Countertransference Problems Research Articles

모래놀이 치료적 관계에서 전이와 역전이 분석

The purpose of this study is to examine the problems of transference and countertransference between the therapist and the client in the sandplay therapy process. Transference and countertransference are important therapeutic functions of psychotherapy. Lowenfeld first mentioned transference in sandplay therapy through a debate with psychoanalysts about transference in psychotherapy, and Kalff emphasized the importance of transference in sandplay therapy through the expression

A return to Bowlby: assessment, boundaries, and inner working models

This article provides an overview of some fundamental aspects of practice within an attachment-oriented view of therapy. The article presents a scholarly approach to understanding the mainstream contribution of the Bowlby–Ainsworth model of attachment as exemplified in the empirical literature (Ainsworth et al., 1978; Owen, 2017). The article starts with a brief conclusion on what John Bowlby argued should be the core aspects of therapy. It connects these ideas to the work of Robert Langs, arguably the one person most responsible for the idea of boundaries and guidelines in contemporary practice since the 1990s. For attachment-oriented practice, the psychodynamics of supplying and receiving care is a central dynamic in therapy. In the case of individual work, there are the countertransference and counter-resistance problems that therapists bring. On the client side of the relationship, there are the problems of what Freud called resistance, a shamefaced inhibition of speech and self-disclosure, plus transference, understood in a broad sense of making assumptions, plus misunderstanding and mis-empathising the intentions of therapists because of clients' personal histories. Bowlby identified the inner working model as explicit or implicit procedural and affective memories that are the link between the onset of an attachment process and its contemporary effects. Attachment is a developmental hypothesis about learned motivation and meaningfulness between the alleged distal causes of proximal events (Bowlby, 1973, p. 44). These topics are discussed in a wider understanding of what it means to provide good enough care.

Prevalence rates of borderline symptoms reported by adolescent inpatients with BPD, psychiatrically healthy adolescents and adult inpatients with BPD.

The validity of borderline personality disorder (BPD) in children and adolescents has not been studied in a rigorous manner reflecting the criteria of Robins and Guze first detailed in 1970. This paper and the others in this series address some aspects of this multifaceted validation paradigm, which requires that a disorder has a known clinical presentation, can be delimited from other disorders, 'runs' in families, and something of its aetiology, treatment response and course is known. Three groups of subjects were studied: 104 adolescent inpatients meeting the Revised Diagnostic Interview for Borderlines and DSM-IV criteria for BPD, 60 psychiatrically healthy adolescents and 290 adult inpatients meeting the Revised Diagnostic Interview for Borderlines and DSM-III-R criteria for BPD. Adolescents with BPD had significantly higher prevalence rates of 22 of the 24 symptoms studied than psychiatrically healthy adolescents. Only rates of serious treatment regressions and countertransference problems failed to reach the Bonferroni-corrected level of 0.002. Adolescents and adults with BPD had only four symptomatic differences that reached this level of significance, with adolescents with BPD reporting significantly lower levels of quasi-psychotic thought, dependency/masochism, devaluation/manipulation/sadism and countertransference problems than adults with BPD. Taken together, the results of this study suggest that adolescents report BPD as severe as that reported by adults. They also suggest that BPD in adolescents is not a tumultuous phase of normal adolescence. Copyright © 2017 John Wiley & Sons, Ltd.

My Father, Myself

This essay presents material from the second analysis of an offspring of two Holocaust survivors, each of whom lost a child during the war. The first analysis (Kogan ) focused primarily on the patient’s relationship with her mother. This second analysis revolves around the elaboration of the complex and painful father–daughter relationship, centering on the events surrounding the death of the patient’s father. The discussion includes an exploration of the father’s deferred action on account of his Holocaust trauma, which he passed on to the next generation; the break in the idealized paternal representation; and the daughter’s identification with her father’s disavowed aggressive aspects. It also examines some of the unique transference and countertransference problems that arose, mainly because patient and analyst belonged to the same traumatized large group.

The Ripple Effect: Patients Influencing Others

This paper deals with what seems an insufficiently explored aspect of psychoanalytic practice: the ripple effect of a patient’s evolution on the present and future of his or her significant others. Clinical vignettes are provided to illustrate patients’ influence on relatives; patients acting as therapists; psychoanalysis by proxy; the ripple effect in psychotherapy; and some countertransference problems. The psychic lives of individuals not in treatment may be considerably affected by their interactions with our patients; seemingly, extraclinical character adjustments may ensue. Sociological findings and plausible psychodynamic explanations are discussed. A psychoanalytic perspective may not only help the analyst understand how therapeutic influence extends beyond the identified patient, but may also help guide interventions that are ripple-effective, even when they depart from classical analytic technique.

