The Importance of a Comprehensive Clinical Diagnosis for Group Psychotherapy of Borderline and Narcissistic Patients

This article presents a psychoanalytically oriented model of group treatment for female adult survivors of childhood sexual abuse. Two key treatment, issues—the survivor's struggle to trust her own mind and her tenacious allegiance to an omnipotent, all-bad self-representation—are used to illustrate ways in which the transference/countertransference matrix of the group permits members to enact, identify, and work through central internalized relational configurations. The group therapist's role is to maintain transitionality, a focus on process, and the capacity for play.     

Analytic change: Assessing ways of being in a psychoanalytic follow‐up interview

The article argues that the concepts of relational scenario, structuralized affect and actualized affect are proposed candidates for observation of changes in relational ways of being as it is expressed in transference. A psychoanalytic follow‐up interview of a former analytic patient is presented in order to illustrate how change in relational ways of being may be registered and studied. By triangulating the patient's verbal report of change with nonverbal information and transference–countertransference dynamics, one may grasp qualitative changes in relational ways of being. The case presented illustrates a former patient's on‐going process of working towards representing aggression in a more direct manner and how this process is made observable with the aid of the proposed concepts in the interview situation. The proposed concepts of relational scenario, structuralized and actualized affect discussed are compared to the concept of transference used in studies of core conflictual relationship theme (CCRT).     

Erotic Transference and Its Relationship to Childhood Seduction

The phenomenon of an erotic transference has long been a difficult, if not mysterious, process within clinical psychoanalysis. Traditionally, the development of an erotic transference has been viewed as a negative clinical event fueled by the analyst's countertransference reaction. A much neglected dimension, the relationship between childhood seduction and the development of an erotic transference, will be introduced and examined. In three clinical cases our data suggest that actual sexual abuse in childhood is a causal factor in the manifestation of an erotic transference in the clinical interaction of an analysis.     

Childhood Sexual Abuse

Abstract

Childhood sexual abuse is a problem that leads to serious psychological disturbances evidenced through the symptoms of post-traumatic stress disorder (PTSD). This article discusses the treatment of sexual abuse survivors within a psychoanalytic framework. Different theoretical perspectives including classical Freudian, ego-psychological, object-relational and self-psychological are presented. Several relational treatment models, including feminist psychodynamic approaches, are offered. Themes include the importance of developing a strong therapeutic alliance and analyzing transference 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.     

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.     

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.     

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.     

Trauma and the transference‐countertransference: working with the bad object and the wounded self

This paper focuses on the transference‐countertransference dynamics that manifest in work with those individuals who experienced severe early relational trauma and, in particular, childhood sexual abuse. The literature is surveyed from Davies and Frawley's (1992a) seminal paper through to more current trauma‐related and sensorimotor approaches, which deepen our understanding greatly. The rapidly shifting, powerful, conflicting and kaleidoscopic transference‐countertransference dynamics are explored in the light of these views and in relation to a lengthy clinical example. The author elucidates the dual‐aspect of the traumatic complex, whereby the abuser figure, which is disavowed by the patient, becomes manifest in prosecuting the analyst for the ‘wounds’ that the analysis evokes. The paper also explores the particular nature of the splitting processes, whereby pressure is put on the analyst to adopt an idealized role, in particular to act as a self‐object, in order to enable the patient to safely express and ‘be’ themselves in an attempt to make up for what was not possible in childhood; the analyst will necessarily fail in this task. In the context of powerful masochisto‐sadistic dynamics, the analyst's masochism is likely to be called up in the spirit of caring ‘humanity’ (another inevitable enactment), which can impede the progress of the analysis if not addressed. The extreme woundedness, intense affect and moral outrage associated with these dynamics are characteristic and compelling. Issues relating to disclosure, enactment and analytic attitude are also discussed.     

Listening to the Erotic Commentary on Paper by Eric Sherman

In this commentary I examine homoerotic countertransference within the context of the analyst's erotic countertransference experience. Discussing male analysts' difficulties receiving and experiencing homoerotic feelings as a function of their dominant erotic desires (along gender lines), I propose both cognitive and affective explanations to illuminate their defenses. I suggest that Sherman's erotic countertransference is best understood when viewed as a product of both induced feelings emanating from his patient's dissociated sexual abuse and also his anxiety and shame in response to particular relational configurations with his patient that arouse him. Finally, I point to the site of the transgressive as integral to the construction of erotic desire and suggest shifts that need to occur in the erotic subjectivity of this dyad so that the treatment can move forward.     

