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PubMed2006

The place of psychodynamic psychiatry in consultation-liaison psychiatry with special emphasis on countertransference.

Psychodynamic theory can be applied to all aspects of consultation-liaison work. There are various psychodynamic treatment approaches that can have a powerful meaning to the patient. This can include understanding the patient's life trajectory through the elicitation of a life narrative, understanding defense mechanisms, and utilizing the patient's fantasies about illness. Patients who are physically ill regress and want to be understood. When this is achieved through a psychodynamic approach, the patient will be more likely to accept a referral for psychiatric follow-up when it is indicated. The consultation-liaison psychiatrist will also encounter transference and countertransference manifestations. Of particular usefulness can be derivatives of classical countertransference, which can be seen as reactions and identifications by the treating psychiatrist or the medical team to the patient that may interfere with effective care. "Countertransference Rounds" is a technique for examining such manifestations during the C-L team's discussion of patients.

Adult↗

PubMed1995

Tangled in the web: countertransference in the therapy of factitious disorders.

OBJECTIVE: Patients who simulate or actually self-induce illnesses to assume the "sick role" present a number of imposing psychotherapeutic challenges. The purpose of this article is to discuss the countertransferential reactions that are mobilized in therapy with these patients. METHODS: Literature searches of the MEDLINE and HEALTH databases were performed using the term "factitious disorder." The resulting citations were examined for descriptions of the potential and actual countertransference responses in therapy with such patients. The few citations with relevant material were supplemented with other clinical literature on countertransference as well as observations from cases in which the authors have served as therapists or consultants. RESULTS: Once the medical dissimulation has been exposed, the most conspicuous difficulty is in persuading the patient to agree to therapy. When therapy does take place, both the patient's overt behaviors, such as actual bodily damage, and his or her underlying emotional issues can mobilize particularly intense reactions in the therapist. CONCLUSIONS: Recognition and management of the countertransference reactions likely to emerge in therapy with factitious disorder patients are particularly important if the therapy is to be maximally effective.

Countertransference↗

PubMed1991

Managing countertransference: what the experts think.

The present study attempted to assess the importance of five factors theorized to play a central role in managing countertransference: Self-integration, Anxiety Management, Conceptualizing Skills, Empathy, and Self-insight. 33 experts provided ratings of 50 characteristics of therapists as to the importance of each in managing countertransference. Analysis indicated that each factor is at least somewhat important to management of countertransference, with two of the factors, Self-integration and Self-insight, rated as playing a particularly important role. Clinical implications are discussed.

Adaptation, Psychological↗

PubMed1992

A peer supervision group: put countertransference to work.

1. As the nurse-patient relationship evolves through a series of ongoing interactions, both participants become "known" and stir in each other a range of positive and negative emotional reactions. 2. When working with severely psychologically disturbed patients, the nurse's affective and behavioral response can be valuable clues to understanding the patient's early experiences that contribute to the pattern of relatedness and to the formulation of change, enhancing therapeutic interactions. 3. The goals of the countertransference peer supervision group were to recognize unconscious countertransference reactions; unravel the origin and meaning of those countertransference reactions; and collaboratively develop therapeutic nursing interventions.

Countertransference↗

PubMed1976

[Role of countertransference in complex psychotherapy].

The psychotherapist has a key position in any psychotherapeutic situation, participating in the psychotherapeutic process with all his personality and responding both consciously and unconsciously to the patient and the entire psychotherapeutic system. Countertransference consists of those actions and emotional manifestations on the part of the psychotherapist, which originate from his unconscious strata as a reaction to the overall situation. The existence of countertransference and its possible interference with, and perhaps adverse effect on, the psychotherapeutic process require close scientific and social controls. Also, it will be necessary to make "self-experience" psychotherapy (educational analysis) a required subject. Countertransference also has important perception- and empathy-promoting functions.

Countertransference↗

PubMed2001

Patterns of consistency and deviation in therapists' countertransference feelings.

The author addressed the question of consistency in psychotherapists' countertransference feelings. Research findings have indicated that the therapist's own personal feeling style may be more important than the patient's impact on the therapist's feelings. In this study, the feelings of 9 psychotherapists toward 28 patients were followed by using checklist self-report after each session during moderately long psychotherapies. ANOVAs and discriminant analyses showed that the therapists were very consistent in their feeling style over different patients and over time. The consistency in feelings toward the individual patients was smaller. Deviations from consistency are analyzed, and their importance for the understanding of different aspects of the countertransference is discussed. It is suggested that a meaningful use of the countertransference concept ought to be based on systematic identifications of recurrent and deviant patterns in the therapist's reactions.

