Control-Mastery

Abstract

This paper will introduce the theory of Control-Mastery, an empirically supported, cognitively oriented interpersonal theory of psychotherapy. Control-Mastery theory offers a distinctive approach to counter-transference in particular and suggests a unique way to understand unconscious functioning. The theory also provides specific guidelines for conducting psychotherapy as well as a useful framework for understanding the impact of familial as well as cultural context on individual psychological struggles.     

Biographical truths and their clinical consequences: Understanding ‘embodied memories’ in a third psychoanalysis with a traumatized patient recovered from severe poliomyelitis

The relationship between ‘narrative’ and ‘historical–biographical truth’ in psychoanalytic treatment has become the subject of many controversial debates in recent years. Findings of contemporary memory research have lead to great scepticism as to whether therapists are able objectively and reliably to reconstruct biographical events on the basis of their observations in the therapeutic situation. Some authors even claim that psychoanalysts should concentrate exclusively on observing the here and now of the patient′s behaviour within the transference relationship to the analyst. In this paper it will be discussed whether the baby has been thrown out with the bathwater in this debate. Centred around the insights from a third psychoanalysis with a patient who suffered from a severe case of childhood polio, the hypothesis will be discussed that working through the traumatic experience in the transference with the analyst, as well as the reconstruction of the biographical–historical reality of the trauma suffered, prove to be indispensable for a lasting structural change. Integration of the trauma into one′s own personal history and identity is and remains one of the main aims of a psychoanalytic treatment with severely traumatized patients. The reconstruction of the original trauma is indispensable in helping the patient to understand the ‘language of the body’ and to connect it with visualizations, images and verbalizations. The irreversable wounds and vulnerability of his body as the ‘signs of his specific traumatic history’ have to be recognized, emotionally accepted and understood in order to live with them and not deny them any longer. Another important aspect in psychoanalysis is to develop the capability to mentalize, in other words, to understand the intentions of central (primary) objects related to the trauma. The concept of ‘embodied memory’ might be helpful in understanding precisely in what way ‘early trauma is remembered by the body’. Observing in detail the sensory‐motor coordinations in the analytic relationship enables one to decode the inappropriate intensity of affects and fantasies which match the original traumatic interaction and are revealed as inappropriate reactions in the present, new relationship to the analyst.     

Body talk: somatic countertransference

This article focuses on a clinically observed event: the impact of the analytic session on the corporeality of the psychotherapist. The author sees this as an example of countertransference, in this instance ‘somatic countertransference’. Short and long clinical extracts are used to detail these events. The author touches on some early ideas on somatizing. The Kleinian concept of projective identification is itself explored and then used to explore further the idea of somatic countertransference.     

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.     

Cultural factors promoting coping among Tibetan refugees: a qualitative investigation

This study is an attempt to understand the role of cultural resources in promoting coping among Tibetan refugees. Tibetan refugee communities have adapted well and managed to preserve their cultural identity in exile and have been cited as models of successful coping with refugee life. Tibet is renowned for its rich culture and traditions. The unique feature of this culture is the devotion towards Buddhism which has exerted a strong influence in almost every aspect of their life and culture. This study is a qualitative investigation of 12 Tibetan refugees coming from diverse background (students, businessmen, activists, and ex-prisoners). Interpretive phenomenological analysis was used to analyse the narratives of case studies in order to explore various cultural factors promoting healthy coping. Major themes related to the cultural resources promoting healthy coping included – protective hand of Dalai Lama and other Lamas, Buddhist philosophy and practices, community bonding and support, and historical exemplars of strength and resiliency.     

Thawing the 'frozen accidents': the archetypal view in countertransference

Jung's concepts of psyche and psychic energy are relevant in countertransference. Working with Jung's archetypes as 'transconscious' dynamic fields of probabilities helps the analyst, as a clinician and teacher with limited human consciousness, to confront and recognize the unconscious cross-purposes of 'anomalous' countertransference, and to convert it to insightful 'participatory' countertransference-Jung's archetypes will be juxtaposed with William James's fields, Gerald Edelman's qualia, and most particularly with Murray Gell-Mann's 'frozen accidents'. Two vignettes – from A clinical and a training setting – suggest chat from a Jungian perspective, countertransference may be seen at the psychic juncture where ego, the personal shadow, the interpersonal other and the archerype of the collective unconscious meet in the determining images of a life, fantasy, dream, analysis, and seminar. So-called 'parallel process' will be seen as enclosure in the circles of reference emanating from the patient's experiences in those arenas deemed archetypal, i.e., structurally significant. The relativity of unconscious time will be mentioned. Jung's notion that, called or uncalled, the archetypes are present, informs the thesis that we must name archetypal images if we are to know them, and we must know them to be free.     

