Amelioration of transference resistance: substitute therapists in milieu group psychotherapy

Building upon Wolf's (1949) notion of the use of an alternate session in group psychotherapy, this paper suggests that an alternate therapist substituting for an absent regular therapist in milieu group psychotherapy can facilitate similar therapeutic benefits. The mechanism of this process of overcoming transference resistance is seen as twofold: (1) sessions with a substitute therapist allow patients to confront the infantilization often present in a milieu setting and experiment with more autonomous ego functioning. (2) Sessions with a substitute therapist create conditions which are apart from the ongoing process of the therapy group, thereby allowing for a therapeutic splitting process to develop wherein transference feelings about the regular therapist can be expressed to his or her "alter ego." Several case vignettes are presented in order to illustrate the clinical utility of a substitute therapist.     

When transference isn't transference: Iatrogenesis of multiple role relations between practicing therapists

Charismatic, grandiose and authoritarian senior therapists often develop complicated relationships not only with practicing therapists who are their colleagues, but also their friends, supervisees, as well as patients. The patient/therapist in a multiple role relationship with such a senior person may be extremely vulnerable and very unaware of the true nature of the problem Under certain conditions, some of these patient/therapists have suffered ego dysfunction and decompensation which appeared to be iatrogenic in origin rather than due to the patient's transference resistance. The implications of these issues for the field of psychotherapy, and underlying dynamics in vulnerable patient/therapist's, and in grandiose, narcissistic group leaders, are highlighted, along with ways of identifying the intrapsychic, interpersonal, and institutional roots of this problem An earlier draft of this paper was presented at the 1990 Meeting of the American Group Psychotherapy Association in Boston.     

The working alliance and the transference/countertransference relationship: Their manifestation with racial/ethnic and sexual orientation minority clients and therapists

Theoretical propositions are offered about the interrelations of three key concepts in psychotherapy: specifically, the working alliance, on the one hand, and both transference and countertransference, on the other. The role these concepts play, including the interactions between them, is extended to the areas of race/ethnicity and sexual orientation. We examine working alliance, transference, and countertransference considerations for therapy dyads in which at least one of the participants is a member of a racial/ethnic or sexual orientation minority group. Our hope is that this theoretical examination will generate further research and theory development on working alliance, transference, and countertransference where cultural factors such as race/ethnicity and sexual orientation are implicated in the therapeutic relationship.     

Reality in analytic group psychotherapy: Beyond transference and countertransference

This study reports the results of a questionnaire, applied to therapists and their patients in 14 analytic therapy groups. It was found that the patients studied had an accurate perception of the group reality in the following dimensions: therapists' preferences for the members in their groups; power position held by each member in the group; and therapeutic benefit achieved by members in the group. Support was given to the existence of a relation among popularity, power position and therapeutic benefit; members who rated high in one of these variables generally were assigned a high position in the other two, and vice versa. These results suggest that patients in analytic group psychotherapy can be objective in their perceptions of the group reality, and that these perceptions are not always distorted by transference. The idea that, no matter how low-disclosing therapists remain, the patients in their groups will perceive their attitudes and feelings was supported by patients' accuracy in perceiving their therapists' preferences for members in their groups. These findings indicate the important role played by reality and the real relationship in psychoanalytic group psychotherapy.     

Destructive and reparative transference in multiple levels of group psychotherapy

Group members are challenged to form psychologically meaningful relationships with therapists, other members, and the group as a whole. The way in which individuals perceive this challenge is based on their past experiences. Early relationships establish a perceptual frame in which fears of being hurt and concern about hurting others coexist. Balance between these two ways of generating meaning enables individuals to form relatively healthy relationships. Imbalance in this perceptual frame results in distorted perceptions and maladaptive patterns emerging as transference manifestations. Working through involves repeatedly addressing distortions as members relate to therapists, others and the group as a whole.     