Adult↗

PubMed2005

Management of intense countertransference in group psychotherapy conducted in situations of civic conflict.

Conducting group psychotherapy in a situation of intractable conflict such as Northern Ireland activates turbulent emotional dilemmas within psychotherapists and group members alike. Professional practice and therapeutic zeal must struggle daily to survive the stark encounter with the reality of a regressive and primitive psychology and on occasion may succumb to atavistic tendencies, dragging relationships down to primitive levels and leaving connections broken. In this article, three group therapists describe their countertransference struggles when leading such groups. They meet in a psychosocial setting in which the risk to one's psyche parallels the risk to one's life and limb. The countertransference experienced here is dark, indeed identified by one author as not unlike Dante's Inferno. They describe how understanding their personal countertransference enables them to survive emotionally even though it may not always lead to the survival of their groups. The effect of those struggles also troubled the act of writing itself making cooperation difficult on occasion, a mirror of the external social matrix.

Conflict, Psychological↗

PubMed1986

Countertransference, empathy, and the analytic ideal: the impact of life stresses on analytic capability.

Analysts' emotional attitudes toward countertransference issues are influenced by unduly perfectionistic ideals that are partly derived from the early period of psychoanalytic theory. Analysts' unconscious receptivity, whether of the beneficially empathic kind or the disadvantageous countertransference variety, is a reflection of a dynamic internal state. This fundamental relationship between empathy and countertransference is illustrated with examples. Important events that occur in the life of the analyst, by virtue of their impact on his own central compromise formations, cannot but affect his analytic functioning. Minor disturbances in analytic capability are commonplace and do not significantly handicap effective work.

Countertransference↗

PubMed1985

Some technical problems of countertransference.

There are several aspects of the psychoanalytic interaction that foster the emergence of countertransference. First is a persistent identification with the patient, based primarily on the sharing of unconscious fantasies. Then there is the evocative power the patient's material may have upon latent unresolved conflicts in the analyst. Finally, the analytic setting itself may evoke a broad range of countertransference responses. Particular attention must be paid to those interventions of the analyst which represent attempts to divert his own and the patient's attention from emerging derivatives of the conflicts. There are many clues that should alert the analyst to the possibility of interfering countertransference.

Countertransference↗

PubMed1994

Countertransference to parents in child psychotherapy.

The author refers in this paper to countertransference to parents of children in treatment, within the conceptual framework of Racker's (1) terms concordant and complementary countertransference. In the second part of the paper the author demonstrates that the use of the concept counter-transference to somebody who is not the actual patient has theoretical basis. It is then hypothesized that the simultaneous analysis of the types of countertransference to the parent and to the child might reveal important information regarding the developmental place of the child, and thus, help the therapist in the child's treatment.

Child↗

PubMed1995

Countertransference effects of absence.

In this paper the author aims to refine and explore some aspects of the clinical use and understanding of countertransference. Emphasising that countertransference is unconscious, the author proposes a specific approach focusing on the nature of the ongoing countertransference work that is required to unravel its meaning. Using a clinical vignette in which the analyst had to understand feeling impatient, irritated and then discouraged, the author describes how she was able eventually to understand what had been happening following insights she gained when she mistakenly understood how long a patient was going to be away and the function of the patient's response to her surprise on his return. This leads the author on to a wider consideration of the countertransferential work that may be needed when the analyst decides to take even regular breaks from patients, or when patients decide not to come. General aspects of the decisions analysts make about how and when to work as well as the specific opportunities presented when the occasion arises to inform patients of holiday arrangements, are considered. Finally, the author turns to possible countertransferential responses and the work that may be required when patients return to their sessions, whether they come back having suffered or acted out following the analyst's absence, or after having taken an absence of their own.

Adult↗

PubMed1995

Analysing forms of aliveness and deadness of the transference-countertransference.

The sense of aliveness and deadness of the transference-countertransference represents a critical dimension of the analytic experience and may be the single most important measure of the moment-to-moment status of the analytic process. In this paper the author presents four clinical discussions that illustrate the importance of analysing the experience of aliveness and deadness in (of) transference-countertransference. In each vignette particular emphasis is placed on the use of transference interpretation derived from experience in the countertransference to address the defensive and expressive role of the dynamic movement of aliveness and deadness at a given juncture in an analysis. The role played by the experience of aliveness and deadness in the structure of the patient's internal object world and quality of object relatedness is examined.