Types of sexual transference and countertransference in psychotherapeutic work with children and adolescents

The question of normal sexuality begins to arise in the treatment of severely sexually abused or sexually offending patients. The author suggests that it is an interesting and delicate moment during the process of recovery when less perverse, more normal sexuality appears mixed with, or even disguised by, the more habitual perverse fantasies. Writers in the adult field have drawn distinctions between perverse, eroticized and normal erotic transferences, and between Oedipal and post-Oedipal sexuality. Some have also distinguished between countertransferences in the analyst of an erotised versus a normal erotic nature. The paper discusses whether these distinctions could have any relevance for child patients. Freud and Klein have taught us much about the child's sexuality in relation to his interest in and attraction to his parents as sexual beings. But can we also detect some origins in earlier experiences in infancy of the child's later capacity to feel himself a sexual being capable of being wanted by an other? How might such a feeling of sexual self-worth differ from narcissism and from sexualised exhibitionism? The paper asks how therapists might deal with such problems and such possibly healthy developments.     

The countertransference: When painful traumatic traces sustain the countertransference and reveal themselves to the psychoanalyst … 14 years later!

Although she experienced, as did the many psychoanalysts before her, the countertransferential dynamics of disgust towards a patient presenting great deficiency in terms of mentalization capacity, the author strives to understand what urged her to tolerate the patient, to invest in her and lead her to develop a capacity for internalization, after 6 years of analytic work filled with transgressive‐transferential acting‐out. Fourteen years later, she becomes aware of the way in which the revival of some grief related to traumatic traces in her own lived experience, sustained, without her knowledge, a saviour/countertransference, creating a specific transferential‐countertransferential spiral which rescued a situation whose advent could have been compromised. This could happen thanks to what she refers to as the unique inter‐relation between her and this particular patient.     

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.     

Transference and countertransference issues with sexually abused clients

Abstract

This paper explores some of the therapeutic issues which arise when working with sexually abused clients. It is suggested that both the client and the therapist may at moments take any of the three positions in the Oedipal triangle and that the mother, father and child status are interchangeable in the transference and counter-transference. It is also suggested that the Oedipus myth represents the failure of a family to contain sexual and murderous passions. I describe a Hindu myth which takes a similar triangle of passion but illustrates how containment is possible. It is proposed that this implies we need to re-evaluate the presence of the erotic in therapy in a more positive light. It is further suggested that the sexually abused client needs to experience the containment of passion if a healing process is to occur.     

Too close for comfort: the challenges of engaging with sexuality in work with adolescents

This paper explores some of the ways in which sexuality can intrude into the psychotherapeutic relationship and present both opportunities and risks to our work with adolescents. It highlights some of the complexities of this area of the clinical encounter, exploring the particular difficulties encountered by both patient and therapist when sexuality emerges in the transference and countertransference. While we are well aware of the centrality of sexual development during adolescence, far less has been written about the way in which sexuality and the erotic transference emerges and impacts on both patient and therapist. Given the profoundly unsettling nature of this area of work and its capacity to disrupt our thinking and psychic equilibrium, it is easy to underestimate how much we are drawn to avoid, negate and defend ourselves against registering such experiences. Through the discussion of clinical material with two adolescent patients, this paper explores some of these dynamics, addressing some of the technical dilemmas that frequently challenge us in this area of work. These include questions about whether and when it is therapeutically important and effective to take up and interpret the emergence of sexuality more directly in the transference and some of the risks to our patients when we ‘play safe’ and fail to do so. Most importantly, this paper aims to facilitate further thinking and discussion about an important but uncomfortable and easily neglected area of our work.     

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.     

Hanin: Nostalgia among Syrian refugees

We examined the psychological functions of nostalgia (hanin in Arabic) among Syrian refugees residing in Saudi Arabia, who were forcibly displaced during the Syrian civil war. Forced displacement entails disruption, loss, and mourning, creating a salient contrast between one's past and present circumstances, which could attenuate the benefits of nostalgia. Studying this population thus affords a strong test of the boundaries of nostalgia's functionality. We experimentally induced nostalgia via vivid autobiographical recall and then assessed various psychological functions, as well as current affect. A supplemental objective was to examine the role of dispositional resilience. Most established benefits of nostalgia also accrued to Syrian refugees. However, contrary to previous findings, nostalgia decreased optimism, highlighting the limits of its palliative capacity among displaced individuals. As hypothesized, the impact of nostalgia was moderated by dispositional resilience, which acted as a catalyst of the emotion's benefits and as an inhibitor of its costs.     

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.     

