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PubMed2001

The countertransference: erotic, erotised and perverse.

The author begins by drawing attention to the dearth of psychoanalytic theory on the sexual countertransference, which he attributes largely to embarrassment associated with the personal superego and to fear of censure by the psychoanalytic community. After a review of the relevant literature, he points out that the term 'countertransference' arose in the context of misbehaviour by the early analysts and that the countertransference was originally seen as something to be controlled and suppressed, partly for the sake of the reputation of psychoanalysis. Theoretical and normative reasons are adduced for the disappearance of sexuality from psychoanalytic scenarios, and the wish for sexual contact with patients is discussed. While it may be deemed perfectly normal for an analyst to have erotic feelings towards patients of either sex, psychopathology is, in the author's view, involved only if he acts out. Clinical illustrations are given of manifestations of the sexual countertransference in its erotic, erotised and perverse forms, which the author considers it important to distinguish. He concludes that the relative absence of theory on the subject means that not enough clinical use is made of the sexual countertransference, which he sees as of great potential value to therapist and patient alike.

Adult↗

PubMed1981

The use of the countertransference in psychotherapy supervision.

The countertransference, the therapist's emotional reaction to the patient at each point in time, should naturally and routinely be part of the data under discussion in the supervisory session. The countertransference is so important a part of the psychotherapeutic process that to ignore it is to risk missing an important part, perhaps even the core, of what is happening in the treatment. The countertransference can be utilized in supervision without risk of intruding into the student-therapist's private life, or of turning supervision into psychotherapy, if the supervisor maintains a mental set of readiness to seek the origins of the countertransference emotions in the therapist's interaction with the patient. That these countertransference emotions also have their connections with the therapist's own neurotic conflicts is acknowledged and in no way minimized, but this is left to one side as not germane to the goals of supervision. The supervisor should always hold in mind the question, "How can these emotional reactions of the therapist lead us to a deeper understanding of the patient, of the patient's current emotional situation, and of the therapeutic process?"

Adult↗

PubMed1997

Malignant eroticized countertransference.

Gabbard (1994) divided the pathology of therapists, both male and female, who commit sexual boundary violations into those who are psychotic, those who are predatory psychopaths, those engaging in masochistic surrender, and those called "the lovesick therapist." Lovesick therapists are the most common type and manifest crucial narcissistic themes of "a desperate need for validation by their patients, a hunger to be loved and idealized, and a tendency to use patients to regulate their own self-esteem" (p. 127). Among the psychodynamic aspects of this curiously circumscribed area of loss of reality testing that makes it difficult for the therapist to see how self-destructive and harmful such enactment is, are an unconscious reenactment of incestuous longings, a misperception of the patient's wish for maternal nurturance as a sexual overture, enactments of rescue fantasies, a projected idealization of the self of the therapist, a confusion of the therapist's needs with the patient's needs, a fantasy that love is curative, acting out disavowed rage at the patient, or rage at an organization, an institute, or one's training analyst, a manic defense against mourning, a narcissistic fantasy that their sexual affair is an exception, insecurity regarding masculine identity, and assorted primitive preoedipal themes. Gabbard's (1991) erotized countertransference is one variety of what I have termed malignant eroticized countertransference. His variety is a development that occurs under the pressure of the patient's preemptive and compelling expressions of lust and love, the patient's erotic transference. But malignant eroticized countertransference can also occur without the patient having offered any such expressions; it can even occur on first meeting the patient when he or she walks into the office! This is akin to the romantic "love-at-first-sight" theme so favored in the movies and by novelists, but it is always pathological when it occurs in the therapeutic situation. Countertransference enactments are a creation between the patient and the therapist on a continuum from one pole, where the patient has just walked into the office and contributes almost nothing directly, to the other pole, where the therapist loses control of himself or herself as a response to the unbearable pressure of the patient's lust. In the treatment of malignant eroticized countertransference it seems clear from this discussion that every case should be evaluated psychodynamically and the treatment should be made to fit the patient, not the patient to the treatment. Each situation should be studied in psychodynamic depth without preconceptions based on generalizations or formulas. Therapists who are psychotic should of course be treated with antipsychotic drugs and usually should not be allowed to practice any further. Therapists who are psychopathic or sociopathic predators should certainly never be allowed to practice. Some of the individuals who are "lovesick," or, as I put it "love/lust obsessed," or those who have made a masochistic surrender to a sadistic destructive patient, are in need of reanalysis and have the potential to continue as effective therapists under careful supervision. Therapists like this do not deserve to be summarily dismissed from the profession but, like therapists who develop other serious neurotic problems, should receive appropriate help from us.

