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.     

Transcendental empathy in the therapeutic encounter

Abstract

The experience of many therapists suggest that most contemporary conceptions of empathy underestimate empathic potential. This paper describes deep or transcendental empathy as a more direct knowing of the client's world. The author examines the epistemic process or the activity of knowing of transcendental empathy by considering two broad forms: transcendental countertransference and psychological resonance. Difficulties and distortions are explored as well as characteristics of an individual that correspond with deep empathy.     

Countertransference as Projective Identification

SUMMARY

While all countertransference reactions call upon the therapist to examine his/her internal family and unresolved issues, many instances of countertransference can best be understood as originating from and replicating and clients' internalized object relations. In this way, countertransference can be likened to projective identification. By processing countertransference as a form of projective identification the couples therapist can more effectively comprehend and work with important relationship problems. This article outlines the process of analyzing and responding to these kinds of countertransference reactions.     

Event countertransference and vicarious traumatization: Theoretically valid and clinically useful concepts?

The event countertransference and vicarious traumatization concepts have been introduced in the 1990s to describe the adverse emotional impacts that working with severely traumatized patients may have for the helping professional. These concepts are increasingly popular among trauma therapists. The present paper critically discusses the empirical evidence, theoretical validity and clinical utility of both concepts. Vulnerable trauma therapists may too eagerly embrace the event countertransference and vicarious traumatization perspectives as a cover up for their own failures. Interpersonal communication theory is suggested as a more useful conceptual framework for the analysis of countertransference reactions in therapies with severely traumatized patients.     

Playing Together: DIR and Child Psychodynamic Therapy

ABSTRACT

This article describes the integration of the developmental, individual difference, relationship model (DIR) and relational child psychodynamic therapy. DIR is an effective treatment for many children with uneven development, not only for those on the autistic spectrum. The importance for child psychodynamic therapists to understand individual differences, as delineated by occupational and speech/language therapists, and to include parents within the treatment will be discussed throughout this article and in a particular case. An understanding of individual differences makes psychoanalytic formulations, especially about the body, more accessible and actionable. Overlooking the contribution of individual differences to a child’s play and development has consequences for progress in treatment. Together, DIR and child psychodynamic therapy can most effectively integrate “psyche” and “soma” (Winnicott, 1949). The child psychodynamic therapist’s particular expertise, in such areas as countertransference enactments and unconscious meaning, crucially contributes to this integration.     

The Mastery of Countertransference or Mynothaur's Labyrinth

This paper considers the fundamental change introduced by Ferenczi in 1919 by proposing the use of countertransference as an instrument. Basically it reconsiders the concept of analytic neutrality; mastery of countertransference is reached through tolerating it, overcoming resistances against it, demanding a very intense involvement of the analyst, as opposed to the image of the surgeon or the mirror. The paper analyzes the implications of this position for psychoanalysis. It places these concepts in the scientific and personal context in which it was written, then follows the later developments of these ideas in Ferenczi's own work, as well as in that of some other authors, and comments on the effects of these ideas on the psychoanalytic movement. Finally it poses some questions regarding our present use of countertransference in clinical work, with two brief vignettes highlighting these points.     

The Psychoanalysis Between Sándor Ferenczi and Elizabeth Severn: Mutuality,Unconscious Communication,and the Development of Countertransference Analysis

ABSTRACT

The psychoanalysis between Sándor Ferenczi and Elizabeth Severn was characterized by a controversial counterference analysis, in which the analysand, Severn, took an active lead. She can be seen as the co-creator of the Countertransference Analysis. In the two-person analytic dialogue that Severn and Ferenczi created to resolve the intractable therapeutic impasse in their analytic relationship, a dialogue of the unconscious emerged. Severn believed she was attuned to Ferenczi’s unanalyzed countertransference reaction to her. They had a special kind of relationship where attunement was at an unconscious level. In a sustained analytic encounter, she helped Ferenczi retrieve the experience of being sexually abused, which was the unconscious derivation of his negative countertransference to Severn.     

The omnipotent clinician: A potential source of iatrogenesis

Clinicians who do not acknowledge their delusions of omnipotence can do harm to their patients when these feelings are acted out in the treatment. In breaking the frame of the therapy these clinicians inadvertently create the potential for iatrogenic treatment reactions. When practitioners knowingly practiced outside the boundaries of the established wisdom and theoretical knowledge of the profession, an ethical problem arises. Under such conditions, it can be said that the practitioner consciously jeopardize his patients emotional, and at time, physical well-being. Justifying their behavior, some therapists ironically assert that they are morally superior to others who adhere to the rules of treatment. As Langs note, when boundaries are blurred therapists often unconsciously dumps their pathology into the patient who must then struggle to contain the toxic feelings of both parties. Resolution to this type of countertransference may come through greater awareness of the therapeutic community at large as to the dangers of acting out feelings of omnipotence in the treatment.     

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.     

Potential Sources of Countertransference Among Religious Therapists

Relational approaches to counseling emphasize the monitoring of countertransference responses as a crucial component in the therapeutic process. Six potential sources of countertransference are discussed that are specific to religious therapists and which may be easily overlooked. These responses are related to the therapist's identification with a community of faith, and they may have a detrimental impact on therapy if they are not monitored. A brief overview of the historical and contemporary understanding of the concept of countertransference is presented. Recommendations are offered for the effective management of these countertransference responses.     

