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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↗

PubMed2006

The analyst's body as tuning fork: embodied resonance in countertransference.

This paper examines the phenomenon of embodied countertransference: where the analyst experiences a somatic reaction rather than the more common countertransference responses of thoughts, feelings, images, fantasies and dreams. Discussion of clinical material considers neurotic and syntonic aspects. The analogy is made of resonance with a tuning fork. Several questions are posed: Why does countertransference resonate in the bodies of some analysts but not all? Why do those analysts who are sensitive to this, experience it with some patients but not with others? And what are the conditions which are conducive to producing somatic responses? It proposes that somatic reactions are more likely to occur when a number of conditions come together: when working with patients exhibiting borderline, psychotic or severe narcissistic elements; where there has been early severe childhood trauma; and where there is fear of expressing strong emotions directly. In addition another theoretical factor is proposed, namely the typology of the analyst.

Countertransference↗

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↗

PubMed1994

Countertransference issues in staff caregivers who work to rehabilitate catastrophic-injury survivors.

Countertransference reactions experienced by caregivers who work to rehabilitate victims of catastrophic physical lesions arise from the fundamental characteristics of catastrophic lesions: they are life threatening, life altering, anatomy altering, and restoration to pre-illness normalcy virtually never occurs. No true preparation is possible: Major physical and psychological work is required to rebuild a traumatized personality and a damaged body so that a life of quality is possible. Countertransference refers to (therapist's) unconscious reaction to patient transference, i.e., to aspects of the patient's behavior that are the product of unconscious factors in the patient's personality, as well as the meanings attached by caregivers to patient's impairment and rehabilitation struggles. Countertransference reactions arise in caregivers from two sources: (1) Socially universal sources: the demands posed by patients' regression; patients' misplaced aggression; patients' thwarting of staff's (narcissistic) professionalism; the threat of obligatory identification; staff disgust at patient's body damage. (2) Individualized sources: individual residues of caregivers' own developmental experience (conscious and unconscious) with issues such as dependency, aggression, sexuality, self-esteem and autonomy. Solutions involve understanding and mastering the distinction between feelings and actions, and sparing patients from two actions: Assault or abandonment. Suggestions for management include better knowledge of basic psychodynamics; working toward continuous self-awareness; special group meetings; and selective use of educationally oriented psychiatric consultations. Three case examples are offered.

Activities of Daily Living↗

PubMed1993

Treatment by a psychotherapist and a psychopharmacologist: transference and countertransference issues.

Recent surveys suggest that collaborations between psychiatrists acting as medication consultants and therapists providing psychotherapy are an increasingly common form of treatment. Complex transference and countertransference reactions can arise in these "therapeutic triangles." Risks include splitting by the patient, conflicts between the two practitioners, and premature termination of either the psychotherapy or pharmacotherapy. The authors discuss typical transference and countertransference reactions that can lead to these problems and present case examples of productive and unproductive collaborative efforts. The authors describe a collaborative approach based on mutual respect, trust, and openness that, along with an awareness of typical transference and countertransference issues, can increase the likelihood of a positive treatment outcome.

Adult↗

PubMed2000

Countertransference, conflictual listening, and the analytic object relationship.

Analytic listening is an ongoing conflictual process, containing all the components of conflict and shaped in every moment by both the patient's and the analyst's conflicts. The mutual responsiveness that develops between analyst and patient stems from a complex conflictual object relationship, fundamentally no different from any other object relationship, in which countertransference at all times simultaneously facilitates and interferes with the analytic work. Detailed clinical process is used to illustrate these and related phenomena, including the use of signal conflict, the benign negative countertransference, the function of countertransference structures, and the analyst's use of projection. The analyst's affects, thoughts, and actions trace the shifting nature of the patient's transference and resistance, and the level of the object relationship continuously being created between patient and analyst.

Attention↗

PubMed2006

Countertransference in defense enactments.

A clinical term is introduced to capture a defense that develops with the patient's deepening but fleeting awareness of painful transference feelings. The analyst's attention to countertransference in such situations is central to the analysis of these defenses. An attempt is made to distinguish defense enactments from other types of defenses, and to differentiate the analyst's countertransference reaction to this type of defense from countertransference reactions that might appear similar. The reasons for this dynamic in the interpersonal space are explored, and a clinical example that describes this phenomenon in the analytic moment is given.

Countertransference↗

PubMed1983

The analyst and the patient's object world: notes on an aspect of countertransference.

