Countertransference enactments informed by cancer in an analyst's child

The author's son was diagnosed with Hodgkin's lymphoma in the spring of 1997. She traces the impact of this trauma on her practice, with specific emphasis on her experience as both analyst and mother, and on the related countertransference feelings and enactments. The paper discusses in detail the analyst's effort to determine for each patient whether or not to disclose the fact of her son's illness, the internal conflict she experienced over those decisions, and the effects of her decisions on her patients. An extensive case discussion focuses on a patient who appeared to intuit in a dramatic fashion the traumatic events in the analyst's private life.     

On countertransference enactments

This communication focuses on the relation of countertransference to psychoanalytic technique, calling attention not to the more obvious forms of countertransference that have been commented on by previous writers on the subject, but to its subtler ones. Often well camouflaged within the framework of traditional, time-tested techniques, this aspect of countertransference may attach itself to our way of listening and thinking about patients, to our efforts at interpretation, to the process of working through, or to the complex issue of termination. Less recognizable than its more boisterous counterpart and in some respects less tangible, this side of the problem of countertransference is no less important. For it is precisely those subtle, often scarcely visible countertransference reactions, so easily rationalized as parts of our standard operating procedures and so easily overlooked, that may in the end have the greatest impact on our analytic work.     

Countertransference revisited

A female patient of mine recounts her week. I listen with interest, waiting for her to arrive at particular conclusions. She has suffered a great deal and still does, but prefers not to dwell on it. My interest turns into patience as she continues to talk but circumvents her discontent. She is adroit at avoidance, but easily offended when I point such things out. "I'd better wait" I think. I grow more aware that I must encourage her digressions. I feel frustrated. Getting further and further away, she skirts the issue with supple grace, then strays off into tangentiality. I forget her point and lose my focus, then get down on myself. The opportunity is soon gone. I glance at the clock as her monologue drones on into banality. I grow more uninterested and distant. There is a subtle irritation to her voice; a whiney indecisive ring begins to pervade my consciousness. I home in on her mouth with aversion, watching apprehensively as this disgusting hole flaps tirelessly but says nothing. It looks carnivorous, voracious. Now she is unattractive, something I have noticed before. I forget who my next patient is. I think about the meal I will prepare for my wife this evening, then glance at the time once more. Then I am struck: Why am I looking at the clock? So soon? The session has just begun. I catch myself. What is going on in me, between us? I am detached, but why? Is she too feeling unattuned, disconnected? I am failing my patient. What is her experience of me? I lamentingly confess that I do not feel I have been listening to her, and wonder what has gone wrong between us. I ask her if she has noticed. We talk about our feelings, our impact on one another, why we had lost our sense of connection, what it means to us. I instantly feel more involved, rejuvenated, and she continues, this time with me present. Her mouth is no longer odious, but sincere and articulate. She is attractive and tender; I suddenly feel empathy and warmth toward her. We are now very close. I am moved. Time flies, the session is soon over; we do not want it to end.     

Countertransference in family therapy

The intent of this article is to describe the importance of one psychoanalytic concept, countertransference, in family treatment by a review of the literature on the subject. Case illustrations will then be used to show how the supervisor of a family treatment case elicited the countertransference in order to move the therapy forward. Some thoughts with regard to training will be offered.     

On Countertransference

Drawing on non-clinical experience and with reference to relevant literature, this article examines countertransference and its impact on the development of a secure frame, focusing in particular on the countertransference dream and on its significance within the therapeutic relationship.     

Countertransference in group psychotherapy

This paper attempts to up-date our understanding of countertransference in the therapy group setting. After a brief review of some of the psychoanalytic and the group psychotherapy literature dealing with countertransference, the paper points out the vulnerability of the group therapist and presents examples of possible countertransferential situations, such as stereotyped roles, reactions to external aspects of patients, and therapists' insecurities. It concludes by suggesting ways in which group therapists can become more sensitive to their countertransferences.     

