Countertransference evolution in theory and practice

A framework is suggested for conceptualizing countertransference, based on expansion of the concept emerging subsequent to Freud's original view of the phenomenon: from Ucs to Cs, from reactions to transference to all reactions, from the analyst's neurosis to the analyst's functioning, from self-analysis to self-scrutiny, from obstacle to contribution. Particular attention is called to the advantages of maintaining the distinction between the patient's transference and the analyst's countertransference; the importance for successful psychoanalytic work of being aware of the subtleties of countertransference in work with neurotic patients, especially in contrast to the blatant countertransference experiences more disturbed patients thrust upon the analyst; the need for further investigation of the relations between the analyst's empathy, regression, and countertransference; the lack of understanding of and information about the homosexual countertransference, based on insufficient knowledge of the mechanisms of resistance to self-analysis, among other reasons; and the need for more reliable information about the limits of and indications for using countertransference responses in particular kinds of clinical situations, whether for informing the patient as to the analyst's responses to him, for informing the analyst in the interpretive process, or in formulating reconstructions. A clinical example provides an illustration of the complexity of countertransference-transference interaction and of the impact of countertransference on the transference.     

A COMPARISON OF MALE AND FEMALE COLLEGE STUDENTS' EXPERIENCES OF SEXUAL COERCION

Research comparing men's and women's experiences of sexual coercion has typically assessed differences in prevalence rates and risk. We extended this line of research by comparing the contexts of sexual coercion and reactions to sexually coercive experiences in an attempt to understand the meanings that men and women attribute to these events. Participants were 433 randomly selected college students who responded to an anonymous survey. In line with past research, more men than women reported being sexually coercive, and more women than men reported being sexually coerced in the preceding year. There was a great degree of correspondence between men's and women's reports of the contexts within which sexual coercion occurred. According to their reports, sexual coercion occurred primarily within the heterosexual dating context. Compared to men, however, women reported more negative reactions and stronger resistance to the use of sexual coercion. These findings emphasize how comparisons of prevalence rates alone may obscure important differences in the phenomenology of sexually coercive incidents for men and women. Findings are discussed in terms of implications for the development of education and prevention programs and the need to reevaluate current approaches to interpreting prevalence reports.     

The week the couch arrived

Changes in the therapeutic environment can elicit intense and unpredictable responses from patients, who then react to the new elements with their own unique thoughts, fantasies, emotions and behaviours. When the change is very specific, and when it entails implications for the treatment itself, these patient responses can coalesce around more profound experiences of the transference as well as of the countertransference. The author, as a candidate or analyst-in-training, purchased an analytic couch for his office and observed the unfolding of what this new couch meant for existing treatments. Using clinical examples, he describes the three most common patient responses that occurred: rejecting, ambivalent, and embracing. The richly variant ideas and fantasies related to the analytic couch are described, and the couch's history within Freudian and Jungian contexts is reviewed. Personal determinants that could lead to the decision of whether to use a couch as part of analysis are considered from the standpoint of the analyst's preferences and own experience with the couch. The couch is discussed as a signifier of the analytic process with cultural meanings alluding not only to familiar stereotypes, but also to psychological healing and self-development.     

Thinking with,and about,patients too scared to think: Can non‐interpretive maneuvers stimulate refl ective thought?

Patients incapable of higher-order (symbolic) thinking can often not tolerate evidence of the analyst's separate existence, particularly when that 'otherness' becomes evident in the process of the analyst's refl ecting upon and interpreting how the patient experiences or represents the analyst. The patient's intolerance of the analyst's efforts to think (refl ect upon and interpret) renders the usual psychoanalytic maneuvers employed to stimulate refl ective thought ineffective with such patients. Such patients have to learn to tolerate multiple perspectives before they can allow the analyst, or themselves, to think in the other's presence. The author presents two clinical vignettes that illustrate how the analyst's efforts to think about the patient were experienced by the patient as both intolerably distancing and as rejecting of an aspect of the patient's subjective reality. Working psychoanalytically with such patients requires the analyst to forgo the use of narrow interpretations that elucidate unconscious meanings and motives in favor of alternate technical maneuvers capable of facilitating the development of symbolic thinking and refl ective thought (insightfulness). These maneuvers include a demonstration of the analyst's willingness and ability to withstand (rather than 'interpret away') how he is being psychically represented by the patient, without becoming destroyed by, or lost within, the patient's characterization of him. Beside modeling a tolerance of alternate perspectives of one's self, other non-interpretive maneuvers that help facilitate the development of self-refl ective thought include: stimulating the patient's curiosity about the workings of his own mind by identifying incompletely understood behaviors or reactions worthy of greater psychological understanding, and insinuating doubt about the adequacy of the patient's explanations of such phenomena.     