I have discussed an aspect of the problem of countertransference that has received little comment--the relation of the analyst to objects in his patient's world. Emotional reactions stimulated in the analyst by his perception of such objects can have a profound effect on the course and outcome of his analytic work. Such responses are a product of complex interactions between the impulses, affects, fantasies, and defenses evoked in the therapist by the mental representations he has formed of these objects. Such objects, in fact, can have a variety of meanings for the analyst. Not only are they related to self-and object representations past and present, but they may, in his imagination, be part of a network of interactions involving the patient, his family, and other of his objects as the result of the reawakening in the analyst of fantasies, memories, and expectations derived from his sibling and family relations. Emotional responses aroused in the therapist by the patient may also be displaced onto objects in the patient's world and not be recognized as countertransference phenomena. Finally, I have commented on the way that reconstructions can be influenced by the analyst's perceptions of his patients' objects, and I have made some note of the special situation when an object in the patient's life is also known to the analyst. While awareness of his conscious attitudes and feelings toward such objects can serve a useful function for the analyst, too complacent an attitude regarding the protective value of such self-awareness may make difficult his recognition of the link between the image of the object known to both patient and analyst and the reawakened self- and object images of the analyst's childhood--a link that, in fact, constitutes the deepest source of countertransference difficulties.

Adolescent↗

PubMed1986

Countertransference and the theory of technique: discussion.

Historical, clinical, and conceptual remarks are presented regarding countertransference and the theory of psychoanalytic technique, preliminary to and in the context of discussing the contributions to the panel, "Countertransference in Theory and Practice" (Tyson, 1984; Loewald, 1984; Jacobs, 1984; Dewald, unpublished). In addition, special emphasis is given to problems of countertransference in training and supervision which may be prototypes for later difficulties in analytic work.

Countertransference↗

PubMed1998

The "unobjectionable" positive countertransference.

Even though Freud said that "the secret of therapy is to cure through love," the "unobjectionable" positive countertransference has remained a neglected topic in clinical and theoretical writings. This paper explores a number of personal and historical reasons to account for this avoidance. A case vignette is presented to highlight the facilitating and therapeutic role of the positive countertransference. It also demonstrates the analyst's struggles with his loving feelings and some of the reasons behind this conflict. The case is then used to explore the functions that the positive countertransference serves for the analysand, the analyst, and the analytic process. In conclusion, a number of questions are posed for an emerging model of psychoanalytic technique that would encompass the analyst's noninterpretive contributions to the process.

Adult↗

PubMed1991

New uses of countertransference for the inpatient treatment of borderline personality disorder.

The author describes the uses of countertransference for the inpatient treatment of borderline personality disorder. Differences from usage in the dyadic outpatient situation are noted. In particular, the countertransference induced in staff may provide a crucial signal function reflecting the patient-ward system. Understanding these feelings provides information not only about the patient's inner world but also about general system features such as the staff's needs, therapeutic capacity and unresolved feelings from previous borderline patients. The signal function may also have diagnostic and treatment implications. A conceptualization of countertransference that encompasses the unique system aspects of inpatient psychiatry is helpful in the care of borderline patients.

Ambulatory Care↗

PubMed2004

Semiotic aspects of the countertransference: some observations on the concepts of the 'immediate object' and the 'interpretant' in the work of Charles S. Peirce.

The field of semiotics, established by Charles S. Peirce, is characterised by its recognition of non-linguistic signs and embedment in a communicative interaction; for this reason, it is especially well suited for a semiotic investigation of intersubjective processes. In this paper, the authors show how these intersubjective processes can be understood in semiotic terms within the transference-countertransference setting. Based on a case vignette, the relationship between the 'real object' (e.g. an unconscious fantasy) and the sign (e.g. a particular facial expression) is first demonstrated. In this mediation between sign and referent, an important role is played by the 'immediate object', by which Peirce understood the mental concept of a sign. However, a further component of the Peircian sign is responsible for the emergence of the countertransference, namely, the 'interpretant'. The core of Peircian semiotics, namely the concept of an (infinite) process of signification, sheds light in semiotic terms on the dialectical movement between transference-signs and countertransference-signs, the interpretation and encounter between two subjects. The paper concludes with a discussion of both the interdisciplinary applicability of Peircian semiotics, for example in the context of the neurosciences, and the differences between the Peircian epistemological position and psychoanalytical conceptions of the objective cognition of mental processes.

Countertransference↗

PubMed1986

The "dumb spot" a special problem in countertransference.

A special kind of countertransference which we call the "dumb spot," has been observed and described. We have delineated "dumb spots" which are the result of unlearned theory, the result of learned but not accepted theory, and the result of learned, accepted but not used theory. Those "dumb spots" resulting from unlearned theory, especially in those areas where psychoanalysis is widening its scope of diagnostic categories, age range, and socioeconomic status, are not considered countertransference errors. Those "dumb spots" resulting from learned, accepted but not used theory, we feel do represent special cases of countertransference phenomena. Theory which is learned but not accepted must be differentiated into that which is not accepted as a result of intellectual judgment and that which cannot be accepted because it would require an alteration in the analyst's self or object representations.

Adult↗