Some uses of the Psychoanalyst in the NHS

SUMMARY

This paper addresses various training issues of psychotherapy training in mental hospitals. It discusses some particular attitudes about the use of the Psychoanalyst as a Psychotherapist as well as the Institutions' (i.e. psychiatric establishments) desire often for a superficial teaching in Psychotherapy. It describes a training for NHS staff in psychodynamics and in particular in use of the counter-transference from Balint's model of general practitioner training groups.

Training groups most usually seen in GP seminars, with their central use of counter-transference by the analyst, can be extended to train medical students, nurses, social workers, etc. It is a form of training that uses the analytic stance rather than something of lesser alloy, and allows the Psychoanalyst to be himself rather than function at the level of a Psychotherapist alone.     

Erotic Countertransference and Clinical Social Work Practice: A National Survey of Psychotherapists' Sexual Feelings,Attitudes, and Responses

Male and female social work psychotherapists were surveyed on sexual feelings toward clients, sexual behavior with clients, and utilization of erotic countertransference. Relationships between these variables and therapists' self-reports of training in erotic counter-transference, utilization of supervisory consultation, length of clinical experience, and theoretical orientation were also examined. Male therapists were significantly more likely than females to report sexual attraction toward clients, and to report using erotic countertransference to further treatment goals. The frequency of therapists' discussion of sexual feelings toward clients in supervision was related to the reported frequency of utilization of sexual feelings in treatment. The majority of therapists reported that their social work training did not prepare them adequately to work with erotic countertransference.     

Clinique de la souffrance en milieu judiciaire : plaidoyer pour un cadre élargi

We think about the practise of the psychologist in judicial milieu who accompany adolescents or adults accused, before judgment. We suggest that this people address a specific demand on the social environment by acting out; their psychic difficulties include the absence of a cure demand. In this context, the verbalisation about the transgressive acting out permit to open a subjectivation work. But for the most suffering patients, the psychologist serve to contain the early life traumatisms, linked to the judicial affair, and which mobilize notably the counter-transference of the clinician. The elaboration of the meet setting, with his paradoxical aspect, constitute one of the conditions to create a relation, in suffering way in the life history of the patient.     

Transference,countertransference and responsibility: Their role in therapy and consultancy

The thrust for this paper lay in the author's experience as a psychotherapist (using broadly psycho-analytic methodologies), and as an Organisation Development Consultant working with individuals and groups in organisations where issues of transference and counter-transference relationships remain uncovered. The paper further explores transference from the point of view of its manifestation as the ghost in the machine in mundane relationships that becomes amplified in the authority relationship of therapy or consultancy. The paper then looks at the crucial issues in counter-transference—in particular issues of responsibility, power and humanity in the relationship. In the concluding section we suggest a taxonomy in order to explore situations in which transference and counter-transference can be benevolent or malevolent.In all, the ideological thrust of the paper is that, from the therapists/consultants' positions, they have, in a hermeneutic sense, to accept their own humanity and take responsibility for it (through the process of the counter-transference) in the therapeutic encounter.     

Transference and counter-transference in counselling

Transference and counter-transference, along with the art of interpretation and the meeting of resistances, are fundamental concepts within psycho-analysis. The former refers to feelings directed by the patient to the analyst which do not belong to him; and the latter to feelings aroused in the analyst by the patient. Both are used therapeutically in psychoanalysis, but are they relevant in counselling? As an example of a school of counselling which does not use these concepts in any fundamental way, the position of Rogers is discussed along with that of Truax and Carkhuff, and various criticisms are made. Counselling which uses transference and counter-transference is then discussed – particularly work emanating from the Tavistock Clinic with Bowlby, Balint and Malan as its main advocates – and difficulties in this approach are noted. A claim is made for categorisation in therapeutic work as it can be useful in enriching rather than diminishing a relationship. Counsellors need to be trained experientially to understand transference and counter-transference phenomena, and suggestions are made as to how this may be done.     

