The many faces of self-harm

This paper explores why open dialogue on the subject of erotic transference and countertransference is so difficult and attempts to offer an understanding of these phenomena which might enable counsellors to work more confidently with it. It also briefly examines the author's own research on therapists' thoughts and experiences of erotic transference, seeking to differentiate between inappropriate sexual contact between clients and therapists and the experience of erotic transference in the context of therapy as a reworking of the Oedipal relationship. Case examples illustrating the experience of countertransference within the therapeutic situation and how its presence can act as a help or a hindrance are offered. The paper concludes by examining the need to reflect on the erotic transference in therapeutic work and proposes its usefulness as a therapeutic tool. Suggestions about how the erotic transference can be managed to therapeutic effect are also explored.     

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.     

A Farewell to Countertransference

The "discovery" of countertransference provided a much-needed corrective to the one-sided view of transference and a patient's pathology. Even if its usefulness in the development of psychoanalysis was indisputable, its days are numbered. When I present my clinical work at conferences, I am often asked questions about my countertransference. These questions contain numerous assumptions that are challenged in this paper. Treatment is discussed from a self psychological perspective to highlight the therapeutic value of enabling the patient to engage a selfobject transference. The concept of "projective identification" is also challenged. Systems theory, in which the therapeutic relationship is understood as a co-construction between therapist and patient, is proposed as a more effective model to deal with the issues formerly included under transference-countertransference.     

Spontaneous Personality Synthesis in Group Therapy

Combined therapy is defined as concurrent dyadic and group therapy with the same therapist. This paper focuses on a neglected aspect of combined therapy: broaching and exploring this question with one's individual, patient. The author shows how raising this question: (1) alters the therapeutic field whether or not the patient joins; (2) can sharpen the therapist's understanding of the indications and contraindications for group membership; (3) offers untapped therapeutic approaches and opportunities to clarify issues in the individual treatment; and (4) stirs up countertransference issues related to issues of profitability, the transference of the patient in individual treatment, and the transference of the group-as-a-whole. Several case examples are provided.     

The Flawed Person of the Analyst: Commentary on Paper by Lauren Levine

The way that the current conception of mutual enactment is understood, any analysis, in order to be ultimately successful must first go badly for some period of time. Any analysis that goes too smoothly is subject to the suspicion that some very difficult interactional material is being mutually unaddressed. In this context I see that Dr. Lauren Levine enacted the role of her abandoned patient (concordant countertransference) and as well, for a time, indeed, figuratively abandoned her patient (complementary countertransference). The author's central contribution in this paper is an illustration of how drawing on difficult and painful dimensions in one's own personal analysis, the analyst has the advantage of being able to withstand highly toxic material in both the transference and the countertransference. Dr. Levine is fortunate in having had a personal analysis that helped her integrate highly shameful aspects of her self, though it must be recognized that this is not always the case in all training analyses.     

Psychoanalysis is a two‐way street

The paper discusses psychoanalysis as a mutual exchange between the analyst and analysand. A number of questions are raised: What was Ferenczi's and the early psychoanalysts' contribution to the interpersonal relational dynamics of psychoanalytic treatment? Why did countertransference become an indispensable tool in relationship‐based psychoanalysis? Why is the transference‐countertransference dynamic seen as a special dialogue between the analyst and analysand? What was Ferenczi's paradigm shift in the trauma theory? How did he combine the object relation approach with Freud's original trauma theory? The paper illustrates through some case study vignettes the intersubjective and intrapsychic dynamic in the process of traumatization. We can look at countertransference as an indicator of the patient's basic interpersonal experiences and traumas. Finally the paper discusses countertransference in the light of attachment theory, connecting the early initiatives of inter‐relational approaches in psychoanalysis with recent research.     

The Unseen Spouse: Pitfalls and Possibilities for the Individual Therapist

Individual therapists often hear a great deal about our patients' spouses or partners, and naturally develop ideas and beliefs about that unseen other and about the causes of any relationship difficulties the patient reports. Not uncommonly, therapists can lose touch with the fact that their impressions of an unseen spouse are constructions that have emerged from the transference/countertransference field, based on only partial or limited information—not veridical truths. They can then talk with the patient about his or her partner or relationship issues in ways that can ultimately do both patient and spouse a significant disservice and perhaps distract from the patient's own issues and analytic goals. This paper discusses several factors that seem to contribute to the development of this problematic dynamic, including various qualities of the transference/countertransference field, and offers suggestions for avoiding or reducing it. Clinical material is used to illustrate key points.     

