PubMed · 7921728
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D R Davies. 1994. Malignant alienation.. https://doi.org/10.1192/s0007125000034553
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During the last thirty years there has been a growing interest in research into physician-patient interaction. This article highlights the research which concerns the physician's countertransference feelings. The concept of countertransference is described and a classification with relevance for physicians in general is explained. The existing research into the incidence and consequences of countertransference is examined. Examples are given of categories of patients, who often evoke specific countertransference feelings in the physician. The consequences of the countertransference feelings for the physician himself are discussed and examples are given of particular situations where countertransference feelings could be of importance. Finally, the existing possibilities to learn about handling countertransference feelings are surveyed and the authors emphasize the need for more research in this particular field.
During the last decade we have seen the development of gay-affirmative psychotherapy and an increase in the use of homogeneous psychotherapy groups for gay men. Today there is greater acceptance that homosexuality is a normal variant within human sexuality and that being gay both describes the focus of one's sexual and emotional expression and constitutes a central aspect of one's core identity. In their pursuit of full acceptance of their lesbian or gay identity, lesbians and gay men continue to experience pressures that are unique, however. Within a psychotherapy group, when the group leader is gay, the process by which the group members work on their transference reactions, as well as their internalized homophobia and shame, can evoke strong countertransference in the gay male group leader and his supervisor; this countertransference is at times distinctly different than that with a nongay group therapist. This article highlights many countertransference themes in such groups and proposes ways to identify and manage these themes.
A critical overview of the current knowledge of engaging in psychotherapy with a cultural minority, Orthodox Jews, is provided. The various forms of psychotherapy that have been utilized to engage Orthodox Jews in meaningful psychotherapeutic encounters are discussed. Psychodynamic, cognitive, behavioral, couple, family, and group therapies have all been employed with success. The first key in working with cultural minorities, including Orthodox Jews, is patience. Patience is required to allow a therapeutic alliance to develop in which the therapist, the outsider, can be trusted. When patients are reluctant to accept the treatment proposed, patience is necessary to give them the time required to verify the treatment with someone they trust, often their rabbi in the case of the Orthodox Jew. Patience is also valuable when patients request a change in the frame of therapy, such as the use of a chaperon or leaving the door slightly ajar if being treated by a member of the opposite sex. The second key in working with this or any other cultural minority is flexibility. Flexibility is required, to chose treatment modalities that best fit with the patient's beliefs, to respect the patient's beliefs no matter the extent they deviate from the therapist's own, and finally, to be critical of oneself when examining transference and countertransference reactions.