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Remarks on transference-countertransference in psychotic states.

Clinical material of patients in psychotic states indicates that in those states the transference is directed into the therapist's body. The emotional experience thus created in the therapist, which is usually called countertransference in its broad meaning, should rather be seen as very early forms of object relationships. The complexities of the above easily influence the analyst in her role of interpreter. Therefore in the actual work with these patients the verbal interpretation, which represents an elaboration of the transference, in the author's view should be seen as countertransference.

Adult

Countertransference.

Countertransference can be used as an instrument in understanding the patient's projective identification. An analogy for the patient/therapist interaction is found in Bion's model of the infant's communicating by projection to the breast and the mother as containing and modifying such projections. The particular countertransference problems created by patients who have been objects of massive parental projections are examined. In such cases the patient's projections induce in the analyst diverse experience of past helplessness in relation to projections.

Countertransference

Sex-role related countertransference in psychotherapy.

Data from one psychological and one psychiatric agency were collected to determine if psychotherapists' treatment decisions about opposite-sex persons might be influenced by sex-role prescriptions for dealing with sexual impulses. Accordingly, male therapists were hypothesized to prolong and female therapists to avoid treatment situations likely to arouse their sexual curiosities. The results at both facilities provide some support for these notions and, if generalizable, establish sex-role primed countertransference as a factor in patient selection and termination.

Counseling

Voice of a hidden minority: identification and countertransference in the cross-cultural working alliance.

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.

Adult

Transference and countertransference in clinical intervention with divorcing families.

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.

Adult

Ethnocultural transference and countertransference in the therapeutic dyad.

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.

Adult

Group therapy with sexually abused boys: leadership, projective identification, and countertransference issues.

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.

Adolescent

Use of the group in resolving the subjective countertransference.

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.

Countertransference

Countertransference as a factor in premature termination of apparently successful cases.

In brief sex therapy rapid disappearance of symptoms may appear to signal success. However, superficial indications of success may be utilized by the sex therapist as an opportunity to escape from a therapeutic situation which evokes uncomfortable feelings. The need to terminate treatment abruptly may be conscious or unconscious. This presentation discusses a few of the multiple factors which may lead the therapist to initiate premature termination or to collude with the patient's problems rather than the patients' to alert clinicians to the adverse effects of countertransference.

Adult

Countertransference and clinical choices in public-sector treatment of a patient and her family.

Clinical decision making in the treatment of families of individuals with prolonged mental illness can be affected by countertransference that is stimulated by the context of treatment as well as by the family being treated. For clinicians, psychoeducation, the current intervention of choice for such families, can serve defensive functions that are motivated by counter-transference; a case example illustrates how such defenses led a clinician to avoid deeper therapeutic work. The authors believe that clinicians must strive to understand their motivations for whatever clinical decisions they make; to facilitate this awareness, intensive psychotherapy should be required as an adjunct to training.

Activities of Daily Living

Utilizing reflected countertransference Applying the reflection process as a teaching tool in supervision.

There are times when teaching cannot proceed through the abstract presentation of content and must progress by the demonstration of what is to be taught. This is true whenever a student is unable, for whatever reason, to appropriately apply such abstract material to the concrete task before him. This may be due to a number of factors, one of the most common of which is the lack of qualitatively similar experiences to which to refer. The teaching of complicated processes such as psychotherapy is an example, especially when the trainee is relatively unsophisticated and/or seems unable to abstract from discussion of blocking phenomena, where it may become necessary to "act in" the feeling tones which are to be the cues for the behaviour to be learned, instead of persisting with abstract interpretations. When, in supervision, a supervisee recreates the conditions existing in the therapeutic situation, this procedural behaviour is called the "Reflection Process". This process often appears to be unconsciously motivated by the need of the supervisee to solicit from the supervisor a practical demonstration which he does not know how to solicit otherwise. Even if the Reflection Process is due mainly to unresolved, unconscious conflicts of the supervisee, it can be a useful clue as to what transference-countertransference problems he is having difficulties with. The fact that such behaviour on the part of the supervisee may arise out of unresolved unconscious conflictual material should not become a reason for dismissing it. Instead, supervisors should become proficient at recognizing the countertransferential feelings in themselves, which can be an accurate reflection of the feelings troubling the supervisee in his dealings with this patient; and they should recognize the distress signal on the part of the supervisee, which can often be responded to constructively. In the supervision, the supervisor at times can, almost unwittingly, come to play the role which the supervised therapists plays in the supervised therapy and, if not aware of the Reflector Process, he may not realize that the countertransferential feelings which underly his assuming that role may not be primarily a response to the character of the therapist he is supervising but rather to that of the patient. They may also be a reflection of the process problem in the supervised therapy. It is not essential that this process be labeled in the supervision; what is essential is that its ramifications be recognized by the supervisor.

