Utilizing artistry in a therapeutic relationship

Abstract

In many humanistic approaches, therapeutic change involves utilizing the relationship between the client and therapist as a tool for personal growth. Like any relationship, the therapeutic relationship is one that is co‐created between those engaged in it, namely, the client and the therapist. Utilizing this co‐created relationship requires a sense of artistry on the part of the therapist. A therapist must be willing to engage in this meaningful relationship with the client. A therapist must also be aware of the personal values that he or she brings into therapy, and how they influence the therapeutic relationship. Finally, a therapist must acknowledge the power that the therapist and the client possess in the relationship, and understand how that power can be used to validate and invalidate the therapist's and the client's personal meanings. These aspects of therapeutic artistry are discussed and the use of therapeutic artistry in Eron and Lund's (1996) narrative solutions approach is presented.     

Effects of Role Expectations on Clients' Perceptions of Disclosing and Nondisclosing Counselors

The authors tested the hypothesis that regardless of whether a counselor self-discloses, a client's perceptions will be more favorable when the counselor's behavior is congruent with the client's precounseling expectations than when the client's expectations and the counselor's behavior are incongruent. Before listening to an excerpted interview, participants (a) were led to expect that counselors self-disclose, (b) were led to expect that counselors do not self-disclose, or (c) were given no expectation regarding counselor self-disclosure. Participants then listened to stimulus audiotapes in which the counselor did or did not reveal personal information. Dependent variables were participants' perceptions of the counselor on three social influence dimensions and two therapeutic relationship dimensions. Results indicated that the disclosing counselor was viewed more favorably than was the nondisclosing counselor, participants' expectations notwithstanding.     

Countertransference as a complex tool for understanding the patient in psychotherapy

This paper shows some of the complexities of the analytic relationship and processes in psychotherapy by focusing on the concept of countertransference. The development of the related concept of transference is briefly outlined and the history of the concept of countertransference and its place in the practice of psychoanalysis is presented. A clinical example is provided to illustrate some of the complexity of the issues that arise when the countertransference is used as a tool to understand the patient. Attention is drawn to the importance of sustaining the countertransference response until the transference aspects and the patient's unconscious communications have been recognised and understood. It is only at this point that an interpretation meaningful to the patient can be made.     

Working with Adopted Clients

When working with clients who have been adopted, therapists must be alert to the fact that lack of information about the birth mother and feelings of rejection can lead their patients to use defense mechanisms and create fantasies that will affect the transference and countertransference. Using examples from both agency and private practice, this article helps the clinician understand how adoption has affected their client's lives both in and out of the therapy room and suggests ways to modify treatment with a greater sensitivity to adoption issues.     

Overcoming My Model of Goodness as a Psychotherapist

Summary

The case of Tina is presented to examine one therapist's countertransference issues with a female client who had features of a Borderline Personality Disorder. The therapist's emotional reactions to this client's raw expression of anger and frustration are explored. The discussion also emphasizes the struggle of the therapist in resolving her discomfort with this client and in setting therapeutic boundaries.     

Reflections of Authority in Psychotherapy

Abstract

This article examines how therapists' expressions of authority affect the psychotherapeutic relationship. The article is based on the proposition that the clinical practitioner is always in a position of authority, regardless of how the role of authority is conceptualized within treatment approaches. The article includes an investigation of power and authority differentials within and across therapeutic approaches that espouse both hierarchical and egalitarian authority relationships. Process material from these approaches is analyzed to identify therapists' exercise of authority within these two approaches. It is suggested that researchers and therapists might use a heuristic research design to study the conveyance of therapeutic authority to identify whether dimensions of authority are overtly or covertly expressed, and whether or how such expression might affect practice and a client's exercise of personal authority.     

A Case Study: A Discussion of Depression,Ambivalence, Attachment,and Culture Portrayed in the Therapeutic Environment

ABSTRACT

This paper uses object relations theory to conceptualize and manage the complexities of a home-based case that was followed for a period of six months. It discusses maternal depression in relation to the caregiver role, self-harm, and self-determination. The client's ambivalence issues are addressed, with particular emphasis on transference and countertransference issues in the relationship and the use of transitional space and objects. Also discussed is the effect of maternal depression and ambivalence on mother-infant attachment, with the introduction of interaction-guidance as a treatment modality. An examination of cultural differences and the concomitant ethical implications that arose in the treatment process is provided. Finally, therapeutic implications and reflexivity are addressed.     