Paternal empathy in the transference/countertransference relationship

This paper explores the process of paternal empathy within the context of the transference and countertransference relationship. The masculine and feminine elements of paternal responsiveness are described with implications for therapeutic resonance and mirroring. Case material illustrates the author's thesis.     

Countertransference as a complex tool for understanding the patient in psychotherapy

This paper shows some of the complexities of the analytic relationship and processes in psychotherapy by focusing on the concept of countertransference. The development of the related concept of transference is briefly outlined and the history of the concept of countertransference and its place in the practice of psychoanalysis is presented. A clinical example is provided to illustrate some of the complexity of the issues that arise when the countertransference is used as a tool to understand the patient. Attention is drawn to the importance of sustaining the countertransference response until the transference aspects and the patient's unconscious communications have been recognised and understood. It is only at this point that an interpretation meaningful to the patient can be made.     

On the edge: The psychoanalyst's transference1

Countertransference is a central topic in analytic work and in the literature. The concept of countertransference includes a basic question which has been understood in different ways. The author attempts to differentiate between the psychoanalyst's transference and his countertransference in the analytic process. It is hard to draw a line between them; analysts are always on the edge. The analyst's transference will be explored and described using three approaches: narcissism, regression profile and the analyst's phase of life. Regression profile is a new concept developed by the author, which may help us to understand the core of the analyst's transference in the analytic situation. She illustrates the topic by clinical vignettes.     

Working in the countertransference

Ferenczi (1988) described the procedure of mutual analysis, in which the patient and analyst switch roles for part of the time in the analysis. This procedure allowed patients in stalled analyses to make progress and enabled the analyst to overcome certain countertransference blocks but was ultimately rejected for certain drawbacks. Working in the countertransference is a modification of mutual analysis that retains some of its benefits and eliminates some of its drawbacks. In such work, the psychoanalyst's personality and psychodynamics become the center stage of the manifest content of the session; the analyst avoids interpretations of the transference and, instead, elicits the patient's detailed understanding of the analyst's psychodynamics. The analyst does not, however, generally volunteer his free associations or facts about his own life. This process allows deep work with patients with a predominance of projective identification. Working in the countertransference may be preferred in cases of severe psychopathology to other procedures for its lessening of the frequency, severity, and persistence of transference psychoses. The procedure is also a useful supplement to transference analysis with neurotic patients, for whom it can break through blocks caused by anxiety‐laden issues or countertransference impediments.     

The countertransference impact of autistic defence in an otherwise neurotic patient

This paper investigates the question of why, in the psychoanalytic psychotherapy of a patient with encapsulated autistic pathology, the steady maintenance of a therapeutically neutral stance can be especially difficult. Transference and countertransference vicissitudes are examined. The author notices that the patient's intolerance of ‘opposites’ (cf. Tustin, 1986), combined with extreme antipathy to having that intolerance noticed, can elicit corresponding, and potentially destabilizing, countertransference reactions. These reactions comprise an unstable tension between co‐existing pressures towards fusion with, or expulsion of, the patient, their co‐existence under further pressure to remain unnoticed. Until perceived, this state of affairs risks collusion with the pressure either to merge with or to expel the patient, and compromises the capacity to notice the detail of the transference process and even to notice co‐existent positive and negative transference images. Detailed clinical illustration is given, including a session where it was difficult to notice the patient's experience of a couple as a combined object. The author finds these observations of bipolar countertransference tensions illuminated by Green's concepts of positive and negative narcissism and of the disobjectalizing function, and specifically accounted for by Ribas's theory of autism as radical drive defusion.     

Private Terrors Sexualized Aggression and a Psychoanalyst's Fear of Her Patient

This clinical paper explores the meanings and evolution of an analyst's reaction of fear in relation to her patient's sexualized aggression. From both an intrapsychic and an intersubjective perspective, the author analyzes the coconstruction of this transference—countertransference phenomenon. Case vignettes illustrate the author's attempts to address her patient's sexualized aggression while struggling to free herself from the feelings of intimidation and fearfulness stirred by his sadomasochistic fantasies and patterns of interaction. The analyst's unconscious identification with the patient's disowned femininity and narcissistic vulnerability is seen as central to this countertransference “stranglehold.” Release from the analyst's masochistic position comes through a shift in her own affective participation. The importance of the analyst's recognizing her own unconscious contributions to this sadomasochistic dynamic is emphasized and elaborated. Discussion also focuses on the relevance of gender to the issue of countertransference fear, as illustrated in this particular male patient—female analyst dyad.     

