Countertransference Experiences Research Articles

Touched by Grace during the Psychoanalytic Hour: the Transformation of a Religious Resistance

Case material is presented illustrating a phase in religious transformation in which the quality of the religious moment—first expressed in transference hints and a dream, and finally augmented by an idiosyncratic enactment of the patient’s—became sufficiently intense that it crossed formal religious boundaries. The patient resisted direct reference to her religious beliefs, yet the deeper roots of her God representations took alternative forms of expression. The analyst’s appreciation of this, which was rendered articulable through a carefully refined countertransference experience, eventually enabled a sincere experience of joining, one that superseded apparent religious differences between analyst and patient.

Focused Countertransference Exploration in Classroom Teaching of Modern Psychoanalytic Candidates

A method of classroom teaching as a paradigm of treatment situations is presented. The focus is on moving candidates from an intellectual to an emotional experience of regression, transference, and countertransference as it is manifested in the classroom setting, and to study these manifestations and the treatment approach used to elicit them. The purpose is to prepare candidates for work with disturbed patients. Some modern and classical psychoanalytic theories and practices are highlighted.

Fostering Curiosity: Using the Educator–Learner Relationship to Promote a Facilitative Learning Environment

“The Teaching Alliance: A Perspective on the Good Teacher and Effective Learning” begins with the concept that teaching is an inherent part of the role of a physician and psychotherapist. Few clinicians ever specifically focus on the development of teaching skills, whereas, psychotherapists generally view the practice of psychotherapy as a quest in life–long learning, thus seek conferences, supervision groups, and other educational opportunities to enhance therapeutic skills. Good psychotherapists are curious about the psychodynamic forces that may be contributing to a patient’s problems and strive to instill a sense of curiosity within the patient, yet in medical education, curiosity has been lost all too frequently by students as well as educators. The comparison of an educator and learner to the psychotherapeutic relationship allows us to more closely examine the critical elements of the teacher–student relationship, in addition to acknowledging the complexities that arise from transference and countertransference experiences. The authors’ definition of the teaching alliance is superb, acknowledging the challenges that will arise if a student, much like a patient, is not motivated to learn. A good teacher, like a therapist, will attempt to discover the roadblocks to learning through instilling curiosity, ultimately enhancing the teaching alliance. A good teacher establishes the learning context, just as a therapist establishes the safe environment of a therapeutic relationship. Indeed, if a student is tentative or fearful of making a mistake or of humiliation, adequate learning will not take place. Teaching is active, with the spoken language generally being the primary mode in the educational process; however, a teacher does indeed impart knowledge without speaking—the nonverbals of attentively listening to a patient or a student, giving a nod of encouragement Psychiatry 70(3) Fall 2007 205

Countertransference as active imagination: imaginative experiences of the analyst

Active imagination is at the heart of Jung's elucidation of depth psychology. Yet, in the discourse of present day analytical psychology theory it is not always given the serious attention accorded to some other Jungian concepts. Active imagination emerges spontaneously within the 'third' area--the imaginal or dynamic field--in-between patient and analyst. It is commonly regarded as the patient's experience but I am proposing that, looked upon as the analyst's experience as well, active imagination offers a distinctly Jungian way of understanding some forms of countertransference. I am describing what I think many present-day analytical psychologists already do in their clinical practice but, as far as I know, it has not been theorized in quite this way before. The intention is to exploit the unique contribution of our Jungian heritage by reframing certain profoundly symbolic countertransference-generated imagery as active imagination. In this article these are differentiated from other less complex forms of imaginative countertransference through examples from clinical practice. The point is that such countertransference experiences may activate the symbolic function in the analyst and thus contribute to the mediation of emergent consciousness in the analysand.

Musical countertransference experiences of music therapists: A phenomenological study

This study investigated the experience of musical countertransference, defined as a musical reply in response to feelings, thoughts, images, and physical reactions evoked by the client. Eight psychodynamically oriented music therapists of various psychodynamic orientations were interviewed using a phenomenological, qualitative approach. The purpose of the research was to investigate factors within the experience including: (a) non-verbal communication; (b) signals; (c) discerning reactions; and (d) response to awareness and utilization of musical countertransference. Treatment value and definition were also explored. The researcher conducted telephone interviews, 45–60 min in length. A phenomenological data analysis followed, extracting themes. All music therapists described the phenomenon as an unconscious musical communication between the therapist and the client that becomes conscious overtime. Common signals included a strong urge to respond and tension. In most cases, the description of music played in session paralleled the relationship. The study examined differences in the experience with various diagnoses, as well as classically trained musicians. Themes with musicians included use of music as defense and competency issues, while the experience was found to be similar across diagnoses. Every participant acknowledged a positive treatment value to musical countertransference and described the phenomenon as useful to understanding his/her clients.