Chickens or eggs? A follow‐up case study exploring links between physical and psychological impact of Tourette's syndrome and sexual abuse

This follow‐up case study highlights the complex relationship when working at the interface between physical and psychological symptoms. The paper draws upon conversations between an ex‐client and myself, held seven years after the end of our six year therapeutic relationship. Conversational interviews, based upon social constructionist beliefs, led to an unexpected exploration of the client's subsequent diagnosis of Tourette's syndrome (given several years after the end of therapy) and evolved into a struggle to reach a shared understanding of how she now makes connection between her problem with eating in public, her neck and facial tics, and childhood sexual abuse. Our research relationship provided both of us with a rare opportunity to reflect upon how she had made meaning of her counselling and its outcomes. The paper draws attention to the impact of counselling and therapy discourses concerning sexual abuse on the work we did at the time and asks how that work might be different today. It also helps us understand the layers of complexity and ambiguity contained within the client's stories. This multi‐layered case study represents the overlap and ‘messiness’ that mirrors the ‘lived experience’ of the persons involved, and provides an example of how co‐constructed research conversations can evoke stories that create meaning as they are told.     

Countertransference and changes in the conception of the psychoanalytic relationship

Abstract

The concept of countertransference has a long history in psychoanalysis. This paper sketches the phenomenon referred to by countertransference and the development of the concept, from being signs of disturbance in the analyst to an important road to knowledge about the patient's inner life. The complexity of the questions discussed today – how to understand the concepts of neutrality, abstinence, and empathy; the relative subjective mutuality and symmetry of the analytic situation; the analyst's enactments and self-disclosure of feelings – reflects the complexity of the contemporary view of the patient–analyst relationship. In conclusion, the author presents a model illustrating the disturbing and informative aspects of countertransference together with the conceptual relationship between countertransference on the one hand and empathy and projective identification on the other. Finally, by differentiating between intuitive and irrational levels of functioning, an integrated model for countertransference is presented, synthesising the essence of the concept as it is used today.     

Working Through Countertransference: Navigating Between Safety and Paranoia for a Client With Complex Trauma History and Borderline Personality Organization

The aftermath of complex trauma deeply impacts one's self-organization and interpersonal relationships, often resulting in clients who present to therapy with borderline characteristics and are typically labeled as difficult to treat. Further clinical complications with paranoid features may quickly place the therapist at a loss with respect to managing perceived and/or actual threats to client safety. Using psychodynamic theories, especially Kleinian understandings of psychosis and Winnicottian approaches to early disturbance and its impact on the emergence of self, this article provides a detailed case illustration that explores how a critical reflection of countertransference as “enactment,” “communication,” and “imagination” can help the therapist to understand the client's unconscious symbolic psychic struggles and to guide treatment selections in the therapy process.     

The many faces of self-harm

This paper explores why open dialogue on the subject of erotic transference and countertransference is so difficult and attempts to offer an understanding of these phenomena which might enable counsellors to work more confidently with it. It also briefly examines the author's own research on therapists' thoughts and experiences of erotic transference, seeking to differentiate between inappropriate sexual contact between clients and therapists and the experience of erotic transference in the context of therapy as a reworking of the Oedipal relationship. Case examples illustrating the experience of countertransference within the therapeutic situation and how its presence can act as a help or a hindrance are offered. The paper concludes by examining the need to reflect on the erotic transference in therapeutic work and proposes its usefulness as a therapeutic tool. Suggestions about how the erotic transference can be managed to therapeutic effect are also explored.     

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.     

Facilitating the client's experience of relational depth in counselling and psychotherapy: A thematic review

Aim

There is increasing interest in relational depth and its relevance and benefits for clients receiving therapy in a number of different therapeutic orientations. This research set out to draw together the available evidence from a wide range of therapies about clients' experiences of relational depth. The aim was to identify approaches that create the conditions where relational depth is more likely to be facilitated. The research focused on clients' views, given the increasing emphasis on their experiences in therapy.

Methodology

A systematic search of papers published in English between January 1996 and September 2022 was conducted using EBSCO Host, Google Scholar and citation chaining. Twenty-seven papers met the inclusion criteria, and a thematic analysis was conducted on these papers.

Findings

Six themes were identified: (1) establishing dialogue with the client's inner world, (2) working with attachment in therapy, (3) responding sensitively to the client's beliefs and values, (4) deepening the client's understanding of the therapist, (5) addressing ruptures in therapy and (6) the client's role in meeting at relational depth.