注意偏向训练对社交焦虑的干预：方法、效果与机制

社交焦虑障碍是最普遍且难于治疗的精神障碍之一。大量研究发现, 注意偏向训练可以有效缓解社交焦虑。研究者从自我报告、结构化评估、生理记录等方面考察发现, 接受了注意偏向训练的社交焦虑个体其注意偏向、生理唤醒和脑神经活动发生变化并且社交焦虑症状有所缓解。注意偏向训练对社交焦虑的干预机制可能是因为训练提升了个体对威胁性刺激的注意解除能力。今后的研究可以进一步明确注意偏向训练干预社交焦虑的效果与机制, 拓宽评估注意偏向训练效果的手段, 并探索其对社交焦虑干预的长期效果和对其它心理疾病的作用。     

Self-Disclosure and Vulnerability

Abstract

Based on the theoretical assumption and clinical observation that projective identification is a natural, constant element in human psychology, clinical material is used to illustrate how projective identification centered transference states create situations where acting out of the patient's phantasies and conflicts by both patient and therapist is both common and unavoidable. Because they are more obvious, some forms of projective identification encountered in clinical practice are easier for the analyst to notice and interpret. Other forms are more subtle and therefore difficult to figure out. Finally, some forms, whether subtle or obvious, seem to create a stronger pull on the analyst to blindly act out.

In some psychoanalytic treatments, one form of projective identification might embody the core transference. In other cases, the patient might shift or evolve from one level of this mechanism to another. Some patients attempt to permanently discharge their projective anxiety, phantasy, or conflict into the analyst. There is a patent resistance to re-own, examine, or recognize this projection. Some of these patients are narcissistic in functioning, others are borderline, and many attempt to find refuge behind a psychic barricade or retreat (Steiner 1993). In other forms of projective identification, the patient enlists the analyst to master their internal struggles for them. This occurs through the combination of interpersonal and intra-psychic object relational dynamics. This “do my dirty work for me” approach within the transference can evoke various degrees of counter-transference enactments and transference/counter-transference acting out.

Another form of projective identification, common in the clinical setting, is when a patient wants to expand the way of relating internally, but is convinced the analyst needs to validate or coach the patient along. This is why such a patient may stimulate transference/counter-transference tests and conduct practice runs of new object relational phantasies within the therapeutic relationship. Over and over, the patient may gently engage the analyst in a test, to see if it is ok to change their core view of reality. Depending on how the analyst reacts or interprets, the patient may feel encouraged to or discouraged from continuing the new method of relating to self and object. The patient's view of the analyst's reactions is, of course, distorted by transference phantasies, so the analyst must be careful to investigate the patient's reasoning and feelings about the so-called encouragement or discouragement. This does not negate the possible counter-transference by the analyst in which he or she may indeed be seduced into becoming a discouraging or encouraging parental figure who actually voices suggestions and judgment.

All these forms of projective identification surface with patients across the diagnostic spectrum, from higher functioning depressive persons to those who are more disturbed paranoid-schizoid cases. Whether immediately obvious or more submerged in the therapeutic relationship, projective identification almost always leads to some degree of acting out on the part of the analyst. Therefore, it is critical to monitor or use the analyst's counter-transference as a map towards understanding the patient's phantasies and conflicts that push them to engage in a particular form of projective identification.     

Influence of perceived social support and functioning on the quality of life of patients with schizophrenia and their caregivers

Perception of social support and functioning of patients with schizophrenia and their primary caregivers and its relationship to quality of life are described. Forty-five patients and their 45 relatives, treated at the Mental Health Services in Arica, Chile, participated. Both patients and caregivers in the study have a poor perception of social support with regard to extra-family people, as well as a low social integration. However, patients showed adequate capacity to function within their immediate family. Unlike what was found in developed countries, these patients showed moderate levels of quality of life, with a strong relationship with perceptions of the social support they receive from family and significant others and the ability to establish and maintain social contacts. Quality of life of primary caregivers is linked to patients' ability to establish and maintain social contacts within the family group, as in other social instances, such as keeping a job. The results of the study suggest the need to consider the design and application of programs of support for these patients and their caregivers, with the central aim of the social functioning of the above-mentioned patients and their familiar and community integration.     

