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PubMed1998

Dynamic perspectives of paradoxical intervention.

This paper describes the use of paradoxical intervention with a patient who, despite his persistent appeals for help, remained uncooperative. It endeavors to show an understanding of the patient's destructiveness as an expression of his neediness and envy, which he expresses via his repeated use of projective identification and suggests this intervention as a way out. From a dynamic perspective the paradoxical intervention encompasses two contrasting aspects: On the one hand, it rechannels the patient's destructiveness and envy in a beneficial direction. In that sense the intervention fulfills the patient's wish for an omnipotent therapist and for painless therapy, while appearing to prevent personality change. On the other hand, the intervention interferes with the continued use of projective identification, it facilitates the expression of non-destructive aggression, creates an ambiguity surrounding the question of who is in fact in control of the therapy and, finally, it possibly facilitates the creation of a potential space. In that sense the paradoxical intervention assists in achieving both the experience of separateness and the ability to use symbolization. Parallel processes are described in the therapist's countertransference.

Adult↗

PubMed1976

[Reflections on and initial experiences with the teaching of psychotherapy after the new regulation for medical licensing (author's transl)].

This study discusses the first psychotherapeutic-oriented portion of the practical course for psychosomatics/psychotherapy which was held in seminar form in small groups. The material for the course was prepared cuts from vitiotapes of first and second therapeutic sessions conducted in a psychotherapeutic outpatient clinic. To a large extent, the initial experience tends to speak for our teaching plan which basically refrained from initially mediating theory. On the other hand, it was also necessary to cutback the original plan in an attempt to use the "countertransference reactions" of the students to better understand the patients. Special attention was given to the affective reactions of the students in the individual groups since a certain dependency on the specific teaching style of the seminar leader was to be expected. Occasionally, there was danger of overestimating the tolerance of the students to their tensions and fears. This intensified the defense reactions. The experience up until now caused us to modify our plan in a few points.

Anxiety↗

PubMed1998

First loves and prime adventures: adolescent expressions in adult analyses.

Adolescent processes are frequently overlooked in the analyses of adults. The author focuses on the importance and meaning of first loves in the lives of adolescents and demonstrates how these prime experiences reverberate in the analyses of adults. She suggests that adolescent experiences cannot simply or usefully be reduced to preoedipal or oedipal meanings. Explanations for the neglect of adolescent phenomena are offered both historically, in terms of Freud's lack of understanding of adolescence, and clinically, in terms of countertransference and transference. It is argued that the intense affects of adolescence contribute to the resistance to re-experiencing them in treatment.

Adolescent↗

PubMed1998

Non-interpretive mechanisms in psychoanalytic therapy. The 'something more' than interpretation. The Process of Change Study Group.

It is by now generally accepted that something more than interpretation is necessary to bring about therapeutic change. Using an approach based on recent studies of mother-infant interaction and non-linear dynamic systems and their relation to theories of mind, the authors propose that the something more resides in interactional intersubjective process that give rise to what they will call 'implicit relational knowing'. This relational procedural domain is intrapsychically distinct from the symbolic domain. In the analytic relationship it comprises intersubjective moments occurring between patient and analyst that can create new organisations in, or reorganise not only the relationship between the interactants, but more importantly the patient's implicit procedural knowledge, his ways of being with others. The distinct qualities and consequences of these moments (now moments, 'moments of meeting') are modelled and discussed in terms of a sequencing process that they call moving along. Conceptions of the shared implicit relationship, transference and countertransference are discussed within the parameters of this perspective, which is distinguished from other relational theories and self-psychology. In sum, powerful therapeutic action occurs within implicit relational knowledge. They propose that much of what is observed to be lasting therapeutic effect results from such changes in this intersubjective relational domain.

Countertransference↗

PubMed2000

The evolution of psychotheroapy training: reflections on manual-based learning and future alternatives.

Although psychotherapists-in-training may rely significantly on their clinical intuitions when first beginning to practice therapy, they quickly discover that much more is required to conduct effective treatment. Increasingly over the past two decades, training manuals have been used to impart explicit guidelines to beginning psychotherapists. In addition, manuals offer a means for helping more experienced therapists to learn new approaches, while also allowing careful research on the relative efficacy of different psychotherapies. In some instances, manuals have been designed specifically to address troublesome transference and countertransference issues (e.g., Time-Limited Dynamic Psychotherapy; Strupp & Binder, 1984). But even manualized treatments that target hostile interactions between therapist and patient are sometimes of limited use in teaching therapists to work with difficult patients, as illustrated by the Vanderbilt II Psychotherapy Research Project. Experimental research on the distinctions between implicit learning and explicit learning (e.g., Lee & Vakoch, 1996) helps explain the constraints of manualized treatments. By relying on explicit, clearly articulated guidelines, treatments conducted in accordance with manuals may interfere with tacit reasoning processes. As a consequence of the strong emphasis that manuals place on explicit rules for treatment, this type of training can hinder the development of complex clinical judgments. Future generations of novice psychotherapists may benefit from training experiences that are designed to promote an integration of implicit and explicit learning.

