Management of intense countertransference in group psychotherapy conducted in situations of civic conflict

Conducting group psychotherapy in a situation of intractable conflict such as Northern Ireland activates turbulent emotional dilemmas within psychotherapists and group members alike. Professional practice and therapeutic zeal must struggle daily to survive the stark encounter with the reality of a regressive and primitive psychology and on occasion may succumb to atavistic tendencies, dragging relationships down to primitive levels and leaving connections broken. In this article, three group therapists describe their countertransference struggles when leading such groups. They meet in a psychosocial setting in which the risk to one's psyche parallels the risk to one's life and limb. The countertransference experienced here is dark, indeed identified by one author as not unlike Dante's Inferno. They describe how understanding their personal countertransference enables them to survive emotionally even though it may not always lead to the survival of their groups. The effect of those struggles also troubled the act of writing itself making cooperation difficult on occasion, a mirror of the external social matrix.     

Onkologisch Kranke als Patienten der psychotherapeutischen Praxis

Background

The high prevalence of cancer and the considerable psychological comorbidity is a challenge for psychotherapists. There are, however, relatively few patients in outpatient psychotherapy. Aim of the study was to survey outpatient psychotherapists concerning this issue and their attitudes towards the treatment of cancer patients.

Methods

All outpatient psychotherapists of an East-German city were surveyed using semi-structured interviews.

Methods

There are various reasons for the relatively rare visits of cancer patients in psychotherapeutic practices: For instance the subjective lack of specific competence, the fear of many psychotherapists to treat physically ill people, insufficient fitting of the relatively inflexible organization structure of psychotherapeutic settings with the vicissitudes of life among physically ill people, e.g. long waiting periods until the begin of treatment, furthermore the psychotherapeutic training focuses on psychosomatic and not so much on somatopsychic perspectives. A further problem is the widespread attitude about psychic causation of cancer, which is contradictory to scientific evidence.

Conclusions

Psychotherapists who want to treat cancer patients need specific and in-depth training in psychooncology.     

Is three a crowd? A perspective on countertransference challenges in psychoanalytic couple psychotherapy

Two seemingly unrelated characteristics of psychoanalytic couple psychotherapy may be better understood when juxtaposed. First, countertransference in psychoanalytic couple psychotherapy holds particularly strong intensity. Second, format decisions are central to couple psychotherapy. The use of conjoint and concurrent formats, or variations thereof, has been key in the historical development of couple psychotherapy and remains an area of much debate. Some couple psychotherapists use the format of couple psychotherapy flexibly, using variations of conjoint or concurrent couple psychotherapy, while others adhere strictly to working conjointly. Decisions regarding whether to undertake concurrent or conjoint therapy are not generally linked to countertransference; this article demonstrates that reading decisions regarding format through consideration of countertransference offers a needed perspective for the therapist. Case studies published by psychoanalytic couple therapists are analysed through this prism to demonstrate that changing the format may serve to dilute countertransference. One particular manifestation of countertransference, linked to oedipal dynamics, is explored: countertransferential intensity for couple psychotherapists potentially relates to being faced with their internal parental couple and their unresolved Oedipal strivings. Possible unconscious motivations to change the format of couple psychotherapy need to be carefully considered, as format changes may mask an avoidance of bearing the countertransference.     

青少年心理行为问题与专业心理求助态度：父母知晓的中介作用

摘 要 对831名中学生施测青少年自评量表、父母知晓量表、专业心理求助态度问卷,考察青少年心理行为问题、父亲知晓、母亲知晓与专业心理求助态度的关系。结果发现：（1）青少年的专业心理求助态度与心理行为问题、父母知晓呈显著相关。（2）父亲知晓在青少年心理行为问题与专业心理求助态度的关系中起部分中介作用,母亲知晓的中介作用不显著。研究结果对青少年专业心理求助的干预有着重要意义。     

Influence of personal therapy on learning and development of psychotherapeutic skills

The aim of the present study was to investigate psychodynamic psychotherapists’ experience of the influence of personal therapy on professional growth during training with a focus on the acquisition of knowledge and the development of psychotherapeutic skills. Thematic analysis was conducted on interviews with former students (N=10) at two training institutes for psychoanalytic psychotherapy. The resulting theme “professional subjectivity” indicated that personal therapy was experienced as having a positive effect on learning and growth of professional skill by facilitating the development of a theory- and knowledge-based professional subjectivity, a personally founded, professional attitude. Important elements of this development are “shared experience,” “personal influence,” and “knowledge integration.” The emergence of professional subjectivity proved to be an important factor in terms of professional advancement for future psychotherapists. Finding and relating to their own subjectivity was crucial in the process of developing a personally founded, professional attitude in the clinical work.     

