Countertransference as an Ally in Sexual Therapy

SUMMARY

This paper illustrates a constructive use of a persistent countertransference response of a therapist towards a client in sexual therapy. The recognition that the transference resistance from the client had multiple motivations assisted the therapist's constructive use of the countertransference to facilitate the treatment process of the couple.     

Overcoming My Model of Goodness as a Psychotherapist

Summary

The case of Tina is presented to examine one therapist's countertransference issues with a female client who had features of a Borderline Personality Disorder. The therapist's emotional reactions to this client's raw expression of anger and frustration are explored. The discussion also emphasizes the struggle of the therapist in resolving her discomfort with this client and in setting therapeutic boundaries.     

Can appraisals of common political life events impact subjective well‐being?

This study examined the psychological impact of global subjective appraisals of influence exerted on people's lives by common political events. A list of 24 political events was administered to a random sample of 400 adults in Poland. Political self‐efficacy, interest in politics, perceived political social support, and political collective efficacy were also assessed as potential moderators of the link between political stress appraisals and subjective well‐being (satisfaction with life, sense on anomie, positive affect). Perceptions of the negative influence of political stressors on one's life and the life of the country were associated with concomitant variations in subjective well‐being. Among psychosocial resources, political self‐efficacy consistently moderated the influence of appraisals of political stressors on satisfaction with life and positive affect.     

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.     

Stress mindset in athletes: Investigating the relationships between beliefs,challenge and threat with psychological wellbeing

ObjectiveStress is omnipresent in daily life and can be acutely experienced by athletes due to additional circumstances such as deselection and injury. Trait beliefs athletes have about the stress they experience as well as the cognitive appraisals of this stress may be important in determining psychological wellbeing. The present study aimed to investigate the relationships between stress mindset, irrational beliefs, cognitive appraisals and psychological wellbeing in athletes using path analysis. Broadly speaking, it was hypothesised that stress mindset would relate negatively to depressive symptoms and positively to vitality through appraisals (i.e., challenge and threat), while irrational beliefs would relate to positively to depressive symptoms and negatively to vitality through appraisals.Methods415 athletes (227 females, Mage = 33.86 years, SD = 17.73) completed an online questionnaire pack assessing stress mindset, irrational beliefs, challenge and threat appraisals, depressive symptoms, and vitality. Using path analysis, the tested hypothesised model demonstrated an excellent fit to the data.ResultsFindings demonstrate that the relationships between stress mindset, irrational beliefs and psychological wellbeing is linked by direct and indirect effects of challenge and threat in athletes. Stress mindset was positively associated with challenge and negatively associated with threat, whilst self-depreciation and awfulizing demonstrated significant positive associations with threat. Self-depreciation was found to significantly relate to stress mindset, challenge, threat and depressive symptoms to a greater extent than the other types of irrational beliefs.ConclusionsFindings suggest practitioners should be aware of the role that stress mindset and other irrational beliefs have in potentially influencing athlete psychological wellbeing.     

Psychoneuroendocrine effects of resource-activating stress management training.

OBJECTIVE: The stress-induced release of cortisol has been linked to detrimental health outcomes. Therefore, strategies to attenuate cortisol stress responses are of interest for prevention and treatment of stress-related symptoms and problems. Previous studies have found protective effects of cognitive-behavioral stress management training--which focuses on the modification of stress-inducing cognitions--on cortisol stress responses; however, the effects of resource-oriented interventions on cortisol stress responses are unknown. DESIGN: The longitudinal effects of resource-oriented stress management training (Zurich resource model training) on cortisol stress responses and cognitive appraisal of a standardized psychosocial stress test were evaluated in 54 healthy male participants assigned randomly to treatment and control groups. The Trier Social Stress Test (TSST; C. Kirschbaum, Wust, & Strasburger, 1992) was administered to all participants 3 months after the treatment group underwent stress management training. MAIN OUTCOME MEASURES: Saliva cortisol samples were taken before, during, and after the TSST, and cognitive stress appraisal was assessed before the test. RESULTS: The treatment group had significantly attenuated cortisol responses and stress appraisals in comparison to the control group. The endocrine differences were mediated by differences in cognitive appraisals. DISCUSSION: These results indicate that resource-oriented stress management training effectively reduces endocrine stress responses to stress in healthy adults.     

