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.     

The function of language in parent‐infant psychotherapy

Parent‐infant psychotherapy, a rather new field in psychoanalysis, raises questions of how to conceptualize the clinical process. Previous publications have used semiotic concepts to account for the therapist's non‐verbal communication and investigated the countertransference, including what the baby might grasp of its variations. The present paper focuses on another argument for using verbal interventions to a baby in therapy; they present him with a symbolic order that differs from that of the parent. The qualitative difference between the parent's and the analyst's address is conceptualized by Dolto's term parler vrai. The therapeutic leverage is not the analytic interventions' lexical content but their message that words can be used to expose conflicts. Thereby, one can transform warded‐off desires into demands that can be negotiated with one's objects. The reasons why this address catches the baby's attention are discussed. A prerequisite for such attention is that the infant brain is prewired for perceiving words as a special communicative mode. Relevant neuroscientific research is reviewed in regard to this question. The presentation relies on concepts by Dolto, Lacan and Winnicott and findings from neuroscience and developmental psychology. It also briefly discusses Chomsky's linguistic concepts in relation to these therapies.     

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.     

More Metaphor: Commentary on Paper by Ken Corbett

Beyond the inevitability of countertransference feelings is the question of countertransference enactments. From a two‐person, participant‐observer or observing‐participant perspective, enactments are inevitable. The analyst becomes influenced by the patient (and influences the patient as well) and enmeshed in the patient's internalized interpersonal configurations. Analysis works not by avoiding such action but by analyzing from within the interactional system. Analysts who are different from one another become engaged in different ways, since the person of the analyst is a significant variable. This article, using case examples, explores two analyst‐related variables, age and family configuration, to expand the examination of countertransference enactments and some effects on the analytic process.     

The analytic setting today: using the couch or the chair?

This paper re‐visits Murray Jackson's 1961 paper in the Journal of Analytical Psychology, ‘Chair, couch and countertransference’, with the aim of exploring the role of the couch for Jungian analysts in clinical practice today. Within the Society of Analytical Psychology (SAP) and some other London‐based societies, there has been an evolution of practice from face‐to‐face sessions with the patient in the chair, as was Jung's preference, to a mode of practice where patients use the couch with the analyst sitting to the side rather than behind, as has been the tradition in psychoanalysis. Fordham was the founding member of the SAP and it was because of his liaison with psychoanalysis and psychoanalysts that this cultural shift came about. Using clinical examples, the author explores the couch/chair question in terms of her own practice and the internal setting as a structure in her mind. With reference to Bleger's (2013) paper ‘Psychoanalysis of the psychoanalytic setting’, the author discusses how the analytic setting, including use of the couch or the chair, can act as a silent container for the most primitive aspects of the patient's psyche which will only emerge in analysis when the setting changes or is breached.     

Superiority and Social Interest by Alfred Adler

This paper examines the advantages of a particular way of supervising psychotherapy, namely, in a group setting with a special focus on the supervisee's countertransference experience. Group supervision is conceptualized as much more than presenting a case and getting feedback. Rather, the group is used in all its interactive complexity as it resonates in a myriad of ways to aspects of the case being presented. Furthermore, because of the complexity of conscious and unconscious interactions and reverberations during this process, it is often helpful to have a focus in the supervision. One helpful possibility is to center on the supervisee's countertransference experience and use the group to reflect, amplify, and process that experience. This can be a highly valuable way of helping the therapists increase their understanding of the case and enhance the quality of therapeutic interventions.     

Emotion in an alliance rupture and resolution sequence: A theory‐building case study

Aims: Alliance rupture and resolution processes are occasions for the client to have his or her core interpersonal patterns activated in the here and now of the therapy and to negotiate them with the therapist. So far, no studies have been conducted on emotional processing, from a sequential perspective using distinct emotion categories, in alliance rupture and resolution therapy sessions. This is the objective of this theory‐building case study. Method: This client underwent a 34‐session long, psychodynamic psychotherapy within the context of an open trial. An alliance rupture‐resolution sequence of two subsequent sessions, along with a third control session, was selected from this case and these sessions were rated using the Classification of Affective‐Meaning States (CAMS), an observer‐rated method to classify distinct emotions, according to current emotion‐focused models. Results: The results indicate that the rupture session was associated, above all, with core maladaptive fear, evoked in the actual here and now of the therapeutic relationship, whereas the resolution session was associated with the expression and experience of adaptive hurt as regards biographical issues of the client. Discussion: These results are discussed with regard to the alliance rupture and resolution model and the exploration of integrating client's emotional processing in the model.     

