Countertransference Phenomena Research Articles

January 6th: An exploration of racial introjection and social construction

ABSTRACT This paper illustrates how racial dynamics emerge through clinical and professional enactments and contribute to the social construction of race in psychoanalytic settings. The author defines societal racial introjects as introjects with a racial valance stemming from societal objects or entities. Societal racial introjects impinge on intrapsychic processes and shape racial expression in the self for both patient and analyst. The intersection of societal introjection and the social construction of race is demonstrated through an analysis of transference and countertransference phenomena between patient and analyst following the 2016 United States Election.

When the body speaks: A case discussion of bodily manifestations of introjection and identification with the aggressor

This paper provides an analysis of the patient’s somatic experiences and fantasies during the psychoanalytic psychotherapy of childhood relational trauma. Somatizations and enactments pertaining to childhood traumas are discussed as they expressed aspects of early stigmatizations, social bullying, and parental boundary violations. A central persecutory theme of impending death during the Covid pandemic is discussed as it revealed previously unspeakable persecutory fears. Obsessional somatic preoccupations and fantasies expressed the patient’s sense of inescapable condemnation and annihilation, which in turn portrayed the patient’s fear of parental homicidal wishes toward the patient. Key aspects of this treatment also concerned an analysis of self-endangerment and suicidality as a defensive process of identification with the aggressor. Somatic aspects of transference and countertransference phenomena are explored as an integral part of the analysis. A discussion of the case material with two psychoanalyst colleagues is included.

Music therapy and psychotherapy - complementarity or antagonism in the treatment of patients with mental disorders.

Aim: The aim of the paper was to compare the principles of music therapy and psychotherapy, pointing out numerous similarities and differences between these two techniques. Materials and Methods: Resistance is observed, as well as the phenomenon of transference and countertransference. In either method, the therapist is a covered therapeutic mirror for the patient/client. Music therapy, unlike psychotherapy, works almost exclusively on emotions and on the symbolic layer of expression of personality. In the case of music therapy, the verbal layer plays a less significant role than in the case of psychotherapy. The clinical effectiveness of music therapy has been studied much less than that of psychotherapeutic methods. In both psychotherapy and music therapy, there is a phenomenon of transference, countertransference and resistance. Conclusions: Psychotherapy and music therapy are complementary methods in the treatment of mental and behavioral disorders.

Working Online During the Contemporary COVID-19 Pandemic.

Within the psychoanalytic school there has been substantial and ongoing debate about the efficacy of teleanalysis. However, as a result of the current COVID-19 pandemic and the online work with which the Jungian analytic community has now had to engage, this paper initially focuses on analysts' actual experiences of working by teleanalysis. These experiences highlight a range of issues like "Zoom fatigue", "online disinhibition", dissonance, confidentiality, the frame and working with new patients. Alongside these issues, there were ample experiences by analysts of both productive psychotherapy apace with analytic work involving transference and countertransference phenomena, all indicating that a genuine and good enough analytic process can occur with teleanalysis. An overview of the research and literature both prior to the pandemic and as a result of it, confirms the validity of these experiences so long as analysts are cognizant of the specifics of such an online modality. Conclusions to do with the question, "what have we learned?", alongside training, ethics and supervision issues are subsequently discussed.

Dialogue With Psychosis: Induced Psychotic Countertransference in Psychotherapy With Psychotically Disturbed Patients

The therapeutic encounter with psychotic patients presents therapists with moments in which they may regress, together with the patient, toward primitive and psychotic areas of experience. Within this shared psychotic world, therapists might feel persecuted, as if the ground is slipping from beneath their feet. The author suggests that the psychotic part of the personality, as argued by Bion, is inherent to all of us and may come alive in the psyche of the therapist in response to patients in psychotic states. The psychotic dialogue that emerges between patient and therapist, which involves projective identification and counter-transference mechanisms, must be worked through. Therapists' capacity to survive the psychosis forced upon them and to move through and beyond it is highly significant. By examining clinical material from therapy with a patient diagnosed with schizophrenia, the author discusses this unique countertransference phenomenon, which he terms induced psychotic countertransference.

