Psychotherapeutic work with refugees: Understanding the therapist's countertransference

Abstract

Most therapists are chosen to work with refugees because they speak the language or come from the same cultural or racial background and/or have had experiences which resonate with those of the client. They are often people who can easily understand the clients' experiences, which creates interesting and potent therapeutic dynamics. They can offer a great deal of support to the person, but often with the high risk of over-identification. This paper is an attempt to examine from the therapist's perspective the complex dynamics involved in working with refugee clients. It is a collection of thoughts and feelings expressed in psychotherapeutic and supervisory work by different types of refugee mental health workers. It is an attempt to understand the therapeutic relationship further by focusing on the therapist's psychological response to the client. The paper will outline briefly some of the common themes reported by refugees, but the primary aim is to focus on the therapist's countertransference feelings. Countertransference in this context is defined as a personal psychological response, as well as consisting of socio-political components.     

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.     

Regression in the countertransference: working with the archetype of the abandoned child

Abstract :  The author describes briefly some experiences of his sense of non-existence as an analyst in relation to five patients. He considers the possible countertransference significance of these experiences and puts forward a hypothesis that his sense of non-existence as an analyst might be a clue to regression in the patient to the anxieties of a baby without a mother, even though other clinical evidence of regression might be lacking. Referring back to Jung's early formulation of transference and countertransference as aspects of the unconscious identity shared between analyst and patient, he further develops his hypothesis, suggesting that, in the cases he has presented, analyst and patient were relating through shared dynamic roots in the archetype of the abandoned child. He briefly demonstrates how the understanding thus achieved was of clinical use in the analyses of the patients he has presented.     

In the last analysis: archetypal themes in the analysis of an elderly patient with early disintegrative trauma

Aspects of the analysis of an elderly patient with early disintegrative experiences are described: separation anxiety, an internalized attack upon vitality, and the fear of dependency were prominent features of the transference/countertransference relationship, while the search for meaning as death drew nearer continued to be the central theme. The patient's many dreams reveal a wealth of images whose complex interlinkings provided evidence of a heightened and energized individuation process aiming at the integrity of personality.     

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.     

A narratological methodology for identifying archetypal story patterns in autobiographical narratives

Based on Jung's definition of archetype the concept 'archetypal story pattern' is developed as well as a research method drawing on narrative analysis and biographical research to identify these archetypal story patterns in life stories. Jung pointed out that personal myths, archetypal patterns found, e.g., in mythology, can govern the life course of individuals unconsciously. In the Theory of Narrative Identity comparable concepts have been mentioned but were never fully developed. In my research I try to combine Jung's concept of the archetype with the elaborated methodology of narrative analysis. Archetypes can manifest as narratives and the identity construction of a person via narrating the life story can be influenced or even totally structured by archetypal stories which give a specific form as well as a specific meaning to the person's identity. The method of extracting an underlying archetypal pattern from an autobiographical narrative is demonstrated. The results of the research on 20 autobiographical interviews and the inherent archetypal patterns are summarized. The major aim of this paper is to describe in detail the application of a well established method of the social sciences on a key concept of Jungian psychology to show that these concepts can be integrated into recent research frameworks of academic sciences. On the other hand it shows that Jungian concepts can be investigated through established and well defined research methods in empirical research settings.     

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.     

Principle of organization: a dynamic-systems view of the archetype-as-such

The personality is a dynamic system. Like all other dynamic systems, it must be self-organized. In this paper I focus upon the archetype-as-such, that is, upon the essential core around which both an archetypical image and a complex are organized. I argue that an archetype-as-such is a pre-existing principle of organization. Within the personality that principle manifests itself as a psychological vortex (a complex) into which we are drawn. The vortex is impersonal. We mediate it through myths and rituals or through consciousness. In this paper I show that Jung's intuition about the archetype-as-such is supported by recent science. I evaluate other concepts of the archetype. My concept is different from that proposed recently by Saunders and Skar. My concept allows each archetype-as-such to be defined precisely in mathematical terms. It suggests a new interpretation of mythology. It also addresses our spiritual experience of an archetype. Because the archetypes-as-such are fundamental to the personality, the better we understand them the better we understand our patients. The paper is grounded with clinical examples.     

Countertransference and the Erotic

Eros is like a huge spark that ignites our passion and then confronts us with the problem of living out this fire in ordinary space and time. What do we each know of this spark, this flame? Who or what was it’s object? Where have we felt this force for unity in ourselves, with another person, with life itself? Where are we unlived erotically? Where are the chinks in our erotic life? In focusing on the erotic in clinical work, we usually begin with the analysand’s transference. I want to explore eros in the life of the analyst for our relation to eros influences the clinical work we do. When eros is constellated, two possibilities of relationship present themselves: to an actual other who must be reckoned with as real, and to a psychic content, equally real, which we do not invent or control. How do we experience this electricity? What is our desire like? What does it take us back to, and toward what unseen purpose does it propel us? Eros brings with it a sense of purpose, of going somewhere important, something that enlists body, soul, and spirit.     

Tyrannical omnipotence in the archetypal father

This paper sets the archetypal relationship between the tyrannical, devouring father and his sons in the context of a disjunction in the parental couple (syzygy) whereby the role of the maternal feminine is eclipsed and excluded. This is shown to originate in an omnipotent defence against infantile dependence on the mother. Successful liberation from the father's tyranny requires the restoration of mutuality between the internal couple. Although the main focus is on the internal world (and a detailed clinical illustration is given, showing the working out of this process in the analytical relationship), reference is also made to political tyranny, attitudes to the control of Nature by technological means and patriarchal forms of masculinity. The Chronos myth is amplified through the use of two modern variants in the films The Terminator and Star Wars.     