Symposium on Psychoanalytic Training and Education: Editors' Introduction

This paper offers an intimate account of a long-term analytic process and a detailed presentation of one pivotal session to illustrate and explore the issues of love, dissociation, and discipline in a therapeutic relationship. Organized around the concept of impasse, this paper presents a relational perspective on the potential in transference and countertransference love to facilitate or curtail the forward progress of therapeutic work. Love may bring life or impasse to a person in analysis. One key to the dynamics of therapeutic love and impasse is the problem of weak dissociation (Stern, 1997) and the impact of the analyst's noticing, or not noticing, a moment in the onrush of familiar clinical process that is ripe for questioning. A new concept is introduced and elaborated in this paper that relates to the resolution of preoedipal and oedipal transference love: The paradoxical analytic triangle.     

The clinical revolution of the ‘wise baby’

In an historical context focused on a close examination of the complex relationship between Freud and Ferenczi, the author shows Ferenczi's contribution to the evolution of psychoanalysis. He describes how his ideas and his therapeutic sensitivity anticipated modern clinical thought (for example, Winnicott and Bion), especially the understanding of borderline and narcissistic pathology. The paper considers the following topics: transference and countertransference; early affectivity; the different psychic trauma; phenomena connected with dissociation; the healing factor of the analysis.     

Das Drama des begabten Kindes und die Suche nach dem wahren Selbst

The clinical material for this study of female fantasies stems from a specific psychoanalytical situation where the analyst and the analysand are pregnant at the same time. The impact of this situation is powerful. The emergence of archaic fantasies is facilitated in transference and countertransference. Fantasies of damage to the baby or to the procreative function may emerge very vividly in the double pregnancy setting and working through these fantasies becomes possible. It is suggested that these fantasies are typical female castration fantasies and manifest the fear of the mother's revenge and punishment for forbidden oedipal wishes. The double pregnancy setting may sensitize the analyst to her pregnant analysand's unconscious communication and yet blind the analyst in some areas to the protection of her own baby. The duality of phallic strivings in the girl's psychosexual development is discussed. They may be employed as a defense against specific feminine anxieties, such as fear of retaliatory attacks on her inner space and its fertility: the female castration anxiety. They may also be constituents of her sexuality, coexisting with inner genital strivings. The co-existence of phallic and inner-genital strivings in the female psyche is always conflictual.     

IRREDUCIBLE SUBJECTIVITY AND INTERACTIONISM: A CRITIQUE1

The authors offer a critique of the privileging of subjectivity in psychoanalysis characteristic of what Hanly has called interactionism, with specific reference to the work of Renik. First, Renik's argument for the irreducible subjectivity of the analyst is explored and critiqued from a philosophical perspective. The need for and plausibility of a subtler notion of objectivity that takes into account the limitations of human subjectivity and that analysts can meaningfully pursue is defended. Second, Renik's ‘re‐visioning’ of psychoanalysis, which follows from his notion of irreducible subjectivity, is explored and critiqued. Renik's view of enactments is contrasted with a ‘totalistic’ perspective of countertransference that allows for important, finer conceptual distinctions. Renik's conceptualisation of countertransference enactments is characterised as a ‘special case’ of countertransference as a vice. Next, Renik's view of transference is critiqued for privileging the adaptive dimensions of transference, and for potentially sidelining archaic dimensions. Finally, Renik's conclusions and ‘revisioning’ of psychoanalysis are shown to follow from his modifying or jettisoning certain features of the analytic situation and process. These features and their implications are elaborated on. The conclusion outlines the extent to which the arguments presented can be extended to other advocates of interactionism.     

A response to Maggie Turp's paper from a body psychotherapy perspective

Whilst appreciating the quality of containment in Turp's work as a learning point for the Body Psychotherapy tradition, the author argues that Turp does not represent a psychotherapeutic way of ‘working with the body’. This would require a deconstruction of the body/mind dualism inherent in much psychotherapeutic (and psychodynamic) theory, so that the complexity of the spontaneous and reflective body/mind processes, especially in their polar extremes (body/mind dissociation – body/mind integration / ‘psyche/soma unity’), can be contained. An holistic body/mind formulation of countertransference is approached by which – rather than being used as a gratifying or cathartic therapeutic shortcut which avoids the intensity of the transference – the body can be seen to constitute an avenue into the full experience of the transference/countertransference process and its relational sources in early development.     

Tuning into the psychotic wavelength: Psychoanalytic supervision for mental health professionals

In this paper, material is presented from supervision groups run for mental health professionals in different mental health settings. I will argue that a psychoanalytic framework, which puts the transference and countertransference at the centre of clinical practice, offers an important model for thinking about psychosis and psychotic means of communication. When staff are able to ‘tune in’ to their patients' communications it can help to change a patient's monologue about his/her delusional world into a meaningful dialogue about their emotional world.