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Countertransference and life-and-death issues in group psychotherapy with child Holocaust survivors.

People, now in their fifties and sixties, who were children during the Nazi Holocaust in WWII, endured persecution, massive traumatization, the constant risk of being killed, as well as the violent loss of (most of) their family members. They have internalized the resulting ongoing confusion and conflicts as to whether they should be alive or dead. This is maintained as an integral part of the child component of their compound personality, described in this paper. During the three years of the psychotherapy group, on which we focused here, these issues were expressed in different ways, such as suicide threats, occasional intolerance to physically remaining in the group, and outbursts of annihilating rage at the therapists. The confusion and conflicts about the legitimacy and risks of their survival came to a head during the termination process we insisted upon. Much attention has also been given to the intricacies of our countertransference--further complicated by our own connection to the Holocaust. We learned, and described, just how essential it is to acknowledge and process this countertransference in order to both contain the intense affects of anxiety, rage, and mourning in the groups, and enable them to be safely expressed. We imagine similar dynamics can be expected in group therapy with other populations who suffered massive, man-made traumatization.

Adaptation, Psychological↗

Complementary dreams: a window to the subconscious processes of countertransference and subjectivity.

The British psychoanalysts were the first to be interested in reciprocal and interpersonal interactions of psychotherapy. The Freudian mirror model was progressively questioned in the 1940s and 1950s. Throughout the 1950s, positions and terms were created that either defended or attacked the use of subjectivity and countertransference in psychodynamic psychotherapy. The objective of this article is to discuss the participation of the therapist's subconscious mind, as it is involved in communication with the patient's subconscious mind during psychodynamic treatment. Specifically, this takes the form of complementary dreams, a clinical phenomenon that I will describe as secondary to the therapist identification with the patient infantile object relations. Complementary dreams will be discussed as a helpful therapeutic tool used to understand the subjective communication that happened between patient and therapist in two separate cases. Complementary dreams will be presented as a helpful therapeutic instrument in containing countertransference enactment.

Adult↗

Passion, countertransference enactment, and breakdown in the psychoanalysis of a young woman.

Transference-countertransference involvement with patients the analyst finds "pleasurable" is examined. Analysis of such patients courts the danger that pathological identifications will go unrecognized and the analysis end at a point where the opportunity for decisive change, which to the patient appears physically and psychically catastrophic, is forgone. A presentation of one aspect of the analysis of a young woman reveals the psychic pain experienced by analysand and analyst when the feared breakdown places a pathological identification in doubt, and the difficulties that can ensue in treatment. Other psychodynamic lines of interpretation and differential diagnostic considerations are put aside in favor of an examination of the special role of enactment and countertransference enactment and their impact in promoting development or strengthening defense.

Adult↗

Countertransference during an analyst's brief illness.

This paper describes an example of acting out of countertransference during a brief but unexpected serious illness. My emphasis is on the regression that occurred with hospitalization and how it dovetailed with a particular patient's transference. A confluence of my residual neurosis, the patient's neurosis, her transference state, her other characteristics (that she was female, for example), plus the fact that she was the last patient contacted, all conspired with the regression from the trauma of being hospitalized to produce the countertransference reaction. This presentation is also intended to add to the very sparse literature on a distasteful subject of supreme importance.

Countertransference↗

Awareness of ageism, motivation, and countertransference in the care of elders with Alzheimer's disease.

This article focuses on the importance of a practitioner's awareness of ageism, motivation, and countertransference in working with elders with dementia. These factors have the capacity to significantly affect a professional's performance. Additionally, they may also affect the type and quality of services a memory-impaired client receives. Ageism is discussed at the micro, mezzo, and macro level, and practitioners are urged to develop an increased awareness of the effects of ageism on client/service options and as well as practitioner's beliefs. Monitoring professional motivation and being aware of countertransference are important considerations in practitioner-client relationships. Professionals are encouraged to incorporate personal introspection and consultation or supervision to ensure that clients receive the most appropriate service available. Case examples are provided to illustrate concepts.

Aged↗

"Things were different then": countertransference issues for younger female therapists working with older female clients.