Allied Health Personnel

Countertransference in the movies: effects on beliefs about psychiatric treatment.

This study examined the effect of viewing the movie Lovesick on college students' beliefs about countertransference and psychiatric practice. Consistent with the concerns of Gebbard and Gebbard (1985) that the public may develop erroneous beliefs about psychiatry from watching such movies, after seeing the film subjects were more accepting of sexual behavior between analyst and patient and were cynical about the motivation of the mental health professions in prohibiting such behavior.

Adult

Countertransference: the analyst's retreat from the patient's vantage point.

As analysts, we may agree with certain basic tenets: we should not impose our truths, whether or not theory-laden; we should maintain the focus on the patient's inner reality, not on how he or she lives in the world--out there; we should be prepared to be surprised, to learn something that hadn't occurred to us; we should look for multiple cues in the clinical data, pay attention to affect and state as may be expressed within the moment, and listen for subtleties that may convey something about how we are being experienced in the transference. But again and again, we fail to adhere to these precepts. Despite our best intentions, we seem to have a fundamental disinclination to maintaining these positions. I have tried to consider some reasons for this difficulty and its relation to the countertransference. Drawing upon several clinical examples, I have attempted to examine ways of enhancing our attunement to verbal and non-verbal cues from the patient which may direct us, sooner, to dimensions of our counter-transference responses otherwise overlooked.

Adult

[Significance of the transference-countertransference constellation in motivation for participation in an epidemiologic field study of psychogenic disorders: a report of experiences].

The present article deals mainly with problems arising from the motivation of individuals for the participation in an epidemiological field study and their solutions on the basis of psychological-psychiatric findings. Subsequent to a more detailed survey of the research project in question formal and technical aspects of the motivational efforts (home visits, phone contacts) which had to be performed by the research group are mentioned. In the following the authors focus on the scientific concepts and orientations of their motivation work including the specific attention paid to the constellation of transference and countertransference. Particular importance is attributed to the presentation of several case studies which illustrate the influence of different psychoanalytical character traits on the motivational process. Finally the authors concentrate on specific problems regarding the sex of the probands as well as on their experiences with so-called hesitators i.e. individuals who for a longer period of time cannot decide whether to participate in the study or not.

Adult

Erotized transference reconsidered: expanding the countertransference dimension.

A reconsideration of the erotized transference from a contemporary perspective has been presented utilizing detailed case material provided by Stoller. The main thesis is that this type of transference, traditionally conceived as a product of a particular kind of patient often felt to be borderline, is better understood as arising in a specific intersubjective context involving both participants in the psychoanalytic situation. The focus is on the intricate interaction of analyst and patient, recognizing that either may serve as a selfobject for the other. This view assumes a more expanded countertransference role than recognized in the earlier literature. The psychoanalytic situation can be erotized by either or both participants. A corollary thesis is that the details of a patient's fantasy should also be viewed as codetermined and that imbedded within it might be the patient's subjective experience of the psychoanalytic interaction. Alluded to peripherally is that the erotized transference in the interaction between male analyst and female patient is, in part, a manifestation of traditional roles assumed in situations involving a male authority figure in close engagement with a female who perceives herself as relatively powerless. This issue has recently received considerable attention from writers who have addressed themselves to the important gender issues in psychoanalysis.

Adult

Countertransference examples of the syntactic expression of warded-off contents.

This is a preliminary statement of the hypothesis that syntax in speech may act as an "incidental stimulus" in the communication of mental contents which the speaker is motivated both to conceal and to express. Ten clinical examples, taken from verbatim transcripts of one psychoanalyst's interventions in a recorded case, illustrate the expression of countertransference attitudes by syntactic and other linguistic properties such as: the agentless passive, pronominal ambiguity, yes/no questions, extraposition, the pseudocleft construction, delaying tactics, the passive construction and conceptual focus, lists and logical complexity, foregrounding, syntactic and lexical ambiguity, subordinate clauses and syntactic opacity.

Communication