Countertransference in working with psycho traumatized patients

The paper presents the theoretical assumptions at the basis of the phenomenon of countertransference and then presents the specifics of countertransference in working with traumatized patients. Several clinical vignettes analyze some characteristics of countertransference reactions in working with psycho traumatized patients. The paper presents some results of countertransference research.

Like a rolling stone: Psychotherapy without (episodic) memory.

People with profound amnesia still retain the capacity to learn about the emotional value of experiences, which is crucial in developing and sustaining interpersonal relationships. In a 2017 paper, we demonstrated for the first time (with patient JL) that transferential feelings develop across the therapeutic process, despite profound episodic memory impairment after medial temporal lesions. This paper reports a second case (GA) of a profoundly amnesic patient in psychotherapy, this time after lesions to the anterior fornix. The work with GA opens issues such as the differences and similarities to the previous case, counter-transference phenomena, and the effects of hyperphagia. The findings make it clear that many phenomena are common to both GA and JL, such as forgetfulness, various types of repetition, the importance of the therapeutic alliance, and the ability to make therapeutic gain. However, there were differences between the cases, for example as regards confabulation, which may relate to either pre-morbid personality or lesion site. The paper also discusses the way in which patients of this type bear the very status of psychotherapeutic work with profoundly amnesic patients. Where others have seen barriers and in principle problems in working with such patients, we see many opportunities.

Dynamic countertransference

ABSTRACT This article suggests a new concept, namely Dynamic Countertransference, which focuses on therapist’s movement qualities/Laban’s Efforts as a countertransferential response to client unconscious material. Particular significance is attributed to subtle involuntary movements, called shadow movements, which in 6 effort-combinations, explained by Marion North, can reveal pre- and non- symbolic unconscious material, and might support its symbolic expression and therapy progression. The portrayal of a dance movement psychotherapy family vignette aims to explain the Dynamic countertransferential mechanism. Familiarity with personal movement profile and competence to sieve through objective and subjective countertransference are important prerequisites for its efficient use. Not only does this apply to Dynamic, but also to the use of Kinetic countertransference, which we find to be significantly different. However, both concepts might be regarded as part of Somatic Countertransference, a still under-researched but crucial area for a thorough use of countertransference phenomena, especially in dance movement psychotherapy.

Taking care of a real self - description of the psychotherapeutic process of a patient with narcissistic personality disorders in the field of dance/movement psychotherapy

Abstract Introduction: Dance/movement psychotherapy (DMT) is a psychotherapeutic trend that belongs to the approaches that involve working with the body. Thinking about a wider perspective, DMT belongs to the group of action-oriented psychotherapies. It assumes that the person, while moving, can show his/her emotional states. Additionally, it can lead to development and personal integration. The goal is to deepen awareness. Psychotherapy with dance and movement is practiced among psychotic patients, patients suffering from neurotic or personality disorders, and as a method of personal development. The aim of the work is to describe the psychotherapeutic process of an individual client in the field of dance/movement psychotherapy as a method in which dance leads to development and personal integration. Material and method: Working with a client, Beata, took place in a strictly defined setting. Meetings took place once a week in the same office during 55 minutes. They were of an individual nature. First, Beata was diagnosed according to the DSM-5 [1] and ICD-10 [2] classification, which was supplemented with the PDM-2 diagnosis [3]. During the therapeutic work, the phenomena of transference and countertransference were taken into account, the patient’s behavior was interpreted according to John Bowlby’s attachment theory and mentalization. During practicing DMT it is important to take care of Authentic Movement method, observation of movement using the Laban Bartenieff Movement System (LBMS) method and the Kastenberg Movement Profile (KMP). Results: The changes that DMT psychotherapy started to bring were observed both in the client’s movement and in the verbal layer. The client has acquired the ability to observe her feelings and needs. This influenced her perception of announcement heard from different people and the decisions she made. The DMT therapy with Beata is not over yet, which makes it possible to take a deeper look at topics related to therapeutic goals. Conclusions: Dance/movement psychotherapy has proved to be an effective method of working with patients with personality disorders psychopathology of the narcissistic type. This method makes it possible to build a sense of the patient’s boundaries and needs, and to strengthen self-esteem. Sessions seem to be very helpful in integrating inner life, feelings and experience. In addition, it helps in dealing with the internal tension of patients and gives the opportunity to expand ranges of movement. In the verbal part, it is possible to discuss the problems that the client carries within himself, which cause him fear, anxiety and other unpleasant emotions.