TREATING A HIGH-RISK MOTHER–CHILD RELATIONSHIP

In this paper, the author presents detailed clinical material to portray the experience of intensive therapy shared with a young school-aged boy and his very troubled mother. The therapy involved a challenging combination of triadic sessions along with dyadic child-therapist sessions observed by the boy’s mother from behind a one-way mirror. The discussion centers on the impact of complex transference and countertransference experiences and recommends conjoint sessions as the first option when treating young school-aged children in relationship with a highly troubled parent.

A struggle to know

The author uses Meltzer's discussion of technical issues involved in working with claustrum dwellers to think about her work with a patient who proved to be a claustrum dweller. In particular, she explores his manoeuvres to prevent the development of a transference relationship and the consequent failure of the work to get him to emerge from the claustrum so that an analysis could take place. She considers the factors in both the therapist and the patient which militate against, and facilitate, their making contact. Various elements, such as narcissism in patient and therapist, the strategies of the claustrum dweller to sabotage contact, the fear of catastrophic change and the difficulties for the therapist of holding on to countertransference experience when there appears to be no foothold in the patient's mind for such thoughts are explored in relation to the author's experience with her patient. Copyright © 2005 British Association of Psychotherapists

THE MANAGEMENT OF DEPRESSION – ANALYTIC, ANTIDEPRESSANTS OR BOTH?

Patients with depression cover the spectrum, in terms of severity of psychopathology, between those receptive to analytic psychotherapy and those that require treatment with medication. In this paper, the author demonstrates how an analytic framework of understanding has a place in the latter group, and can aid general psychiatrists in relation to their depressed patients. It will be demonstrated, with clinical illustrations, how analytic thinking can help to make sense of many of the symptoms of depression, including early-morning wakening, diurnal mood variation, agoraphobia and hypochondriasis. It is also important to help the supportive relative with their countertransference experiences, when their partner is undergoing a depressive episode. Finally, the notion of a pathological ego-destructive superego taking over the driving-seat in depression is explored. The need to unseat it and replace it with a more mature superego provides an overall framework of approach to the treatment of depression.

Relational Fields in Sandplay Therapy

Uncovering the symbolic meaning of relational fields that emerge between client and therapist can illuminate sandplay processes that may otherwise be difficult to understand. A new relational fields theory for sandplay is presented, and four archetypal fields of relational experiencing are identified and described: Original Oneness/Merger, Twoness/Rupture, Differentiated Oneness/Tran¬sitional Space and the Numinous Field of the Transcendent Function. The first two fields, never before described in the sandplay literature, explain and normalize disturbing countertransference experience, helping us put it to therapeutic use. The third field is sandplay's well-known field of the meaningful use of the symbol, and the fourth field is one of numinous experience. Clinical examples illustrating each field and transitions between fields are presented.

Listening to the Erotic Commentary on Paper by Eric Sherman

In this commentary I examine homoerotic countertransference within the context of the analyst's erotic countertransference experience. Discussing male analysts' difficulties receiving and experiencing homoerotic feelings as a function of their dominant erotic desires (along gender lines), I propose both cognitive and affective explanations to illuminate their defenses. I suggest that Sherman's erotic countertransference is best understood when viewed as a product of both induced feelings emanating from his patient's dissociated sexual abuse and also his anxiety and shame in response to particular relational configurations with his patient that arouse him. Finally, I point to the site of the transgressive as integral to the construction of erotic desire and suggest shifts that need to occur in the erotic subjectivity of this dyad so that the treatment can move forward.

Is there a Place for Psychoanalysis in Public Mental Health?

Objective: To describe a programme of theoretical and clinical seminars, and to discuss the benefit of introducing a psychoanalyst's perspective to the supervisory process in psychiatric training. Conclusions: Vignettes of work from seminars provide examples that explain how the teaching that occurs is at the level of understanding of the countertransference experience, rather than at the level of psychoanalytic formulations. An application of the psychoanalytic concept of containment is found to be helpful to the trainees in understanding patients, particularly those with borderline personality disorder.