The relevance of infant observation to clinical training and practice: An interpretation

In this paper, I discuss the effects of infant observation on the observer and the implications for mental health professionals. Similarities and differences between two Infant Observation Seminar groups of students are presented. Students performed in-home observations once a week over a 2-year period. Initially, there were motivational differences between the groups of students. One group had members committed to an intensive training program in psychoanalytic psychotherapy with children (Training Group), and the other group was a service delivery front-line worker group whose members voluntarily attended a weekly in-service training seminar (Work Group). In addition to infant observation, the Training Group had ongoing didactic seminars in psychoanalytic theory, 3 hours weekly for 4 years. The Work Group had a didactic seminar on some aspect of relevant infancy literature or psychoanalytic theory for 1 hour per week for the duration of the seminar, which was 2 years. The findings suggest that mental health workers can enhance their clinical skills through infant observation, that they can obtain a working knowledge of infant development, that prior training did not affect observation, and that all observers had difficulty observing mother-infant relationships due to counter-transference difficulties that involved unresolved conflicts from the past.     

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.     

How Psychoanalytic Thinking Lost its Way in the Hands of Men: The Case for Feminist Psychotherapy

A feminist stance is adopted to challenge the androcentric nature of many of the concepts which lie within the tradition of male psychoanalytical thinking. Such thinking steadfastly refused, and largely still refuses, to acknowledge the social reality and consequences of women's experience of living in a patriarchal society. It is argued that psychoanalytical theory has construed women as inferior and is wholly revealing of what men expect and want women to be. Any psychotherapy based solely within that tradition thus plays its part in the oppression of women. Two concepts from analytical psychotherapy, transference and counter-transference, are used as specific examples, and some contrasting researches advanced by feminist psychotherapy are outlined.     

Adaptive Inferential Feedback Partner Training for Depression: A Pilot Study

Adaptive inferential feedback (AIF) partner training is a cognitive technique that teaches the friends and family members of depressed patients to respond to the patients’ dysfunctional thoughts in a targeted manner. These dysfunctional attributions, which AIF addresses, are a common residual feature of depression amongst remitted patients, and are associated with poor long-term consequences. Thus, an AIF partner training intervention, as a supplement to individual cognitive-behavioral therapy (CBT), may help to improve clinical outcomes through the continuing reinforcement of the cognitive restructuring that takes place in the context of the patient’s individual treatment. This 10-patient pilot study examines the feasibility and outcome of the augmentation of standard CBT with 4 sessions of AIF partner training. The patients’ depression, anxiety, negative inferences, and perception of social support, and their partners’ knowledge and provision of AIF significantly improved over the course of the study, with gains maintained at 2-month follow-up. Further research is needed to investigate any incremental value of this intervention beyond standard CBT. A detailed case example, illustrating the application of AIF partner training techniques, is included.     

Fears of death and fears of dying in the counter-transference

It is commonplace for people to say they are not afraid of death but they are afraid of dying. I discuss unconscious aspects of fears of dying and fears of death which are revealed in counter-transference experiences in therapy with people suffering from terminal illnesses and with older people. Studying the counter-transference shows that fears of dying, which usually refer to lingering and disabling illnesses, unconsciously are linked with fears of dependency and the apprehension that if one becomes dependent then no-one will want to look after you. This apprehension is often a residue of failures in the early dependency relationship which can be re-enacted in adult life through projective identification when therapists and carers may be induced to abandon the caring role. Despite the ubiquitous denial, fears of death surface in the counter-transference, often obliquely but always with a particular terror for the survival of the self. This unconscious terror confirms Freud’s insight about the denial of death that what is unthinkable is the annihilation of the self. I conclude with a discussion about the importance of setting an ending date in therapy with those who are old or terminally ill.     

