Countertransference Issues Research Articles

Facing death with a clientConfrontation or collusion, counter-transference or compassion?

Abstract This paper has been written to highlight counter-transference issues with a disabled and terminally ill client and to raise some of the issues that arise when a client dies at the end of a long-established counselling relationship. The importance of maintaining a therapeutic frame in psychodynamic counselling is reviewed and a case study of a young counselling trainee in therapy as a requirement of her course is presented, followed by a discussion of the dilemmas encountered as her health dramatically declined and after her death. In this work the terms counselling and therapy are used interchangeably.

Forensic child and adolescent psychiatry.

This brief chapter has been written as an overview of child and adolescent forensic psychiatry. An attempt was made to briefly and simply summarize several topics. At the end of the chapter, the interested reader will find additional sources to pursue areas of interest in depth. Many important issues were not addressed, including aggression, homicide, the child as witness, countertransference issues, lesbian mothers and gay fathers, and dual-agency conflicts, among others. These and other issues are beyond the scope of this brief chapter, but nonetheless, important issues in forensic child and adolescent psychiatry. Forensic child and adolescent psychiatry is not for everyone. Those interested in working in the field will find it challenging. Beginners are urged to seek consultation from more experienced colleagues and the inexperienced practitioners will find consultation helpful. Although some may wish to avoid the forensic arena completely, those of us who work in the field find it rewarding.

Hostage of the fee: Meanings of money, countertransference, and the beginning therapist

SUMMARY The issue of money and fees for treatment is one of the most inadequately discussed issues in the psychotherapy literature. Despite its relevance to every psychotherapy, and its irrefutable impact on the psychotherapeutic relationship, there appears to be a resistance among us to exploring this issue either in our literature or in our training. This discussion highlights some of the meanings of fees in the arena of psychoanalytic psychotherapy, and poses some possible explanations for its absence from our literature and training. Case material is presented from the author's beginning psychotherapy practice. Transference and countertransference issues are discussed, as are some more general experiences and impressions of the author having to do with money, values, and the ethics of professional practice regarding fees. The importance of more open discussion, especially among beginning therapists, and therapists in training, about money and fees, as well as their countertransference implications and...

Transference and countertransference issues with sexually abused clients

Abstract This paper explores some of the therapeutic issues which arise when working with sexually abused clients. It is suggested that both the client and the therapist may at moments take any of the three positions in the Oedipal triangle and that the mother, father and child status are interchangeable in the transference and counter-transference. It is also suggested that the Oedipus myth represents the failure of a family to contain sexual and murderous passions. I describe a Hindu myth which takes a similar triangle of passion but illustrates how containment is possible. It is proposed that this implies we need to re-evaluate the presence of the erotic in therapy in a more positive light. It is further suggested that the sexually abused client needs to experience the containment of passion if a healing process is to occur.

A Therapy Group for Mothers with Dissociative Disorders

This paper describes the evolution of a therapy group for mothers with dissociative disorders. Although the group is for survivors of childhood trauma, its focus is on the present dilemmas of child rearing rather than on past traumas. It uses mothering as a common bond to improve parenting and interpersonal skills and to propel forward each member's individual therapy. The article summarizes the relevant literature, provides a rationale for such a group, and discusses the issues of cotherapy, combined therapy, group process, transference, countertransference, and thematic material.

Boredom in the Therapist: Countertransference Issues

ABSTRACTWhen a therapist is bored in the clinical session this is always, unless pathological, a countertransference issue. Understanding the causes and meanings of this boredom thus adds to an understanding of the therapeutic process and relationship. It may have a variety of causal factors which need teasing out in the furtherance of the therapeutic process. Boredom may be connected with feelings of emptiness or drowsiness but is in itself a distinct phenomenon.

Patient suicide and assault: their impact on psychiatric hospital staff.

Psychiatric nursing entails its own particular hazards, specifically patient suicide and patient assault on staff. The reactions to these occurrences are manifested in the symptoms of PTSD and grief, which often are exacerbated by administrative reactions and the staff's own countertransference issues.

Feminist Psychopharmacology

What is feminist psychopharmacology and why do we need it? Numerous issues related to gender come to mind. Gender bias can be seen in medical research, medical training, psychiatric diagnoses, and prescription practices. A feminist psychiatrist attends to these biases. In addition, a feminist practitioners uses the principles of feminism and feminist therapy in all aspects of her work. This includes an understanding of the history of the study of women's psychology, the study of psychological trauma, the newer models of women's development and psychology, and societal and cultural incluences on these. These are all relevant in addressing the transference and countertransference issues that arise in the evaluation for and prescription of medications. The feminist psychiatrist will be aware of these issues, and will collaborate with the client, using empathy, respect, validation, and empowerment as important principles.

Countertransference Issues in Group Psychotherapy with HIV-Positive and AIDS Patients

Mental health professionals are increasingly aware of the special difficulties encountered by therapists working with HIV-positive and AIDS patients. In this report, countertransference issues experienced by therapists leading a psychotherapy group for heterosexual, drug-using HIV-positive and AIDS patients in an inner city hospital are explored. Countertransference is discussed under the headings of helplessness, death anxiety, and anger.

