A Picture Book of Internal Events: The Colours of Rage and Love

The views on countertransference in psychoanalytic theory and practice have undergone a change within the last fifty years. From being considered an impediment to analysis, countertransference is today looked upon as an important potential for a tentative understanding of what is unconsciously communicated from the analysand to the analyst. This implies that the analyst is susceptible to the unconscious interaction in the transference and the countertransference, and that he/she becomes conscious as quickly as possible of what is taking place. This applies especially to erotic feelings which are often intensified in analyses with patients with a serious psychopathology, as well as in analyses with patients in regressive phases where projective identification is the dominant factor used as a defence and a communication. Opinions differ as regards the question of how to deal with such a situation, especially whether it is right to be candid about the analyst's countertransference feelings towards the analysand, something most would caution against. In an example from an analysis, the analyst describes how he was influenced by an unconscious erotic countertransference. After three years of therapy with a patient with a serious psychopathology, he developed ?motherly” feelings, which he interpreted as reflecting a child's longing for closeness and physical contact. The result was that a few times, he ?forgot” to indicate the end of the session, which was then prolonged, and also that he embraced her on several occasions before she left the session. One year later, he had intense sexual fantasies and dreams about the analysand, which he experienced as both enticing and alarming, and as an impediment to the analysis. He soon became aware of the element of projective identification in the interaction, and by interpreting the analysand's unconscious communication, he regained his ability to maintain an analytic attitude and clear boundaries.     

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.     

Dilemmas and countertransference considerations in group psychotherapy with adult children of alcoholics

This article will explore special leader issues that emerge in psychodynamically oriented therapy groups with adult children of alcoholics. Particular focus will be on countertransference feelings that get stirred up in group leaders and techniques for dealing with some of these special dilemmas. Specific issues include (a) assumption of sameness between the therapist and the patient (the therapist assuming that he or she "understands" because of having also grown up in an alcoholic family); (b) the "will to restore," which may be destructive when the therapist, whose own self-esteem is dependent on the patient's progress in therapy, forces a "rush to recovery" on the patient; (c) other personal issues in the life of the therapist that may also resonate with experiences of the patient; (d) "countertransference goodness and availability" as it affects therapists' abilities to set reasonable limits on their patients, as well as reasonable expectations for themselves; and (e) special issues regarding therapist transparency and self-disclosure.     

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.     

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.     

Paul Gray's narrowing scope: a "developmental lag" in his theory and technique

A cental thesis of Paul Gray's work is that a "developmental lag" pervades modern psychoanalysis in its failure to assimilate and apply knowledge gained about the role of the unconscious ego in intrapsychic life. But Gray himself, it is proposed, has become a victim of a new "developmental lag," of his own construction. As he somewhat single-mindedly pursued the ramifications of his "developmental lag" concept, Gray may have foreclosed on some noteworthy ideas developing around him. The most important example is his claim--herein refuted--that proper interpretive technique can avoid being infused with transference. He also seems to have rejected the theoretical importance of the internalization of the analyst and the clinical usefulness of countertransference. While emphasizing defense analysis, he ignores defenses such as splitting, denial, and disavowal as substantive problems for his technique of close-process attention. Gray's "undoing" of the rapprochement between "ego analysis" and "id analysis" by viewing the matter as an either-or proposition undermines the very real value of his contribution to the field.     

PSYCHOANALYSIS AND PSYCHOANALYTIC PSYCHOTHERAPY

This paper attempts to address the similarities and differences between psychoanalytic psychotherapy and psychoanalysis as practice. Starting from the manifest technical points, which he dismisses as peripheral, the author reaches the position that he considers to be the fundamental area of contention, i.e. the tranference‐countertransference arena. Focusing on the countertransference stance of the professional in this process, the author distinguishes the defining differences of these two approaches, and hopes to show them to be more complementary than antagonistic.     