Psychoanalytic case presentations in a weaving thoughts group: On countertransference and group dynamics

This article summarizes experiences of psychoanalytic case presentations in weaving thoughts (WT) peer groups. The format is presented and illustrated using a session with a group of analysts. In this setting, the frame of the presentation is guaranteed by the moderator. One aim is to create a group setting with many parallels to the analytic situation. A second aim is to discourage members from becoming enmeshed in destructive group functioning, such as internal disputes that may block a deeper understanding of the material. Classical psychoanalysis permits the analyst to reflect behind the patient on the transference–countertransference interplay. However, such reflections may be marred by undetected countertransference problems. Different supervision formats have different ways of helping the analyst with them. The WT format ‘copies’ the analytic session to the group, hence each member associates to the material in peace. Meanwhile the presenter looks, metaphorically speaking, at the web of their associations at his or her own pace. This may help him or her to confront and reflect on unresolved countertransference issues. This article indicates the method’s similarities and differences compared with other formats. Arguments are supported by a child psychotherapy session, but the method is equally suitable for adult case material.

It Takes a Borderline Village

It Takes a Borderline Village

Psychotherapy of Psychoses: Some Principles for Practice in the Real World

Treatment of psychoses must include psychological treatments for the mind joined with the commonly employed biological treatments for the brain. There are various schools of psychotherapy, but psychoanalytic treatment is the only Western discipline devoted to comprehensive understanding of the subjective mind. Psychoanalytic authorities have written extensively on the psychodynamics involved in treatment of psychoses, but such approaches are limited by the realities of limited resources and number of therapists who have advanced training. Also, the techniques and understandings developed by prominent authors cannot always be implemented by many therapists who do not enjoy as robust a theoretic background. Presented here are five principles that are useful to keep in mind during the treatment of people with psychotic problems. These principles are: safety in the therapeutic situation, empathy as a means of understanding the patient and avoiding countertransference problems, validation in the therapeutic situation as enhancing safety and promoting ego strength in a fragile ego, being a "real person" with the patient rather than a taciturn traditional psychoanalytic "mirror", and "transmuting internalization" as the way in which the therapeutic process promotes the development of a stronger self able to live in conventional reality. These principles are easy to keep in mind and are compatible with cognitive and behavioral techniques as well as other psychoanalytic theories and approaches.

Contrastare l'ipocrisia: considerazioni sulla vergogna nel controtransfert

The Author examines the countertransference characteristics in the case of traumatic situations that strike the analyst, forcing to confront himself with the sense of life frailty and transience. The narcissistic axis risks suffering cracks and mutilations, that can heavily interfere with the therapeutic contract and with the relational field. This paper focuses on countertransference feeling of shame. This affect on one hand signals a distance breakdown between the Self and the other, but on the other it can have a structural value, preserving the analytical couple from insensibility and ambiguity fall. The recognition of countertransference envy and shame is a necessary passage to oppose the fatal attraction toward conventional hypocrisy (Freud, 1915), that menaces thought vitality. The A. proposes a clinical vignette to illustrate her ethical, conceptual and technical position about the peculiar countertransference problems of this situation.

Do Ask, Do Tell? Narcissistic Need as a Determinant of Analyst Self-Disclosure

Do Ask, Do Tell? Narcissistic Need as a Determinant of Analyst Self-DisclosureSteven KuchuckSteven Kuchuck222 West 14 Street, Suite 5M, New York, NY 10011. E-mail: [email protected]Search for more papers by this authorPublished Online:December 2009https://doi.org/10.1521/prev.2009.96.6.1007PDFPDF PLUS ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations About Previous article Next article FiguresReferencesRelatedDetails Cited byCited by1. To a Promised Land: Viral Dreams and Collective Trauma in the Era of COVID-19Online publication date: 30 April 2021. Go to citation Crossref Google Scholar2. The Analyst’s Subjectivity: On the Impact of Inadvertent, Deliberate, and Silent DisclosureOnline publication date: 14 September 2018. Go to citation Crossref Google Scholar3. The Personal is Political is Psychoanalytic: Politics in the Consulting RoomOnline publication date: 21 December 2017. Go to citation Crossref Google Scholar4. Relational Psychoanalysis Out of Context: Response to Jon MillsOnline publication date: 25 August 2017. Go to citation Crossref Google Scholar5. Do I Have to Tell My Patients I’m Blind?Online publication date: 22 April 2016. Go to citation Crossref Google Scholar6. The ‘too muchness’ of excitement: Sexuality in light of excess, attachment and affect regulationOnline publication date: 31 December 2017. Go to citation Crossref Google Scholar7. Lo demasiado de la excitación: la sexualidad a la luz de los excesos, el apego y la regulación afectivaOnline publication date: 1 August 2017. Go to citation Crossref Google Scholar8. ReferencesOnline publication date: 30 September 2013. Go to citation Crossref Google Scholar9. The Great MistakeOnline publication date: Go to citation Crossref Google Scholar Volume 96Issue 6Dec 2009 Information© 2009 N.P.A.P.PDF download

