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.     

Real relationship,working alliance,transference/countertransference and outcome in time-limited counseling and psychotherapy

Six client/therapist dyads (three therapists each working with two clients) were studied to determine how the real relationship unfolds over the course of time-limited treatment and how this unfolding relates to the development of the client/therapist working alliance, client transference, and therapist countertransference. We also examined how these indices of the relationship fluctuate as a function of treatment outcome. Results indicate that in general for all six dyads, therapists’ and clients’ ratings of the real relationship and working alliance were strong throughout treatment. However, patterns of real relationship and working alliance over the course of treatment varied between dyads categorized as more vs. less successful. Therapists’ countertransference was low, as was client transference, but differences in ratings were evident when the dyads were classified by outcome.     

Depth of discussion of multicultural identities in supervision and supervisory outcomes

The present study empirically examined the relationship between perceived depth of discussion of multicultural identities in clinical supervision and supervision outcomes in 132 practicum trainees and interns from American Psychological Association-accredited doctoral programs in counseling, clinical, and combined psychology. Results indicated that ethnic minority trainees and gay, lesbian, and bisexual trainees perceived increased depth of discussion of their corresponding identities compared to White trainees and heterosexual trainees, respectively. However, women and men reported no difference in perceptions of depth of discussion regarding gender. Perceived depth of discussions of three multicultural identities (gender, race/ethnicity, and sexual orientation) was significantly and positively correlated with supervisory working alliance, multicultural intervention self-efficacy, and general counseling self-efficacy, and significantly and negatively correlated with role ambiguity and role conflict. These relationships between perceived depth of discussion and role ambiguity and working alliance-rapport remained significant for the three identities while controlling for past training experiences. The relationships between perceived depth of discussion of gender and role conflict, of race/ethnicity and working alliance client focus, and of sexual orientation and role conflict, multicultural intervention, and working alliance client focus also remained significant while controlling for past training experiences. Implications for supervisory practice, training, and research are discussed.     

Transference: current concepts and controversies

In this paper I have presented a brief outline of some of the more important issues regarding transference. To summarize I shall restate ten transference issues heretofore discussed: What should be included in the definition of transference? Should it be defined narrowly or broadly? In what ways can transference be usefully viewed in relation to reality? What merit is there in distinguishing the working alliance from transference? Should self and object transference be differentiated? Should transference neuroses be discriminated from transference reactions on the one hand and from transference psychoses on the other? In addition to sexual and aggressive transferences, should sexualized and aggressivitized transferences, respectively, be distinguished? How may transference be conceived of as a vehicle of cure and yet also as a resistance to cure? What is to be said for the relative merit of the "here and now" versus the "there and then?" What is the role of transference in relation to insight on the one hand and to the therapeutic object on the other? What are some of the basic issues in countertransference?     

Toward a Critical Global Psychoanalysis

In light of the contemporary shift away from the universalizing of the Eurocentric perspective, brought into focus with the advent of globalization, it may be useful to consider reorienting traditional psychoanalytic assumptions about human nature to those that are more appropriate to the recognition of a culturally pluralistic world. The author argues that ego psychology originated in the Western Enlightenment's emphasis on liberal individualism, which has limited its applicability across races, classes, and cultures. Relational theories, in their capacity to include the examination of the socially constructed dimensions of the analytic dyad (including race, class, gender, ethnicity, and sexual orientation), offer crucial theoretical and clinical possibilities, lacking in traditional psychoanalysis, that may help analysts to address some of the important cultural sources of psychological suffering. In the relational view expressed here, the unconscious—as made manifest in everyday life and in the transference and countertransference of the analytic situation—is reformulated to include social and cultural influences.     

Therapists’ perspective on the therapeutic relationship: Examining a tripartite model

The components of a tripartite model of the therapeutic relationship, namely the working alliance, the transference configuration (transference and countertransference), and real relationship, were examined in terms of how they relate to one another and to the outcome of a psychotherapy session, from the therapists’ perspective. Although previous studies have examined these components separately, no study to date has examined the components together in their relation to session outcome. Licensed psychotherapists (n = 249) were recruited from two Divisions of the American Psychological Association. Therapists completed measures for the last session they had with a client. Results revealed that from the therapist’s perspective the real relationship and working alliance related positively to session outcome, and countertransference behavior related negatively to session outcome. The components related to each other mostly as predicted by the tripartite model, and a principal-axis factor analysis revealed the presence of four distinct factors resembling the components theorized to comprise the tripartite model. The components together accounted for 27% of the variance in session outcome and only the real relationship and the working alliance predicted session outcome when all the components were looked at simultaneously in a regression model.     