Adult↗

PubMed1995

Countertransference in court interpreters.

Transference and countertransference are important concepts in the therapist-patient relationship in psychiatry. They are also important elements of the courtroom setting and the court interpreter's verbalizations. Transference and countertransference are defined and illustrated in both the psychotherapeutic setting and the courtroom setting with interpreters. The role of the forensic psychiatrist as consultant in interpreter countertransference is discussed in this article.

Countertransference↗

PubMed1997

On receiving the patient's transference: the symbolizing and desymbolizing countertransference.

This is an empirical study of the therapist's experience of the patient delineating the boundaries between empathy and constructive and destructive forms of countertransference. The unique step was taken of focusing a video camera on the therapist in order to trace the therapist's nonverbal behavior during listening. The same therapist was observed first in a "not-so-difficult" and then a "difficult" session; the sessions could then be distinguished along dimensions of rhythmicity or arrhythmicity of nonverbal behavior. These observations suggested three modes of experiencing the patient: empathy marked by rhythmicity, a symbolizing countertransference marked by a transitory arrhythmicity, and a desymbolizing countertransference marked by continuous arrhythmicity. The congruence of these formulations based on direct observation of therapist behavior and ones derived from retrospective reconstructions of analysts in sessions (Schwaber, Jacobs, and Laskey) was explored and was found to enhance the validity of the proposed formulations.

Countertransference↗

PubMed1998

Countertransference disclosure and the conceptualization of analytic technique.

Most discussions of countertransference disclosure have focused on points of impasse. Here, I will discuss countertransference disclosure in which the analyst attempts to make explicit to the patient how the analyst experiences something during an analytic session that differs from the way the patient experiences the same moment. The analyst presents his observation as something for the patient and analyst to work on together, with the aim of arriving at further understanding. In a clinical example, I suggest a way of comparing uses of countertransference that relate to other approaches in analytic technique. Since the analyst's disclosure evokes questions regarding asymmetry and anonymity in the analytic process, I will briefly elaborate these dimensions.

Countertransference↗

PubMed1998

[Countertransference in psychoanalytic therapy of children and adolescents with obsessive-compulsive disorders].

Understanding countertransference in dynamic therapy of children and adolescents is important for the clarification of unconscious conflicts because of the frequent absence of dreams and free association in the analytic process. When compulsions determine the course of the psychic disorder countertransference becomes an important landmark for comprehending and resolving the affect-loaded sadomasochistic collusion as an externalization of intrapsychic conflicts. Compulsive acts and thoughts helping to preserve seriously threatened structures of the self and the ego engender different countertransference reactions in the analyst than the ego-superego-conflicts of compulsion neurosis. This makes them essential for diagnosis and therapeutic interventions.

Adolescent↗

PubMed1999

Anti-Semitism in the clinical setting: transference and countertransference dimensions.

Despite the salient presence of Jews in the history of psychoanalysis, literature on the subject of anti-Semitism in the clinical setting is surprisingly sparse. This paper attempts to comprehend the reasons for the dearth of literature on this important topic. A clinical section then breaks the silence surrounding expressions of anti-Semitism in the consulting room. The major focus is on transference and countertransference reactions that arise with regard to anti-Semitism in the clinical setting. Since the first section is concerned with silence in the psychoanalytic community, its focus is primarily on countertransference issues that may hinder the analyst's understanding and use of anti-Semitic material. The second, clinical section focuses on the ways both transference and countertransference reactions combine and influence one another and how they may, when properly attended to, serve as catalytic tools for advancing therapeutic goals.

Adult↗

PubMed2005

Management of Intense Countertransference in Group Psychotherapy Conducted in Situations of Civic Conflict.

Conducting group psychotherapy in a situation of intractable conflict such as Northern Ireland activates turbulent emotional dilemmas within psychotherapists and group members alike. Professional practice and therapeutic zeal must struggle daily to survive the stark encounter with the reality of a regressive and primitive psychology and on occasion may succumb to atavistic tendencies, dragging relationships down to primitive levels and leaving connections broken. In this article, three group therapists describe their countertransference struggles when leading such groups. They meet in a psychosocial setting in which the risk to one's psyche parallels the risk to one's life and limb. The countertransference experienced here is dark, indeed identified by one author as not unlike Dante's Inferno. They describe how understanding their personal countertransference enables them to survive emotionally even though it may not always lead to the survival of their groups. The effect of those struggles also troubled the act of writing itself, making cooperation difficult on occasion, a mirror of the external social matrix.

Journal Article↗