Countertransference reactions toward specific client populations: a review of empirical literature

Countertransference reactions can either benefit or hinder mental health professionals during the therapeutic process. An awareness of countertransference reactions can aid clinicians in understanding and anticipating their own specific emotional responses toward certain client populations. Recent empirical research suggests that common countertransference reactions may occur in mental health professionals when relating to certain client types. Since a literature review indicated that more numerous and reliable tests have been developed to measure countertransference during the past decade, as well as better research designs, this article reviews and summarizes all empirical research studies on countertransference reactions toward specific client populations during the past 10 years, from 1990 to 2001.     

Minority stress and intimate partner aggression among male same-sex couples

Intimate partner aggression (IPA) is high among gay, bisexual, queer, and other sexual minority men (SMM), and is strongly linked to minority stress. These links might be further magnified or buffered by communication between partners (i.e., negative and positive communication, respectively). The present study investigated associations of minority stress and IPA, and the moderating role of positive/negative communication, among male couples (N = 932 individuals, 466 couples). Partners completed measures of communication skills, minority stress, and IPA, which were analyzed using moderated actor-partner interdependence models. Results suggested that microaggressions increase one's own (i.e., an actor effect) and one's partner's (i.e., a partner effect) verbal IPA victimization, verbal IPA perpetration, and physical IPA victimization. Positive communication moderated the association between microaggressions and verbal IPA victimization, suggesting that high levels of positive communication may buffer the microaggression-verbal IPA link. Thus, minority stress' detrimental impacts on relationship functioning among male same-sex couples may be reduced by the presence of positive communication (e.g., effective conflict resolution). We discuss structural and clinical innovations to prevent IPA among male couples, with particular emphasis on the absence of positive communication as an aggravating factor.     

Listening to the Erotic Commentary on Paper by Eric Sherman

In this commentary I examine homoerotic countertransference within the context of the analyst's erotic countertransference experience. Discussing male analysts' difficulties receiving and experiencing homoerotic feelings as a function of their dominant erotic desires (along gender lines), I propose both cognitive and affective explanations to illuminate their defenses. I suggest that Sherman's erotic countertransference is best understood when viewed as a product of both induced feelings emanating from his patient's dissociated sexual abuse and also his anxiety and shame in response to particular relational configurations with his patient that arouse him. Finally, I point to the site of the transgressive as integral to the construction of erotic desire and suggest shifts that need to occur in the erotic subjectivity of this dyad so that the treatment can move forward.     

Tom Thumb in hospital: The fairy tale workshop in a paediatric oncology and haematology ward

Abstract

Definitions of and attitudes towards countertransference have changed throughout the twentieth century. From being seen as a contaminant in the analytical process, countertransference has come to be seen by many therapists as a potentially useful source of information about a client and his or her problems. There are dangers as well as benefits associated with analysis and utilization of countertransference. This article reviews these issues and proposes some guidelines that therapists may find useful when contemplating their countertransference reactions to clients, and when considering how best to utilize these.     

A change in frame and countertransference experiences: Transitioning from face-to-face to telepsychotherapy

Unprecedented changes in traditional psychotherapeutic practice arose from the lockdown restrictions associated with the COVID-19 pandemic. These changes to practice included the imposed change to the therapeutic frame when transitioning clients from face-to-face meetings to delivery of psychotherapy sessions via videoconferencing (defined here as telepsychotherapy). The current study conducted qualitative interviews with 16 Australian psychologists who transitioned their existing adult psychotherapy clients from face-to-face therapy to telepsychotherapy and explored their novel experiences associated with countertransference reactions during this period. Thematic analysis of the interviews revealed several unique findings. The type of countertransference reactions towards existing clients was consistent across both face-to-face and online meetings; however, the felt intensity of countertransference reactions was reduced. Psychologists reported an increased hesitance to work with intense emotions during telepsychotherapy sessions and felt increased pressure to work harder during online sessions when compared to face-to-face meetings. Exposure to their clients' personal and home environments during telepsychotherapy sessions elicited several novel reactions towards their clients. These findings on countertransference and telepsychotherapy are informative for future practice and training. Awareness of these unique countertransference experiences is recommended prior to engaging in telepsychotherapy or when transitioning clients to this modality.     