Is there anybody there? A psychodynamic view of panic attack

The effectiveness of cognitive-behavioural therapy is frequently cited when adopting this model as treatment of choice for panic attacks and anxiety disorders. However, Frank (1974), in discussing treatment effectiveness and patient compliance, argues that 'the more closely the conceptual framework of therapy fits that of the patient, the more readily he can accept it' (p. 370). In the following process analysis, my client's clear requirement for an exploratory approach meant that it was a psychodynamic understanding of the complex aetiology of her panic attacks that ultimately produced improved coping skills and a subjective sense of improvement for her. Process analysis has been chosen to illustrate the theoretical base, clinical impact and experiential immediacy of psychodynamic work; attention is drawn to the importance of transference and countertransference experiences in the choice of clinical interventions which tally with the client's sense of internal reality.

Video games and children's imagination

This paper explores the meaning of video games from a psychotherapeutic perspective, addressing the technical problem of whether or not this type of play activity favours the development of the infantile transference. Clinical material drawn from intensive psychoanalytic psychotherapy with two children forms the basis for description of the different meanings the video game may assume during the course of the therapeutic process. Particular attention will be paid to the countertransference experience and to the changes in the therapeutic attitude that are necessary in order to facilitate the use of the video game as a tool for communication. The hope is that a description of the internal processes that appear inside the consulting room when children play with video games may offer some insight to all those who deal with childhood - parents, psychologists, psychiatrists and teachers - into the ways in which video games present an opportunity for development of the child's imagination, powers of judgement and ethical sense.

Some difficulties in the analysis of a withdrawn patient

The author discusses some difficulties that arose in the analysis of a seriously disturbed patient who found talking about himself extremely problematical. He defended against awareness of conflicts, ideas and affects while being tormented and overwhelmed by them. He seemed to have acquired an inhibited character that was not, however, schizoid. He related to others in a wary, quarrelsome, yet passive way. It became apparent that his sense of identity was confused. Attention to archaic fantasies led to the uncovering of a parthenogenetic unconscious fantasy involving identification with his mother and the attempted eradication of the mental function of his father. Experiences of differentiation led to extreme anxiety including risk of failure of ego functions with the arousal of latent psychotic anxieties. Interpretation of the content of sessions became possible only after several years: until then interpretation of defensive processes aimed at preventing contact or change predominated. Disclosure of ‘unofficial’ communications by the patient, expressed as lapses of vigilance by his severe superego, revealed his crises and feelings. These idiosyncratic, muted appeals for help became a vehicle through which interpretation of content and its transference meaning became possible. Some confusing transference and countertransference experiences in the analysis are described.

Some difficulties in the analysis of a withdrawn patient.

The author discusses some difficulties that arose in the analysis of a seriously disturbed patient who found talking about himself extremely problematical. He defended against awareness of conflicts, ideas and affects while being tormented and overwhelmed by them. He seemed to have acquired an inhibited character that was not, however, schizoid. He related to others in a wary, quarrelsome, yet passive way. It became apparent that his sense of identity was confused. Attention to archaic fantasies led to the uncovering of a parthenogenetic unconscious fantasy involving identification with his mother and the attempted eradication of the mental function of his father. Experiences of differentiation led to extreme anxiety including risk of failure of ego functions with the arousal of latent psychotic anxieties. Interpretation of the content of sessions became possible only after several years: until then interpretation of defensive processes aimed at preventing contact or change predominated. Disclosure of 'unofficial' communications by the patient, expressed as lapses of vigilance by his severe superego, revealed his crises and feelings. These idiosyncratic, muted appeals for help became a vehicle through which interpretation of content and its transference meaning became possible. Some confusing transference and countertransference experiences in the analysis are described.

The Evolutionary and Developmental Origins of Patient-Induced Countertransference

The concept of patient-induced countertransference is important is in a number of contemporary schools of psychoanalysis. This phenomenon is a product of emotional induction, the primary form of communication among prehuman animals, and the channel of communication used between infants and adults prior to the acquisition of language. Emotional induction is interwoven with all areas of human emotional communication even after the acquisition of language. It is often tied to the repetition compulsion. In the analytic setting it stimulates the analyst's experience of the patient-induced countertransference, and is an integral part of all stages of the psychoanalytic process.