On the countertransference of the patient: Transformations of the psychoanalyst's 'theoretical self' and their possible articulations with the vicissitudes of the analytic relationship

In this paper the author examines one of the many levels of the analyst/analysand relationship: the possible interaction between the analyst's mental routes in relation to theories (also meant, but not only, as internal objects) and the vicissitudes of the psychoanalytic relationships with his patients. The author assumes that an important variable affecting the transformation of certain therapeutic relationships is the change that takes place in the relationship between the analyst and that part of his internal world where his theories find their place. He names this part of his internal world 'theoretical self', and 'precipitates of the analyst's theoretical self' those complex formations, akin to more or less cohesive conglomerates, that are formed by his relationship to theories and to psychoanalytic institutions, and by the various, 'personal' internalised objects. The psychoanalyst will relate to these precipitates in a variety of ways, and he will make use of them mostly at an unconscious level in his analytical work; and his patient is likely to 'react' to them, almost chemically. The author also offers some working indications: the psychoanalyst, despite his knowledge of some aspects of his own countertransference, is in fact lacking in knowledge, unless he constantly does some extra work focusing on how his mental position (i.e. the relationship with the precipitates of his theoretical self) may intervene in any of the therapeutic relationships that he establishes-not necessarily in the same way in each of them. The author also illustrates his reflections and conceptualisations by reporting dreams and excerpts from sessions taken from three psychoanalytic treatments in the course of several years.     

The death of an analysand: transference, countertransference and desire

This paper is offered as an exploration of transference and countertransference issues when, in the process of analysis, the analysand becomes terminally ill. Written from the point of view of the analyst, eros and boundary issues are discussed. It is proposed that those who are about to die may form particularly intense erotic attachments and that this is characteristic of a speeded up individuation process. The paper is based on the case of a suicidally depressed man who formed an immediate, dependent and erotic transference. After three months, he was diagnosed as having an inoperable lung cancer. From then on the analytic frame was challenged by pressures to act out in a number of different ways. It is argued that gender difference and the heterosexual pairing facilitated the differentiation of adult, sexual and Oedipal feelings from infantile, pre-Oedipal ones. Maintenance of the analytic frame enabled the individuation process to continue to the end.     

Testimony work with Bosnian refugees: living in legal limbo

Mental health professionals working with refugees are often confronted with traumatised survivors who are living in legal limbo. Complicated asylum procedures or provisions of only 'temporary' protection trigger existential fears, reexperiencing of trauma and feelings of hopelessness and deep despair and can actively contribute to further destabilise survivors. Mental health centres have to reconceptualise their provided services for these clients. The paper introduces a testimony project for traumatised Bosnian refugees in Frankfurt, Germany, who were living in legal limbo for many years. The testimony method was used in combination with supportive therapy and informed advocacy to try to reduce the survivors' feelings of humiliation and demoralisation which for them were at the centre of their survival. By giving testimony, survivors benefited psychologically and became better able to cope with the difficult present. Feelings of self-worth and dignity could be regained and a trusting relationship between the survivor and the listener facilitated the therapeutic process. The testimony material documented human rights abuses both in the country of origin and in exile, helped us to perform informed advocacy for this group and informed a larger public on the psychological costs of refugee resettlement policies.     

Human capital,acculturation and social identity: Bosnian refugees in Australia

This article explores the processes of acculturation and identity among refugees from Bosnia and Herzegovina who resettled in the Australian cities of Perth and Sydney during the 1990s. We start from the idea that refugees, through the process of forced migration, lose aspects of their identities that were embedded in their former communities, jobs, skills, language, and culture. Upon arrival in a new society, they seek to reconstruct their identity, and we argue that this happens in the context of the process of acculturation. We use two social psychological perspectives, social identity theory and acculturation theory, and the sociological theory of the migration of human capital, to examine our data collected by qualitative research methods from refugees and Australian professionals who work in the government‐funded refugee resettlement programme. Our data highlight the loss of identity experienced in forced migration, difficulties in refugee acculturation and identity reconstruction, and collective and individual strategies in acculturation and identity adaptation. We see our perspective as essentially interdisciplinary, and take an interactional view of the acculturation and identity processes, as the characteristics of both the host society and the immigrants affect them. Copyright © 2003 John Wiley & Sons, Ltd.     

Political and media discourses about integrating refugees in the UK

This article addresses political and media discourses about integrating refugees in the UK in the context of the “refugee crisis”. A discursive psychological approach is presented as the best way to understand what talk about the concept is used to accomplish in these debates. A large corpus of political discussions (13 hours of debate featuring 146 politicians) and 960 newspaper articles from the UK were discourse analysed. The analysis identified five dilemmas about integration: Integration is positive and necessary, but challenging; Host communities are presented as welcoming, but there are limits to their capacity; Refugees are responsible for integration, but host communities need to provide support; Good refugees integrate, bad ones don't; Refugees are vulnerable and are skilled. All are used to warrant the inclusion or exclusion of refugees. The responsibility of western nations to support refugees is therefore contingent on the refugees behaving in specific ways.