Working Through Shame in Groups for Victims of Trauma and War

The feeling of shame is very difficult to recognize, to reveal, to face, and to work through. Starting with some expressions of human aggression, the authors underline the difference in treating feelings of guilt and feelings of shame. The authors detail the elaboration of shame in group psychotherapy with released prisoners of war and with war veterans and review important analytic theoretical concepts of shame, projective identification, empathy, and countertransference. They examine the importance of unlocking and identifying the silent shame, as well as the mourning process essential to working through the burden of catastrophic shame. Special counter transference problems with PTSD patients are analyzed.

E-Therapy: Caveats from Experiences with Telephone Therapy

Experiences with telephone counseling are used to illustrate potential problems for e-therapy: therapy becoming conversational, problems of transference and countertransference, and the effects of client's control and immediacy of contact.

Psychotherapeutic Issues with “Kinky” Clients

People whose sexual repertoire includes BDSM, fetish, or other “kinky” practices have become increasingly visible, on the Internet, in the real world, and in psychotherapists' offices. Unfortunately, the prevailing psychiatric view of BDSM remains a negative one: These sexual practices are usually considered paraphilias, i.e., de facto evidence of pathology. A different, affirming view of BDSM is taken in this paper. After defining BDSM and reviewing common misconceptions, a variety of issues the practitioner will face are described. These include problems of countertransference, of working with people with newly emerging sexual identities, working with spouses and partners, and discriminating between abuse and sexual “play.”

Psychoanalytische Aspekte zur Ätiologie und zum Verständnis schizophrener Psychosen

The author -- specialized in Psychiatry and Neurology as well as a Psychoanalyst -- reports her experience during some decades of treating patients with schizophrenia in greatly different hospitals and institutions. Many examples demonstrate that psychoanalytical knowledge and recognizing psychodynamic connections can essentially contribute to understanding and treating psychotic patients. From the multitude of psychoanalytic theories on the etiology of schizophrenia some aspects are demonstrated, mainly those regarding their use in practical work. Some of them are: ego-disturbance, the psychotic symptom as a defence mechanism and the problem of countertransference. Regarding the ego-disturbance some examples show that usually not all ego-functions are impaired. Thus, cognitive functions may not only frequently be preserved, but may be working even better than usual. Out of numerous mechanisms of defense in schizophrenia projection, identification, projective identification, splitting, denial and regression are especially important. Moreover, psychotic patients frequently show certain symptoms that are related to very personal experiences. They can often be recognized quite easily as defence mechanisms. Countertransference is of great importance when treating such patients. Three of these numerous phenomenous are mentioned especially: anxiety, compassion, which may lead to identification, and the incapacity to accept the limit of therapeutic measures. The author is convinced that the so-called "psychodynamic" and "biological" psychiatry are not in opposition. Splitting them is not justified because according to the different stages of illness treatment with drugs as well as with different psychotherapeutic methods, even with psychoanalytical ones and social rehabilitation, are necessary. The etiology of schizophrenic psychosis cannot be explained with psychoanalysis either. Yet, the knowledge of psychodynamic processes can contribute essentially to understanding the illness and treating the patient. The compliance accomplished thereby can improve the quality of life of the patient and possibly for the therapist too.