The dynamics of empirically derived factors in the therapeutic relationship

The therapeutic relationship is the source of major concepts in psychoanalytic clinical theory. Such concepts as resistance, transference, countertransference, and the alliance are fundamental, even though there may be shifts in meaning between theoretical schools and clinical contexts. In the clinical psychoanalytic literature, disagreement exists over the nature of the alliance and its essential components. Empirical studies using reliable patient, therapist, and observer scales to assess the alliance demonstrate a correlation with psychotherapeutic gains. In the study reported here, thirteen patients were followed for 6 to 33 months of psychodynamic psychotherapy, during which time their views of the therapeutic relationship were assessed, and several experiential measures taken, all on a weekly basis. Statistical analyses reveal that the therapeutic relationship, as reflected in the patients' weekly responses to the St. Louis Therapeutic Relationship Rating Scale, has four distinct components: therapeutic alliance, resistance, transference love, and negative transference. On a week-by-week basis, the therapeutic alliance was the strongest predictor of improvement in patient-reported general adjustment, as reflected in such areas as self-esteem, positive affect, social relations, work productivity, satisfaction, and optimism. Time plots of the variables show the typical time course for the components of the therapeutic relationship, as well as for improvement on the experiential variables. Results indicate that the therapeutic alliance, transference, and resistance are central components of the psychotherapeutic relationship, which in turn predict the ongoing life experience of the patient.     

Relational Aftereffects in Manhood of Boyhood Sexual Abuse

Despite its high prevalence rate, the sexual abuse of boys is underrecognized and undertreated. This paper will examine the relational aftereffects of boyhood sexual abuse that emerge in adulthood. The vicissitudes of relational restructuring through the transference and countertransference are explored, with examples discussed of the various transference/countertransference paradigms often encountered.     

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).     

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.     

Invited commentary on the interview with Jan Stensson

Abstract

The potential of psychoanalysis as social criticism is explored in the context of the major social divides of gender, sexual orientation, race, social class, and ethnicity. It is argued that these divides play central roles in constructing individual psyches, and that their influence is inseparable from other social/ familial forces. Further, analyst and patient alike, inevitably enact the imperatives of class, race, gender, and sexuality in the analytic dyad. It is crucial that psychoanalytic theory be extended to account for the formative power of these cultural categories both in the construction of individual identity, and on the course of analytic work. Further, individual psychoanalysts must be aware of cultural countertransference in the analytic engagement. Finally, as a profession we have an obligation publicly to oppose the destructive imperatives of our economic, political, and social systems in the interest of individual and community psychic well-being.     

Cultural ruptures in short‐term therapy: Working alliance as a mediator between clients' perceptions of microaggressions and therapy outcomes

Aim: To determine whether or not clients' perceptions of microaggressions varied based on their own and the therapist's race/ethnicity and whether or not they would be negatively related to the effectiveness of therapy and if the working alliance would mediate this effect. Method: The study utilised a cross‐sectional, retrospective, methodology. Clients were recruited from a large university counselling centre in the United States (N=232 clients and 29 therapists). Results: Neither clients' race/ethnicity, therapists’ race/ethnicity, nor client‐therapist ethnic matching predicted perceptions of microaggressions. Clients' ratings of microaggressions were negatively associated with their psychological wellbeing; however, this effect was mediated by clients' ratings of the working alliance. Implications: Therapists should take into account the cultural messages they may be conveying to both white and racial/ethnic minority clients. Therapists should develop strategies that are consistent with a general therapeutic approach that promotes discussions about culture with their clients and, most importantly, should attend to the therapeutic relationship.     

Transference with the borderline client

This paper addresses the question of what is involved in psychodynamic counselling with borderline clients. The concept of borderline functioning or structure is explained and the technical difficulties of working in this area noted, especially in the establishment of a working alliance. The types of transference manifestations with borderline clients are then described, looking in particular at the emergence of a psychotic transference. Two case examples are given of working with borderline clients, where the transference was dominated by primitive elements, provoking powerful countertransference reactions in the counsellor. How both the client and the counsellor can be contained in the therapeutic work is then addressed. Finally, some implications of this discussion are drawn out for the training of psychodynamic counsellors, in order to equip them best for working with borderline clients. Three features of what a training should offer are identified: it should provide students with the opportunity for the exploration of the psychotic parts of their own personality; it should allow for and encourage the internalization of psychoanalysis itself as a sustaining internal object; and it should provide students with the experience of working with clients over sufficient time and at sufficient depth so they can learn about the timing and effectiveness of interventions in work with borderline clients.     

The disregarded analyst and the transgressive process: discontinuity, countertransference, and the framing of the negative.

