Countertransference in psychotherapy of paranoid patients

Abstract

The complexity of psychotherapy is based on the very nature of the paranoid process. The therapist must not only have a good understanding of the paranoid process, but also needs to be especially careful regarding the transference-countertransference emotions. Long-standing experience in psychotherapeutic work with paranoid patients, in the individual and group setting, has enabled us to systematize countertransference reactions. Dominant projective mechanisms require a high ability to contain emotions from the therapists. The most prominent is aggression, in regard to which the countertransference feelings appear, ranging from aggression to exposedness, impotence, and victimization. The therapist must constantly separate feelings which represent his “blind spot” from those which he perceives as a patient's part in therapist himself. The latter countertransference enables the therapist to experience the internal object of the patient by the mechanism of projective identification. Beside the aggression, the feelings from the narcissistic spectrum related to topics of value, competence, rivalling, idealization, and devaluation represent a significant countertransference problem. The countertransference feelings in group psychotherapy are of lower intensity, and rarely focused on the therapist himself. In the group, there is also the possibility of significant intensification of the projection of aggression, when the whole group is focusing the projections onto the therapist. In the group milieu, commonly emphasized countertransference feelings are related to the position in the group, competence, autonomy, and dependence. The understandings and way of coping with countertransference emotions determine the potential for creating the safe emotional ground in psychotherapy.Disclosure of interestThe authors have not supplied their declaration of competing interest.