Power cut in the countertransference

This paper is an attempt to describe and understand a certain type of defence that I shall call a 'power cut' because of its crippling and anti-relational nature. I will take extracts from a baby observation to show how this type of defence can be adopted from the beginning of life, followed by vignettes from my work with a young child and an adult patient which addresses the particular kind of difficulty the analyst has to face with patients who resort to such a defence. I am arguing that while defending from another, the patient is able to destabilize not only the connection between himself and this other, the analyst, but also that between the analyst and the analyst's internal world. I understand this as the violent re-enactment of the patient's uncontained and split off primitive experience. I see recovery from 'power cuts' as the main challenge for the analyst who is helping the patient to recover from an early failure in containment which has led to defective splitting. Only when the unthinkable experience of 'power cut' can become an experience that can be lived through and converted into a deintegrate, may integration be achieved.     

Some images of the analyst's participation in the analytic process

This paper was originally presented at a workshop (with G. Atwood and S. Parks) on The analyst's participation in the analytic process'. The analyst's 'vulnerability' is highlighted, with specific reference to the ideas of Winnicott, Searles and Jung. Some personal metaphors for the nature of the analytic engagement are offered, as is the image of the 'troubled analyst' from a patient's dream. The burden and necessity of the analyst's participation are emphasized.     

Experiencing whole type: living into the archetypal Self

Expanding on Jung’s use of the role of the superior and inferior functions, Angelo Spoto advances a new typological model based on ‘whole type’ that utilizes a typological perspective on the archetypal Self. In this new model four cognitive modes taking superior positions are developed in the first half of life and four cognitive modes taking inferior positions are encountered in the second half of life. This model indicates that type development and type dynamics take place through the holding of the tension of opposites between superior and inferior functions, helped by the transcendent function operating differently in the first and second halves of life. Specifically, in the first half of life, the transcendent function produces a tertium that moves typological development along to consolidate an ego-pattern. In the second half of life, the transcendent function takes the individual into encounters having to do with an appreciation of sacrifice, transformation, and symbol-making, as the personality advances towards a greater awareness of wholeness, by way of the inferiors.     

Transference, countertransference and mentoring: the ghost in the process

The concepts of transference and countertransference are used in this paper to explore some of the deeper dynamics of the relationship between mentor and mentee; it is hoped that this perspective gives a useful gaze on the mentoring process. Three aspects of the relationship are examined. The first is an exploration of the ambivalent relationship of mentor and mentee to the third party at the meeting--the organisation. The second is an examination of the mentoring process where transference theory illuminates aspects of the power, authority, control, affiliation and resistance in the freezing, unfreezing and refreezing aspects of the ebb and flow of transference and countertransference. The third aspect is an examination of the relationship between mentor and mentee with a glance at the narcissistic impulses of altruism and a sceptical brush with the dominant image of unconditional positive regard that is commonly supposed to flow from mentor to mentee.     

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 fear of the body in psychotherapy

This paper identifies the fear of attending to and engaging with the patient's body and the therapist's body, regardless of therapeutic orientation, as a topic rarely explored in books and articles but pervasively experienced because of the cultural norms brought to the consulting room. It explores how we might name the constituent parts of this fear and describes how they inter-link. A case study then exemplifies learning about and transforming such fear in both patient and therapist. Finally, the paper offers suggestions of how therapists might increase their awareness and turn this fear into a tool which extends their range of skills.     

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.     

Tricking into the Position of the Outcast: A Case Study in the Emergency and Effects of Communist Power

This paper is an experiment in understanding the logic of communism from the perspective of political psychology. In Hungary, communism became a means for transforming the entire psychical make-up of a country in a moment of reduced intensity of consciousness, a transitory or liminal period, produced by the Second World War. In liminal conditions, unconscious impulses are set free that are channeled by the use of archetypical images. As an empirical case study, this paper discusses the speeches of the first post-war Hungarian Communist Party leader, Matyas Rakosi, delivered in the years immediately after the devastations of the war, in an effort to discern the techniques and mechanisms by which the Communist Party managed to capture the allegiance of a large segment of the population. The analysis of these speeches and their effects indicates that communism was not merely a consequence of Soviet occupation, and therefore the withdrawal of the troops did not eliminate the lasting, mostly hidden but still predominant, effects of communism on the countries that were in its grip.     

Dissatisfied psychotherapy patients: A tentative conceptual model grounded in the participants' view

Usually, between 5% and 20% of psychotherapy patients are dissatisfied with their treatments. This naturalistic study explores seven clearly dissatisfied patients' view of the therapeutic process and outcome. Interviews at termination of psychoanalytic psychotherapy and at a 1.5-year follow-up were analysed to create a tentative conceptual model of patient dissatisfaction using grounded theory approach. At the core of the model is an experience of abandonment by a therapist felt to be insufficiently flexible, a therapy lacking intensity, and links missing between therapy and everyday life. Dissatisfied patients lacked confidence in their relationship with the therapist, described their therapists in negative terms and concluded that their therapies lacked direction. They wanted more response from the therapist. Paying greater attention to the patient's emerging dissatisfaction may prevent lasting disappointment, unnecessary continuation of fruitless treatment, and probably increase efficiency.