Group processes and the therapist's subjectivity: interactive transference in analytical group psychotherapy

Interactions among the group therapist, the group members, and the group as a whole, especially enactments, are conditioned by the therapist's identity, defenses, and present relationships within his or her social networks. It follows from these considerations that difficulties in a group process stem from the group therapist's inability to understand well-enough what the group members are acting out and that they can be overcome only if the therapist extends the limits of his or her identity. Therefore, it has to be taken into account that the leader of a group is always a member of other groups whose dynamics in turn determine one's capability to understand the interactions in the group in which he or she is a therapist.     

Beliefs and practices of therapists who practice sexual reorientation psychotherapy

There is currently controversy regarding whether sexual reorientation or conversion therapies are ethical and effective forms of treatment for dissatisfied homosexually oriented people. We present the results of a survey of 206 psychotherapists who practice sexual conversion therapy. 187 therapists said they believed homosexuality is a developmental disorder and that the 1973 decision by the American Psychiatric Association to "depathologize" homosexuality was politically motivated and unscientific. The therapists believe that the majority of dissatisfied homosexually oriented clients who seek conversion therapy benefit from it, experiencing both changes in their sexual orientation and improved psychological functioning. We conclude that therapists who persist in providing reorientation therapy do so because they believe it is an effective and ethical treatment option for their clients.     

Intraclass correlation associated with therapists: estimates and applications in planning psychotherapy research

It is essential that outcome research permit clear conclusions to be drawn about the efficacy of interventions. The common practice of nesting therapists within conditions can pose important methodological challenges that affect interpretation, particularly if the study is not powered to account for the nested design. An obstacle to the optimal design of these studies is the lack of data about the intraclass correlation coefficient (ICC), which measures the statistical dependencies introduced by nesting. To begin the development of a public database of ICC estimates, the authors investigated ICCs for a variety outcomes reported in 20 psychotherapy outcome studies. The magnitude of the 495 ICC estimates varied widely across measures and studies. The authors provide recommendations regarding how to select and aggregate ICC estimates for power calculations and show how researchers can use ICC estimates to choose the number of patients and therapists that will optimize power. Attention to these recommendations will strengthen the validity of inferences drawn from psychotherapy studies that nest therapists within conditions.     

Changes in adolescent and parent hopefulness in psychotherapy: effects on adolescent outcomes as evaluated by adolescents,parents, and therapists

We examined the role of hope in the behavioral and socioemotional outcomes of adolescents referred to psychotherapy. Adolescents (n = 3517), aged 12–17 years, and their parents rated adolescents’ behavior problems, adolescents’ adaptive behavior, and their own subjective experience of hopefulness at intake and at 3-month follow-up. Therapists also rated adolescents’ behavior problems and adaptive behavior at intake and follow-up. Adolescents who reported increased hopefulness during treatment showed significantly fewer problems and significantly greater adaptive behavior at follow-up than adolescents who reported stable or decreased hopefulness. Similarly, adolescents’ outcomes were significantly associated with parents’ change in hopefulness during treatment. Results were consistent for adolescent, parent, and therapist ratings of outcomes. Our findings provide some of the first empirical evidence for the importance of hopefulness in the psychosocial treatment of adolescents and highlight the need to attend to hopefulness in both youths and their parents.     

Supervision, transference and countertransference

The author discusses supervision, transference and countertransference as seen in the context of the clinical case of a patient who had been first seen as a training analysis case and who later, in a fortuitous way, was treated by the supervisor of the training analysis. The supervisor, who in the first instance did not recognize the patient, discusses the reasons for this unusual experience in terms of the presence and absence of transference during the analysis of this patient as a training case and the problems inherent in the task of supervising. The patient's feelings towards the first and the second analyst and the vicissitudes of transference and countertransference during the supervision of the training analysis and its influence on the presentation of the analytical sessions by the student are also detailed and discussed. The question of recorded supervision presentations and their possible influence on the dynamics of supervision is raised.     

