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Following a brief discussion of the primary types of psychotic transferences, viewed from a theoretical position combining ego psychology with an object relations approach, the author presents detailed clinical material illustrating these transferences. The analyst's countertransference in work with such patients is also discussed in depth, including its use as a unique window into the patient's inner world.
Material from the psychoanalytic psychotherapy of a patient with breast cancer demonstrates the emergence of constructive meaning in areas of psychological experience burdened by conflicts regarding the dimension of time and faith. During analytic work, the spontaneous appearance of religious metaphors revealed deeper layers of memory where time, faith, language, and the sense of being listened to once interacted in ways whose significance could be conceptualized, with the help of the countertransference, as a rediscovery of a hearing breast, or even a sacred hearing breast. Implications for the psychoanalysis of religious experience are discussed.
Experienced psychotherapists realize that there are many levels of meaning behind much that is said during the therapeutic hour. The challenge for the competent professional is to become wise enough to learn what to ignore and sensitive enough to know what to emphasize. Sorting this out is at the heart of the practice of good psychotherapy. In this article, we will briefly share our thoughts on this rich but complicated interpersonal interaction using Kohutian self psychology theory to understand the role of countertransference in the process of conducting psychotherapy.
The concept of countertransference has been seen as problematic by feminist therapists. However, feminist therapy theory is intensely interested in the symbolic levels of the relationships between therapists and clients, with an emphasis on how the here and now social context informs and transforms those symbols. This article describes a feminist perspective on the therapist's symbolic relationships to clients, and the positive and challenging ramifications of those symbolic encounters.
In an experiential alternative, the therapist and the client attend mainly to a "third thing" throughout the session instead of to one another. A case is presented in which the experiential alternative can offer some new, and perhaps interesting, uses of the therapist's personal reactions in comparison with the uses of countertransference and personal reactions of the therapist when therapist and client attend mainly to one another throughout the session. These new uses are presented and illustrated.
This article presents a clinically oriented synthesis of research findings pertaining to countertransference (CT). Findings are organized around five therapy-relevant questions concerning the origins, triggers, manifestations, management, and effects of CT. To date, research has focused primarily on impediments posed by therapists' CT reactions and mechanisms for managing them. It is argued that future research needs to be directed toward better understanding how therapists can use CT to enhance their work with clients.
Throughout this issue on countertransference (CT) and elsewhere, the multiple terms used to describe CT events provide rich conceptual diversity, but also result in theoretical isolation and clinical compartmentalization. Our study and understanding of CT would benefit remarkably if we could agree on empirical-therapist features that any CT conceptualization must target. Subsequent discussions of CT then could specify which of the respective empirical features are being addressed. Accordingly, I offer a descriptive framework that asserts that CT and its hypothesized subtypes (e.g., subjective and objective) can be detected empirically whenever a therapist's experiences and actions with a particular client assume one of several definable "deviations from baseline." If, in our clinical or research pursuits, we are to understand CT, we have to take the time to assess the necessary behavioral baselines for therapists and their clients.
A Mexican-American woman who complained of persistent head pain and a bothersome "voice" was seen by a team consisting of a psychiatrist, social scientists, and spiritualist healers in a Cultural Consultation Clinic of a Psychiatric Consultation Liaison Service. This single case is analyzed to provide an understanding of the interpretive dimensions of psychiatric practice. It is argued that a hermeneutic analysis of clinical phenomena focuses attention on three distinct aspects of interpretation: on the interpretation by clinicians and clients of the discourse of the other in terms of their own clinical models; on the influence of deeply embedded personal meanings on this interpretive process; and on the role of the observer in clinical ethnography. It is argued that to sustain a hermeneutic analysis of psychiatric practice, an account of transference and countertransference in terms of interpretation theory will have to be developed.
Severely, chronically mentally ill, poor prognosis, long-term patients in state mental hospitals do succeed in moving out of hospitals into community residences. They succeed by virtue of small but critical behavior changes. For some, these changes in behavior follow a treatment strategy that recognizes and corrects treatment impasses that have developed and been maintained by fixed countertransference positions on the part of hospital staff. In the two case examples presented, the historical information necessary to unravel the transference paradigm was part of routine hospital records, corrective action did not entail any major staff interventions, improved behavior led directly to movement out of the hospital, and community adjustment was successful. Improved mental and behavioral functioning was sustained at a year and a half follow-up.