Critical realism: distinguishing the psychological subjectivity of the analyst from epistemological subjectivism

To clarify the concepts of critical realism, subjectivity, and subjectivism, distinctions are drawn among ontological subjectivism, moral subjectivity, psychological subjectivity, and epistemological subjectivism. Psychological subjectivity, including the ongoing affective life of the analyst, is an essential aspect of the analyst's response to the patient, and may either facilitate or distort an adequate observation of transference and countertransference dynamics and of the psychic reality of the patient. Subjectivism in current psychoanalytic literature involves an argument that there is an "irreducible" subjectivity in the analyst, who is bound to see things from an incorrigibly personal point of view, such that there is no substantial subject-object differentiation between analyst and patient. Issues of authoritarianism in the analyst, or of pathological certainty, should not be confused with the issues of epistemological objectivism. The concept of critical realism or scientific objectivism includes the essential idea that there is no pure knowledge, no complete knowledge, that often evidence is insufficient for knowledge of some aspect of nature, and that care must be to taken understand what is sufficient knowledge in a given area, in this case clinical psychoanalysis. The question is raised whether "projective identification" makes the sorting out of "what comes from whom" impossible. It is argued that when free association is sufficiently facilitated, when there are enough corrections of the distortions wrought by transference and countertransference, when defenses are analyzed, and when sufficient subject-object differentiation is recovered, the analyst can get to know enough of the patient's psychic reality for the therapeutic and scientific purposes of psychoanalysis.     

Feeling like a good psychotherapist — Or a bad one: Critical incidents in psychotherapists' experiences

What makes a therapist feel competent or incompetent in a session, a concept related to the good — or bad — hour, is an implication of what the therapist believes is good therapy and therefore is trying to do — or believes is bad and therefore tries to avoid doing. In an attempt to infer covert processes in therapists, twenty-seven psychoanalytically-oriented psychotherapists furnished written accounts of sessions when they had felt like good — or bad — therapists. Accounts were analysed and interpreted to uncover the varieties of good and bad experiences and their grounds. Resistance and countertransference were found to be critical phenomena. When the therapist was able to cope with such complications, good feelings were generated, and when he was unable, bad ones — provided he became aware of this inability. If not, the therapist acted out patient-specific or unspecific countertransference feelings in ways that made him feel like a good therapist.     

Process‐orientated psychoanalytic work in initial interviews and the importance of the opening scene

From the very first moment of the initial interview to the end of a long course of psychoanalysis, the unconscious exchange between analysand and analyst, and the analysis of the relationship between transference and countertransference, are at the heart of psychoanalytic work. Drawing on initial interviews with a psychosomatically and depressively ill student, a psychoanalytic understanding of initial encounters is worked out. The opening scene of the first interview already condenses the central psychopathology – a clinging to the primary object because it was never securely experienced as present by the patient. The author outlines the development of some psychoanalytic theories concerning the initial interview and demonstrates their specific importance as background knowledge for the clinical situation in the following domains: the ‘diagnostic position’, the ‘therapeutic position’, the ‘opening scene’, the ‘countertransference’ and the ‘analyst's free‐floating introspectiveness’. More recent investigations refer to ‘process qualities’ of the analytic relationship, such as ‘synchronization’ and ‘self‐efficacy’. The latter seeks to describe after how much time between the interview sessions constructive or destructive inner processes gain ground in the patient and what significance this may have for the decision about the treatment that follows. All these factors combined can lead to establishing a differential process‐orientated indication that also takes account of the fact that being confronted with the fear of unconscious processes of exchange is specific to the psychoanalytic profession.     

The emotional impact of treating child abuse

The author agrees with the need for pastoral intervention in child abuse and neglect, but warns that pastors need to be prepared to handle the intense emotional effects that result. The emotional impact of treating child abuse and neglect is examined under the rubric countertransference. Three sources of countertransference are outlined: identification with the child, identification with the parent, and encountering resistance. Finally, ways to cope with countertransference engendered by treating child abuse and neglect are explored. The need for quality supervision is especially stressed.     

Freud, Dora, and the maid: a study of countertransference

Early advances in psychoanalytic knowledge, profound though they were, were incomplete structures to be built upon, modified, and partially discarded. In addition to errors due to insufficient knowledge, Freud's difficulties with Dora stemmed from countertransference. Dora's transference included an identification with a governess/maid. Important oedipal role played by a nursemaid in Freud's life made him vulnerable to being left by Dora. The maid, Monika, "the prime originator" of Freud's neurosis, seduced him, chastised him, and taught him of hell. In his self-analysis she was associated with Freud's mother who left him when she gave birth to his sister. When he was two and a half years old, Monika was discharged and jailed for stealing. I suggest that Freud's attraction to Dora revealed itself in his libidinal imagery of the treatment and his premature sexual interpretations, the effects of which he misjudged. Defending against his attraction, he pushed her away from him, did not act to keep her in analysis or allow her to reenter analysis later. In addition, since Dora had left him as he must have felt his childhood nursemaid had, he reacted as if she were that maid. Hurt, saddened, and angered, he used reversal and deserted her, thus damping his feelings.     

