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PubMed1989

Technique and countertransference in Freud's analysis of the Rat Man.

Freud's records of his treatment of the Rat Man constitute a unique document in the history of psychoanalysis. Through the years different analysts have used these records to support different theories about analytic technique. Certain non-interpretive interventions of Freud's have especially aroused their interest, and many reasons have been put forward to "explain" Freud's behavior. One reason never yet advanced and documented is that a countertransference tension may have been involved in one of these instances. This is surprising, since countertransference is a necessary part of every analysis. Evidence is presented that Freud's behavior may indeed have been under the sway of countertransference. Some recently discovered details concerning his early life are discussed as constituting a plausible background for ths countertransference enactment.

Countertransference↗

PubMedDate not supplied

Notes on countertransference in borderline conditions.

"When dealing with borderline or severely regressed patients, as contrasted to those presenting symptomatic neuroses and many character disorders," Kernberg (1975) observed, "the therapist tends to experience rather soon in the treatment, intensive emotional reactions having more to do with the patient's premature, intense and chaotic transference and with the therapist's capacity to withstand psychological stress and anxiety, than with any specific problem in the therapist's past" (pp. 16-17). The argument in the present paper contends that Kernberg's description of countertransference reactions to borderline patients is a caricature that applies only within a limited range of borderline conditions, specifically the most primitive or poorly organized level of borderline functioning or regressive borderline states. The description does not apply to the full range of borderline psychopathology, and in many cases can be misleading. It has generally been recognized that countertransference vicissitudes play an extremely important role in the therapy of borderline patients at one or another phase of the treatment. At critical points in the development of transference (TR) and countertransference (CT) and their interaction, the therapist's recognition of and capacity to deal with CT issues become crucial to the treatment progression. The present paper explores the dimensions of CT experience and provides a tentative model for the understanding of transference-countertransference (TR/CT) interactions. The central points emphasized are: (1) that borderline disorders form a spectrum of character pathology falling between the psychoses on one side and the narcissistic personality disorders on the other; (2) that these conditions reflect varying degrees of pathological disruption and varying levels of personality integration; (3) that, depending on the form of pathological organization, these conditions manifest a variety of types and degrees of intensity of TR involvement and elicit corresponding CT reactions; and, finally (4) that these forms and degrees of TR/CT call for corresponding modifications in therapeutic response.

Aggression↗

PubMed1994

Sexual excitement and countertransference love in the analyst.

The psychoanalytic literature has been remarkably silent on the subject of erotic countertransference feelings. The recent emphasis on transference-countertransference enactments in the analytic setting has resulted in increased openness about development of such feelings. Several key themes appear to be involved in the analyst's sexual excitement, including loss of the "as-if" nature of transference and countertransference, a measure of hostility and contempt, the perception of a deficit state in the patient, a defense against loss and mourning, and oedipal and preoedipal enactments involving a variety of gender configurations. These themes are illustrated with clinical material. The differences between those analysts who contain and constructively process erotic countertransference and those who destructively act it out are also discussed. The crucial role of consultation with a colleague is emphasized as a valuable recourse.

Countertransference↗

PubMed1993

[Countertransference as therapeutic instrument in analytic child psychotherapy].

In the process of psychoanalysis or psychoanalytical therapy countertransference plays a significant role: On the one hand still unconscious countertransference reactions of the therapist hinder the progress of the patient, especially when they lead to an acting-out of the countertransference resistance. On the other hand every analyzed countertransference reaction helps directly in understanding the patient and furthers of the process of therapy itself. This also applies to analytical child-therapy, which is demonstrated by means of some case histories.

Child↗

PubMed1997

Countertransference. Its continued importance in psychiatric education.

Psychotherapy is likely to play a minor or nonexistent role in the future general psychiatrist's training and practice. However, the component skills of recognition and management of the countertransference will remain important. Because psychotherapy training and supervision have been the venues for countertransference learning, the field is in danger of losing its teaching laboratory and hence losing these skills. The authors examine the concept of countertransference and discuss its importance in four increasingly significant areas: managed care, psychopharmacological treatment, emergency intervention, and the management of professional boundaries regarding sexual misconduct. Methods are discussed for enhancing residents' countertransference skills through supervision, training groups, and the resident's personal psychotherapy.

Adult↗

PubMed2001

Whither countertransference in couples and family therapy: a systemic perspective.

