Working with countertransference

The transference-countertransference relationship is only one of five modalities of relationship that research has identified as potentially present in the therapeutic encounter. This paper gives the background and definition to one aspect of this - the countertransference - and traces the development of the concept from Freud's first use of the term in 1910 to the contemporary view that it is a useful tool of psychotherapy. The first part explains its connection with the Kleinian concept of projective identification and discusses its elaboration by the object relations school. There is general acceptance nowadays that the countertransference contains a great deal of information about the client's psychological world. It is therefore important to understand this process and the authors have identified three main dimensions to countertransference. These are its vector (or direction and force), its variance (the quality it represents), and its valence (its effect on the client). The second part of the article illustrates, through the use of example and metaphor, how these three dimensions are defined and can be recognized. Common themes and paradigms of countertransference are identified and discussed along with some ways in which experience has shown how these might be contained and worked with constructively. Finally, a clinical vignette is presented in which some of the dimensions of countertransference are identified and used to understand the client's psychic world and foster therapeutic change.     

Narrating attachment: Some lessons learned from Charles Dickens' novel ‘Little Dorrit’

In this paper the author aims to explore the way in which contemporary society is informed by the values of technology, and how this ‘technological milieu’ influences the practice of counselling and therapy. The philosopher Albert Borgmann identifies some of the values of technology as efficiency, speed of results and ease of availability. While acknowledging technology's undoubted benefits, Borgmann warns that allowing these values to dictate ever more aspects of life threatens to impoverish us. In contrast with technological devices, the ‘focal’ experiences which give our lives meaning are rich and complex, as much to do with the journey as with reaching a goal. In this paper, the author argues that it is important to try and preserve counselling and psychotherapy as focal experiences, despite increasing pressure to conform to a more technological approach. In the light of this, the drive towards evidence-based treatments, the promotion of time-limited focused approaches to treatment and current trends such as the interest in neuropsychological approaches to attachment theory are examined.     

The Therapeutic Alliance in Multicultural Practice

Abstract

The therapeutic relationship rests on both an emotional bond with the therapist and a rational, “working” connection. Both dimensions of the alliance have relevance for multicultural clinical work. There have been many contributions to multicultural practice that emphasize either cognitive or emotional levels of the alliance. This paper uses both empirical studies and clinical papers to synthesize both the emotional and the rational perspectives on the multicultural alliance. Examples are drawn from literature, published case examples, and the author's own clinical practice.     

Avoiding Colonizer Positions in the Therapy Room: Some Ideas About the Challenges of Dealing with the Dialectic of Misery and Resources in Families

Some authors have argued that certain acts of family therapists—despite their best intentions—may represent a form of colonizing the family. When acting as a colonizer, a therapist is understood as becoming overly responsible for the family and focusing too strongly on change. In so doing, the therapist disrespects the family's pace, and neglects their own resources for change. This paper aims to highlight the need for therapists to be hypersensitive both to the resources of families entering therapy as well as to the impact of prevailing ideologies on their own positioning in the session. The kind of sensitivity advocated here is dialectical in the sense that every family is understood as having potentials promoting dynamism, happiness, and well-being as well as potentials contributing to stagnation, unhappiness, and misery. In this article, using illustrations from clinical practice, we present some ideas for resisting the tendency by the therapist to assume a colonizing position as a professional solver of problems for families. Our main aim here is to redirect the therapist toward connecting with the family's suffering, as well as with the resource repertoire it has developed for navigating and negotiating its way through life.     

L’évaluation thérapeutique et collaborative : preuves empiriques

This paper covers the empirical research that addressed utility and effectiveness of therapeutic assessment or of its components (i.e., providing individualize feedback to clients). Studies vary in terms of methods and problems addressed but provide the consistent picture of therapeutic assessment as a brief approach which increases process variables related to subsequent treatment and has direct effects of symptoms reduction for a variety of psychological problems. Future directions of studies in this are finally provided.     

Therapeutic Assessment with couples

Therapeutic Assessment can be helpful to many types of couples, including (1) those who are considering marriage and wish to know each other more deeply, (2) long-term couples who are in distress and considering separating, and (3) couples who have decided to separate but wish to better understand why they were unable to stay together. This article comprises the first complete case study of Therapeutic Assessment (TA) with couples. I describe how those steps common to all forms of TA (initial sessions, extended inquiries, assessment intervention sessions, and summary/discussion sessions) differ when applied to couples. I also discuss the use of the Consensus Rorschach as an assessment intervention with long-term distressed couples engaged in problematic projective identification. The case example involves a young heterosexual couple married for 12 years who were at an impasse in couples therapy. The assessment helped the partners explore mutual conflicts around the expression of anger and dependency needs, and to resolve a power imbalance within the couple. Long-term follow-up showed that the Therapeutic Assessment helped the couple have more compassion for each other and move beyond the destructive role-lock they had fallen into. Also, the referring therapist reported that the TA helped resolve the impasse in the couples’ therapy.     

Évaluation thérapeutique et obligation de soins

This article presents an application of therapeutic assessment in a mandatory treatment setting. Assessment has been traditionally considered as specially important in this setting. Following previous works (Chudzik & Aschieri, 2013) about the therapeutic relationship in this setting, we show that TA is useful to avoid some common pitfalls and make a real psychotherapeutic process possible. We consider the specificity of each step of TA in this setting and we illustrate it by a clinical case.     

A Comparison of Positive Versus Negative Emotional Expression in a Written Disclosure Study Among Distressed Students

This study investigated the effects of expressing through writing either positive feelings, negative feelings, or both about an upsetting event in order to assess which mode of expression facilitated greater emotional and cognitive processing. Undergraduate student participants with self-reported unresolved upsetting experiences were randomly assigned to one of three writing groups. After completing three writing sessions, they were evaluated at baseline, postexperimentally, and at 1-month follow-up. All groups experienced positive benefits; however, participants in the positive writing group showed greater adaptive cognitive changes than the other groups. Thus it appears that the written expression of positive feelings is as therapeutic as the written expression of negative emotions, which may prompt increased cognitive reorganization or benefit finding among a nonclinical sample.     

Marital Problems Occurring in Midlife: Implications for Couples Therapists

The ability of therapists to adequately address the presenting problems of couples impacts the process and outcome of therapy. Although research has examined the types of problems that couples commonly experience, little is known about problems among midlife couples. Midlife marital problems were examined using data from a national random sample of 632 married people between the ages of 40 and 50. The results indicated that the most common problems were financial matters, ways of dealing with children, and sexual issues. Values, commitment, spiritual matters, and violence were the least common problem areas. There were few differences when gender, remarriage, and length of marriage were considered.     

Treatment Planning as Collaborative Care Map Construction: Reframing Clinical Practice to Promote Client Involvement

Collaborative care map construction is proposed as an alternative reference to the clinical practice of treatment planning. This reframe is intended to highlight the importance of client–therapist collaboration in “mapping out” care. Six therapist postures or practices are presented and discussed that promote client involvement: (a) speaking tentatively, (b) revisiting role induction, (c) inviting client preferences, (d) determining direction, (e) wondering aloud, and (f) checking for clarity and soliciting feedback. Suggestions are provided for employing these postures within the time constraints and external controls of managed care entities.