Countertransference↗

PubMed2003

Countertransference reactions toward specific client populations: a review of empirical literature.

Countertransference reactions can either benefit or hinder mental health professionals during the therapeutic process. An awareness of countertransference reactions can aid clinicians in understanding and anticipating their own specific emotional responses toward certain client populations. Recent empirical research suggests that common countertransference reactions may occur in mental health professionals when relating to certain client types. Since a literature review indicated that more numerous and reliable tests have been developed to measure countertransference during the past decade, as well as better research designs, this article reviews and summarizes all empirical research studies on countertransference reactions toward specific client populations during the past 10 years, from 1990 to 2001.

Countertransference↗

PubMed1995

Physicians' emotional reactions to patients: recognizing and managing countertransference.

Traditionally, physicians have been socialized to repress emotional responses to patients in an effort to maintain clinical objectivity. In this article we call into question that assumption, maintaining that rather than being hindrances such natural responses can be facilitators to the development of stronger physician-patient relationships. We focus on the concept of countertransference, defined here broadly as incompletely recognized emotional reactions a physician has toward a patient or his/her circumstances. In this article we differentiate between internally-focused and externally-focused countertransference. Internally-focused countertransference refers to unrecognized reactions that reflect the unique psychological state of the physician, whereas externally-focused countertransference focuses on the reactions that primarily derive from the behaviors or other characteristics of the specific patient or circumstances. We conclude by presenting a 3-step strategy for recognizing and managing countertransference responses to patients.

Countertransference↗

PubMed1993

Transference, countertransference and acting out in psychoanalysis.

The development of the transference concept is described and studied from structural, genetic, dynamic and adaptive points of view. A sketch is given of the development of a transference neurosis during treatment, and of the difference between transference phenomena and transference neurosis. A number of examples from practice are given, also in connection with the occurring repetition compulsion. In the discussion of the countertransference concept a distinction is made between the so-called classic approach and the totalistic approach to this concept. The author studies the possible interference of the countertransference during treatment. If the analyst can withdraw from his trial identification with his patient no interference will occur. Sudden countertransference phenomena may be eliminated by self-analysis. Chronic countertransference phenomena can only be solved by re-analysis. Examples from practice are given and the fact is demonstrated that analyst and patient are not only transference-countertransference objects for each other, but also real objects. Attention is paid to the old and the new concept of acting out. Examples from practice are given of acting out during and outside the analytic sessions.

Acting Out↗

PubMed1996

The manifestation and management of staff countertransference on a pediatric AIDS team.

The authors discuss the countertransference reactions that arise in staff who work in a hospital outpatient clinic with children with HIV and AIDS. Countertransference feelings such as guilt, anger, and helplessness can be easily aroused when working with a young, impoverished, dying population. Factors that precipitate these feelings and their manifestations are discussed, as well as the antitherapeutic effects of acting on one's countertransference. Psychodynamic explanations are offered for some of the more salient countertransference reactions. Finally, suggestions are made for management of countertransference, such as strong team leadership, ongoing support groups, and redefinition of therapeutic objectives.

Acquired Immunodeficiency Syndrome↗

PubMed2002

[Specific countertransference experience and interpersonal problem description in psychodynamic psychotherapy].

In psychodynamic psychotherapy, countertransference and its professional use is seen as an important means to identify central difficulties of patients. The present study examines the correspondence of countertransference and interpersonal difficulties in 30 therapist-patient couples in day hospital psychodynamic psychotherapy. Interpersonal problems were recorded using the inventory of interpersonal problems (IIP) and countertransference was measured using the impact message inventory (IMI). Correspondence was measured as the correlation of IIP data from the patients and IMI data from the therapists. Data were collected at the start of therapy, after 4 weeks of treatment, and at the end of treatment. Over the course of the therapy, an increase in the correspondence of interpersonal problems as reported by patients and countertransference could be observed, starting with r = 0.22 at the beginning of therapy and continuing through r = 0.47 after 4 weeks to r = 0.58 at the end of therapy. The mean correlation was slightly above that of a control group of 20 nonclinical couples associated for at least 6 months.

Adult↗

PubMed2006

The concept of objective countertransference and its role in a two-person psychology.

