Countertransference and changes in the conception of the psychoanalytic relationship

Abstract

The concept of countertransference has a long history in psychoanalysis. This paper sketches the phenomenon referred to by countertransference and the development of the concept, from being signs of disturbance in the analyst to an important road to knowledge about the patient's inner life. The complexity of the questions discussed today – how to understand the concepts of neutrality, abstinence, and empathy; the relative subjective mutuality and symmetry of the analytic situation; the analyst's enactments and self-disclosure of feelings – reflects the complexity of the contemporary view of the patient–analyst relationship. In conclusion, the author presents a model illustrating the disturbing and informative aspects of countertransference together with the conceptual relationship between countertransference on the one hand and empathy and projective identification on the other. Finally, by differentiating between intuitive and irrational levels of functioning, an integrated model for countertransference is presented, synthesising the essence of the concept as it is used today.     

Art - A Feasible Illusion

This article discusses the approximation between art and psychoanalysis, considering both as manifestations of the unconscious. Art is viewed as a successful instinctual substitute which differs from the symptom in terms of effectiveness. A work of art is the symbolic universe of the artist, who, by withdrawing into the world of imagination, encounters the pathways of reality. Artistic manifestation is not interpretable, however it communicates with the observer who may also find satisfaction for his own unconscious desires therein.     

Making room: Developing reflective capacity through group analytic psychotherapy – in the analyst and in the group. Part one

Abstract

This paper is in two parts. This, the first part, traces the inter-related development of trainee group analyst and training group during the first nine months of the group's life. The influence that personal group analytic psychotherapy, supervision and theoretical learning have on the trainee are also considered in relation to the development of the group and its members, many of whom suffer from narcissistic and borderline disorders. The metaphor of ‘making room’ is used to explore the efforts of analyst and group to contain the chaotic, confused and unbounded projective identifications of its members. In this way, amidst the crowded turbulence of the group, a space begins to open up in which, slowly and painfully, the capacity for reflection may emerge.     

The Failure to Contain: How Persecutory Anxieties Contribute to Noncompliance in Adult Patients with Congenital Chronic Pain Conditions

ABSTRACT

Patients with sickle-cell disease suffer from lifelong pain. Many prefer to receive emergent rather than managed health care, which results in these people being termed “noncompliant.” This paper explores the contributing factors of such noncompliance in the adult patient with painful chronic illness. In the earliest stages of development, internal pain is attributed to external origins, and the effects of this on the psyche are analogous to those of physical abuse. When the infant's pain cannot be contained, projective identification and persecutory anxieties become deeply ingrained. Interventions that focus on healing from trauma and building trust are preferable to those which most value immediate compliance, as the patterns of behavior are so firmly entrenched.     

Emotional turbulence during the ending of psychotherapy with an anorexic adolescent

In this paper I reflect on the phase of the analytic process which precedes the termination of a psychoanalysis and describe my work with an adolescent girl. Adolescents with serious eating disorders relive in a particularly violent way, in the final phase of their analysis, the catastrophic anxiety of separation and the fear of annihilation connected with this. The perception of the final date, felt to be irrevocable, reactivates in these patients the psychotic part of their personality, which tries through a phantasy of omnipotent possession (expressed through pathological projective identification) to obscure the reality of separateness and loss. It is useful with these patients to set a date for ending at least a year in advance to enable the working through of these psychotic anxieties. Clinical material illustrates how in the final year of treatment all phases of the analytic process are relived in a violent way, and how this emotional turbulence manifests id as a battle between omnipotent phantasy and an increasing insight into psychic reality.     

Keeping mother alive: psychotherapy with a teenage mother following human trafficking

The power of new traumatic events to reignite memories and the distress of traumatic experiences earlier in life is well known to psychotherapists. When the recent trauma has been extreme, the task of assisting the patient to understand their response in the light of their earlier experience can be doubly challenging. This paper describes the therapy with an adolescent girl and her infant daughter, following the girl's escape from illegal detention, physical abuse and forced prostitution, after she was trafficked to the UK from Eastern Europe. The discussion works towards developing an understanding of the emotional interchange between the mother and infant, and the influence of the mother's traumatic experiences, on that interchange. Projective identification could be seen to occur from the mother, into her daughter, in a reversal of the situation traditionally described. The function of this for the mother and the impact on the developing infant, are considered.     

Light and movement: making contact with a traumatised and embattled latency girl

This paper shows a child psychotherapist learning and developing her technique as she attempts to make contact with a child who is extremely hard to reach. It is based on the first two years of three-times-weekly intensive psychotherapy of a latency girl who had little faith in a helpful therapeutic relationship. Her defences against such a relationship were entrenched and hard to shift. In this clinical work, the psychotherapist relies on close observation and her countertransference to develop a relationship with the child, in order to begin to make sense of her non-verbal emotional experience and communication.