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PubMed1992

The countertransference position and the countertransference.

The concept of countertransference assumes different meanings depending on the context in which it is used. And yet it is an essential concept whose absence would have important theoretical and practical consequences. At the risk of increasing the psychoanalytic Babel, I propose the concept of the counter-transferential position which, in my view, allows a better understanding of the multiple determinations which impinge upon the analyst during the session. In a brief clinical example, I examine a 'countertransferential symptom' and the analyst's function of 'listening to listening'.

Affect↗
PubMed1986

Countertransference evolution in theory and practice.

A framework is suggested for conceptualizing countertransference, based on expansion of the concept emerging subsequent to Freud's original view of the phenomenon: from Ucs to Cs, from reactions to transference to all reactions, from the analyst's neurosis to the analyst's functioning, from self-analysis to self-scrutiny, from obstacle to contribution. Particular attention is called to the advantages of maintaining the distinction between the patient's transference and the analyst's countertransference; the importance for successful psychoanalytic work of being aware of the subtleties of countertransference in work with neurotic patients, especially in contrast to the blatant countertransference experiences more disturbed patients thrust upon the analyst; the need for further investigation of the relations between the analyst's empathy, regression, and countertransference; the lack of understanding of and information about the homosexual countertransference, based on insufficient knowledge of the mechanisms of resistance to self-analysis, among other reasons; and the need for more reliable information about the limits of and indications for using countertransference responses in particular kinds of clinical situations, whether for informing the patient as to the analyst's responses to him, for informing the analyst in the interpretive process, or in formulating reconstructions. A clinical example provides an illustration of the complexity of countertransference-transference interaction and of the impact of countertransference on the transference.

Countertransference↗
PubMed1998

An analysis of the concept of countertransference.

A knowledge of countertransference is a necessary step in using it therapeutically in the nurse-patient relationship. However, this concept, which has its roots in psychoanalytic theory, has been applied to nurses and nursing situations in an unhelpful and ambiguous manner. In fact, the term is often used to denigrate nurses without providing clarity as to what the components of countertransference are and how they might be understood and used therapeutically. As such, it is necessary to delineate the meaning of countertransference in its entirely as a concept suitable for nursing practice. Positive countertransference, negative countertransference, and empathy are the composite parts of the concept of countertransference. Through concept analysis, by using methods outlined by Rodgers (1989), Journal of Advanced Nursing, 14, 330-335, it is suggested that countertransference is an inescapable factor in the nurse-patient relationship. Furthermore, a comprehensive analysis of the concept of countertransference will assist nurses in recognizing it when it occurs and may enhance the use of the understanding gained to the benefit of the nurse-patient relationship.

Adult↗
PubMed2005

Approaching countertransference in psychoanalytical supervision: a qualitative investigation.

A recent examination of the literature concerning countertransference and its developments reveals its clinical usefulness in different psychoanalytical cultures. Nevertheless, a shortage of publications is apparent with respect to its approach in supervision. The authors' aim in this study was to examine the concepts of transference and countertransference and how countertransference is approached in supervision, in the training of candidates, at an institute of psychoanalysis belonging to a society affiliated to the International Psychoanalytical Association (IPA). Qualitative research was carried out, interviewing supervisors and supervisees. Through analysis of the material acquired, the authors classified the data into initial, intermediate and final categories. The principal findings were subdivided into three categories: the concepts of transference and countertransference, psychoanalytical listening and the complementarity of the phenomena, and the approach to countertransference. The concepts of transference and countertransference predominantly used by those interviewed are based on the totalistic outlook. Countertransference in supervision has been approached in a more direct and objective way when compared with the previous period, although great care is taken to delimit the boundaries between supervision and personal analysis. The main aim of supervision is to broaden comprehension and to deepen the interpretations directed towards the patient. These findings suggest that the evolution of the concept of countertransference in different psychoanalytical cultures and developments in the analytical field are contributing to this change.

Countertransference↗
PubMed1993

House of Games: a cinematic study of countertransference.

In this paper we have described how examining the film House of Games can lead to an enriched understanding of the concept of countertransference for both neophyte and experienced psychotherapists. This absorbing film portrays countertransference phenomena from a number of crucial perspectives: predispositions to countertransference, direct and indirect indicators, countertransference in the "totalistic" sense as well as countertransference in the "classical" sense, parallel-process dynamics between therapy and supervision and the value of social and professional support in managing this inevitable burden. Cinema is another method, along with more traditional supervisory and didactic approaches, of assisting therapists to increase their cognitive and affective mastery of countertransference phenomena by encouraging them to analyze their emotional reactions to patients. This is no small task. In summary, we believe that the recognition, analysis and management of countertransference reactions is a necessary and life long professional task for any serious psychotherapist.

Countertransference↗
PubMed2000

The development of the inventory of countertransference behavior.