Conclusion

Facilitating the client's experience of relational depth can support and enhance many aspects of therapeutic practice and in itself may contribute to healing. Therapists who offer warmth and genuine engagement are more able to build confidence and trust, as long as these conditions are received by their clients. It is the clients who ultimately decide whether or not to share their deepest feelings.     

��bertragung und Gegen��bertragung

The article presents a modern concept of transference and countertransference in the context of psychodynamic psychotherapy. The concept of transference is contrasted with the therapeutic relationship and the work relationship. The main part of the article discusses the concept of countertransference with the typical countertransference complications and considerations about countertransference and interpretation technique. The advantages of a countertransference-focused interpretation technique, especially in the case of seriously disturbed patients, are described in detail.     

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.     

The internet and psychotherapy with adolescents and preadolescents: some thoughts about the countertransference

Technological advances in the computer and communication fields (the internet, social networks, virtual realities,) have created a world in which most of our patients, especially pre-adolescents and adolescents, are immersed. In this paper we think about the meaning of ‘digital natives’ communication in the framework of the therapeutic relationship and the resulting countertransference. Interactions through technology, we argue, significantly reduce the difference between being together and being separate and can make it very difficult to experience a feeling of authentic intimacy or loss. Furthermore, exploring the world through the web does not provide children with the opportunity to ask questions and give voice to their doubts: it is a one-direction communication. These elements need to be considered in the therapeutic relationship with pre-adolescents and adolescents. In this paper we present three cases in which the world of internet enters into the sessions and we illustrate the countertransference this arouses and how it needs to be worked through.     

Issues in using interpreters in therapeutic work with refugees. What is not being expressed?

‘Interpreting’ could be thought about as a legal equal opportunities or human rights issue. Whereas interpreters are likely to focus on the linguistic issues, and will be aware of the technical complexities of their work. Clinicians may worry about the impact on the therapeutic relationship of the interpreter's presence, how this will be managed and how it may depend on the match or mismatch of such factors as the client's gender, age and first or other language. This paper considers the issue on each of these levels to reveal the complexities and dilemmas of effective clinical work with interpreters, but also what can be achieved: the multiple layers of meaning concerning the client's experience and communication which can be elicited through effective working between interpreter and clinician.     

Révéler son humanité ? L’autorévélation du thérapeute à la lumière de la recherche empirique

Self-disclosure, which consists in revealing personal information about oneself to one's client, could be a beneficial therapeutic technique. There are yet many definitions of this concept. However, empirical research shows that self-disclosure may be favourably perceived by clients and that it could influence how they perceive their therapist. Moreover, it could positively influence treatment outcome. Self-disclosure about immediate feelings in the therapy and about the therapist–client relationship would be particularly effective in resolving problematic events by enabling feelings to be expressed and accepted and by providing clients with interpersonnal learning. Several authors finally advise using this technique infrequently, about moderately intimate but relevant themes in relation to the therapy, examining each client's specific needs, and always with the intention of helping them or improving the therapeutic relationship.     

The Body and Mind (Including of the Analyst) in the Treatment of a Psychotic State: Some Reflections: Commentary on Paper by Riccardo Lombardi

Riccardo Lombardi's paper is considered from a British (Independent) object relations perspective. Although the paper deals with the experience of shame and its relationship to fantasies about sex and death and how these are experienced (including in the body), shame is also a profoundly object related mental state, perhaps one of the most damaging when suffered in infancy, leading to reflexive functioning. The nature of shame is touched upon and its impact on personality development, and how this is handled in the transference and countertransference by Riccardo Lombardi with his particular patient. Although the patient's struggle to own his own hate is Lombardi's principal focus in the clinical account, this author suggests that Lombardi was attuned primarily to the patient's developmental failings due to the impact of shame and, by working primarily in the countertransference, was able to facilitate growth of certain personality functions for the first time.     

On the edge: The psychoanalyst's transference1

Countertransference is a central topic in analytic work and in the literature. The concept of countertransference includes a basic question which has been understood in different ways. The author attempts to differentiate between the psychoanalyst's transference and his countertransference in the analytic process. It is hard to draw a line between them; analysts are always on the edge. The analyst's transference will be explored and described using three approaches: narcissism, regression profile and the analyst's phase of life. Regression profile is a new concept developed by the author, which may help us to understand the core of the analyst's transference in the analytic situation. She illustrates the topic by clinical vignettes.