Effects of a cognitive-behavioral intervention on field hockey players’ appraisals of organizational stressors

ObjectivesWe assessed the effects of a cognitive-behavioral intervention on English field hockey players’ appraisals of organizational stressors, emotions, and performance satisfaction.DesignA concurrent, across-participants, multiple-baseline, single-case research design with a three months post-intervention follow-up.MethodFour high-level female field hockey players participated in a four phase intervention that lasted between 24 and 26 weeks: rapport-building and observation (phase I), baseline monitoring (phase II), educating the players and facilitating acquisition of a cognitive restructuring technique (phase III), and encouraging integration of the technique during sport performance (phase IV). Questionnaires and social validation were used to record the participants' appraisals, emotions, and performance satisfaction throughout the intervention. A three months post-intervention follow-up was conducted to assess the participants’ retention of the intervention effects.ResultsReduced threat and loss appraisals and elevated challenge appraisals were reported immediately after Phase III had been introduced. Pleasant emotions and performance satisfaction increased while unpleasant emotions decreased throughout the intervention. Social validation immediately post-intervention and at the end of the follow-up period indicated sustained adaptive changes in each of the outcome variables.ConclusionsCognitive restructuring represents a promising technique for optimizing high-level hockey players’ appraisals. Challenge appraisals and pleasant emotions appear to be linked with increased performance satisfaction and positive intervention effects can be retained for a period of three months post-intervention. Researchers should examine the effectiveness and efficacy of the cognitive restructuring technique with other populations to develop a robust evidence base for appraisal optimization in sport.     

Counselling students' views and concerns about weeping with clients: A pilot study

This study examines counselling students' concerns and views about a phenomenon that has received little attention in the counselling literature: the counsellor weeping during a session with a client. Over 20 per cent of the counselling students who were surveyed reported being concerned about weeping in session with clients. However, the majority of students believed, to varying degrees, that weeping with clients could facilitate the therapeutic process. This paper sheds light on this unexplored dimension of countertransference, and has implications for those involved in providing counsellor training.     

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.     

Real relationship,working alliance,transference/countertransference and outcome in time-limited counseling and psychotherapy

Six client/therapist dyads (three therapists each working with two clients) were studied to determine how the real relationship unfolds over the course of time-limited treatment and how this unfolding relates to the development of the client/therapist working alliance, client transference, and therapist countertransference. We also examined how these indices of the relationship fluctuate as a function of treatment outcome. Results indicate that in general for all six dyads, therapists’ and clients’ ratings of the real relationship and working alliance were strong throughout treatment. However, patterns of real relationship and working alliance over the course of treatment varied between dyads categorized as more vs. less successful. Therapists’ countertransference was low, as was client transference, but differences in ratings were evident when the dyads were classified by outcome.     

The dynamic nature of the stress appraisal process and the infusion of affect

Very little is known about the process in which people reappraise a stressful environment or the factors that may influence this process. In the current study, we address the several limitations to previous research regarding stress reappraisals and explore the role of affect on this process. A total of 320 participants (mean age = 20 years, 60% male) completed an increasingly demanding team-based coordination task. Mood and stress appraisals were assessed at three time points using self-report surveys during four different waves of data collection. The longitudinal design enabled us to assess primary and secondary reappraisals (change in appraisals during the experiment), task-irrelevant affect (affect assessed prior to experiment participation), and task-relevant affect (change in affect experienced during the experiment). Guided by the Transactional Theory of Stress, we argue that the relationship between primary reappraisal and secondary reappraisal is an accurate representation of a dynamic stress appraisal process. We found that participants were more likely to engage in the stress appraisal process when they experienced less task-irrelevant positive affect and greater task-relevant positive affect. Both task-irrelevant and task-relevant negative affect were not found to influence the stress appraisal process.     