The wish to regress in patient and analyst

The analyst's wish to regress is used as a paradigm of the "forbidden" topic of what analysts want from their analysands. The aim is to expand the subjective domain of analysts' awareness so that they can analyze better by grasping more of their temptations with patients before enactment can occur. Clinical examples illustrate how the author temporarily joined patients in wish-fulfilling mutual regression. Analytic process is disrupted when the analyst wishes to relinquish the more differentiated role of the containing and interpreting analyst in favor of more childlike relatedness both with the patient and with the analyst's internal objects. The author, expecting a more typical counter-transference, had not anticipated that he might temporarily join these nonpsychotic patients in mutual regression. It is suggested that in the face of analytic impasse analysts should consider whether they might temporarily have joined the patient in mutually regressive wishes that have taken them away from more responsible analytic functioning.     

Individual response patterns and the effects of different behavioral methods in the treatment of social phobia

The importance of individual response patterns in the treatment of phobic patients was examined in the present study. Forty psychiatric outpatients with social phobia were assessed with a social interaction test which was videotaped. Heart rate was continuously monitored during the test. On the basis of their reactions in the test situation, the patients were divided into two groups showing different response patterns; behavioral and physiological reactors. Within each group half of the patients were randomly assigned to a behaviorally focused method (social skills training) while the other half received a physiologically focused method (applied relaxation). The patients were treated individually in 10 sessions. The within-group comparisons showed that both treatments yielded significant improvements on most measures. The between-group comparisons showed that for the behavioral reactors, social skills training was significantly better than applied relaxation on six out of ten measures, and for the physiological reactors applied relaxation was significantly better than social skills training on three of the measures. The results support the hypothesis that greater effects are achieved when the method used fits the patient's response pattern.     

Observer,percevoir, partager : réflexions épistémologiques à partir d’une enquête ethnographique dans cinq établissements d’enseignement secondaire

For our research on “Gender practices and violence between peers: the stakes of mixed education” (ANR-09-ENFT-006), two researchers observed interactions between students within five schools during the 2011–2012 school year in an large French city. This paper focuses on the challenges of ethnography, the validity of the results produced by such a methodology, and the opportunity to intersect clinical (notably transference and counter-transference) and socio-anthropological concepts. Our analyses center on questions related to social class and the sex-gender system.     

Beyond you and I: role play and reflection-in-action in communication training

This article will explore the development of communication training within nurse training. Beginning by outlining current thinking around this practice, it then discusses Schön’s notion of reflective practice and its frequently cited relevance to nursing before pointing out some of its limitations. In particular, it looks at the limitations of the individual being able to critically reflect on their self within a broader social context. Drawing on the theories of Habermas and Bourdieu, it suggests that encouraging a greater awareness of one’s own social context, and hence of one’s own subject position, would develop a deeper awareness of other potential perspectives and a better ability to listen to patients. Finally, it argues for the use of role play in assisting nurses to gain such awareness, particularly in difficult clinical situations such as end-of-life care.     

Desire and the female analyst

The literature on erotic transference and countertransference between female analyst and male patient is reviewed and discussed. It is known that female analysts are less likely than their male colleagues to act out sexually with their patients. It has been claimed that a) male patients do not experience sustained erotic transferences, and b) female analysts do not experience erotic countertransferences with female or male patients. These views are challenged and it is argued that, if there is less sexual acting out by female analysts, it is not because of an absence of eros in the therapeutic relationship. The literature review covers material drawn from psychoanalysis, feminist psychotherapy, Jungian analysis, as well as some sociological and cultural sources. It is organized under the following headings: the gender of the analyst, sexual acting out, erotic transference, maternal and paternal transference, gender and power, counter-transference, incest taboo - mothers and sons and sexual themes in the transference.