This paper describes the difficulty of working with patients who have adopted conflict solutions common to perversion. These analysands' rapid shifts from one discontinuous mental state to another draw the analyst into a regressive transference/countertransference engagement characterized by alternations of actualized self and object representations. The analyst's disengagement from this regressive interaction is crucial, but difficult. A detailed clinical example illustrates the process of disengagement as well as the transformation of this transference into a more traditionally consolidated one. A technical approach is suggested and questions of representation and symbolization are explored.     

Race,religion and a cat in the clinical hour

Racial and religious identities are complex, often mired in dynamics of ‘othering’. Such dynamics easily become a means of distancing the pain, fear and rage of intergenerational traumas, thus undermining ways race and religion can be powerful vehicles for the transference and countertransference. Drawing from a history of race in America as well as Jung's anxiety when meeting the stranger within himself, this paper focuses on 17 years of work between a black female patient and white female clinician (me). Together we encountered themes of hatred, silence, guilt and intimacy in the transference and countertransference, themes eventually symbolized by the presence of my cat which was locked into the bathroom for each session. This cat came to represent a bridge through developmental traumas and wounds of racism.     

Approaching countertransference in psychoanalytical supervision: A qualitative investigation1

A recent examination of the literature concerning countertransference and its developments reveals its clinical usefulness in different psychoanalytical cultures. Nevertheless, a shortage of publications is apparent with respect to its approach in supervision. The authors aim in this study was to examine the concepts of transference and countertransference and how countertransference is approached in supervision, in the training of candidates, at an institute of psychoanalysis belonging to a society affiliated to the International Psychoanalytical Association (IPA). Qualitative research was carried out, interviewing supervisors and supervisees. Through analysis of the material acquired, the authors classifi ed the data into initial, intermediate and fi nal categories. The principal fi ndings were subdivided into three categories: the concepts of transference and countertransference, psychoanalytical listening and the complementarity of the phenomena, and the approach to countertransference. The concepts of transference and countertransference predominantly used by those interviewed are based on the totalistic outlook. Countertransference in supervision has been approached in a more direct and objective way when compared with the previous period, although great care is taken to delimit the boundaries between supervision and personal analysis. The main aim of supervision is to broaden comprehension and to deepen the interpretations directed towards the patient. These fi ndings suggest that the evolution of the concept of countertransference in different psychoanalytical cultures and developments in the analytical fi eld are contributing to this change.     

The Development of an Analytic Perspective in the Group Leader: Some Basic Thoughts

Previous experience working with individuals on a one-to-one basis along with previous analytic therapy are important prerequisites for analytic group training. Training must emphasize understanding of group-as-a-whole processes, such as basic assumption life, complex transference manifestations, as well as awareness of one's countertransference toward individuals, subgroups and the group-as-a-whole. Specific concepts derived from object-relations theory such as projective identification are crucial to master. Personal analytic group therapy is recommended.     

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.     

Transference, countertransference and mentoring: the ghost in the process

The concepts of transference and countertransference are used in this paper to explore some of the deeper dynamics of the relationship between mentor and mentee; it is hoped that this perspective gives a useful gaze on the mentoring process. Three aspects of the relationship are examined. The first is an exploration of the ambivalent relationship of mentor and mentee to the third party at the meeting--the organisation. The second is an examination of the mentoring process where transference theory illuminates aspects of the power, authority, control, affiliation and resistance in the freezing, unfreezing and refreezing aspects of the ebb and flow of transference and countertransference. The third aspect is an examination of the relationship between mentor and mentee with a glance at the narcissistic impulses of altruism and a sceptical brush with the dominant image of unconditional positive regard that is commonly supposed to flow from mentor to mentee.     

The impact of race and ethnicity on transference and countertransference in combined individual/group therapy

Interracial group psychotherapy is workable. Psychodynamics get cathected onto race; as this paper will show, the group process elicits feelings about racial and ethnic differences with greater intensity than in individual therapy. Analysis of race/ethnicity can be both problematic and growth enhancing for treatment. The process of identifying conscious and unconscious feelings and thoughts of race/ ethnicity can stimulate major resistance, which can engender difficulties in maintenance of a working alliance. However, the working through of these feelings/thoughts may have a catalytic effect and lead to a more rapid unfolding of core psychodynamic issues. Case material from a multi-racial/multi-ethnic therapy group illustrate these issues.The author wants to thank Drs. Nina Fieldsteel, Bob Addison, and Judith Caligor for their support and critical commentary, and Helene Kylen for her editorial assistance. An earlier version of this paper was presented in 1986 at Culture, Race, and Ethnicity in Group and Family Therapy, sponsored by Eastern Group Psychotherapy Society, New York University, and the University of Puerto Rico.