Objective countertransference comprises those feelings the analyst experiences with the patient that are repetitions of feelings from the patient's life outside the analysis. It is viewed as being induced by the patient and is understood in the context of the patient's life, not the analyst's. The concept is used to understand the relationship of some of the analyst's feelings to recurrent interpersonal patterns in the patient's life. It has often been viewed as being incompatible with a two-person psychology. Here, in contrast, it is argued that objective countertransference is only one current within the analyst's total emotional response to the patient, and that it should be conceptualized as a component of a broader two-person psychology. However, the use of objective countertransference as a conceptual tool highlights aspects of the analytic relationship that differ from those emphasized in current two-person models. A case example is analyzed from both perspectives to illustrate their similarities and differences. Although the concept of objective countertransference can enrich the analyst's understanding of certain dimensions of the analytic relationship, it is not a theory of technique and it is not wedded to any particular style of psychoanalytic intervention.

Countertransference↗

PubMedDate not supplied

Countertransference in the family therapy of survivors of sexual abuse.

As family therapy of sexual abuse survivors has become more common, theoretical and technical issues have received considerable attention. Less attention has been devoted to the countertransference experience of the therapist. Unexamined therapist countertransference is a critical element in the treatment of these families, which markedly influences the nature and direction of treatment. Particular types of countertransference are presented here. In addition, the contention is made that countertransference is not only evoked by the particular presentation of the family members, but also by the therapist's unexplored political and moral beliefs.

Adolescent↗

PubMed1999

The lived experience of countertransference in psychiatric/mental health nurses.

The purpose of this study was to evolve a structural description of nurses' experience of countertransference. The phenomenological method was chosen for the study. The sample consisted of 5 participants who met selection criteria. The participants gave audiotaped descriptions of their experiences in caring for patients for whom they experienced countertransference. The lived experience of countertransference emerged from the findings of this study as a process of the continuous growth of self-awareness. Initially, the experience entailed the struggle to abandon objectivity, emotional neutrality, and therapeutic omnipotence. It was the abandonment of these principles that enabled the nurse to begin to use the self's experienced emotions therapeutically in interactions with patients. For the participants, the feelings aroused in the self came to be understood as having meaning within the concept of countertransference and thus, came to be understood as normal responses to caregiving. It is the continuing ability of these nurses to transcend this normal, human response, and to use their growing self-awareness to provide an appropriate level of care to the patient, that is the hallmark of the lived experience.

Awareness↗

PubMed1996

Teacher-induced countertransference in clinical teaching.

Although it is acknowledged that clinical teaching is an interpersonal process that is relational in nature, little has been written regarding the conflicts and feelings that can exist within the student-teacher relationship. The article is a discussion of the concept of countertransference in psychotherapy, specifically as to how it may be applied to understanding clinical teachers' subjective responses to students. The authors present arguments to support the fit between the concept of countertransference and clinical teaching, focusing on the negative effects of a teacher's countertransference in clinical teaching. The implications of the concept of countertransference in clinical nursing education is explored.

Countertransference↗

PubMed1996

Countertransference in the treatment of patients with eating disorders.

THE term countertransference has undergone considerable change in meaning in recent decades. Freud (1910/1957) defined countertransference as the emotional reaction of the analyst to a patient's transference. It was seen as the unresolved needs and conflicts of the therapist, often unconscious, which interfered with his/her understanding of the patient. Recently, Abend (1989) chronicled the shift in the definition of the term and noted Kernberg's (1965) more totalistic" description of countertransference. In Kernberg's view, the therapist's reactions have more to do with the patient's often intense transference and with the therapist's capacity to withstand the subsequent stress and anxiety, than with any particular problem from the patient's past. Abend (1989) concluded that most clinicians refer to countertransference in this revised way and used the term quite broadly to denote "all those reactions of the analyst to the patient that may help or hinder treatment" (Slakter 1987, p. 3).

Adolescent↗

PubMed2006

Countertransference to psychiatric patients in a clinical setting: development of the Feeling Checklist-Japanese version.