Gegenübertragung im stationären Therapie-Setting

Background

Countertransference is seen as an instrument of research into a patient’s unconscious and is therapeutically useful in furthering psychodynamic work. For inpatient psychodynamic psychotherapy, where patients are treated by a team of psychotherapists, countertransference is much more complex and makes consideration and integration of different countertransference feelings necessary. Using the first German translation of the countertransference questionnaire (CTQ, Zittel Conclin and Westen, the countertransference questionnaire, 2005) an attempt was made to identify differences in countertransference phenomena in a team of psychotherapists and to show the impact countertransference has on therapy outcome.

Materials and methods

A total of t multiprofessional teams of psychotherapists (15 physicians, 5 psychologists and 9 body and art therapy psychotherapists) took part in the study and completed the CTQ for 137 patients (100 female, 37 male) at the beginning and at the end of inpatient psychotherapy. In addition, the patients completed two questionnaires, the Symptom Check List Revised 90-R (SCL-90) for the severity of symptoms and the Assessment of DSM-IV Personality Disorders Questionnaire (ADP-IV) for personality disorders.

Results

Body and art therapy psychotherapists expressed more positive, protective and involved countertransference feelings whereas psychotherapists for single and group therapy expressed more aggressive and hopeless feelings. Countertransference has an impact on therapy outcome and feelings of a lack of interest, aggression and resignation at the beginning of therapy can point to a poor outcome. Patients with personality disorders activate more negative countertransference reactions than patients without personality disorders but at the same time they may also evoke parent-like feelings of protection.

Conclusions

Using the CTQ it is possible to differentiate countertransference phenomena in a team of psychotherapists treating inpatients with psychodynamic psychotherapy. The timely perception and integration of countertransference feelings has a positive influence on the therapeutic process and therapy outcome.     

Psychotherapists' attitudes towards and observations of nonverbal communication in a greeting situation: II. Relationships to background variables.

An interview study of 79 Swedish psychotherapists was performed to investigate their attitudes towards and observation of nonverbal communication in a reference situation in relation to background factors such as gender, length of professional experience, and theoretical approach. The greeting situation, i.e., the first time a therapist and patient meet in a waiting-room, was chosen as the reference situation. Face communication in that greeting situation was significantly less achieved by male psychotherapists with relatively short experience than by female therapists. However, this sex difference was not significant among therapists whose psychotherapeutic experience was longer than 13 years. Attaching great importance to nonverbal communication in psychotherapy was related to an intention to be well-kept and to perform correctly in front of the patient, to establish direct communication in the greeting situation, and to background factors such as frequent work in psychotherapy and an eclectic psychotherapeutic approach.     

Psychoanalytisch begründete Ans?tze in der forensischen Psychiatrie und Psychotherapie

After many years where manualized mainly behaviour treatments dominated in forensic settings, psychodynamic therapies are gaining acceptance and are performed and evaluated more and more in forensic hospitals and in prisons. This encompasses individual, couple, family and group therapies. Individual and group analysts are starting to perform these tasks again, mostly as workers in forensic settings but also as external therapists and supervisors. All staff members are important in creating a therapeutic community based on group analytic principles. They are therefore required to build up a therapeutic attitude supported by regular external case and team supervision. Delictogenic situations occur in everyday life as well as in professional settings and are analysed mainly in group therapies, considering situations of the past and the effect on other people. Modern manualized analytical concepts, such as transference-focussed psychotherapy (TFP) and mentalization-based therapy (MBT) depthen the quality of therapeutic work of all professionals in forensic settings. The multimorbid and sometimes dangerous patients require good ethical and professional attitudes. The psychoanalytic concepts of defence and resistance, transference and countertransference are essential parts of changing internalization and corrective emotional experience, important parts of useful forensic treatments.     