Together - apart: in touch in a time of separation.

This paper explores the experience of working as a Jungian analyst through the various phases of the global COVID-19 pandemic, examining the importance of the physical containing space alongside the analyst's internal mind and how technology can both help and hinder understanding. A number of clinical vignettes illustrate the challenge of communicating over a distance, paying particular attention to the way countertransference phenomena can become re-attuned. Reference is made to mythology and symbols of hope, and consideration given to the meaning and purpose of the pandemic.

Improving the physician-patient relationship utilizing psychodynamic psychology: a primer for health professionals

ABSTRACT Background The quality of the physician-patient relationship is associated with improved healthcare outcomes and patients’ complaints due to dissatisfaction. Factors that influence the quality of the physician-patient relationship include verbal communication, nonverbal communication, and clinical empathy. These factors have been studied from diverse theoretical approaches hindering their integration into a theoretical framework applicable in clinical practice and accessible for lay clinicians. Objective The aim of this paper is to put forward a psychodynamic framework that includes the factors associated with a better quality of the physician-patient relationship and is applicable in clinical practice and accessible for lay clinicians. Theoretical discussion Basic concepts necessary to comprehend transference and countertransference phenomena were outlined. Then, based on the concepts of transference and countertransference, a psychodynamic framework to understand and manage the physician-patient relationship was put forward. Conclusion This is the first paper that presents a psychodynamic framework applicable in clinical practice and accessible to lay clinicians for understanding and managing the physician-patient relationship. Additionally, this work could serve as introductory material to Balint groups.

Countertransference Processes in Psychodynamic Therapy with Dependent (Anaclitic) Depressed Patients: A Qualitative Study Using Supervision Data.

Although Blatt's two-polarity model of depression has suggested that patients' interpersonal styles may shape countertransference phenomena in psychotherapy, empirical research on this topic has remained scarce. This article provides an in-depth study of countertransference processes in clinical work with dependent (anaclitic) depressed patients using a qualitative methodology. Thematic analysis of narrative material of psychodynamic therapists discussing patient cases during supervision (n = 7) resulted in four recurrent themes: "empathy, compassion, and support," "anxiety, feeling overwhelmed, and protection," "frustration, irritation, and confrontation," and "inadequacy, incompetence, and fatalism." We found that these countertransference processes mainly revolved around perceived adaptive and maladaptive aspects of patients' relational functioning. Regarding clinical practice, our study suggests that therapists can use countertransference to determine in which position they are maneuvered by patients, although we caution against the exclusive use of subjectively informed data as a benchmark in the diagnostic and treatment process. We conclude that further in-depth research on countertransference and personality styles is needed to identify pitfalls in the treatment of depression.

‘I don’t want to die, I want to feel better’: finding hope through psychoanalytic parent-infant psychotherapy

ABSTRACTThis paper follows the journey of a young black woman as she enters motherhood during treatment in psychoanalytic parent-infant psychotherapy with a black female therapist. The impact of the mother’s early trauma on the developing parent-infant relationship is explored through the theme of being seen. Transference and countertransference phenomena are examined. There is a particular focus on the mother’s race, sexuality and gender and their impact on her growing son. Winnicott’s attention to the use of black in the consulting room is drawn upon, to open up a discussion about some of the clinical implications regarding sameness in therapist and patient, both being black and female. Finally, the practice of video-recording sessions and what this elicits in the countertransference is also explored, providing another perspective to the theme of being seen.