Captivity and terror in the therapeutic relationship

This article discusses the experience of therapeutic work with those who have suffered prolonged and repeated trauma and relates this to the concept of destructive narcissism introduced by Herbert Rosenfeld (1971, 1987). There is a focus on the extreme experiences of torture and abuse of an evil, sadistic nature, whether this be represented within the inner world or based on actual events. Alongside clinical discussion of patients, I also set out to understand a particular countertransference experience of the therapist. This is of a two-fold nature: one of feeling as though pinned to the spot like a captive and the other of having a sense of being on an edge, that is to say alert to some unknown danger. The overall effect is of being in constant suspense. At these moments I am unable to function as a thinking, containing therapist. In attempting to understand this absence of a capacity to think reflectively, I introduce ideas of Ronald Britton.

Making a Memorial Place: The Photography of Shimon Attie

Assisting the analysand in making the past a living present held within a bearable yet unpredictable future is what psychoanalysis is so much about. Events of the past can never be redone, or fully repossessed, but they must be reconstructed in the context of the transference–countertransference experience of the analytic relationship. In order to make the past a useful present and presence, we need metaphors to give it shape—metaphors that capture the memorial activity linking the past with the present and future in a meaningful manner. In this paper, I explore the ways in which the work of the American photographer Shimon Attie creates a memorial place in which the past is not simply remembered but instead is actively mourned. In The Writing on the Wall, Attie collects broken fragments from prewar German-Jewish life in Berlin, and, by projecting these found shards of former lives onto the buildings in the Berlin Scheunenviertel, which once housed these people, he creates a potential space in which a present can suddenly come alive by the superimposition of a past that was supposed to have been obliterated. In this transitional realm, the spectator is given a wide realm of to-and-fro movements between past and present that permits the creation of an object world that did not exist before. I suggest that Attie's intricate weavings of past, present, and future serve as instructive models for the psychoanalytic process in which the analyst can find himself in a similar position of opening up a playground where the past can be brought into the present and where the presentness of the past can come alive. The ability to move back and forth between the present and the past suggests a link to the Freudian concept of deferred action, later taken up by Lacan under the notion of après-coup, where the impression (Prägung) of an earlier event, having lain dormant for a long time, breaks through into the present through a retroactive action that then completely reshapes the present impression. I draw comparisons to psychoanalytic practice, in which the superimposition (the stacking on top of one another) of recollections, dreams, and associations pries open in the analysand's mind a psychic space in which memories of a seemingly insignificant past absorb a sudden sense of urgency when revisited through this retroactive process.

Supervisor countertransference: A qualitative investigation into its identification and description.

Interviews were conducted with 11 psychotherapy supervisors about an experience of supervisor countertransference with a predoctoral intern. On the basis of a qualitative analysis, results revealed that supervisor countertransference manifestations consisted of affective (e.g., emotional distress), cognitive (e.g., questioning one's own competence), and behavioral (e.g., disengagement) components. Sources of supervisor countertransference always included both the intern's interpersonal style and the supervisor's unresolved personal issues and at times pertained to intern-supervision environment interactions, problematic client-intern interactions, intern-supervisor interactions, and supervisor-supervision environment interactions. Supervisors typically believed their supervisor countertransference initially weakened but eventually strengthened the supervisory relationship. Most supervisors managed their supervisor countertransference reaction by talking with colleagues, and most acknowledged they had received little or no training in addressing supervisor countertransference issues with trainees.

‘The taboo which silences’: Is erotic transference a help or a hindrance in the counselling relationship?

This paper explores why open dialogue on the subject of erotic transference and countertransference is so difficult and attempts to offer an understanding of these phenomena which might enable counsellors to work more confidently with it. It also briefly examines the author's own research on therapists' thoughts and experiences of erotic transference, seeking to differentiate between inappropriate sexual contact between clients and therapists and the experience of erotic transference in the context of therapy as a reworking of the Oedipal relationship. Case examples illustrating the experience of countertransference within the therapeutic situation and how its presence can act as a help or a hindrance are offered. The paper concludes by examining the need to reflect on the erotic transference in therapeutic work and proposes its usefulness as a therapeutic tool. Suggestions about how the erotic transference can be managed to therapeutic effect are also explored.