Braving the erotic field in the treatment of adolescents*

Abstract

The psychoanalytic literature on erotic transference and countertransference in adolescence is notably sparse, despite the centrality of the developing sexual body/mind. Erotic feelings in the consulting room with an adolescent can feel taboo, causing the analyst to avoid the immediacy of these feelings. Excessive timidity on the part of the analyst can limit the growth of the capacity for containment of sexual feelings and yield what I term ‘erotic insufficiency’ in our work with adolescents. I offer clinical material from a period of erotic transference and countertransference with a 12-year-old boy to consider these ideas. Further, I suggest that the very terms ‘erotic transference’ and ‘erotic countertransference’ can feel defensively remote and antiseptic. I suggest that ‘erotic field’ better captures the subtle, nuanced interplay of feelings.     

Research & clinical exchange

Abstract

Question: Family therapists are often called upon to do consultations to schools about children having social and educational difficulties. In what ways is the family therapist's role different when he or she is called in to consult as an “outsider’ to the school system about a particular child whom he or she does not know, compared to being called upon by the school for advice about a child who is already being seen in treatment by that therapist?     

The ghost in the group room: countertransferential pressures associated with conjoint individual and group psychotherapy

Conjoint individual and group therapy is a commonly used, effective psychotherapeutic treatment. The relationship between the conjoint therapists significantly influences the treatment. This article examines countertransference dilemmas of the group and individual therapists arising from the real and fantasied conjoint relationship. Case examples illustrate specific countertransference dilemmas. Therapists are encouraged to consider the possibility of difficulties with each potential conjoint treatment. Consultation and supervision are recommended to help the conjoint therapists identify and manage countertransference pressures.     

Naturalistic Observation in Psychoanalysis

Abstract

The writer advocates a naturalistic approach to psychoanalysis. The Jane Goodall technique is an application of this approach in which the analyst studies the analysand as a naturalist would study and document the behavior of an animal species. The technique is particularly useful during difficult phases of treatment, and is sometimes quite powerful. Case material is presented showing how use of the technique can identify various forms of emotional induction used by analysands, the kinds of inductions which often produce countertransference reactions. Topics discussed include projective identification, supervision, and nature of psychoanalytic facts.     

Countertransference and Projective Identification Revisited and Applied to the Practice of Group Analytic Supervision

Countertransference and projective identification are two concepts that are very useful when describing the dynamics of atmospheric processes and also more explicit issues in supervision groups. Researching both aspects of interpersonal relationship helps the group analyst to better identify and understand the emotional reactions in the group experience. However, it is important to see the different approaches of these two concepts. Projective identification deals with keenly involuntary and often unperceivable ego-syntonic actions and unconscious thinking related to early identificatory feelings.

While other instances of countertransference are often comparatively easy to perceive, projective identification is considerably more difficult to recognize and therefore more difficult to work through. Concrete examples of countertransference and projective identification predominating countertransference respectively, as well as to commonly occurring, mixed forms of these emotional answers to supervision groups illustrate this.     

The Application of Therapists' Maternal Capacity in Prerepresentational Body-Based Transference and Countertransference

Abstract

The paper explores the maternal capacity of therapists in working with patients for whom developmental deficits render the traditional verbal tools of psychoanalytic treatment ineffective, particularly in the early phases of treatment. Viewed from the perspective of a mother in relation to an infant, the therapist's role is seen as providing a safe holding environment, often in non-verbal ways, for the patient. The capacity of male therapists to access their maternal capabilities is considered. The manifestation of preverbal transference and counter-transference is explored through the presentation of relevant clinical material.     

Transference in Gerontologic Group Psychotherapy: Studies in Gerontologic Human Relations IV

For a number of reasons, we decided to bring three long-term, open-ended psychodynamic therapy groups to termination. We examine the process that began with the announcement of the change to a time-limited format, and concluded with the termination of the group. The transition had a powerful impact on the members and the group-as-a-whole. The therapists used supervision to deal with the intensity of the group process and the countertransference demands posed by the transition. Groups facing a similar change due to economic pressures may benefit from these observations.     

Response to MacIntosh’s Systematic Review of Psychoanalytic Couple Therapy: A Brief Note from the Classical Perspective

ABSTRACT

Working with couples from a classical perspective can be thought of as an oxymoron, unlike working from object relations and relational viewpoints, often seen to be the more natural fits. This article offers a fresh look at those parts of the classical perspective that relate very clearly to working with two partners in a couple. Freud’s theories in Three Essays on the Theory of Sexuality (1905) and On Narcissism (1914a) provide theoretical background for the work. Concepts such as transference (between partners, between the partner[s] and the therapist) and countertransference are shown to be manifested in complex ways with couples. Being mindful of unresolved developmental issues—for example, Oedipal and separation-individuation issues—which may have played a part in partner choice and in the resulting problems, allows the therapist to offer deep interpretations of within- and between-partner conflicts. Interestingly, unresolved Oedipal issues, particularly, may form an important part of the countertransference.     

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.