Countertransference in Activity Group Therapy

A controlled, clinical trial investigation of short-term psychoanalytically oriented group psychotherapy (STG) was conducted which included eight psychotherapy groups led by experienced therapists. Patient psychological mindedness (PM) was investigated as a selection criterion and prognostic variable. Seventy-nine psychiatric outpatients experiencing prolonged or delayed grief reactions were matched for level of PM and then randomly assigned to STG or a wait list. There was repeated measurement of several areas and sources of outcome. Results indicated a strong main effect for STG but not for PM on outcome, and minimal evidence for an interaction effect. Benefits were maintained at six-month follow-up. Psychological mindedness emerged as highly predictive of attrition. A clinical discussion is presented wherein the efficacy of STG is considered as reflecting a good patient—treatment match.     

The evocative power of enactments.

The inevitability of analytic enactments, defined as symbolic interactions between patient and analyst, is discussed. Clinical material from the psychoanalysis of a latency-age child is presented to illustrate the role of enactments and to demonstrate their usefulness in furthering the analytic work.     

Countertransference and reality

The psychoanalytic situation provides many opportunities for people to observe their analysts closely. These observations are inevitably woven into the fabric of patients’ transference experience. Because the observations can be uncomfortable for the analyst, there is a constant temptation to ignore or deny the plausibility of patients’ perceptions. They can be, and often are, quickly reinterpreted as derivatives of sexual or aggressive urges. Psychoanalytic drive theory, with its emphasis on impulse rather than observation as the force behind transference experience, can encourage counter‐transferential disclaimers and lead to blind spots. Some technical suggestions are offered to avoid this tendency and are based on a relational understanding of the nature of transference.     

Countertransference in the Group Psychotherapist

This report describes a pilot study of a waiting-list group (preliminary process group [PPG]) that provided treatment for applicants to a university affiliated, urban mental health center. All individuals on the treatment waiting list were informed of the PPG. This semistructured group, meeting weekly, began with members presenting their problems, followed by free discussion, and ending with goal setting for the next week. Approximately one seventh (35 out of 262) of the clinic's applicants during a 4½-month period chose to enter the PPG. They differed from those who chose not to particpate (wait list) by being older and less educated. Approximately 80% of both wait-list and PPG participants subsequently entered therapy. Significantly more PPG patients than those on the wait list entered group treatment. The PPG served clinic needs by providing prompt service for self selected individuals and by supporting the group therapy program.     

Concerning Transference and Countertransference

This paper is presented primarily for its historical interest. The author's first attempted publication in psychiatry or psychoanalysis, it was submitted successively to two publications in 1949, rejected by each, and filed away until now. In it, the author suggests that transference phenomena constitute projections, and that all projective manifestations—including transference reactions—have some real basis in the analyst's behavior and represent, therefore, distortions in degree only. The latter of these two suggestions implies a degree of emotional participation by the analyst which is not adequately described by the classical view of him as manifesting sympathetic interest, and nothing else, toward the patient. It has been the writer's experience that the analyst actually does feel, and manifest in various ways, a great variety of emotions during the analytic hour. The analytic usefulness of this actual richness of emotional participation, by the analyst, is detailed.     

Therapeutic Passion in the Countertransference

The place of the analyst's “influence” in psychoanalytic theory and practice is explored. There is a current in the literature in which it is welcomed as an aspect of “corrective experience,” although usually legitimized by being forced into the narrow channel of interpretation and understanding. A taboo on influence persists despite theoretical shifts that would seem to clear the way for greater acceptance of its importance. Among other factors, the aversion to influence is traced to its association with hypnotic “suggestion,” which implies little room for the patient's autonomy. Opening the door to embracing the possibility of influence goes hand in hand with, on one hand, the analyst respecting the patient as a competent free agent and, on the other hand, the analyst combining willingness to take a stand with willingness to reflect critically on his or her participation. In that context, and with those caveats, the analyst takes on the responsibility to combat destructive introjects and to become an inspiring, affirmative presence in the patient's life. The analyst's passion for the patient's well-being and for changes that entail the realization of dormant potentials now has its place. Different kinds of expression of therapeutic passion in the countertransference are described and illustrated.