Therapeutic Work with Trauma,Revictimization, and Perpetration: Bearing Witness,Offering Hope,Embracing Despair

ABSTRACT

This paper offers a case study of a survivor of childhood incest who in adulthood has become a victim of violence in her relationships with chosen partners and is concerned that she herself may be a perpetrator of sexual abuse. It examines selected literature on attachment, dissociation, transference/countertransference, role responsiveness and sadomasochistic therapeutic enactments, the two-system superego model, and the triadic self. The paper focuses on long-term treatment dynamics with survivors of cumulative trauma and explores such psychodynamic psychotherapy issues as the therapist as a perpetrator of violence, the development of sacred space, authenticity, and the importance of both offering hope and embracing despair in this work.     

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.     

Psychoanalysis is a two‐way street

The paper discusses psychoanalysis as a mutual exchange between the analyst and analysand. A number of questions are raised: What was Ferenczi's and the early psychoanalysts' contribution to the interpersonal relational dynamics of psychoanalytic treatment? Why did countertransference become an indispensable tool in relationship‐based psychoanalysis? Why is the transference‐countertransference dynamic seen as a special dialogue between the analyst and analysand? What was Ferenczi's paradigm shift in the trauma theory? How did he combine the object relation approach with Freud's original trauma theory? The paper illustrates through some case study vignettes the intersubjective and intrapsychic dynamic in the process of traumatization. We can look at countertransference as an indicator of the patient's basic interpersonal experiences and traumas. Finally the paper discusses countertransference in the light of attachment theory, connecting the early initiatives of inter‐relational approaches in psychoanalysis with recent research.     

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.     

Cracking In: The Psychotherapeutic Action of Comedy

The relational reach and psychotherapeutic action of comedy are examined in the opening phase of treatment with a man who had an early history of neglect and consequent neurotic isolation. Through the examination of a series of comedic enactments that cracked into the beginning phase of this treatment, comedy's animating force to defy neurotic gravity and aid in the reanimation of primal density is considered. The ways in which laughter opened into a maternal erotic transference—countertransference is further detailed, in conjunction with reflection aimed at the aggression of this comedic bond, including countertransference hate.     

A response to Maggie Turp's paper from a body psychotherapy perspective

Whilst appreciating the quality of containment in Turp's work as a learning point for the Body Psychotherapy tradition, the author argues that Turp does not represent a psychotherapeutic way of ‘working with the body’. This would require a deconstruction of the body/mind dualism inherent in much psychotherapeutic (and psychodynamic) theory, so that the complexity of the spontaneous and reflective body/mind processes, especially in their polar extremes (body/mind dissociation – body/mind integration / ‘psyche/soma unity’), can be contained. An holistic body/mind formulation of countertransference is approached by which – rather than being used as a gratifying or cathartic therapeutic shortcut which avoids the intensity of the transference – the body can be seen to constitute an avenue into the full experience of the transference/countertransference process and its relational sources in early development.     

The Clinton Impeachment: A View from France

Our article is about dissociative phenomena in the transference—countertransference patterns that emerge in patients known to have been sexually abused as children [Davies and Frawley, 1992, p. 94].     

An ego psychology-object relations theory approach to the transference

This paper summarizes an ego psychology-object relations theory and its application to psychoanalytic technique, particularly to the analysis of the transference. The relative importance of verbal, nonverbal, and generally relational "channels" of communication in patients with differing degrees of transference regression is examined. The use of countertransference reactions in formulating transference interpretations is reviewed. The relations between unconscious meanings in the "here-and-now" and unconscious meanings in the "there-and-then" are explored in the transferences of patients with varying degrees of severity of psychopathology. Differences with other theoretical approaches are highlighted throughout.     

Basic Considerations in the Application of Therapy and Education to Parent Groups

This article presents a couples group therapy treatment approach that uses analytic object relations concepts such as transference/countertransference, projective identification, containment, and the holding environment. Object relations theory is seen as the most useful theory with which to view couple interaction because it is based on a two-person psychology and focuses on the impact of relational systems on the development of the person. This includes the idea that the person grows within the attachment to another person. Group therapy is seen as a more effective treatment approach because the group is a resilient holding environment that provides an avenue in which projective identifications can be understood and contained, power can be redefined, isolation of the couple can be decreased, and the couple's responses can become more versatile. The model described is illustrated with clinical vignettes from an open-ended couples group.     

Paternal empathy in the transference/countertransference relationship

This paper explores the process of paternal empathy within the context of the transference and countertransference relationship. The masculine and feminine elements of paternal responsiveness are described with implications for therapeutic resonance and mirroring. Case material illustrates the author's thesis.