Four illustrations have been presented which demonstrate the uses and interpretations of envy in countertransference reactions to religious patients. To be sure, envy reactions to any patient are significant, whether they simply distort the therapist's perception or contribute to a deeper understanding of the patient. In the case of the religious patient, envy reactions in the therapist may serve as an additional instrumentality for under-standing the ways in which the dynamic determinants of religious behavior and metaphor become enmeshed in and also transform the pathology of the patient as well as the therapeutic process itself. Both the constructive and destructive object relational implications of envy must be borne in mind by the therapist in order to adequately explore the range of reciprocating forces between therapist and patient. Primitive mechanisms such as projective identification and psychotic transference are particularly prone to evoke envy reactions of surprising intensities, yet an empathic attitude will usually enable the therapist to differentiate the true source of his envy as he more carefully comprehends the quality of object relational and dynamic needs such envy serves.
This paper has expanded the psychoanalytical definition of the working alliance to include the influence of culture. The cross-cultural working alliance is a therapeutic dyad that incorporates a psychotherapist and a patient of dissimilar backgrounds. Each participant enters the alliance with cultural introjects--values, attitudes, and ways of behaving that stem from ethnocultural roots. These introjects influence the intrapsychic world, shape the conscious worldview, and the perception of life experience. The influence of cultural predispositions on the psychopathologies of the patients was prominent in two case examples: a black West Indian male and a Korean-American male. The therapist also brought cultural predispositions to her work. A constructive countertransference phenomenon occurred in the working alliance that had a direct connection to its cross-cultural nature. This phenomenon is called associative identification--the conscious identification of therapist with the ego experience of patient. With the use of the associative identification, the therapist uncovered parallel memories that promoted theoretical understanding and informed therapeutic technique. Just as anthropologists claim that cultures share universal institutional patterns, it is proposed that universal cultural conflicts may also be observed in the cross-cultural working alliance. The analyst and patients in this study had two culture-conflicts in common: the longing to be seen, and the pull for disidentification. It is concluded that associative identification enriched the reparative quality of treatment, and encouraged the integration of isolated, split-off parts of the self.
This article describes issues of countertransference in disaster psychiatry and makes use of specific examples from therapists working in the aftermath of the terrorist attacks of September 11, 2001.
The final scenes of the failed marriage are replayed in the consulting room not only in the painful content of the verbal interactions but in the transference reactions of client and countertransference responses of clinician--material rooted in the current crisis as well as the developmental histories of the protagonists. The theoretical underpinnings of this broadened conception of transference/countertransference are discussed and its role in assessment and treatment is highlighted.
The relevance and validity of ethnocultural factors in transference and countertransference reactions are proposed. Some of those prevalent in dyadic psychotherapy are described, focusing on intra-ethnic and inter-ethnic dyads. Case vignettes are presented to illustrate the ways in which ethnocultural factors serve as catalysts for such major therapeutic issues as trust, ambivalence, anger, and acceptance of disparate parts of the self.
Group therapy is an essential component of the treatment of sexually abused children. Since the painful effects associated with the abuse are often dissociated or acted out, the group leaders learn of the affective experience of the abuse through the process of projective identification. The leaders must be aware of this process, set limits on the abusive acting out in the group, and help moderate, label, and empathize with the affect. It is through this difficult process that the children have a chance to reintegrate and work through their abuse experiences so they no longer feel compelled to act them out through repetitive abusive relationships. Specific leadership, countertransference, and projective identification issues in group therapy with sexually abused boys are discussed.
Subjective countertransference can sharply limit any group leader's effectiveness. However, a therapist can use the group itself to identify such a bias and to remove it as an influence. A five-step method for doing this is presented. These steps begin with introspection but hinge upon the analyst's turning to the group for the vital information that, in the end, clarifies the analyst's own perceptions and helps him or her free the group from the harmful effects of any bias.
This paper reviews and critiques the literature on countertransference (CT) in group psychotherapy. The literature review is organized within a framework that calls attention to the origins, triggers, manifestations, and effects of CT in groups, as well as CT management factors. An overriding critique is that the present literature lacks a research foundation of any kind. An argument is made for beginning research in this domain, and guidelines for doing so are presented.
Most of the literature on countertransference reactions with criminals has emphasized negative emotions such as hatred, rage, and fear. This article discusses reactions that have been relatively neglected, such as fascination and envy. Fantasies of leading a life of excitement are frequently evoked. Recognizing these fantasies and emotions and accepting them as attractive can increase our understanding of the offender and his life. The lure of criminality, despite its severe consequences, become more understandable. Accepting these emotions can bring a challenge to life, and a reevaluation of one's morals and values. A balance between the reality of "normal" life and fantasy is ultimately accepted.