Psychoanalyst's Values and Countertransference

On the subject of countertransference we attempt to establish a line of continuity between Freud's own expression "blind spot" and Fromm's idea of "counterattitude". It is pointed out that both expressed the idea of the analyst's unconscious as an "instrument" for understanding the patient's unconscious. It follows that the decision to openly use or not to use countertransference in analysis also depends on the concept we have of it and on its extent. The psychoanalyst's real and illusory values and his convictions with regard to human nature influence the countertransference and the analytic relationship. Analytic listening itself may be distorted by it. We must be highly aware of this to avoid enclosing what the patient says in a theoretic scheme. What is needed, therefore, is an open theoretic scheme, more oriented towards understanding than interpretation. Aspects of analytic communication and of the relationship between language, thought and insight are examined. A humanistic point of view is assumed in distinguishing between the transferral and the real plane, and the reasons behind the legitimacy of such a distinction are expounded.     

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.     

Technique and countertransference in Freud's analysis of the Rat Man

Freud's records of his treatment of the Rat Man constitute a unique document in the history of psychoanalysis. Through the years different analysts have used these records to support different theories about analytic technique. Certain non-interpretive interventions of Freud's have especially aroused their interest, and many reasons have been put forward to "explain" Freud's behavior. One reason never yet advanced and documented is that a countertransference tension may have been involved in one of these instances. This is surprising, since countertransference is a necessary part of every analysis. Evidence is presented that Freud's behavior may indeed have been under the sway of countertransference. Some recently discovered details concerning his early life are discussed as constituting a plausible background for ths countertransference enactment.     

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.     

The analyst's countertransference to the psychoanalytic process1

There is countertransference, not just to individual patients, but to the process of psychoanalysis itself. The analytic process is a contentious topic. Disagreements about its nature can arise from taking it as a unitary concept that should have a single defi nition whereas, in fact, there are several strands to its meaning. The need for the analyst's free associative listening, as a counterpart to the patient's free associations, implies resistance to the analytic process in the analyst as well as the patient. The author gives examples of the self‐analysis that this necessitates. The most important happenings in both the analyst's and the patient's internal worlds lie at the boundary between conscious and unconscious, and the nature of an analyst's interventions depends on how fully what happens at that boundary is articulated in the analyst's consciousness. The therapeutic quality of an analyst's engagement with a patient depends on the freeing and enlivening quality, for the analyst, of the analyst's engagement with his or her countertransference to the analytic process.     

Movement,Stagnation, and Renewal of Movement in the Therapeutic Session

This article examines the term potential space in the therapeutic session and the pathological situations in which this space collapses. The article suggests that such failures occur in the weaving of transference and countertransference between patient and therapist. The potential to free and repair this space can be found in emotional thinking that occurs between the therapist and the patient. When the object-therapist can play or dream, the infant-patient can do so too. Thus, a new shared experience may be created in the therapeutic session and in the patient's mind. This article reviews the different types of collapse of the potential space, as suggested by Ogden, and offers a new additional type.     

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.     

KLEIN,FERENCZI AND THE CLINICAL DIARY

The aim of this article is to revisit Ferenczi’s Clinical Diary (1932) to investigate the influence he had on Melanie Klein’s work. It starts from the position that insufficient recognition has been given to Ferenczi’s contribution to Klein’s body of work and her professional development. Her analysis with Ferenczi lasted 5 years, a relatively long analysis for the period. It explores his influence in three specific areas: the importance of raw and early emotion in the maternal bond, the importance of freedom and authenticity in the analytic relationship, and finally the use of transference and countertransference feelings. Ferenczi’s ill-fated experiment with mutual analysis will be discussed as it opened up a route to explore the analytic relationship, with important consequences for the future development of psychoanalysis.