This study addresses various perspectives on transference and countertransference dynamics from the context of couples and family therapy. It considers the phenomena of countertransference in couple and family therapy and illustrates treatment with three specific kinds of patient populations: adult survivors of childhood incest who receive therapy with their partner; couples group therapy; and psychotherapists and their families. How supervisors help trainees recognize and deal with the transference and countertransference in clinical practice also is explored. These reciprocal phenomena are even more complex to identify and handle in couple and family treatment than in individual therapy.

Adult↗

PubMed2002

Countertransference management and therapy outcome: an initial evaluation.

The relationship between therapist countertransference management ability and therapy outcome was examined. Participants were 32 therapist-trainees and their clinical supervisors. Supervisors completed the Countertransference Factors Inventory (CFI) with regard to their supervisees. The CFI assesses five therapist characteristics thought to comprise countertransference management: Self-Insight, Self-Integration, Anxiety Management, Empathy, and Conceptualizing Skills. Both trainees and their supervisors rated the degree of improvement for each client seen in therapy. Results indicated that the CFI total score and the subscales of Anxiety Management and Conceptualizing Skills were positively related to both trainee and supervisor ratings of outcome; Self-Integration was related to trainee, but not supervisor, outcome ratings.

Adult↗

PubMed1993

Countertransference and the multiple amputee patient: pitfalls and opportunities in rehabilitation medicine.

Current psychoanalytic literature on countertransference broadly defines the term as a helping professional's overall response to an individual patient. Reactions of rehabilitation professional to their traumatically injured patients can significantly impact on the patient's treatment as well as the individual therapist's and entire rehabilitation team's effectiveness. In this paper, a case is presented illustrating a process of understanding countertransference toward a multiple amputee patient. Implications for the rehabilitation team are also described. The analysis of a single case demonstrates how countertransference interpretation might be used as a vehicle to enhance understanding the patient and promote team effectiveness.

Amputation, Surgical↗

PubMed1989

Countertransference and failure to report child abuse and neglect.

Though every state has laws requiring the report of suspected child abuse and neglect, failure to report remains a significant problem. Review of previous research on failure to report suggests that the reporters' anxieties about disrupting their relationship with the child's family as well as the reporters' gender, experience, and training affect willingness to report. Countertransference fear, guilt, shame, and sympathy are discussed as a basis for understanding the reporter's anxieties. We suggest that countertransference issues should be addressed in the training and ongoing practice of mandated reporters. The following mechanisms are offered to deal with this issue in training and practice: (1) teaching professionals about how countertransference reactions may arise during the reporting process (this training may include the use of risk management groups for private practitioners); (2) identification of a community child abuse expert for consultation; and (3) educating child protection workers about psychodynamics aspects of case management.

Anger↗

PubMed1993

The hoarding habit, countertransference, and consultation anthropology in a Peruvian psychiatric hospital.

The 'hoarding habit' is the practice of collecting a large number of mostly useless objects by psychiatric patients. Countertransference consists of distorted perceptions by psychotherapists in their study of individuals, or social scientists in their study of human groups, which interfere with the pursuit of their therapeutic or research goals. A case is here presented from observations made by the author in one pavilion of the Hospital Victor Larco Herrera in Lima, Peru, of a 'bag man' who persisted in carrying his 'hoard' with him in large market bags. The practice of hoarding is related to the culture and social structure of the hospital, patients' use of physical space, the existence of trade networks, the smuggling of alcohol, and patients' needs to retain a feeling of selfness and personal autonomy as well as to maintain ties with the external world. In all these senses the hoarding habit is overdetermined: it is both a symptom of pathology and a sign of healthy functioning. However, its clinical construction may be expanded by an observer who can function as a 'culture broker' and who may be able to apply the dialectic of pathology and health to the operation of psychiatric services for more therapeutic ends. However, the observer, in a consultation capacity, is advised to go beyond the study of transference and countertransference in his or her subjects to focus on his/her own countertransference in order to consult more effectively.

Anthropology, Cultural↗

PubMed1998

Countertransference considerations for the gay male when leading psychotherapy groups for gay men.

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.

Countertransference↗

PubMed1986

Countertransference in cross-cultural psychotherapy: the example of Jewish therapist and Arab patient.