Passion and emotions: The mediating role of cognitive appraisals

Research reveals that harmonious passion leads to more positive emotions than obsessive passion, whereas the opposite result is true with respect to negative emotions. The purpose of this research was to evaluate the role of cognitive appraisals as mediators of the passion-emotion relationships. In Study 1, 227 participants engaged in different sports completed an online questionnaire about their passion for their specific sport, as well as cognitive appraisals and emotions generally experienced during an important game of their sport. Results of a structural equation modeling analysis and an indirect effect test showed that harmonious passion was linked to positive emotions through the mediating role of challenge appraisals, and that obsessive passion was linked to negative emotions through the mediating role of threat appraisals. In Study 2, 194 athletes completed questionnaires before and after a competitive game and focused on cognitive appraisals and emotions experienced during the game. Results of analyses conducted separately in the victory and defeat conditions based on game outcomes supported the model found in Study 1 in the case of defeat for both types of passion, and in the case of victory for harmonious passion only. Obsessive passion was not linked to threat appraisals among victorious athletes. These results suggest that both types of passion trigger different cognitive appraisals that lead to corresponding emotions. Future research is needed to replicate these findings and to better understand the role of passion and cognitive appraisals in emotions experienced in the realm of sports.     

Use of an analogue method to examine children’s appraisals of threat and emotion in response to stressful events

An analogue methodology was used to present a set of realistic, salient stressors to children in grades 3, 5, and 7. Children (N = 146) viewed eight videotaped vignettes depicting interpersonal and non-interpersonal stressors; these were expected to differentially threaten psychological needs for relatedness, competence and autonomy and provoke different emotional reactions. Analyses showed that scenarios portrayed stressors that were commonly experienced by children and evoked a differentiated profile of appraisals and emotions. When tenets of the motivational theory of stress and coping were tested, scenarios more threatening to needs were more distressing, sadness was linked to relatedness and competence threat appraisals, and fear was a more common reaction to parent stressors that involved dyadic conflict. After accounting for threat appraisals and previous experience of stressors, younger children and girls appraised events as more distressing than older children and boys. Future research could use the analogue procedure to focus on children’s development of regulation and coping with stress.     

Counseling Clients Who Self‐Injure: Ethical Considerations

This article provides an overview of ethical considerations related to counseling clients who engage in self‐injurious behaviors. Ethical issues concerning client welfare, counselor competence, countertransference, referral and consultation, informed consent, and duty to protect are discussed in relation to the American Counseling Association's (1995) Code of Ethics and Standards of Practice. Implications and recommendations for counselors who work with clients who self‐injure are provided.     

A path analysis of stress appraisals, emotions, coping, and performance satisfaction among athletes

Objectives

In this study we examined athletes’ stress appraisals, emotions, coping, and performance satisfaction ratings using a path analysis model. This is the first study to explore all of these constructs in a single study and provides a more holistic examination of the overall stressful experience that athletes encounter.

Design

Cross-sectional.

Methods

Participants were 557 athletes, aged between 18 and 64 years (M age = 22.28 years, SD = 5.72), who completed a pre-competition measure of stress appraisals and emotions. Participants also completed a coping questionnaire and a subjective performance measure after competing, with regards to how they coped during competition and how satisfied they were with their performance.

Results

Path analysis revealed that appraisals of uncontrollable-by-self, stressfulness, and centrality were positively associated with the relational meaning threat appraisals. Threat appraisals were associated with unpleasant emotions, prior to competition, and pre-ceded distraction- and disengagement-oriented coping. The pre-competition appraisals of controllable-by-self, centrality, controllable-by-others, and stressfulness were associated with challenge relational meanings, which in turn were linked to task-oriented coping during competition. Task-oriented coping was positively related to superior subjective performance.

Conclusions

Our findings support the notion that stress appraisals, emotions, and coping are highly related constructs that are also associated with performance satisfaction.