Experiences of psychotherapists transitioning to private practice during COVID-19

The purpose of this qualitative phenomenological study was to gain insight into the lived experiences of psychotherapists transitioning to private practice during the COVID-19 pandemic. With an ever-expanding need for targeted and accessible mental health care, it is vital to understand this phenomenon and how it impacted patient access and care, and the providers themselves. Eighteen licensed psychotherapists were interviewed and their responses highlighted meaningful professional and clinical implications. As a result of the participant interviews, three major themes were identified: (1) the unknown related to COVID-19, (2) ease of transition and (3) work–life balance. Eleven additional subthemes emerged. Results suggested that psychotherapists had various personal and professional stressors exacerbated by the pandemic, along with a desire to balance work and life, manage the changes brought on by the pandemic, and gain or retain autonomy in their professional careers. Ultimately, the results of the study point to some shared experiences among psychotherapists, potential issues of access to psychotherapy, issues related to career satisfaction among psychotherapists, as well as some important areas for future research.     

Best professional practices when approaching religiosity/spirituality in psychotherapy in Brazil

The religiosity/spirituality (R/S) dimension is recognised as an important component of the concept of health advocated by the World Health Organization; however, it does not appear in the undergraduate Psychology curricula in the Brazilian context, revealing a gap in the way this theme has been covered. In order to identify the professional reality of Brazilian psychotherapists in relation to this theme, this study aimed to identify what constitutes the best professional practices when approaching R/S in psychotherapy. We interviewed 24 psychotherapists of both sexes, with a mean age of 36.43, from two medium‐sized cities of two Brazilian states. According to the interviewees, the best practices considered when addressing R/S, that is, the most appropriate actions/attitudes, are as follows: (a) Respect; (b) Knowing how to separate what is from the psychotherapist and from the patient/client; (c) Recognising the theme as an integrative dimension of the human being; (d) Knowing how to listen; (e) Questioning the role of R/S in the life of the patients/clients; (f) Knowledge about the subject matter; and (g) Not imposing knowledge, practices or doctrine. These practices were revealed as the skills, competencies and knowledge needed to deal with the subject and highlight important references to think about the theme in psychotherapy, guiding the formation of new professionals and updating practising psychotherapists.     

Therapists' positive emotions in‐session: Why they happen and what they are good for

Aim: The therapist's feelings play a remarkable role in contemporary models of psychotherapy. However, these models are biased towards negative feelings. The present study explores therapists' personal experience with positive emotion in‐session. Method: A grounded theory analysis was conducted of interviews with 26 Brazilian psychotherapists. Results: Clinicians derive positive affect from the client's input in treatment, from their own input, and from the personal relationship with the client. Therapist positive emotion adds to the material that can be worked on in‐session by providing interpersonal events in the relationship with the client. It can improve therapist input in treatment by increasing in‐session awareness, resourcefulness and daring and by cuing efforts for professional development. It enhances involvement in the relationship with the client by prompting compassion and closeness in the dyad. Its effects may spill over and contribute to the therapist's personal thriving. Discussion: These results are discussed in light of what positive psychology can add to current work on therapist effects in the treatment process.     

Between Hippocrates and God: Ugandan mental health professional's views on suicide

A negative attitude towards suicide is generally assumed to be predominant in low-income countries. In order to understand the negative attitude in general it is necessary to look at how religion and morality influence the attitudes. Our aim in this qualitative interview study was to investigate what attitudes professional mental health workers in Uganda bear towards suicide and suicidal persons. The professionals argue for their attitude by employing religious, communal and medical ethics arguments, which draw both in a negative and positive direction. The professionals are in general unambiguously negative towards suicide and positive towards suicidal people who are mentally ill. In cases other than mental illness non-accepting attitudes surface. This is discussed against previous research showing that effective treatment of suicidal people is to be based on a trusting and accepting relationship.     

Übertragung und Gegenübertragung in Verhaltenstherapie und Psychoanalyse

Most psychotherapists and researchers agree that a good relationship essentially contributes to therapeutic change. The psychoanalytic concepts transference and countertransference which describe fundamental aspects of the psychotherapeutic relationship have now become integrated into behavior therapy. These concepts, however, are used differently in psychoanalysis as well as in behavior therapy. This makes the communication between psychotherapists coming from different orientations difficult. Therefore, a research approach which describes the important verbal and nonverbal elements of a helpful therapeutic interaction independently from therapeutic orientation could help to evaluate their effectiveness in different psychotherapeutic methods. In this way a culture of integration into psychotherapy could be encouraged.     