A measure was developed to assess supervisor-perceived countertransference (CT) behavior during counseling sessions. Eleven experts provided face validity for the items, indicating that each item was at least somewhat an expression of countertransference. Exploratory factor analysis of ratings of 126 supervisors of supervisee counseling sessions revealed, as expected, the existence of two factors. However, rather than reflecting the dimensions of overinvolvement and underinvolvement as hypothesized, the factors were better captured by the terms Negative Countertransference and Positive Countertransference. The total scale and each subscale demonstrated high internal consistency. In addition, both positive and negative CT were found to relate positively with an existing one-item index of countertransference behavior and negatively with an existing measure of countertransference management ability. Research and clinical implications are discussed.

Adult↗
PubMed1989

Resistance and countertransference in child and adolescent psychotherapy.

Countertransference brings to light the influence of both anxiety and family processes on the child's or adolescent's maturation and character development. The significance of developmental, dynamic, and family-interpersonal factors have all been stressed as part of the latent communication inherent in resistance. Family influences on resistance and countertransference have to be the subject of analytic scrutiny. The engagement of children and adolescents in the therapeutic process seriously threatens parents' defensive operations both as couples and as individuals. Countertransference responses afford the opportunity not only to clarify the meaning of resistances but also to pinpoint anxieties that have been reexperienced by the child or adolescent with the analyst at points of threat and disorganization. The twofold therapeutic task with children and adolescents consists of delineating and counteracting the family's negative impact on the child's development and self, in addition to addressing the children's contribution to their own pathological traits and immaturities. Countertransference anxiety confirms the dynamic and family implications of the analyst's participation with the patient. Countertransference resistance suggests the analyst's lack of openness in investigating how the treatment has evoked the child's anxiety, the parent's anxiety, and the analyst's anxiety. Resistance-transference-countertransference exchanges reveal the child's or adolescent's efforts to move towards health while emerging from the internalized family.

Adolescent↗
PubMed1998

Countertransference in the nurse-patient relationship: a review of the literature.

Countertransference is a psychoanalytical concept which, when applied to nursing, refers to the unconscious response of the nurse to the patient. Psychoanalytical concepts such as the unconscious are infrequently mentioned in the nursing literature and have received little research attention. In this paper the literature about the nurse's countertransference is reviewed. In order that the psychodynamic aspects of this phenomenon are more fully appreciated, both the concepts of the unconscious and transference are first described. The nurse's countertransference has many expressions. The literature under review has highlighted the expression of countertransference through physical symptoms, through the nurse's level of involvement with the patient and through the nurse's positive and negative descriptions of patients. The value of recognizing countertransference is universally acknowledged. It is suggested that countertransference in the nurse-patient relationship should be explored further. The knowledge provided would help provide greater insights into the nurse-patient relationship, and ultimately will be reflected in the quality of care which the patient receives.

Attitude of Health Personnel↗
PubMed2005

Countertransference phenomena and personality pathology in clinical practice: an empirical investigation.

OBJECTIVE: This study provides initial data on the reliability and factor structure of a measure of countertransference processes in clinical practice and examines the relation between these processes and patients' personality pathology. METHOD: A national random sample of 181 psychiatrists and clinical psychologists in North America each completed a battery of instruments on a randomly selected patient in their care, including measures of axis II symptoms and the Countertransference Questionnaire, an instrument designed to assess clinicians' cognitive, affective, and behavioral responses in interacting with a particular patient. RESULTS: Factor analysis of the Countertransference Questionnaire yielded eight clinically and conceptually coherent factors that were independent of clinicians' theoretical orientation: 1) overwhelmed/disorganized, 2) helpless/inadequate, 3) positive, 4) special/overinvolved, 5) sexualized, 6) disengaged, 7) parental/protective, and 8) criticized/mistreated. The eight factors were associated in predictable ways with axis II pathology. An aggregated portrait of countertransference responses with narcissistic personality disorder patients provided a clinically rich, empirically based description that strongly resembled theoretical and clinical accounts. CONCLUSIONS: Countertransference phenomena can be measured in clinically sophisticated and psychometrically sound ways that tap the complexity of clinicians' reactions toward their patients. Countertransference patterns are systematically related to patients' personality pathology across therapeutic approaches, suggesting that clinicians, regardless of therapeutic orientation, can make diagnostic and therapeutic use of their own responses to the patient.

Attitude of Health Personnel↗
PubMed1995

Countertransference: the emerging common ground.

In the last decade or so, the understanding of countertransference has become an emerging area of common ground among psychoanalysts of diverse theoretical perspectives. This convergence can be traced to the development of two key concepts--projective identification and countertransference enactment. Projective identification has evolved from a patient's intrapsychic fantasy in Klein's original work to an interpersonal interaction between patient and analyst. The notion of countertransference enactment has been widely used to capture clinical situations in which a countertransference reaction in the analyst corresponds to the patient's attempt to actualise a transference fantasy. These ideas, in conjunction with the contributions of social constructivists and relational theorists, as well as Sandler's conceptualisation of role-responsiveness, have led to an understanding of countertransference as a 'joint creation' by analyst and patient. The relative contributions of analyst and patient vary somewhat according to the theoretical perspective espoused by the analyst. This common ground is best regarded as comprising a gradient or continuum in which more weight is given to the analyst's contribution on one end of the continuum and more emphasis to the patient's contribution on the other. While countertransference enactments are widely regarded as inevitable, their role in creating intrapsychic change is more controversial.

