Countertransference in psychoanalytic psychotherapy with children and adolescents

Abstract

This is a rich, compact volume. Despite the seminal article by Winnicott, “Hate and the Counter-transference” (1949), child therapists have been slow to discuss countertransference issues. Children's preference for action, their closeness to primary process thinking, and the role of the therapist as play participant interact to enhance countertransference reactions. Preoedipal preverbal traumata communicated in nonverbal and regressive modes tend to evoke preoedipal issues in the therapist that may have been poorly or incompletely analyzed. Nevertheless, countertransference can become a resource in working with the child, particularly with regard to those split-off parts that become “contained” in the therapist. The countertransference issues in child analysis and psychotherapy entail emotional interactions with and by parents who, while supportive of the treatment and its goals, cannot tolerate the very changes so fervently desired. In the introduction, John Tsiantis's brief summaries of each of the 11 chapters serve to create bridges and connections between them. Anastopoulous and Tsiantis provide an exhaustive review of countertransference issues, achieving an excellent balance of completeness, condensation, and historical viewpoints enhanced by their own critical comments. This chapter could easily become required reading in the training of all child psychotherapists. In a brief chapter, Judith Trowell demonstrates how the skills required to observe young children, if focused on the observer's inner responses, provide exceptionally useful information about the inner child. Alex Holder spent 20 years at the Anna Freud Center treating children four to five times per week and the last 10 years in Hamburg, where government restrictions limit sessions to twice a week. The significant differences in containment, regression, momentum, intensity, elaboration of fantasies, and depth of transference are well addressed. Holder emphasizes that all of these specific patient factors are mirrored in the analyst as well. The clear advantages of high-frequency meetings are identified. Holder's unique experiences and his thoughtful and incisive comments are more worthy of repeated reading than summarization. Holder conceptualizes the differences convincingly. Anne-Marie Sandler discusses the countertransference difficulties of the therapist when the patient is overwhelmed by the shame of a worthless and devalued self-image and similarly refuses to value the help and the person of the therapist. In this way the patient is spared the intolerable disappointment of an object relationship. Francois Ladame takes the theoretical position that language is the “unique tool” of psychoanalysis, and cautions us neither to “despise” nor to “prize” countertransference. Ladame redefines countertransference as a challenge from the patient that is experienced by the therapist as “narcissistically frightening.” Ladame suggests group discussions rather than individual supervision in helping the therapist deal with these anxieties. Using clinical vignettes, Jacqueline Godfrind shows how readily countertransference errors can arise from the parents' attitudes toward the child, toward the treatment's progress, and toward the therapist herself. Didier Houzel uses a Kleinian orientation of “psychic envelopes,” part/whole objects, and bi-sexuality involved in the primitive splitting of maternal and paternal part objects. I found the material hard to comprehend and the clinical vignettes unconvincing. Tsiantis discusses the formidable challenge of an inpatient setting for traumatized adolescents. Challenges in this setting include splitting in the transference, projective identifications with the staff, the balance between the therapeutic individual role and the administrative team role, and the multiple opportunities for acting out of transference/countertransference roles among all involved. Tsiantis attributes success to the training and the “stamina” of the nursing staff, their consultation, and their treatment as respected team members. The traumatized adolescent in long-term residence is adept at recreating with the staff his or her own traumatic circumstances. Tsiantis demonstrates how experience, thoughtfulness, and attention to the subtle and not so subtle interplay between transference and countertransference among all those involved can be therapeutic. Ten pages of valuable references are complemented by a very serviceable index. There might be some difficulties for the American reader in encountering terms and conceptualizations that are not in everyday use here, but it is obvious that the authors know more about analytic work in the United States than we know about the Europeans. I think the book will be used as a standard text (perhaps also the advanced text) for those therapists who treat children and their parents in depth. I suspect it will become the standard reference and a classic in its time.