On countertransference enactments

This communication focuses on the relation of countertransference to psychoanalytic technique, calling attention not to the more obvious forms of countertransference that have been commented on by previous writers on the subject, but to its subtler ones. Often well camouflaged within the framework of traditional, time-tested techniques, this aspect of countertransference may attach itself to our way of listening and thinking about patients, to our efforts at interpretation, to the process of working through, or to the complex issue of termination. Less recognizable than its more boisterous counterpart and in some respects less tangible, this side of the problem of countertransference is no less important. For it is precisely those subtle, often scarcely visible countertransference reactions, so easily rationalized as parts of our standard operating procedures and so easily overlooked, that may in the end have the greatest impact on our analytic work.     

Approaching countertransference in psychoanalytical supervision: A qualitative investigation1

A recent examination of the literature concerning countertransference and its developments reveals its clinical usefulness in different psychoanalytical cultures. Nevertheless, a shortage of publications is apparent with respect to its approach in supervision. The authors aim in this study was to examine the concepts of transference and countertransference and how countertransference is approached in supervision, in the training of candidates, at an institute of psychoanalysis belonging to a society affiliated to the International Psychoanalytical Association (IPA). Qualitative research was carried out, interviewing supervisors and supervisees. Through analysis of the material acquired, the authors classifi ed the data into initial, intermediate and fi nal categories. The principal fi ndings were subdivided into three categories: the concepts of transference and countertransference, psychoanalytical listening and the complementarity of the phenomena, and the approach to countertransference. The concepts of transference and countertransference predominantly used by those interviewed are based on the totalistic outlook. Countertransference in supervision has been approached in a more direct and objective way when compared with the previous period, although great care is taken to delimit the boundaries between supervision and personal analysis. The main aim of supervision is to broaden comprehension and to deepen the interpretations directed towards the patient. These fi ndings suggest that the evolution of the concept of countertransference in different psychoanalytical cultures and developments in the analytical fi eld are contributing to this change.     

A Pilot Study of a Method for Teaching Clinical Psychology Trainees to Conceptualise and Manage Countertransference

There is evidence that therapists' countertransference responses can affect the therapeutic relationship. There is also evidence that trainee therapists can experience difficulty understanding and managing countertransference. This evidence suggests the need for greater focus on countertransference in the training of professionals, such as psychologists, for whom therapy is a core activity. However, little is currently known about the best way of providing such training or the impact of such training on recipients. This pilot study examined clinical psychology trainees' responses to a teaching and learning method for conceptualising and managing countertransference. The method was designed to be accessible to a range of psychology trainees including those in cognitive behavioural therapy programmes. This article outlines the method and its pilot evaluation. An anonymous online questionnaire was completed by 55 trainees pre‐intervention and 40 post‐intervention. Qualitative methods were used to examine changes in trainees' analyses of countertransference pre‐ and post‐intervention, and their reports of understanding and managing countertransference. Trainees also rated the intervention. The majority of participants who completed the post‐intervention questionnaire reported that training increased awareness of or the ability to conceptualise countertransference. They reported strategies for managing countertransference, although they were less confident in this area.     

Working with countertransference

The transference-countertransference relationship is only one of five modalities of relationship that research has identified as potentially present in the therapeutic encounter. This paper gives the background and definition to one aspect of this - the countertransference - and traces the development of the concept from Freud's first use of the term in 1910 to the contemporary view that it is a useful tool of psychotherapy. The first part explains its connection with the Kleinian concept of projective identification and discusses its elaboration by the object relations school. There is general acceptance nowadays that the countertransference contains a great deal of information about the client's psychological world. It is therefore important to understand this process and the authors have identified three main dimensions to countertransference. These are its vector (or direction and force), its variance (the quality it represents), and its valence (its effect on the client). The second part of the article illustrates, through the use of example and metaphor, how these three dimensions are defined and can be recognized. Common themes and paradigms of countertransference are identified and discussed along with some ways in which experience has shown how these might be contained and worked with constructively. Finally, a clinical vignette is presented in which some of the dimensions of countertransference are identified and used to understand the client's psychic world and foster therapeutic change.     

The revival of "Dora": advances in psychoanalytic theory and technique

For nearly six decades after its publication in 1905, Freud's remarkable case of Dora remained untouched by critical comment. However, beginning in the early 1970's, an abundance of articles began to appear, which focused exclusively on the Dora case. The present paper reviews the literature of this so-called "Dora revival" in order to explain the historical and theoretical reasons leading to this extraordinary burst of research. Above all, two vital developments in the psychoanalytic discipline created the climate that fostered the Dora revival. First, there was a revolutionary change in attitude toward the phenomenon of countertransference: in contrast to the classical view of countertransference as a disruptive interference in treatment, analysts increasingly regarded countertransference as a pervasive and natural process, which could be potentially utilized to enhance understanding of the patient's unconscious conflicts and defenses. Second, there was enormous and rapid growth of a comprehensive psychoanalytic theory of adolescence and its treatment. Thus, based on a more favorable attitude toward countertransference, and a much improved understanding of the unique problems of adolescence, psychoanalysts could reexamine and better understand the decisive events that contributed to Freud's abortive analytic treatment of Dora.     

