incapacities of the patient have been identified through an examination of the clinical history. To which of the suicide-inviting affects (worthlessness, aloneness, murderous rage) is the patient vulnerable? On what exterior sustaining supports has the patient relied in the past to ward them off? What exterior sustaining supports have been lost, and which remain available in the present? What maneuvers must the psychotherapist undertake in order to offset the narcissistic deficiencies of the patient? These questions are addressed as they bear on psychotherapeutic interventions with older patients, and specific problems of countertransference are reviewed.

Aged↗
PubMed1991

The dialogical dimension in therapists' dreams about their patients.

The author develops a conception of the dialogical dimension in therapists' dreams about their patients by using elements of Martin Buber's dialogue philosophy, particularly "Inclusion." By way of illustration, the author discusses one of her cases, and a dream she had about her patient, "The Dream of the Meeting." The dream is interpreted along the lines of the classical countertransference interpretation, the projective identification and the uncovering of the dialogical dimension. The use of dreams as part of "Inclusion" therapy is then discussed.

Adult↗
PubMed1991

The emergence of oedipal centrality comments on Michael Feldman's paper 'Common ground: the centrality of the Oedipus complex.

The Oedipus complex is indeed a central organizing focus of human development. Given the opportunity to review psychoanalytic work illustrative of how this concept influences clinical theory and technique, patches of common ground and of significant differences are described. The patient discussed was in the termination phase of a very long analysis, resulting in a concentration and telescoping of the three weeks of reported material from six months prior to termination. This facilitated the elucidation of similarities and differences in viewing and handling manifestations of resistance, transference and countertransference. In particular, differences in conceptualization of the Oedipus complex were addressed, especially the constraints imposed on the analyst's thinking and technique by an obligatory perception that all material represented oedipal themes. In an alternative view, a pre-oedipal, dyadic developmental foundation provides a framework for the elaboration and evolution of oedipal, triadic complexities as a developmental achievement. This enables a reconsideration of transference manifestations of conflictual object relations in terms of distinctions between dyadic, pre-oedipal and triadic, oedipal themes, thus enhancing the analyst's interpretive relevance.

Countertransference↗
PubMed1990

The interviewer's "presenting problems" in the initial interview.

Complex countertransference responses that contribute to the interviewer's presenting problems in the initial interview with a patient are related to: the clinician's preinterview fantasies, the interviewee's empirical reality, and the patient as experienced creatively. Presenting problems may be an unavoidable component of clinical contact, but when the interviewer responds to them with psychological-mindedness, they can contribute to realistic assessment and positive case disposition.

Countertransference↗
PubMed1990

[Staging the psychoanalytic situation in supervision].

Fantasies, parapraxes, and associations that figure significantly in the transference-countertransference process between patient and analytic candidate also work their way into the relationship between the candidate and the supervisor--sometimes in disguised fashion. The author illustrates this observation with vignettes and shows how, with the help of Lorenzer's concept of scenic understanding, the interaction pattern observable in the supervision can be utilized for the understanding of the material presented by the patient.

Countertransference↗
PubMed1990

[The dream of Irma's injection. Theme polyphony and problem solving].

This paper on the specimen dream of psychoanalysis presents in its first part a survey of the manifold interpretive themes that have been found in this complex dream. Apart from wish fulfillment attributed to its content by Freud himself, this dream contains themes of the dreamer's creativity and points out the developmental state of psychoanalysis existing at that time. It gives a rather accurate picture of Freud's knowledge on transference and countertransference in 1895 and informs us on a series of psychological problems of the dreamer himself: his feelings of guilt, his latent homosexual tendencies, his aggressiveness toward colleagues and women as well as the state of his marital relation. A problem solving interpretation of the Irma dream reveals the still defective state of his new healing method as illustrated by the many therapeutic errors committed in the therapy of his patient Irma. The polyphony of themes that can be seen in the initial dream of psychoanalysis warns of monothematic interpretive proposals by therapists that are likely to be ill-understood or frankly rejected by patients in favor of openended interpretations.

Countertransference↗
PubMed1990

Cues: the perceptual edge of the transference.

In spite of Freud's recommendation in his postscript to Dora, analysts may neglect, as Schwaber has pointed out, the patient's perception of the analyst's participation in the analytic context. Examination of the patient's experience of the 'external', by attending to the patient's search for and use of perceptual cues, can lead to essential aspects of the patient's intrapsychic life. Beginning with the description of a particular analytic intervention, the author discusses the nature of cues, their origins developmentally, their role in the development of transference and in the generation of a particular form of resistance, and their place in the ongoing clarification of the transference, countertransference and the analyst's technique. The author then contrasts the approach described with positions taken by Langs, Gill and Sandler, and discusses why Freud's recommendations may have been neglected.

Countertransference↗
PubMed1990

A review of clinical approaches to gender dysphoria.

Gender dysphoric patients are not infrequently encountered in the clinical practice of psychiatry. A comprehensive review of the world literature reveals that the systematic study of severe gender disorders--as exemplified by transsexualism--is relatively new, consisting of just over 25 years of collective experience. While the formal diagnosis of transsexualism is rare, this disorder represents the most severe form of the gender dysphoric conditions. Many nontranssexual patients with a variety of other psychiatric disorders present to psychiatrists desperately requesting somatic treatments (cross-gender hormones, sex reassignment surgery, and other cosmetic surgical procedures). A lengthy differential diagnosis needs to be considered, and a specialized approach to interviewing gender dysphoric patients is highly recommended. Available treatments and their efficacy are discussed. Large prospective controlled studies of treatments for gender dysphoria, such as sex reassignment surgery and psychotherapy, are lacking. Countertransference issues are noted to be particularly relevant in the care of gender dysphoric individuals.