The Emotional Impact of Ambivalent Sexism: Forecasts Versus Real Experiences

Research on affective forecasting indicates that people regularly mispredict the emotional impact of negative events. We extended this work by demonstrating several forecasting errors regarding women’s affective reactions to ambivalent sexism. In response to a survey about sexism against women, students at a university in the Central U.S. (N?=?188) overestimated the negative impact of hostile sexism, and underestimated the negative impact of benevolent sexism, relative to women’s reports of their actual experiences. Moreover, people mispredicted both the intensity of women’s initial affective reactions to, and the duration of women’s recovery following, ambivalent sexism. The data supported a model in which inaccurate estimates of initial intensity fully accounted for people’s inaccurate estimates of recovery duration following ambivalent sexism.     

The analyst's theory: A third source of countertransference

The author asserts that the analyst's theory, personal and/or academic, is an important source of countertransference which complicates our traditional understanding of the analyst's emotional responses as being constructed from a mix of his transferences and the patient's effects on him. From this perspective, theory - because it has no intrinsic relevance to the essential phenomena of individual analytic processes - may be a confounding, as well as a necessary, factor in clinical work. Although the analyst's theory might be conceptualized as a component of his personality that shapes his emotional reactions to a patient, the author believes that there is a valuable increment of conceptual clarity and additional clinical utility to thinking about a more direct role of theory in the process of countertransference formation. He uses aspects of the clinical analysis of narcissistic resistances to illustrate how some theories might predispose an analyst to confounding unconscious enactments by generating either positive or negative countertransferences which can be used defensively by the patient and/or analyst. He also illustrates how, in some contexts, an analyst's theory might attenuate potentially informative countertransference reactions and interfere in this way with the analyst's apprehension of the patient's psychic functioning. Finally the author addresses the importance of 'fit' between an analyst's working theory and a patient's psychopathology, and considers implications of his ideas for psychoanalytic training and practice.     

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.     

The analyst's caseload as a family: transferences to fellow patients

This article draws attention to a topic that has been mostly ignored in our literature: the manifold transference meanings of our patients' reactions to our other patients. Central aspects of the patient's transference may be displaced onto the analyst's other patients. The author includes clinical examples of hospitalized patients, where such transferences to other patients are often more dramatic and obvious, as well as examples from neurotic patients, where such transferences may be less dramatic and may tend to resolve more readily through interpretation. The displacement of transference feelings onto the analyst's other patients also has important implications for training analyses, where analysands are likely to have multiple relationships with the analyst's other analysands, supervisees, and students.     

Some vicissitudes of aggression in the interpretive process.

Interpretation is a product of compromise formation that requires optimal use of the analyst's aggression to be an effective analytic intervention. Aggressive aims useful for the interpretive act are problematic for analysts and have led both to clinical difficulties and to various theoretical reactions against considering interpretation essential for analytic progress. In analysis, diverging aims of analyst and patient are highlighted in connection with the analyst's function as interpreter. The interactions between patient and analyst pertaining to interpretation provide insights into the patient's intrapsychic conflicts that may be less apparent in other material.     

THE CONCEPT OF OBJECTIVE COUNTERTRANSFERENCE AND ITS ROLE IN A TWO-PERSON PSYCHOLOGY

Objective countertransference comprises those feelings the analyst experiences with the patient that are repetitions of feelings from the patient's life outside the analysis. It is viewed as being induced by the patient and is understood in the context of the patient's life, not the analyst's. The concept is used to understand the relationship of some of the analyst's feelings to recurrent interpersonal patterns in the patient's life. It has often been viewed as being incompatible with a two-person psychology. Here, in contrast, it is argued that objective countertransference is only one current within the analyst's total emotional response to the patient, and that it should be conceptualized as a component of a broader two-person psychology. However, the use of objective countertransference as a conceptual tool highlights aspects of the analytic relationship that differ from those emphasized in current two-person models. A case example is analyzed from both perspectives to illustrate their similarities and differences. Although the concept of objective countertransference can enrich the analyst's understanding of certain dimensions of the analytic relationship, it is not a theory of technique and it is not wedded to any particular style of psychoanalytic intervention.     

The elusive concept of the psychoanalytic process

Although the term psychoanalytic process is frequently used, there is no consensual definition of its meaning. Some authors use it to designate a recognizable set of experiences within psychoanalysis. Others, a majority, use it as a synonym for the entire psychoanalytic experience, describing in detail what analysts do to achieve their goals. A range of views may be found between these extremes. A distinction is drawn here between the structure and content of the psychoanalytic process, which is regarded as a specific, definable entity--a red thread--within the psychoanalytic treatment experience as a whole, consisting of a microprocess and a macroprocess. The former is predominantly an amalgam of the patient's and the analyst's highly subjective experiences and entanglements, while the latter is predominantly an amalgam of the infantile and childhood origin of the patient's difficulties, as well as the analyst's conception of these difficulties based on a preferred theory. These ideas are used to formulate a definition of the psychoanalytic process based on clinical experience and are traced here primarily through lessons learned from a patient, Mr. K, over the course of a long and arduous analysis.     

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.     

Slips of the analyst.