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.     

THE COUNTERTRANSFERENCE: EROTIC,EROTISED AND PERVERSE3

The author begins by drawing attention to the dearth of psychoanalytic theory on the sexual countertransference, which he attributes largely to embarrassment associated with the personal superego and to fear of censure by the psychoanalytic community. After a review of the relevant literature, he points out that the term ‘countertransference’ arose in the context of misbehaviour by the early analysts and that the countertransference was originally seen as something to be controlled and suppressed, partly for the sake of the reputation of psychoanalysis. Theoretical and normative reasons are adduced for the disappearance of sexuality from psychoanalytic scenarios, and the wish for sexual contact with patients is discussed. While it may be deemed perfectly normal for an analyst to have erotic feelings towards patients of either sex, psychopathology is, in the author's view, involved only if he acts out. Clinical illustrations are given of manifestations of the sexual countertransference in its erotic, erotised and perverse forms, which the author considers it important to distinguish. He concludes that the relative absence of theory on the subject means that not enough clinical use is made of the sexual countertransference, which he sees as of great potential value to therapist and patient alike.     

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.     

The analyst's countertransference when supervising: friend or foe?

This paper explores transference and countertransference dynamics in the supervisory relationship and their impact on the task of supervision. The development of analytic theory in relation to supervision is described and the value-and ambiguity-of the concepts of 'mirroring', 'parallel process' and 'reflective process' are discussed. The impact of organizational dynamics on the supervisory relationship is investigated in relation to four main unconscious forces: a) organizational defences, b) power and authority, c) accountability and responsibility, d) ethical concerns. Clinical situations which illustrate these issues are described and explored and used as a basis for examining the role of the supervisor's countertransference in supervision. The different framework of practice in supervision, as opposed to analysis, is described in terms of its focus, the supervisor's ways of responding and the dynamic process, and the concept of refracted countertransference is introduced and explained.     

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.     

Relational Aftereffects in Manhood of Boyhood Sexual Abuse

Despite its high prevalence rate, the sexual abuse of boys is underrecognized and undertreated. This paper will examine the relational aftereffects of boyhood sexual abuse that emerge in adulthood. The vicissitudes of relational restructuring through the transference and countertransference are explored, with examples discussed of the various transference/countertransference paradigms often encountered.     

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.     

Induced emotional reactions and attitudes in the psychoanalyst as transference in actuality

The long hiatus between Freud's seminal paper on countertransference in 1910 and the contributions of the 1950s on totalistic countertransference is analyzed in terms of historical factors and others intrinsic to psychoanalysis. Induced reactions in the psychoanalyst as transference in actuality is differentiated from classical countertransference and the growing literature on totalistic countertransference, as well as from transferences involving the usual displacement and projective mechanisms. Several cases are discussed to indicate the wide range of psychopathology in which induced reactions occur and their value in reconstruction. The reasons for the confusing use of the concept, countertransference, for a variety of psychological processes in the analyst are cited, and a new model of five categories centering around modes of communication are posited: empathic transitory identifications, preconscious associations and imagery, induced reactions to transferences, induced reactions as transference in actuality, and classical countertransference. The relationship of induced reactions to classical countertransference is discussed, as well as implications of induced reactions as transference in actuality for internalization theory, and implicitly for the psychology of the self. Finally, some clinical issues in the use of induced reactions are eluciated.     

Body talk: somatic countertransference

This article focuses on a clinically observed event: the impact of the analytic session on the corporeality of the psychotherapist. The author sees this as an example of countertransference, in this instance ‘somatic countertransference’. Short and long clinical extracts are used to detail these events. The author touches on some early ideas on somatizing. The Kleinian concept of projective identification is itself explored and then used to explore further the idea of somatic countertransference.     

DESIRE AND RESPONSIBILITY: THE ETHICS OF COUNTERTRANSFERENCE EXPERIENCE

The analyst's desire expressed in impactful wishes and intentions is foundational to countertransference experience, yet undertheorized in the literature. The “wider” countertransference view, associated with neo‐Kleinian theory, obscures the nature of countertransference and the analyst's contribution to it. A systematic analysis of the logic of desire as an intentional mental state is presented. Racker's (1957) talion law and Lacan's (1992) theory of the dual relation illustrate the problems that obtain with a wholesale embrace of the wider countertransference perspective. The ethical burden placed on the analyst in light of the role played by desire in countertransference is substantial. Lacan's ethics of desire and Benjamin's (2004) concept of the moral third are discussed.     