Countertransference is an important dimension of the therapeutic alliance between care providers and patients. The Feeling Checklist (FC) is a self-report questionnaire for the assessment of countertransference by hospital staff toward patients. The FC was translated from English into Japanese and its factor structure, reliability, and validity in the Japanese version (FC-J) were examined. A total of 281 Japanese psychiatric nurses were tested with the FC-J. All nurses were primarily involved in provision of psychiatric care. Principal-component factor analysis with varimax rotation was performed to identify the potential components of the FC-J. In a factor analysis of the FC-J, seven factors were extracted. The five subscales that were determined and labeled included Reject, Distance, Helpfulness, Closeness, and Involvement, which collectively accounted for 56.0% of the variance. Cronbach's alpha, a measure of internal consistency, for individual subscales was 0.833 for Reject, 0.763 for Distance, 0.768 for Helpfulness, 0.617 for Closeness, and 0.663 for Involvement. Notably, there was a significant correlation between the FC-J and the Nurse Attitude Scale (P < 0.0001). Moreover, one-way anova was performed with each FC-J subscale to examine differences among psychiatric diagnoses in the study sample. A significant difference was found for Involvement (P < 0.001), with the total score on Involvement being the highest in the personality disorder group. These results are considered to verify the reliability and validity of the FC-J as a scale to measure countertransference among Japanese care providers. The use of this scale allows individual care providers to recognize and be cognizant of their own countertransference objectively and thereby contributes to improve the relationship between patients and care providers.

Adult↗

PubMedDate not supplied

Transference and countertransference.

TOPIC: The utility of transference and countertransference in professional nursing relationships. PURPOSE: To provide an introductory text for nurses new to these concepts. SOURCES: Literature specific to transference and countertransference illustrated by examples related to professional practice. CONCLUSIONS: Transference and countertransference influence relationships in ways that under certain conditions may be unhelpful to all concerned. Understanding how transference and countertransference manifest themselves has implications for the safe structuring of professional relationships.

Adaptation, Psychological↗

PubMed1986

Countertransference responses in short-term dynamic psychotherapy.

The concept of countertransference is used in a broader sense (Heimann, Kernberg) or a more restricted one (Reich, Dewald) in the psychoanalytic literature. All authors generally agree that it is of great importance 'to have countertransference under conscious awareness and control' (Singer and Luborsky). Our study stresses the importance of the countertransference phenomenon in the context of short-term dynamic psychotherapy (STDP). Three clinical examples were selected to illustrate only the specific issues of this study. Psychotherapies were carried out in the Psychotherapy Unit of the Psychiatric Clinic, Athens University. Therapists were residents in psychiatry and were supervised by psychiatrists with a formal psychoanalytic training and experience. Taking into account the therapeutic processes, three kinds of countertransference responses were discerned: (a) those connected with the patient's transference pattern; (b) those linked with the therapist's character structure, and (c) those manifested in specific stages of STDP, especially during the termination phase.

Adult↗

PubMed1995

Countertransference-derived elaboration of religious conflicts and representational states.

Polysemous qualities of the religious patient's use of language and metaphor are among the subtle factors involved in the creation of an ambience conducive to projective identification, leading to the evolution of countertransference crises in the psychotherapist. The psychotherapist's activity during countertransference crises consists in converting the patient's unsorted images, memory traces, and affective states that have never before been symbolified into resilient representational material. This requires the psychotherapist's imaginative process, but it also involves the accurate preconscious perception and amalgamation, within the countertransference, of the patient's unmetabolized representational object- and self states. The guidelines for organizing such material are communicated through the projective-introjective exchange. Gradually, silent internal exchanges between the therapist and his WORP facilitate novel conceptualizations that free the external linguistic interchange to convey complex relational communications. This development bears directly upon religious objects and representations since these are particularly laden with traces of early, preverbal transformative processes. Through the resolution of transformational countertransference crises during treatment, and the alignment of the patient's historical memories and objects with their subjective meaning, many of the paradoxical or mysterious characteristics that were attributed to God in a conflict-bound manner regain their somewhat more modest, containable, and knowable human proportions. This results in less dichotomy and splitting in the perception and relation with God, without challenging the root otherness and ontological distance that encompass most representations of divinity.

Adolescent↗

PubMed1998

Transference and countertransference interpretations: harmful or helpful in short-term dynamic therapy?

Finding effective and economical interventions in brief therapy has become a challenge for therapists of all orientations needing to make noticeable progress within a short period and to achieve positive, measurable outcomes. In this paper three theoretical positions and the empirical data purporting to support them were examined: (1) not using either transference or countertransference interpretations; (2) using transference but not countertransference interpretations; and (3) relying heavily on both kinds of interpretations. Though limited research prevents firm conclusions, findings support infrequent, careful, and cautious usage of transference and countertransference interpretations, including crafting them to meet specific patient characteristics and reflect presenting problems. If appropriately used, both interpretations can affect outcome by contributing to alliance building, perseverance in therapy, and goal attainment. If inappropriately used, however, both interpretations can cause harm, even premature termination. Finally, research findings do not support the theoretical position that positive outcome depends on transference and countertransference interpretations.

Cost-Benefit Analysis↗