THE CONCEPT OF OBJECTIVE COUNTERTRANSFERENCE AND ITS ROLE IN A TWO-PERSON PSYCHOLOGY

Objective countertransference comprises those feelings the analyst experiences with the patient that are repetitions of feelings from the patient's life outside the analysis. It is viewed as being induced by the patient and is understood in the context of the patient's life, not the analyst's. The concept is used to understand the relationship of some of the analyst's feelings to recurrent interpersonal patterns in the patient's life. It has often been viewed as being incompatible with a two-person psychology. Here, in contrast, it is argued that objective countertransference is only one current within the analyst's total emotional response to the patient, and that it should be conceptualized as a component of a broader two-person psychology. However, the use of objective countertransference as a conceptual tool highlights aspects of the analytic relationship that differ from those emphasized in current two-person models. A case example is analyzed from both perspectives to illustrate their similarities and differences. Although the concept of objective countertransference can enrich the analyst's understanding of certain dimensions of the analytic relationship, it is not a theory of technique and it is not wedded to any particular style of psychoanalytic intervention.     

Cross‐Situational Learning: An Experimental Study of Word‐Learning Mechanisms

Cross‐situational learning is a mechanism for learning the meaning of words across multiple exposures, despite exposure‐by‐exposure uncertainty as to the word's true meaning. We present experimental evidence showing that humans learn words effectively using cross‐situational learning, even at high levels of referential uncertainty. Both overall success rates and the time taken to learn words are affected by the degree of referential uncertainty, with greater referential uncertainty leading to less reliable, slower learning. Words are also learned less successfully and more slowly if they are presented interleaved with occurrences of other words, although this effect is relatively weak. We present additional analyses of participants’ trial‐by‐trial behavior showing that participants make use of various cross‐situational learning strategies, depending on the difficulty of the word‐learning task. When referential uncertainty is low, participants generally apply a rigorous eliminative approach to cross‐situational learning. When referential uncertainty is high, or exposures to different words are interleaved, participants apply a frequentist approximation to this eliminative approach. We further suggest that these two ways of exploiting cross‐situational information reside on a continuum of learning strategies, underpinned by a single simple associative learning mechanism.     

The act of interpretation1

The author understands the interpreting act as an attempt to perceive what happens in the transference/countertransference fi eld and not just what happens in the patient's mind. Interpretation transcends mere intellectual communication. It is also an experience in which analysts’ emotions work as an important instrument in understanding their patients. Interpretation is seen to possess manifest as well as latent content; the latter would contain the analysts’ feelings, emotions and personality. The unconscious content of an interpretation does not inconvenience or preclude the development of the analytic process, but, on the contrary, it allows new associative material to emerge, and it transforms the analytic session into a human relationship. Analysts’ awareness of this content derived from patients’ apperceptions is a signifi cant instrument for understanding what is happening in the analytic relationship, and what transpires in these sessions provides fundamental elements for analysts’ self‐analysis. Some clinical examples demonstrate these occurrences in analytic sessions, and how they can be apprehended and used for a better understanding of the patient. The author also mentions the occurrence of diffi culties during the analytic process. These diffi culties are often the result of lapses in an analyst's perception related to unconscious elements of the relationship.     

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.     

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.     

Segregation of study items in memory determines the magnitude and direction of directed forgetting

When words at study are divided into to‐be‐remembered and to‐be‐forgotten ones, people recall more of the former than of the latter in a surprise memory test for all words. In this study, we also tapped memory for word identity at study (forget or remember) by asking participants to reproduce in memory selected portions of the original words. We found word identity to be parasitic on word reproduction. As a result, there is a noted tendency to recall forget‐words from study as remember‐words in the memory test more than vice versa.     