Zur Natur des „Sechsten Sinnes“

Unconscious interactions have been conceptualized since Sigmund Freud, especially within the framework of transference and countertransference,. Nowadays, findings in the cognitive neurosciences (cognitive psychology, neurobiology) allow for a broader view of unconscious mental processes, e.g., in terms of subliminal perception or unconscious information processing. In this paper, a model is presented for understanding countertransference processes in the context of both psychoanalysis and the cognitive neurosciences. The basic concept of this model is that, within the framework of (unconscious) transference, the patient sends complex social information which the therapist perceives both consciously and unconsciously. Further unconscious information processing leads to the known countertransference phenomena, which consist of specific emotions, body feelings, fantasies, or impulses for action, and in some respects facilitate a “sixth sense” on the part of the therapist. The various processes of unconscious information processing lead to a situation in which countertransference includes parts of both the patient and therapist. At the conclusion of the paper, current neuroscientific concepts of unconscious processes are applied to countertransference, and the unconscious nature of countertransference is discussed from this perspective.     

Gegenübertragung im stationären Therapie-Setting

Background

Countertransference is seen as an instrument of research into a patient’s unconscious and is therapeutically useful in furthering psychodynamic work. For inpatient psychodynamic psychotherapy, where patients are treated by a team of psychotherapists, countertransference is much more complex and makes consideration and integration of different countertransference feelings necessary. Using the first German translation of the countertransference questionnaire (CTQ, Zittel Conclin and Westen, the countertransference questionnaire, 2005) an attempt was made to identify differences in countertransference phenomena in a team of psychotherapists and to show the impact countertransference has on therapy outcome.

Materials and methods

A total of t multiprofessional teams of psychotherapists (15 physicians, 5 psychologists and 9 body and art therapy psychotherapists) took part in the study and completed the CTQ for 137 patients (100 female, 37 male) at the beginning and at the end of inpatient psychotherapy. In addition, the patients completed two questionnaires, the Symptom Check List Revised 90-R (SCL-90) for the severity of symptoms and the Assessment of DSM-IV Personality Disorders Questionnaire (ADP-IV) for personality disorders.

Results

Body and art therapy psychotherapists expressed more positive, protective and involved countertransference feelings whereas psychotherapists for single and group therapy expressed more aggressive and hopeless feelings. Countertransference has an impact on therapy outcome and feelings of a lack of interest, aggression and resignation at the beginning of therapy can point to a poor outcome. Patients with personality disorders activate more negative countertransference reactions than patients without personality disorders but at the same time they may also evoke parent-like feelings of protection.

Conclusions

Using the CTQ it is possible to differentiate countertransference phenomena in a team of psychotherapists treating inpatients with psychodynamic psychotherapy. The timely perception and integration of countertransference feelings has a positive influence on the therapeutic process and therapy outcome.     

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.     

Potential Sources of Countertransference Among Religious Therapists

Relational approaches to counseling emphasize the monitoring of countertransference responses as a crucial component in the therapeutic process. Six potential sources of countertransference are discussed that are specific to religious therapists and which may be easily overlooked. These responses are related to the therapist's identification with a community of faith, and they may have a detrimental impact on therapy if they are not monitored. A brief overview of the historical and contemporary understanding of the concept of countertransference is presented. Recommendations are offered for the effective management of these countertransference responses.     

Developing countertransference awareness as a therapist in training: The role of containing contexts

The psychodynamic literature suggests that countertransference is an inevitable part of therapy and a significant feature of the client-therapist relationship. However, countertransference is also considered to be a ‘double-edged sword’: when it is reflected on by the therapist, it can offer valuable insights into the therapeutic relationship, but when it remains outside of awareness and therefore unmanaged it can result in the therapist unwittingly acting out in the therapeutic relationship and responding in counter-therapeutic ways. The purpose of this research was to explore the factors involved in the development of countertransference awareness in therapists and to construct a grounded theory of the process. Fifteen qualified therapists were recruited and interviewed, either face to face or via Skype, using a semi-structured interview schedule. The grounded theory constructed from the data suggests that during training participants initially experienced countertransference as threatening and overwhelming. When this experience was contained in supervision and therapy, the organisational context and by participants’ theoretical framework, they could reflect on their countertransferential responses and make sense of their experience, which then developed their self-awareness and other insights to the benefit of the therapeutic relationship. Conversely, a lack of containment in these domains resulted in participants acting out their countertransference and becoming either over or under available in the therapeutic relationship. The findings offer a useful process model on the role containing contexts play in the development of countertransference awareness for therapists in training.