Countertransference↗
PubMed1989

Paranoia and narcissism in psychoanalytic theory. Contributions of self psychology to the theory and therapy of the paranoid disorders.

Many factors go into a choice of a therapeutic focus: the patient's psychopathology; the therapist's training, countertransference reactions, and ideological beliefs; and, importantly, a decision about what seems most amenable to treatment and change. As a theory, self psychology describes one aspect of the paranoid process; as such, it is an incomplete theory that complements rather than invalidates more classical theories. As a technique, however, it suggests a style and focus conducive to working with paranoid patients, one that is markedly supportive, nonconfrontational, yet also interpretive. In this context, it must be remembered how difficult it is to treat paranoid patients psychotherapeutically, much less to keep them in treatment. The strategies discussed above do not wholly replace other dynamic approaches (e.g., counterprojective techniques), nor are they universally applicable. Some patients may be more amenable than others. However, the techniques provide a very supportive framework that may help the therapist to be more available to and in contact with the paranoid patient. More broadly, this paper's application of self psychology to the theory and therapy of the paranoid disorders further illustrates the practical utility of this approach. Attention to the narcissistic developmental line, interpersonal selfobject relationships, intrapsychic conflicts and deficits, and empathic immersion in the patients's world are important adjuncts to the psychotherapy of paranoid patients. Rather than an either/or dichotomy, the principle of overdetermination suggests a both/and relationship between self psychology and traditional theory, such that the self psychological approach complements rather than contradicts the classical psychoanalytic theory. The vicissitudes of the self simply add another perspective or vantage point from which to understand and respond to the patient, one which has perhaps more applicability for preoedipally disordered patients.

Countertransference↗
PubMed1989

Case presentation: Jean.

This symposium was devoted to the consideration of Dr. Mary Libbey's treatment of a 22-year-old woman. The unfolding of the analysand's symbiotic attachment to her mother, the devastating sequelae of her having been the stable center of a pathological family that devoted itself to the care of a severely handicapped sibling, and her immersion in unresolved mourning form the center of this richly detailed and carefully reported case study. In addition, four verbatim sessions are reported, one from each year of the first two years of treatment, and two from the third year of treatment. Dr. Epstein's discussion, praising Dr. Libbey's therapeutic skill, makes note of the issues in the patient's family of origin that served to prepare her to feel endangered in the treatment. Dr. Epstein's view is that the analyst has created an analytic situation that, because it is minimally impinging, allows the patient to become increasingly aware of her unmet needs in a way that is tolerable and minimally "destabilizing to the symbiotically based organization of her internal self and object world." In the climate of safety created in the treatment, the patient can begin to complete the work of mourning for her sister, friend, and aunt, a process of mourning that would be impossible in the context of her nuclear family, centered as it is on a mother who cannot tolerate separation. Limit-setting in the treatment is seen to be reassuring to the patient, facilitating as it does the analyst's commitment to maintaining the integrity of the analytic situation. Dr. Schafer's discussion, while in agreement with Dr. Epstein in recognizing the excellence of the presentation and the sensitivity and hard work that had gone into both the treatment and the clinical presentation, included some specific and focused observations about the transference and countertransference situations prevailing in this treatment and also some suggestions for creating a more consistently safe analytic atmosphere for this particular patient and others like her. Dr. Schafer proposes that the therapist acknowledge to herself and accept as well as possible the inevitable feeling of helplessness such patients provoke. In a more concrete vein, he advocates talking in the first person declarative as much as possible, preferring "I don't understand" to the more standard "What do you mean?" or "Why?" The therapist is encouraged to eschew interpreting what the patient says about the therapeutic relationship for a long time, and, further, he suggests not quickly connecting or easily reducing the therapeutic relationship to childhood prototypes.(ABSTRACT TRUNCATED AT 400 WORDS)

Acting Out↗
PubMed1989

The maternal erotic transference.

After reviewing literature on gender and erotic transferences, which have often been treated as primarily problematic, this paper offers a positive and transformational view of aspects of what is called the maternal erotic transference (MET). Rooted in mother and baby's earliest sensual contacts, it manifests in concrete transferences to the real parts of the body of the therapist; its expressions are typically inhibited as preverbal and/or defended against out of shame and fear of humiliation. Analysts of both genders who have access to their own maternal erotic countertransferences and their patients' matching transferences may enable their patients' acceptance of and immersion in the maternal erotic transference in its loving and sado-masochistic permutations and thus foster the making of a sense of wholeness, and connectedness to living. Experienced thus, MET may herald the transition in the analysis from a dyadic to a triadic oedipal phase animated by accessible pre-oedipal aggressivity and sensuality.

Breast↗
PubMed1979

Some additional remarks on problems of transference.

I have dwelt on the nature of the analytic relationship with patients suffering from narcissistic character pathology. I prefer the term narcissistic tie to narcissistic transference. The narcissistic patient lacks the resources necessary to establish a working alliance, and the analyst's principal task is to bring the patient to the point where he is capable of a sense of reality, of tolerating frustration, of taming rage, and of true object relatedness. I have also pointed to the particular tasks these patients set for the analyst in terms of countertransference reactions.

Awareness↗
PubMed1989

[Splitting and ambivalence. On the therapeutic dilemma in treating patients with early damage].

The article refers to the pathological problem of severe psychic disturbed patients (with: borderline syndromes/pathological narcism/character neurosis/basic faults and/or disorders of ego structure). The author refers to countertransferences and acting out of affects and reports on the changes and possibilities in the therapy of these patients. The therapists fundamental attitude will be described and supplemented by favouring a treatment in day-hospital-settings. Basic literature has been compiled and is reported as survey.

Borderline Personality Disorder↗