Education, Professional↗

PubMed2001

Sexuality and attachment: a passionate relationship or a marriage of convenience?

The ubiquitous and persistent bodily urges of sexuality and their vicissitudes are explored in this paper, focusing on the complex relationship between libidinal desire and the attachment system, especially the latter's affect-regulating function. This complicated interrelationship is highlighted with clinical vignettes. Implications for transference and countertransference are explored in the discussion of affect regulation and its possible sexual entwining. Clinical data is presented to highlight the plasticity of sexuality. Sexuality's protean nature allows for a reassessment of the case of Little Hans, with emphasis on the unique interconnections between sexuality and the vital need for an attachment relationship. Stressing such interconnections raises important questions about the traditional concept of psychosexual stages.

Adult↗

PubMed2001

On being forgotten and forgetting one's self.

This paper assumes that evocative constancy, the ability to evoke reliably good-enough images of self and object in times of stress, underlies not only self and object constancy, but also the development of memory and the symbolic processes. It is suggested that a crucial element in this development is the mother's ability to construct and retain a vivid, cohesive, and reliable memory of her child, and to engage--in a multitude of implicit ways--in a process of mutual holding in memory. Where this process is deficient, the child, and later the adult, may experience discontinuities of the self, which find expression in profound anxieties, phobias, and problems of memory and learning. As these discontinuities are revived in the transference and the countertransference, both patient and analyst must work together to keep each other reliably alive in memory.

Ego↗

PubMed2003

Time and the psychoanalytic situation.

Implicitly or explicitly, time dominates the psychoanalytic situation. The precision, consistency of duration, and regularity of analytic sessions enhance the patient's ego boundaries, counteracting the regressive effects of timelessness induced by free association. The extended overall duration of psychoanalysis and the high frequency of sessions favor the development of transference neurosis. The interpretation of the transference in the here and now of the analytic situation illuminates the past, and as a result, the patient's self-image and that of the world become better integrated. The sense of time in the analytic situation for both patient and analyst varies along with the vicissitudes of transference and countertransference.

Free Association↗

PubMed2005

Conflict in relational treatments.

Various features of relational perspectives on conflict are outlined. Points of contact and difference between relational and modern conflict theory are discussed. Five approaches to considering conflict are examined: countertransference conflict as the site of interfaces between the social and the intrapsychic; conflict within the register of speech; conflict within a theory of multiple identifications; conflict as the site of psychic change; and conflict in the context of intersubjectivity. Clinical vignettes are introduced to illustrate the scope and function of conflict within one relational perspective.

Conflict, Psychological↗

PubMed2006

Different differences: revelation and disclosure of social identity in the psychoanalytic situation.

The authors propose a taxonomy of social identities, suggesting that three different classifications of identities can be distinguished. These comprise those that are innate and visible, such as race or gender; those that are innate, but invisible, such as sexual orientation; and those that are acquired or achieved, such as marital status or political affiliation. The authors argue that each of these categories has different implications for the revelation or disclosure of aspects of the therapist's identity, as well as for transference-countertransference dynamics. These points are illustrated with brief clinical examples.

Ethnicity↗

PubMed1996

Forensic child and adolescent psychiatry.

This brief chapter has been written as an overview of child and adolescent forensic psychiatry. An attempt was made to briefly and simply summarize several topics. At the end of the chapter, the interested reader will find additional sources to pursue areas of interest in depth. Many important issues were not addressed, including aggression, homicide, the child as witness, countertransference issues, lesbian mothers and gay fathers, and dual-agency conflicts, among others. These and other issues are beyond the scope of this brief chapter, but nonetheless, important issues in forensic child and adolescent psychiatry. Forensic child and adolescent psychiatry is not for everyone. Those interested in working in the field will find it challenging. Beginners are urged to seek consultation from more experienced colleagues and the inexperienced practitioners will find consultation helpful. Although some may wish to avoid the forensic arena completely, those of us who work in the field find it rewarding.

Adolescent↗

PubMed1988

Posttraumatic stress disorder and substance abuse. Clinical issues.