Older, pre-feminist women have different expectations about marital fulfillment and their role in society than younger women who have grown up with feminist ideals. These differences can emerge within the clinical encounter between a younger female therapist working with an older female client, especially as the latter reviews her life and marital history. This paper discusses the countertransference reactions cross-generational disparities engender in the younger female clinician. The author posits that these need to be examined and addressed in order to build a therapeutic alliance and temper empathic failure on the part of the therapist. The literature on countertransference reactions with the elderly and the role of the life review process is reviewed. The impact of the women's movement and implications for clinical practice are discussed.

Adult↗

On misreading and misleading patients. Some reflections on communications, miscommunications and countertransference enactments.

This author focuses on an aspect of transference-countertransference interaction that enacted covertly is often overlooked. He argues that conflicts, needs and biases that may go undetected for lengthy periods of time are not infrequently contained within the analyst's accurate and technically correct interventions and that for defensive reasons, patients often suppress, deny or rationalise their accurate perceptions of these countertransference elements and fail to confront their analysts with them. The mistakes, miscommunications and misperceptions that arise as a consequence of the unconscious collusions that develop between patient and analyst can have a profound effect on the analytic work. Several clinical examples are presented to illustrate the operation of such covert communications in analysis and their impact on the treatment process.

Communication Barriers↗

Countertransference and the female triangular situation.

This paper represents an attempt toward reconciling contemporary changes in psychoanalytic understandings of female development, particularly in respect to separation issues, with their clinical applications to female patients. Psychoanalytic thinking typically has categorized separation conflicts as pre-oedipal, but the authors suggest that these are an integral part of the triangular situation of the girl. The authors argue that an allegiance to erroneous theory and/or individual blind spots have led to the infantilization, pre-oedipalization or cultural stereotyping of females, which constrains the effectiveness of their analyses. The authors present a selected review of the literature on gender-based countertransference biases in both male and female analysts, with reference to female 'oedipal' material. Analytic case material of two women is presented which demonstrates how theoretical misperceptions and countertransferences to triangular separation conflicts can produce an impediment to progression in analysis.

Adolescent↗

The analyst's countertransference to the psychoanalytic process.

There is countertransference, not just to individual patients, but to the process of psychoanalysis itself. The analytic process is a contentious topic. Disagreements about its nature can arise from taking it as a unitary concept that should have a single definition whereas, in fact, there are several strands to its meaning. The need for the analyst's free associative listening, as a counterpart to the patient's free associations, implies resistance to the analytic process in the analyst as well as the patient. The author gives examples of the self-analysis that this necessitates. The most important happenings in both the analyst's and the patient's internal worlds lie at the boundary between conscious and unconscious, and the nature of an analyst's interventions depends on how fully what happens at that boundary is articulated in the analyst's consciousness. The therapeutic quality of an analyst's engagement with a patient depends on the freeing and enlivening quality, for the analyst, of the analyst's engagement with his or her countertransference to the analytic process.

Awareness↗

The countertransference dream.

Can the analyst's night-dream about his patient be considered as a manifestation of countertransference--and, if so, under what conditions? In what way can such a dream represent more than just the disguised fulfillment of a repressed wish of the analyst? Is there not a risk of the analyst unconsciously taking up and 'using' the content of a session or other elements coming from the analytic situation for his own psychic reasons? The author, closely following Freud's dream theory, shows the mechanisms which can allow us to use the dream content in the analytical situation: preserved from the secondary processes of conscious thinking, other fantasies and affects than in the waking state can emerge in dream thought, following an 'unconscious perception'. After examining the countertransference elements of Freud's dream, 'Irma's injection', which leads off The interpretation of dreams, the author presents a dream of her own about a patient and its value for understanding affects and representations which had hitherto remained unrepresented.

Countertransference↗

Psychoanalytic peregrination VI: "the effect on countertransference of the collapse of civilization".

There is an aspect to countertransference that has not been discussed very much in the literature of psychoanalysis, one that is becoming increasingly important. This centers around the effect on the analyst's countertransference of the deterioration of the culture in which he or she is immersed. I discuss the decline of Western civilization as it is described by a number of contemporary authors in order to show how changes in the value system of the psychoanalyst or his or her turning a blind eye to the injustices and barbarism of the cultural surround both affect the capacity to immerse in the creative process of psychoanalysis, and send a tacit message to the patient about the permissability of hiding certain material. All this contradicts the "fundamental rule" of psychoanalysis, and disturbs the analyst's listening process. The impact of the dumbing down and deterioration of the educational, cultural, and home upbringing milieu of the new generation of psychoanalysts will be profound in influencing the future practice of psychoanalysis.