Self-disclosure in treatment: What therapists do and don't talk about

In contrast to the traditional view that sees therapist self-disclosure as a form of countertransference acting-out that either makes the therapeutic process more difficult or subverts it completely, this paper will present a self psychological rationale for the selected use of therapist self-disclosure in treatment. It will discuss the nature of therapist self-disclosure, issues in its use, countertransference issues, and its evaluation.

Working with staff and patients in a hospital for the elderly

Abstract An account of work in progress with staff and patients in a long-stay hospital for the elderly physically frail. Initial work with staff support groups, and then some small groups of selected patients, and a monitoring of the countertransference, led to a gradual appreciation of the emotional difficulties of getting more involved with the patients, which in turn led to setting up community meetings for all the patients and staff on the wards. Illustrations of the small groups and then the community meetings from one ward over a six-month period show that a recurring theme was the pain of the multiple losses the patients suffered, especially revived by absences and holidays of the staff. The meetings showed patients seeking various ways of protecting themselves against the emotional pain, some withdrawing into states of mindlessness and some into fragments of conversations from the past. The meetings include occasions when patients and staff shared some of the sad feelings and other occasions when they were drawn into persecutory struggles. There is a discussion of the patients’ and staff's reactions to the meetings, of their anxieties and defences, and of the countertransference issues.

Stages of group psychotherapy supervision: a model for supervising beginning trainees of dynamic group therapy.

This article presents a model for supervising beginning therapists of dynamic group psychotherapy. It is geared to their experience with the challenging patients most often seen in training clinics. The model presupposes no particular metapsychology but, to meet trainees' needs, advocates a hierarchically organized set of operational goals. The supervision is conceptualized as ideally occurring in three sequential stages: (a) The "Technical" phase conveys the fundamentals of technique, the "craft." (b) The "Enrichment" stage emphasizes appreciation of group phenomena, including formal group dynamic theory. (c) The final phase highlights the more "Personal" side of becoming a skilled group psychotherapist, including countertransferential issues and the termination process. The model, not intended to be applied in a Procrustean manner, also serves, nevertheless, as a description of how a satisfactory supervision for beginners generally proceeds.

Looking Through the Mirror of Disability: Transference and Countertransference Issues with Therapists Who Are Disabled

Looking Through the Mirror of Disability: Transference and Countertransference Issues with Therapists Who Are Disabled

Looking Through the Mirror of Disability:

This article attempts to examine issues of transference and countertransference in psychotherapy with therapists and clients with disabilities. Common strengths, defenses and limitations of therapists who are disabled are discussed from both a personal and professional perspective. Transference and countertransference reactions are identified in diagnosis, assessment and treatment planning with particular emphasis on expectational systems, strengths and weaknesses. Typical transference reactions of clients who are disabled are often intensified and may include such feelings as anger, resentment, incompetence and comparison with the disabled therapist. Discussions of typical countertransference reactions include guilt and anger, oversheltering, overidentification, overestimation of abilities and codependency with clients.

Group psychotherapy with inner-city grandmothers raising their grandchildren.

A year-long psychotherapy group consisting of two co-therapists and eight grandmothers who were parenting their daughters' children is presented. Three models that correspond to the co-therapists' psychoanalytic developmental orientation were used to describe the group phases of development. A number of themes that emerged at different points in the group's life are delineated. They include: authority, control, sibling rivalry, the generation gap, dealing with schools, illness and mortality, isolation, defensiveness, anger, fear of going crazy, guilt, shame, separation, and abandonment. Transference and countertransference issues are also discussed.

Can we grow flowers here? countertransference issues in work with maternal sexual abuse

Summary This paper is about maternal sexual abuse. I first explore the language that we use when talking about abuse, or people who have been abused. Then I address the issue of sexual abuse generally and what the experience of sexual abuse may be for a child. Working with sexual abuse raises important countertransference issues which I attempt to identify. Finally I describe therapy sessions with a girl who had been sexually abused by her mother.

Countertransference issues in crisis work with natural disaster victims.

Countertransference issues in crisis work with natural disaster victims.

When the therapist needs therapy: Characterological countertransference issues and failures in the treatment of the borderline personality disorder.

When the therapist needs therapy: Characterological countertransference issues and failures in the treatment of the borderline personality disorder.

Supervision of the Beginning Therapist: Privileges and Problems

SYNOPSISMost of the trainee psychotherapists providing treatment within the National Health Service setting are psychiatrists in training. The Royal College of Psychiatrists recommends that supervised experience in psychotherapy should be gained by all trainees during their general professional training in preparation for the Membership examination. Short‐term dynamic psychotherapy is commonly offered as an economical treatment approach for psychiatric patients within the public sector provision. The conflict between attitudes rewarded in medical training and the qualities needed for the practice of psychotherapy creates problems for the trainees which emerge in supervision. Experience of supervising beginning therapists, the privileges and the problems, and countertransference issues are discussed. A framework for supervision is outlined.

Countertransference: A Theoretical Review and Case Study with a Talented Client

AbstractIt is our dual identity of artist and therapist that can be particularly problematic for the art therapist. Transference and countertransference issues are complicated by these roles. In this theoretical review and case study, my role as artist, and my narcissism at seeing a talented young client blossoming under my direction, complicated the therapeutic process greatly. Fourteen-year-old Carlos was the “dream client.” He was motivated, prolific, talented, enthusiastic, and was dramatically improving behaviorally as a result of art therapy. This article points out serious complications which are attributed to problems of transference and countertransference.