Understanding the analyst's work and its vicissitudes has been a major focus of recent psychoanalytic writing. This study on slips of the analyst represents an attempt to advance our understanding of analytic work. The slips described support the view that slips reflect not simply contributions from instinctual life, but active work-related goals of the analyst in carrying out the analytic tasks. Countertransference is discussed as reflected in the disturbance of intentionality betrayed by the occurrence of a slip. The essential role of the analyst's understanding his or her own reactions is emphasized.     

Discontinuities in the male psyche: waiting, deadness and disembodiment. Archetypal and clinical approaches

The discontinuities of development in the male psyche that are manifested in some analyses in unconscious experiences of inner disintegration are described. Narcissism and a de-somatized relationship to their own presence are the dominant clinical presentation in these patients. The analyst sometimes experiences these analyses as 'dead', as a result of the projection of a 'dead mother' object. The question of how psychic deadness and impotence can be worked with is examined. Clinical experience with these men shows how notions associated with the puer-senex archetype can illuminate the stark realities of a patient's early experiences, particularly in how mother's presence is felt. A theoretical and clinical bridge is proposed between puer and narcissus to frame how a man may unconsciously strive against psychic fragmentation by clinging to an identification with both--in order to remain intact in the face of being caught in a pre-pubescent state which reflects the insecure attachment to mother. The author describes how patients may find a more grounded embrace of reality via the use of the analyst's empathy and a greater potency through work in the transference/countertransference. These strengthening achievements help men to begin to leave the 'dead mother' behind.     

Strategies and Dispositional Correlates of Sexual Coercion Perpetrated by Women: An Exploratory Investigation

This research tests whether theoretical constructs typically associated with male perpetrators of sexual coercion are predictive of women who perpetrate sexual coercion. We administered a questionnaire that contained measures of sexual experience, social dominance, ambivalent sexism, sex roles, attitudes toward sexual harassment, and lovestyle approaches toward intimate relationships to a sample of women undergraduates. Results found 18% of women to report engaging in sexually coercive behaviors. Coercive women exhibited higher tolerance of sexual harassment, and were significantly higher in femininity than noncoercive women. Coercive women were also found to embrace a ludic (manipulative, game-playing approach toward love) lovestyle significantly more than noncoercive women, while pragma (a logical approach toward love) was negatively associated with coercion. Lastly, a significant difference was found between coercive and noncoercive women and self-reported victimization. Eighty-one percent of women who reported using coercive strategies in their relationships also reported having been sexually victimized.     

The analyst's reluctance to begin a new analysis

Given the decline in the average psychoanalytic practice, it is crucial to examine the variables affecting the individual analyst's practice. One such variable is the analyst's reluctance to begin a new analysis. Literature exploring its origins, possible manifestations, and effects on the analyst's thinking and practicing is reviewed. The analyst's reluctance is considered (1) as a defense against powerful affects, (2) as a co-created resistance, and (3) as a manifestation of the analyst's conflicts. Two clinical examples illustrate how this reluctance and its subsequent recognition influence the analyst's work. It is suggested that the present reality of a socioeconomic climate adverse to psychoanalysis, with fewer patients willing to engage in analysis from the outset, might be used to rationalize the analyst's reluctance to begin. It is also suggested that the analyst's reluctance to begin a new analysis is much more pervasive and influential than is presently recognized.     

Self-compassion and reactions to unpleasant self-relevant events: the implications of treating oneself kindly

Five studies investigated the cognitive and emotional processes by which self-compassionate people deal with unpleasant life events. In the various studies, participants reported on negative events in their daily lives, responded to hypothetical scenarios, reacted to interpersonal feedback, rated their or others' videotaped performances in an awkward situation, and reflected on negative personal experiences. Results from Study 1 showed that self-compassion predicted emotional and cognitive reactions to negative events in everyday life, and Study 2 found that self-compassion buffered people against negative self-feelings when imagining distressing social events. In Study 3, self-compassion moderated negative emotions after receiving ambivalent feedback, particularly for participants who were low in self-esteem. Study 4 found that low-self-compassionate people undervalued their videotaped performances relative to observers. Study 5 experimentally induced a self-compassionate perspective and found that self-compassion leads people to acknowledge their role in negative events without feeling overwhelmed with negative emotions. In general, these studies suggest that self-compassion attenuates people's reactions to negative events in ways that are distinct from and, in some cases, more beneficial than self-esteem.     

Reconstruction of preverbal experiences

Only a few analysts (Deutsch, 1947, 1952; Braat?y, 1954) have systematically tried to investigate how nonverbal behavior may be derived from events and experiences from the preverbal phase of development. Their approaches to the analysis of such behavior differ. Extracts of an analysis are used to illustrate basic technical and theoretical questions with regard to the possibility of making use of nonverbal material to reconstruct preverbal experiences. It is inferred that the analyst's visual observations of the patient's nonverbal behavior may be a cue to significant events and trauma from the preverbal period. Besides, the specific visual imagery of the patient that, in this case, emerged just after the appearance of nonverbal behavior, may be a valuable source of data for analytic reconstruction.