A review of clinical issues relevant to the treatment of individuals with a combination of posttraumatic stress disorder and substance abuse disorder is presented. There are several issues that these two disorders share, including the need for heightened awareness on the part of clinicians, the ability to make the diagnoses, the conceptualization of etiological factors, and the issues of therapeutic attitudes and countertransference problems. In addition, a brief review of relevant therapeutic approaches is presented and treatment priorities discussed.

Alcoholism↗

PubMed1979

The use and abuse of psychiatry in dealing with pain patients.

The question of real vs. psychogenic pain is considered, and the importance of psychiatric counseling discussed. Hospital staff should also be advised by trained psychiatric personnel how to deal with countertransference. Flexible, eclective, and intensive therapy can certainly help the pain-prone patient.

Adult↗

PubMed1994

Narcissism: shame, rage and addiction.

This paper employs perspectives from Self psychology to illuminate our understanding of narcissism. Striving for complete independence and autonomy, a goal of classical psychoanalysis, encourages the disavowal of narcissism. Instead, narcissism is viewed as necessary for the survival of a sense of self and not on the same continuum with object love. The concepts of self-object and self-object functions are defined. Shame and rage are explained as byproducts of self-object failure. It is postulated that shame emerges out of self-depletion and that narcissistic rage emerges out of self-fragmentation. Countertransference and treatment implications are discussed. Following Lichtenberg, addictions are viewed as deriving from the quest for self-object experience, regardless of the long-term detriment.

Adolescent↗

PubMed1997

[Research in psychosocial aspects of ENT tumor surgery (excluding laryngectomy): 4-part analysis of the literature. 3: Results of research].

The available literature on psychosocial aspects of head and neck cancer surgery from 1950 to 1995 was reviewed in four parts. Part 3 is a detailed description of the findings looked at from four different points of view: 1. Restrictions by illness and treatment (dysfunction, mutilation, emotional and social reactions); 2. Coping; 3. Course of illness and treatment (treatment delay, preoperative phase, hospitalization, early and later rehabilitation, tumor recurrences, terminal disease); 4. Relationships between patients and professionals (doctor-patient relationships, countertransference).

Adaptation, Psychological↗

PubMed2002

[Psychodynamic therapy approaches in depressive disorders. Pathogenesis models and empirical principles].

Targets for psychodynamic psychotherapy are the core conflictual relational mode and its consequences for mood, social behaviour, and self image. Libido- and conflict-based concepts of the relational mode are increasingly being replaced by the concept of intersubjectivity, which includes also nonconflictual, healthy modes of relations as a basic human mental task. According to recent mother-infant interaction research, the psychotherapeutic effect on the relational mode can be interpreted in terms of procedural learning rather than insight-oriented discourse. The mother-infant paradigm is a particularly suitable research paradigm to elucidate unconscious procedural acquisition of mental representations of dyadic interactional styles. Procedural learning requires a more active corrective style of interacting on the therapist's side, beyond abstinence and control of countertransference. Evaluative studies show that psychodynamic psychotherapy of depression is nearly as effective as cognitive behaviour therapy (CBT) and interpersonal therapy (IPT).

Adult↗

PubMed2006

Commentary on Becoming a Daughter: Trauma is a powerful teacher.

Personal life crises profoundly impact genetic counselor practice. In this commentary, themes from Matloff's (in press) article, Becoming a Daughter are highlighted and expanded upon. These themes include: personal impact of a life crisis, and professional impact vis a vis empathy countertransference, self-disclosure, nondirectiveness, and self-confidence. Strategies that help genetic counselors manage personal life crises within their clinical practice and also promote their professional development are emphasized, including normalization of life crises, self-reflection, boundary-setting, and use of peer supervision and consultation.

Breast Neoplasms↗

PubMed1984

Strategies of intervention.

This paper begins with a discussion of the optimal conditions for the provision of infant mental health services to infants and toddlers. It argues for the importance of the automatic provision of service at all levels of need. The pediatric setting is emphasized as the natural locus for the integration of such preventive services and as the first and often sole contact of parents and infants with professionals. The various kinds of possible service are delineated as are the sources of stress. It is suggested that the understanding of these factors should dictate the kind and level of response which might be most efficacious. Finally, some basic difficulties in establishing a working alliance with parents whose relationships with their infants and toddlers are developing very negatively are discussed. A framework for understanding some of these problems which may interfere with the parents' utilization of services is provided by employing the psychoanalytic concepts of transference and countertransference. The influence of these transference feelings on the relationship between parents and service providers of all kinds is emphasized and explored.

Child Abuse↗