Systematic Exploration of Countertransference Phenomena in the Treatment of Patients at Risk for Suicide

Despite its critical role in clinical suicidology, empirical evidence on the nature of countertransference (CT) to patients at risk for suicide (PRS) is lacking. This study aimed to provide a systematic description of CT phenomena to PRS. Psychiatrists, psychologists, and psychotherapists completed the Therapist Response Questionnaire (TRQ) online, with reference to a PRS. Factor analysis (n = 267) yielded a 7-factor structure, including 1) entrapped/rejecting, 2) fulfilled/engaging, 3) aroused/reacting, 4) informal/boundary crossing, 5) protective/overinvolvement, 6) ambivalent/inconsistent, and 7) mistreated/controlling. On average, clinicians reported that CT dimensions tended to not apply to them, except for the positively connoted factor. Our findings suggest that patients at risk for suicide elicit specific dimensions of CT. We offer two alternative interpretations of clinicians’ CT endorsement patterns.

Origins of countertransference and core conflictual relationship theme of a psychotherapist in training as emerging in clinical supervision.

Therapists' unresolved conflicts might be the source of countertransference phenomena. To investigate the origins of countertransference, the aim of this supervision single-case study was to identify conflictual areas that characterize private life relationships and therapeutic relationships of one therapist in training. With this aim, we applied the core conflictual relationship theme method to the analysis of the therapist's relationship episodes with patients, as emerged spontaneously during clinical supervision sessions, and to the analysis of relationship episodes concerning his personal life, collected using the relationship anecdotes paradigm interview. Quantitative data showed that core conflictual relationship theme pervasiveness scores concerning private life relationships and therapeutic relationships were significantly interrelated. Qualitative examples of these associations are provided in the paper, and the implications for supervision and training are discussed. (PsycINFO Database Record

In the margins: Art therapy with a homeless man under the influence of alcohol

This article presents a case study of short-term art therapy with a homeless man that was undertaken in a residential hostel by a trainee therapist. One of the features of this work was that the client was an alcoholic who came to his sessions in varying degrees of intoxication. Although this presented some challenges the authors argue that his engagement in a therapeutic process had meaning that could be understood through a clinical witnessing of enactments within the transference-countertransference matrix. This required paying close attention to countertransference phenomena as expressed through the trainee therapist’s art responses to sessions, which were explored in supervision. Keywords: homelessness, alcohol dependency, witnessing, art therapy, art therapy training, clinical supervision.

Clinician-Guided Assessment of Personality Using the Structural Interview and the Structured Interview of Personality Organization (STIPO)

ABSTRACTThis article demonstrates the utility of a theory-guided psychodynamic approach to the assessment of personality and personality pathology based on the object relations model developed by Kernberg (1984). We describe a clinical interview, the Structural Interview (SI; Kernberg, 1984), and also a semistructured approach, the Structured Interview of Personality Organization (STIPO; Clarkin, Caligor, Stern, & Kernberg, 2004) based on this theoretical model. Both interviews focus on the assessment of consolidated identity versus identity disturbance, the use of adaptive versus lower level defensive operations, and intact versus loss of reality testing. In the context of a more clinically oriented assessment, the SI makes use of tactful confrontation of discrepancies and contradictions in the patient's narrative, and also takes into account transference and countertransference phenomena, whereas the more structured approach of the STIPO incorporates clinical judgment informed by clinical theory into a well-guided interaction with the patient. Both interviews have good interrater reliability and are coherent with the alternative model for personality disorder diagnosis proposed by the Diagnostic and Statistical Manual of Mental Disorders (5th ed.), Section III. Finally, they provide the clinician with specific implications for prognosis and treatment planning and can rationally guide clinical decision making.