Civilization↗

Countertransference problems in the treatment of a mixed group of war veterans and female partners of war veterans.

AIM: Analysis of countertransference problems in the treatment of a heterogeneous group of war veterans. METHOD: The method used in this work was psychodynamic clinical observation and analysis of countertransference phenomena in group therapy. RESULTS: In the beginning of our work, we faced with a regressive group, which was behaving as it was re-born. The leading subject in the group was aggression and the need for hospitalization to protect them and their environment from their violence. With the development of group processes, a feeling of helplessness and lack of perspective appeared, together with suicidal ideas, which, because of the development of group cohesion and trust, could be openly discussed. With time, the group became a transitional object for its members, an object that gave them a feeling of safety but also a feeling of dependence. CONCLUSION: The role of the therapist is to support group members in becoming independent. The therapist's function is in controlling, containing, and analyzing of the destructive, regressive part and in encouraging the healthy parts of the patient. With the integration of good therapeutic process, the healthy parts of the patient gain control over his or her regressive parts.

Countertransference↗

From countertransference to "passion".

Bion's ideas may be extended to describe an emotional phenomenology of the analyst's subjectivity and a methodology which helps differentiate countertransference enactments from fuller emotional participation. Bion called the process of integrating and utilizing one's most basic and important emotions to make meaning, "passion." The analyst's primal feelings--of love, hate, and curiosity--serve as a central organizer of meaning in the analytic interaction. These feelings involve pain, and to the extent the analyst unconsciously decides to evade or foreclose the evolution of the feelings, such that they remain unintegrated in the thinking process, the analyst is liable to become mired in repetitive transference-countertransference experiences without establishing fresh meaning. A case example illustrates the relevance of "passion" to contemporary relational theory and practice.

Adult↗

Countering countertransference: a forensic trainee's dilemma.

Forensic psychiatry involves an adaptation to a role that is very different from the psychiatrist's previous clinical experiences. To render an unbiased forensic opinion, psychiatrists have to rise above their countertransference feelings. This takes years of practice and experience. The following is an account of a forensic trainee who faced several countertransference problems as he evaluated a patient charged with attempted murder. The case report is interspersed with a review of the relevant literature.

Adult↗

Countering countertransference, II: beyond evaluation to cross-examination.

Countertransference is a clinical term introduced by Freud in 1909. For years, despite mounting criticism, forensic psychiatrists borrowed this clinical concept to explain their emotional experiences and responses to examinees' emotions and behavior. The authors describe the impact of examinee and nonexaminee factors during evaluations and beyond, including during trial and while providing forensic testimony. The suggestion is made that using the term countertransference in forensic psychiatry can be problematic. The authors delineate the complexities of the term as related to forensic psychiatry and consider modified terms to provide a better explanation of these concepts in forensic contexts.

Adult↗

[Importance of countertransference in the initial psychoanalytic interview].

The author points out the responsibilities and difficulties an interviewer faces in the initial psychoanalytic interview and discusses different theoretical positions in dealing with countertransference. Apart from "free floating attention" and "free floating responsiveness" he emphasizes the important diagnostic and therapeutic factor of "free floating introspectiveness". Finally, with a clinical example, he demonstrates that countertransference should already be taking place at the beginning stage of an interview.

Countertransference↗

Roles played by music as revealed during countertransference facilitated transference regression.

Clinical and experimental investigations have demonstrated that music may serve subtle and complex psychological functions, the sounds per se serving more primitive roles than the themes and lyrics. The present study offers data obtained during the psychoanalysis of a musically talented man who had suffered life-threatening croup and asthma until the age of 5 or 6. Regression that was achieved as the result of interpretations based on the analyst's countertransferential responses revealed that the analysand was unable to achieve psychological separation from his mother and that music served predominantly the function of retaining a life-supporting connexion with her. Presumably as the result of a complex elaboration of respiratory and auditory introjection, music came to symbolize the noise of air-flowing through tubes into the steam tents and blood coursing through the umbilical cord, conceptualized as connecting him with his mother and making them permanently interdependent. The early ego defect was overcome through a transference-countertransference interaction that is delineated in detail. Then, the less primitive meanings and psychological uses of musical themes and lyrics were elucidated, again in response to interpretations based on countertransference reactions.

Adult↗