Countertransference↗
PubMed1998

Therapists' differential countertransference reactions toward clients with major depression or borderline personality disorder.

The purpose of this study was to examine psychotherapists' differential countertransference reactions toward either clients diagnosed with either Major Depression or Borderline Personality Disorder. Specifically, psychotherapists' personal perceptions and emotional reactions to these clients were assessed utilizing the Impact Message Inventory and the Stress Appraisal Scale (N = 155). Direct feelings, action tendencies, cognitive attributions, and perceived anxiety were evaluated. Results indicated that clients with Borderline Personality Disorder are perceived as significantly more dominant and hostile, whereas clients with Major Depression were considered significantly more submissive, friendly, and salient. In addition, it was found that as clinicians' years of experience increased, degree of countertransference decreased. These results suggest that countertransference reactions can be measured empirically, that differential countertransference reactions are evoked toward clients manifesting different symptoms, and that awareness of countertransference may be important for positive therapeutic outcome.

Adult↗
PubMed1991

Effects of therapist-trainees' anxiety and empathy on countertransference behavior.

This study examined the relationship between therapist-trainees' state anxiety and countertransference behavior and the possible moderating role played by empathy. Primary hypotheses were: (a) Trainee state anxiety is related positively to countertransference behavior; and (b) the adverse effects of anxiety would influence only less empathic trainees. Thirty-five trainees (11 males, 24 females) conducted counseling sessions with each of two clients, who then rated their counselor's empathy. Countertransference behavior subsequently was assessed through trainees' responses to two audiotaped clients; state anxiety was self-reported after each audiotape "session." State anxiety was found to relate to countertransference as predicted, but only for male trainees. The hypothesized moderating effect of empathy was unsupported. The role of gender as related to anxiety and countertransference is discussed.

Adult↗
PubMed2001

A contemporary psychoanalytic model of countertransference.

Over the last 100 years, countertransference has evolved from a narrow construct referring to the analyst's transference to the patient to a jointly created phenomenon that is ever-present in the psychotherapeutic situation. In recent years, a myriad of theoretical perspectives have begun to converge around the view that countertransference is partly determined by the therapist's preexisting internal object world and partly influenced by feelings induced by the patient. Countertransference is now regarded as inevitable, and minor enactments of countertransference may provide valuable information about what is being recreated in the therapist-patient dyad. Self-disclosure of countertransference may be useful in some situations, but the sharing of some feelings will overwhelm patients and burden them in a way that may be destructive to the therapeutic process.

Adult↗
PubMed1983

Classification of countertransference for utilization in supervision.

Supervision of countertransference has been problematic for a number of reasons. Countertransference has had many different meanings and negative affective connotations associated with it. Conflict has existed over whether it is a subject more appropriate to personal therapy than to supervision. The absence of a single consistent conceptual framework to define and clarify these problems has contributed to them. This paper proposes a classification of countertransference into six types of phemonena: concordant identification, complementary identification, interactional reactions, life events, institutional countertransference, and classical countertransference. Examples from supervision of psychiatric residents are used to illustrate the utilization of this classification.

Adult↗
PubMed2001

Countertransference, supervised analysis, and psychoanalytic training requirements.

Because psychoanalysts have an ever expanding appreciation for the many factors that contribute to the psychoanalytic treatment process, they no longer view themselves simply as the receiver of the patient's transferences. When patient and analyst meet in the consulting room, they bring along with them a blend of intrapsychic and external ingredients--including countertransference--that make up the analytic soup. Candidates in psychoanalytic training must contend with even more sources of indirect countertransference reactions (Racker 1968) than experienced graduate analysts, due to aspects of the training experience itself. The author contends that minimum graduation requirements for supervised analyses are one such source of indirect countertransference. Four clinical examples of control analyses demonstrate this form of indirect countertransference during the assessment, opening, middle, and termination phases. These examples are followed by implications and recommendations for didactic psychoanalytic training curricula, countertransference awareness, supervision of control cases, institute governance policies and procedures, publication of clinical material, and future research.

Countertransference↗
PubMed1986

On countertransference enactments.

This communication focuses on the relation of countertransference to psychoanalytic technique, calling attention not to the more obvious forms of countertransference that have been commented on by previous writers on the subject, but to its subtler ones. Often well camouflaged within the framework of traditional, time-tested techniques, this aspect of countertransference may attach itself to our way of listening and thinking about patients, to our efforts at interpretation, to the process of working through, or to the complex issue of termination. Less recognizable than its more boisterous counterpart and in some respects less tangible, this side of the problem of countertransference is no less important. For it is precisely those subtle, often scarcely visible countertransference reactions, so easily rationalized as parts of our standard operating procedures and so easily overlooked, that may in the end have the greatest impact on our analytic work.

Adult↗