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The young Jewish revivalist: a therapist's dilemma.

This article presents and discusses: (a) some of the diagnostic and psychotherapeutic problems which emerged when dealing with extremely religious Jewish young men; and (b) conscious ethical questions and unperceived counter-transference reactions to religion and religious patients which may overburden the therapist's helping capacity, thereby curtailing the beneficial extent of his intervention. The setting of the therapeutic process is an open intensive care unit. The possible implications and effects of carrying out institutional therapy with this particular kind of patient are also analysed.

Adolescent↗

Younger man/older woman: a cautionary tale.

This is a single case study of a parallel relationship between (a) the patient and his romantic partner and (b) the patient and his therapist. While parallels such as these are not unusual in therapy and may, in fact, be universal, coincidences of age and duration facilitate the understanding of some of the competitive aspects of the patient-therapist-significant other triangle.

Adult↗

Staff counter-transference in the therapeutic milieu: creating an average expectable environment.

Counter-transference, investigated and described as a powerful technique in individual psychoanalytic psychotherapy, has been less extensively studied in the psychodynamically oriented milieu therapy of more regressed patients. Features of the setting of the psychodynamic milieu are suggested which foster the use of the staff's counter-transference (evoked feelings) as a therapeutic tool. Several clinical examples are given which highlight the features necessary (1) to create a moment of illusion for the patient; (2) to create an observational frame of reference for the staff; (3) to clarify when certain intra-staff differences about the patient's therapy reflect the patient's re-creation of intrapsychic lacunae or conflicts among the staff. The importance of action is discussed as a means of communication for regressed patients. This concept is reconciled with Loewald's stance that feelings and actions should be represented in words. A developmental hierarchy of interpretation is suggested which involves several levels of action, through levels of symbol. A review of the literature supports this hierarchy. Both in the consulting room and in the psychodynamic milieu, the phenomenon of evoked feelings (counter-transference) offers an interface between two sets of internal laws: the therapist's and the patient's. The therapist's task is to treat these two sets of laws with mutual respect, offering the patient an opportunity to experience a successful autonomous act, that is, affecting his or her therapist. This concept, when extended to the psychodynamic milieu, treats the milieu as a social organism that requires ongoing observation and revision by all its participants.

Adolescent↗

Counter-transference reactions contributing to completed suicide.

Counter-transference reactions are frequently elicited while treating suicidal patients and they may contribute to the patient's committing suicide. Therapeutic constellations including the failure of the therapist to (1) cope with the patient's aggressiveness, (2) tolerate the patient's dependency, (3) handle the erotic transference adequately and (4) preserve loyalty towards the patient; they have all been identified as being responsible for a therapeutic impasse with fatal consequences. Knowledge of the therapeutic constellations especially prone to facilitate negative counter-transference reactions may help the therapist to master them effectively.

Adaptation, Psychological↗

Reflections on the role of the supervisor.

Counter-transference can be conceived of as being composed of two components: therapist-induced counter-transference (TIC), and client-induced counter-transference (CIC). These components are mostly intertwined into combined counter-transference. One of the foremost tasks of the supervisor is to help the therapist to analyse counter-transference, when encountered in the combined form, into its contributing components in order to apply each component in accordance with its defining origin. Strong transferential forces, that are independent of the specific contents of the therapy, are generated inside the supervisory situation, manifesting themselves, sometimes destructively so, in the therapy (parallel process in reverse). In order to forestall this destructive effect, these forces ought to be interpreted by the supervisor to the supervisee inside the supervisory situation. In order to gauge the extent of such interpretations as well as those of other dynamic manifestations in supervision, the supervisory situation is compared to therapy administered to the therapeutic couple ex parte. The situation of the supervisor vis-à-vis the patient is briefly discussed.

Adaptation, Psychological↗

Hypochondriasis, acting out and counter-acting out.

The clinical picture of hypochondriasis is clear, the psychopathological structure less so. Hypochondriasis is characterized by a particular kind of acting out, basically medical, which in turn is likely to evoke medical counter-acting out on the part of the therapist. Acting out may be 'broad', as a character trait, and 'narrow', in close connection with the psychotherapeutic process. The medical acting out of the hypochondriac, 'broad' prior to therapy and occurring outside of the therapy situation, in the course of therapy becomes 'narrow' and contained within the boundaries of therapy.

Acting Out↗

Personal constructs of survivors of childhood sexual abuse receiving cognitive analytic therapy.

Increasing numbers of survivors of childhood sexual abuse (CSA) are now seeking psychological therapy; yet little evidence currently exists concerning optimum treatment formats, especially when re-victimization has occurred in adulthood. This study reports an exploratory investigation of re-victimization, and of the use of cognitive analytic therapy (CAT) with seven CSA survivor women, six of whom had experienced re-victimization and five of whom were self-abusive. Results of single element and dyad grids administered before and after therapy were consistent with the exploratory hypothesis that abuse forms a central component of the women's relationships, hence making recurrence of abuse a real possibility. Outcome of therapy using CAT was positive, although the considerable and significant symptomatic changes observed were accompanied by significant change in only a relatively small number of the women's constructs, suggesting the persistence of the centrality of abuse despite therapy. For two women, levels of disturbance remained high after termination, and some evidence of relapse was also evident at three-month follow-up.

Adolescent↗

Transference and counter-transference variations in the course of the cognitive-analytic therapy of two borderline patients: the relation to the diagrammatic reformulation of self-states.

The cognitive-analytic therapy of two patients with borderline personality disorder is described. Patients and therapists completed post-sessional questionnaires which yielded measures of transference and counter-transference. The relation of changes in these to the sequential diagrammatic reformulation of the patients' self-states is considered.

Adult↗