Acculturation and young Iranian women: attitudes toward sex roles and intimate relationships

This study examined the nature and extent of acculturation of Iranian women into the American culture of Los Angeles, California, their attitude toward the role of women, and their attitude toward intimate relationships. It was expected that acculturation level would be related negatively to participants' age at migration and positively related to the length of time away from Iran. Data were obtained from a sample of 77 Iranian women aged 17-32 years living in Los Angeles. Acculturation level was measured by a modified version of one designed by Cuellar, Harris, and Jasso (1980). The Sexual and Premarital Attitude Inventory designed by Schofield (1965) was used to gauge attitudes about intimate relationships. The short version of the Attitude Toward Women Scale designed by Spence, Helmreich, and Staff (1973) was used to assess differences in ideology about the role of women in society and the family. Findings indicate that acculturation level was positively associated with premarital sexual attitudes, a sex role attitude, and sex role attitudes specific to Iranians. Greater acculturation was associated with more liberal sex roles. The age at which Iranian women left Iran was negatively correlated with acculturation. Younger age was associated with a higher score. The number of years away from Iran was associated with a higher acculturation score. Educational level was not significantly related to acculturation. The author proposes that conflict between the pressure to assimilate and attachment to cultural identity may be an adaptive solution in itself. One caveat was the higher socioeconomic status of this sample population.     

Change after long-term psychoanalytic psychotherapy

Psychoanalytic psychotherapy in clinical practice is traditionally a long-term treatment conducted by well-trained psychotherapists. However, very few studies have been published that evaluate the effects of such treatment. To redress this lack of studies, 55 individuals selected for long-term psychoanalytic psychotherapy (average, 3 years) were invited to participate in a naturalistic study. The psychotherapists had a mean of 15 years of professional experience. The 36 patients who completed psychotherapy manifested a substantial reduction in symptomatic suffering and decreased levels of character pathology, as measured by the Karolinska Psychodynamic Profile (KAPP) and the Karolinska Scales of Personality. Generally, such changes were not found in the individuals who did not engage in treatment. In the therapy group, improvements were found on eight KAPP subscales defining different aspects of character: Intimacy and Reciprocity, Frustration Tolerance, Regression in the Service of the Ego, Coping with Aggressive Affects, Conceptions of Bodily Appearance and their Significance for Self-esteem, Sexual Function, Sexual Satisfaction, and Personality Organization. The results indicate that individuals who engaged in psychotherapy improved their capacity to handle crucial aspects of life and reduced their symptomatic suffering.     

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.     

Attitudes Towards Work and Family Roles and Their Implications for Career Growth of Women: A Report from India

This paper explored attitudes towards work and family roles of professional men and women in India. Ninety-two husband–wife pairs from salaried, upper middle class, dual-career families in India participated in the study. Propositions based on adult development theories of men and women, regarding reward value derived from and commitment made to occupational, parental, marital, and homemaker roles over the life cycle, were tested. Results indicated that there was no change with age, in attitudes towards occupational and homemaker roles. Instead, gender-based differences in attitudes towards these roles were observed. Attitudes towards the marital and parental role varied across the life cycle, although not in keeping with propositions based on the adult development theories of men and women. There was no reversal in attitudes towards work and family roles of men and women after midlife. Rather, some reversal in attitudes appeared to occur between the marital and parental role, over the life span of both men and women. Results are reviewed within the Indian cultural context and their implications for the career development of women are discussed.     

Minorities' acculturation and social adjustment: The moderator role of meta‐perceptions of majority's acculturation attitudes

Two studies addressed the role of Black meta‐perception of acculturation attitudes on the relation between minority acculturation attitudes and their social adjustment (school achievement and perceived quality of intergroup relations). Participants in both studies were Black Lusophone adolescents living in Portugal. Study 1 (N = 140) indicated that participants' attitude regarding the host culture was positively correlated with their school achievement and to their evaluation of intergroup relations. It also indicated that participants' meta‐perception of majority attitude add to the explained variance of participants' social adjustment. Study 2 (N = 62) manipulated the perceived majority high/low support of immigrants' learning the host culture. The dependent variable (DV) was perceived quality of intergroup relations. Only in the low support condition were participants' attitudes towards the host culture positively related to perceived quality of Black–White relationships. These results suggest that perceived social context is central to understand the relationship between minority adolescents' acculturation attitudes and key dimensions of their adjustment to host societies.