Art within analysis: scapegoat, transference and transformation

Through clinical example and pictorial illustration, the author examines ways in which art offers a particular means of psychological transformation in states which may otherwise be in expressable. A transference to the art work itself is proposed. It is submitted that, mediated within the transference/ countertransference dynamic, this 'scapegoat transference' facilitates a particular process of psychological differentiation. The aesthetic qualities of art presented within analysis will resonate with other countertransference affects. Clinical material demonstrates how observation of this--aesthetic countertransference--leads to a distinction between the 'diagrammatic' and the 'embodied image. The process of integration of shadow material is furthered by the temporary safe-keeping of the art work by the analyst.     

Race, brain size, and intelligence: a reply to Cernovsky

Cernovsky's 1990 critique of my work on the relation between brain size and IQ inadequately presents my position. I did not address the issue of sex differences in brain size nor did I conclude that "women are less intelligent than men" (p. 337). In the autopsy study cited by Cernovsky, it was concluded that, when body size is controlled, the male-female difference in brain size is removed but the black-white difference in brain size remains. Cernovsky also ignores much additional data, including that Mongoloid populations have larger and heavier brains than Caucasoids. Here, I review evidence on the relation between (a) brain size and race and (b) brain size and intelligence. Data are also tabulated for personality, speed of maturation, and sexuality, on all of which the Caucasoid average consistently falls between those of Mongoloids and Negroids. This ordering may be explained by a gene-based evolutionary theory of r/K reproductive strategies in which Mongoloids are more K-selected than Caucasoids and Caucasoids more than Negroids.     

Race, brain size, and intelligence: another reply to Cernovsky

Five sets of observations require explanation. Firstly, within both black and white populations there is a small positive correlation between IQ and brain size whether or not there is control for body size. Secondly, racial differences in average brain size occur such that Mongoloids greater than Caucasoids greater than Negroids especially with control for body size. Thirdly, mammals with larger brains relative to their bodies perform better on learning tasks than mammals with smaller brains relative to their bodies. Fourthly, average racial differences on measures of cognitive performance parallel the differences in average brain size. Fifthly, average racial differences on numerous other traits parallel the differences in intelligence and brain size. It is incumbent on scientists to explain these facts.     

Mug shot exposure prior to lineup identification: interference, transference, and commitment effects.

The effects of viewing mug shots on subsequent identification performance are as yet unclear. Two experiments used a live staged-crime paradigm to determine if interpolated eyewitness exposure to mug shots caused interference, unconscious transference, or commitment effects influencing subsequent lineup accuracy. Experiment 1 (N = 104) tested interference effects. Similar correct decision rates were obtained for the mug shot and no mug shot groups from both perpetrator-present and absent lineups. Experiment 2 (N = 132) tested for commitment and transference effects. Results showed that the commitment group made significantly more incorrect identifications than either the control or the transference group, which had similar false-identification rates. Commitment effects present a serious threat to identification accuracy from lineups following mug shot searches.     

Screen memory: its importance to object relations and transference

A screen memory of an obsessive and narcissistic man, reported early in psychoanalysis, both represented and disguised the patient's oedipal conflict, incestuous wishes, and sibling rivalry. It symbolized for him his relationship with his mother and was treated by him, in a repetitive and fetishistic manner throughout treatment, as the reason for his bitterness toward life, his sense of entitlement, his narcissism, and his distrust of women. In the transference, the memory-far from being inert- constantly played an active role in his wishes and disappointments regarding the analyst, and in his fantasied oedipal triumph over him. As the analysis progressed, and after years of treatment, the encapsulated nature of this memory began to give way to the patient's growing awareness of his oedipal wishes, the full range of his feelings toward his mother, and his sense of abandonment by her. The nature of screen memory is explored, including how it relates to a patient's personality and use of the past in general, how it may figure in the development of a person's object relations, and the decisive role it may play throughout a treatment.