“I’ve got you under my skin”: Relational therapists’ experiences of patients who occupy their inner world

The aim of this study was to conduct an in-depth exploration of therapists’ experiences of patients who affect them more than others and occupy their inner world beyond the context of therapy sessions. A phenomenological analysis was performed on semi-structured interviews with five relational therapists. All the therapists had a strong experience of a particular patient getting “under their skin.” In all these cases, the patient was a traumatized woman. The distinctive characteristic of the phenomenon was a sense of blurred or too permeable boundaries between the therapist and the patient. This was associated with fear and anxiety, but also with feelings of love. The therapists’ reactions to having a patient “under their skin” varied from resistance to symbiotic relatedness. The therapists’ ideas of their professional role influenced how the experience of carrying the patient’s suffering was interpreted. The phenomenon of the patient’s presence in the therapist’s representational world might be interpreted as a distinct countertransference phenomenon when working in a more “thin boundary” manner with particular cases. The therapists’ ability to effectively manage their vulnerabilities, activated in the countertransference, seems to be crucial for therapeutic progress. Implications for research, clinical practice, and training are discussed.

Clinical interventions via Skype with parents and their young children

In this article, the author discusses her experience of working with six families from two Greek islands. She focuses on her reflections and reservations on using cyber-communication technology in brief psychoanalytic parent–infant psychotherapy. Communication technology may be a useful way of providing support to families with young children living in remote areas without mental health services. Advances in cyber-communication have created the possibility of offering timely, primary mental health care to prevent difficulties becoming chronic and complex. The parent–infant psychotherapy focuses mainly on emotional difficulties related to stress in the parents’ and infant’s life and on transgenerational problems. The use of cyber-communication (Skype) for this work raises many issues and difficulties and the need for changes in technique, the expectation of technical difficulties and interruptions, the absence of physical proximity, differences in establishing the therapeutic relationship, the working alliance, transference and counter transference phenomena and in the power of unconscious processes.

La dynamique relationnelle entre l’éducateur et l’enfant en contexte de placement familial

ObjectivesTo our knowledge, there is not a lot of research to understand relationship between educator and child in foster care context analyzed by the attachment theory and a psychodynamic approach. For that, we will think about dynamics of this relationship in this specific institution with this approach complementary. We will ask ourselves to what extent educator has a specific attachment relationship with child placed in foster home. Reciprocally for professional we will ask how this alternative attachment relationship promoted an insecure attachment expression, and what is link with his caregiving compulsive system. To better thinking about complexity of this relational dynamic between two protagonists of this meeting, we will suppose existence of counter-transference phenomena for professional. For child, we will suppose existence of transference phenomena. Patients or materials and methodsFor this study we have eight subjects divided into two main conditions (educators and children placed in foster care). The tools used to measure professional's attachment are Edicode which is an interview inspired by Adult Attachment Interview and the relationship questionnaire (or RQ). We will evaluate counter-transference by a clinical interview experimental research semi-structured of thirty items. To measure children's attachment we used these instruments: the CCH, the RQ and the Ca-mir. Transference will be experimentally evaluated through a clinical interview semi-structured search and by drawing test. ResultsFor children, results show an attachment insecurity and transference phenomena expression. In addition, results demonstrate existence of an attachment relationship between children placed with their educators, these last thus constituting for them a figure of alternative attachment. For professionals, we find different results depending on the instruments used. In more Edicode shows attachment insecurity and counter-transference phenomena. ConclusionsIn our view, lack of attachment disorganization among children could be explained on the one hand, because of the small size of our sample and secondly because lack of sensitivity on our instruments on this type of attachment. For that, we believe necessary to strengthen methodology by other measuring instruments such as the use of Edicode for children from 10–12 years. Moreover, we think that kind of attachment is important to understand secure base among children placed. About educator we feel it would be an alternative attachment figure and we question about his secure base, namely to what extent this security base would be dependent on construction of that child. Finally we believe that study concern of educator's attachment must be articulated with a psychodynamic approach by introducing two concepts that we consider key in his understanding: the process of parentification and the notion of repair (in Klein's view).