Full and empty spaces in the analytic process2

In this paper the author discusses two categories of patients which differ in terms of the impact they have in the countertransference. On the one hand, there are patients who create an empty space in the analyst's mind. The response they provoke is a kind of depressive feeling that remains after they leave. The patient may bring dreams and associations, but they do not reverberate in the analyst's mind. The experience is of dryness, a dearth of memory, which may‐at times‐leave the analyst with a sense of exclusion from the patient's internal world. At the other extreme, there are patients who fill the consulting room. They do that with their words, dreams and associations but also with their emotions and their actions. The experience is that the analyst is over‐included in the patient's world. They have dreams that directly refer to the analyst and the analyst feels consistently involved in the patient's analysis. The pathway through which the analyst can understand both these types of patients is via the countertransference or, to put it another way, the analyst's passion. In ‘Analysis terminable and interminable’ Freud suggested that the bedrock of any analysis is the repudiation of femininity. The author believes this statement may be viewed as lying at the crossroads of the discussion about the limits of the theoretical and clinical psychoanalytic formulations which she refers to. In the examples presented the author relates the repudiation of femininity in its connections to the gaps implicit in psychoanalytic understanding.     

Foetal trauma,body memory and early infant communication: a case illustration

This paper presents the complex case of a male patient who started life as an unwanted pregnancy and adoptee in an era of socio‐cultural shame and blame. When able to contact his birth mother later in life, he experienced a number of confronting synchronicities as well as visions which he felt were related to failed abortion attempts and to other pre‐ and post‐natal events. The case material lends weight not only to Freud's, Ehrenwald's and FitzHerbert's assertions that the earliest form of mother‐infant communications is telepathic in nature but that this mode of communication can be retained if emotional trauma inhibits normal developmental processes. Contemporary neuroscience research is presented supporting the hypothesis that emotional memory can become imbedded in the psyche/soma of the foetus. Such memory traces can later emerge into imagery and/or words if the traumatic impingement has been substantial enough and if other defensive strategies are in place. Clinical implications are then suggested regarding analysts’ attention to the emotional conditions underpinning their patients’ conceptions and foetal development; the connection to projective identification components of the countertransference as being aspects of the earliest telepathic mother/infant communication channel and the need for reductive analyses in analyst training programmes.     

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.     

“THESE ANXIETIES ARE NOT MINE”: ADOLESCENCE,THE OEDIPAL CONFIGURATION,AND TRANSGENERATIONAL FACTORS

Part 1 of this paper draws on the film Back to the Future (1985) to highlight various aspects of adolescence, the oedipal situation, and transgenerational factors. The authors then discuss the Oedipus myth and its themes of adolescence, narcissism, identity, acting out, repetition, aggression, and the parent–child relationship, among others. Comments drawn from Winnicott's writing on oedipal issues are discussed as well. As an illustration of some of these issues, in Part 2, the authors present the clinical case of Osvaldo, age sixteen. Transference‐countertransference issues in this treatment are explored in depth.     

Implicit meaning in 18‐month‐old toddlers

A substantial body of evidence demonstrates that infants understand the meaning of spoken words from as early as 6 months. Yet little is known about their ability to do so in the absence of any visual referent, which would offer diagnostic evidence for an adult‐like, symbolic interpretation of words and their use in language mediated thought. We used the head‐turn preference procedure to examine whether infants can generate implicit meanings from word forms alone as early as 18 months of age, and whether they are sensitive to meaningful relationships between words. In one condition, toddlers were presented with lists of words taken from the same taxonomic category (e.g. animals or body parts). In a second condition, words taken from two other categories (e.g. clothes and food items) were interleaved within the same list. Listening times were found to be longer in the related‐category condition than in the mixed‐category condition, suggesting that infants extract the meaning of spoken words and are sensitive to the semantic relatedness between these words. Our results show that infants have begun to construct the rudiments of a semantic system based on taxonomic relations even before they enter a period of accelerated vocabulary growth.     

Actions speak louder

Case material is presented from three analyses in which dramatic, unexpected movements by patients on the couch dominated the analytic hours for long periods of time. The psychoanalytic literature pertinent to this area of acting in is reviewed, and some formulations regarding the shift from verbalization to motor behavior are presented. These center on the proposition that the patients had identified with aggressor parents who regarded actions, not words, as the ultimate conveyers of reality. The analyst's use of countertransference responses as clues to the understanding of the actions is discussed.