In the course of most psychotherapies, the cultural background of the therapist vis-à-vis the patient seldom emerges as a potential barrier to treatment. This is so for the simple reason that generally both participants share similar backgrounds. When this is not the case, however, divergent cultural values and assumptions may invade the treatment--sometimes undermining it altogether. The focus of this paper shall be on some of the countertransference issues in cross-cultural psychotherapy, with reference to one specific, and in some ways unique, therapist-patient dyad: the Jewish (Israeli) therapist and Arab patient. In the paper, I shall explore some of the more typical and troublesome countertransference issues that often occur in this particular example of cross-cultural psychotherapy. In addition, some suggestions will be made regarding the technical management of these countertransference problems.

Aggression↗

PubMedDate not supplied

The evolution of countertransference and its applicability to nursing.

While psychiatric nurses frequently use the term countertransference, the lack of a uniform definition may result in misunderstandings. In addition, some have questioned the applicability of countertransference to nursing. The author proposes that historical developments have led to a gradual expansion in the definition of this concept. However, some psychiatric nurses have also described countertransference incidents that are more intense and enduring than the transitory experiences described by the expanded views. The result has been conceptual confusion that limits nursing's ability to benefit from an increasingly valuable therapeutic tool. Modifications may therefore be required to make this concept applicable to certain nursing settings.

Countertransference↗

PubMed1984

Countertransference in focal psychotherapy.

The authors discuss the role and development of countertransference in brief psychotherapy. Factors inherent to the goals, setting and techniques of brief therapy appear to undercut the development of a regressive countertransference. The countertransference phenomena that seem to be more prevalent in brief treatment are those stemming from the reality-based response of the therapist to the patient. The impact of these factors on patient selection and treatment outcome in brief therapy are discussed.

Countertransference↗

PubMed1976

Countertransference: a neglected subject in clinical supervision.

As an acknowledged aspect of psychotherapy, countertransference would be an anticipated subject for discussion in clinical supervision. However, the authors' review of videotapes of 24 supervisors working with second-year residents revealed that 12 made no comments on the subject, 8 approached the subject directly, and 4 approached it indirectly. The authors discuss the reasons for this avoidance of countertransference issues and note that discussion of countertransference does not necessarily change supervision into therapy.

Countertransference↗

PubMed1980

Transference and countertransference in homosexuality--changing psychoanalytic views.

This retrospective review of the psychoanalytic treatment literature about homosexuals traces the development over the years of views of transference and countertransference. Shifts are identified in the dynamic understanding of transference phenomena, from an early emphasis on Oedipal issues to the contemporary focus on early maternal relations and how disturbances in these are recapitulated in the homosexual transference; this evolution parallels broader trends in clinical psychoanalysis. Against the background of rapidly changing social and professional attitudes toward homosexuality, and in light of burgeoning interest in countertransference among psychoanalysts, the absence of any discussion of countertransference in the treatment of homosexuals is considered significant. Further, the overwhelming attention given to male, compared to female, homosexuals is noted. Finally, some questions are raised about the implications of the contemporary status of psychoanalytic thinking about the treatment of homosexuality.

Countertransference↗

PubMed1987

The resident's countertransference: approaching an avoided topic.

The resident's countertransference to his/her patient may offer essential information about certain denied processes within that patient. It may also signal the existence of countertherapeutic scotomas within the resident. This paper offers a clinically based approach for directly identifying, exploring, and utilizing the information emerging from the resident's countertransference. This approach focuses on the "only or never" phenomenon, the parallel process, and introspective curiosity as modes of identifying the existence of countertransference responses. It highlights the importance of confrontation and clarification to explore the meaning of these responses in the context of that particular resident with his/her particular patient.

Adult↗

PubMed1994

Variations in countertransference reactions in psychotherapy with children.

This paper has further developed and argued for a broadened concept of countertransference in psychotherapy with children and adolescents. The model presented here emphasizes that countertransference difficulties may result because of therapist reactions (1) to the child that are acted upon directly in the child's treatment, (2) that are stimulated by the child and displaced onto parents, or (3) that are stimulated by the parents themselves, while still being acted upon in the treatment of the child. In all of these situations, the therapist unconsciously may alter the treatment of the child or the guidance offered the parents about the child. Supervision and consultation in therapy, as well as therapists' examination of their own reactions to all members of the family system (including to those who are not present) are helpful in understanding and managing these complicated countertransference reactions. Finally, it is highly recommended that therapists see parents of a child in treatment regularly to decrease distortions of them and to appreciate them appropriately as ordinary human beings.

Adolescent↗