Evidence-Based Treatment of BPD: Not an Oxymoron

Back to table of contents Previous article Next article From the PresidentFull AccessEvidence-Based Treatment of BPD: Not an OxymoronMarcia Goin, M.D.Marcia GoinSearch for more papers by this author, M.D.Published Online:19 Sep 2003https://doi.org/10.1176/pn.38.18.0003Hearing the title of my scheduled talk, “Evidence-Based Treatment of Borderline Personality Disorder (BPD),” colleagues kidded me, saying. “Marcia, that’s an oxymoron—a concept as paradoxical as ‘airplane food’ or ‘postal service.’ ‘Evidence?’ There’s not enough ‘evidence’ on which to base the treatment of BPD.”This reaction reflects common misperceptions about what constitutes “evidence-based medicine.” Similar misperceptions probably prompted David Sackett, one of the founders of the process, to write the paper “Evidence-Based Medicine: What It Is and What It Isn’t: Its About Integrating Individual Clinical Expertise and the Best External Evidence” (BMJ1996; 312:71-72).As Sackett stated, evidence-based medicine is not about making decisions based solely on the results of controlled studies. It is not about providing a cookbook approach or clinging rigidly to algorithms or reifying evidence. It is about being clinically and culturally sensitive and evidence informed. Formulate the question, search for answers, appraise the evidence, apply the results, and assess the outcome.APA’s Practice Guideline Development Process for BPDThe DSM-III publication in 1980 was the first time borderline personality was officially defined. In 1989 APA convened a task force to review the possibility of developing a treatment guideline for patients with borderline personality disorder. The group appreciated that such treatment is very difficult; it is associated with severe transference and countertransference problems and has a highly variable outcome. The questions were there, but there was not enough material in the literature to enable APA to develop a treatment guideline.The question of a guideline was revisited in 1999, at which time there was a fair-sized database that included some randomized controlled studies. The guideline is not as evidence rich as the treatment guideline for bipolar illness, which cites 492 references, but with 198 references, the BPD guideline is certainly not evidence poor. In the BPD guideline, important references to clinical trials comparing the efficacy of different psychopharmacologic approaches to symptom spectra commonly suffered by these patients are noted. The evidence also includes four published randomized, controlled studies of psychotherapy. These were all long term, and one paper had an 18-month follow-up with impressive positive data.Explicating Evidence-Based MedicineTo quote Sackett again, “It [evidence-based medicine] is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.” An example in the guideline of this principle is the recommendations regarding the use of MAO inhibitors. Although the efficacy of MAO inhibitors is equal to that of SSRIs for reducing affective dysregulation in patients with BPD, they are not a first-line choice in the treatment algorithm. In the context of informed consent for the use of MAO inhibitors, safety considerations are heightened for patients who are impulsive and suicidally vulnerable. The potentiation of sympathomimetic drugs or related compounds by MAO inhibitors may produce hypertensive crises. High concentrations of tyramine or dopamine in aged cheese, beer, wine, liver, dry sausage, fava beans, and excessive intake of caffeine may also generate hypertensive crises. Impulsive or suicidal patients may forget or purposely ignore these dietary limitations. Treatment with an SSRI avoids this considerable risk.Evidence-based medicine requires us to evaluate the validity and reliability of the available evidence, but not lose sight of the limitations of this evidence. Common problems are that trials are small, have a short duration, rely on surrogate outcomes, or use controls of uncertain validity. Presented with internally valid, well-conducted trials, sensitive clinicians will still face the need to determine how to apply this evidence to our individual patients.Psychiatrists practicing evidence based-medicine will identify and apply the most efficacious interventions to maximize the quality of life for their patients. This is not a cost-saving device. Adoption of this clinical strategy may raise rather than lower the cost of patient care.Is evidence-based treatment of patients suffering from BPD an oxymoron?The answer is clearly “No.” Unfortunately, we can’t say the same for airline food or postal service. ▪ ISSUES NewArchived

Imaginary hide and seek - A technique for opening up a psychic space in child psychotherapy

Working with concrete states of mind confronts the analyst with major countertransference problems: faced with the emptiness of the patient's psychic functioning, the analyst is threatened with the deadening of his own psychic capacities and the crumbling of the analytic process. This paper examines two cases of children who presented in very different ways, one featuring deeprooted depression and empty behaviour, the other featuring mastery and destructive omnipotence. It proposes a specific technique to enable the reconstruction of representational functioning through play. In the context of the transference/countertransference relationship and the analytic process, the introduction of a game of imaginary hide and seek, whose rules are defined and analysed, may represent an instrument of choice for opening up an undeveloped psychic space in these pathologies.

Recovered Memories of Child Sexual Abuse: Psychological, Social, and Legal Perspectives on a Contemporary Mental Health Controversy

Recovered Memories of Child Sexual Abuse: Psychological, Social, and Legal Perspectives on a Contemporary Mental Health Controversy

Imaginary hide and seek - A technique for opening up a psychic space in child psychotherapy

Working with concrete states of mind confronts the analyst with major countertransference problems: faced with the emptiness of the patient's psychic functioning, the analyst is threatened with the deadening of his own psychic capacities and the crumbling of the analytic process. This paper examines two cases of children who presented in very different ways, one featuring deeprooted depression and empty behaviour, the other featuring mastery and destructive omnipotence. It proposes a specific technique to enable the reconstruction of representational functioning through play. In the context of the transference/countertransference relationship and the analytic process, the introduction of a game of imaginary hide and seek, whose rules are defined and analysed, may represent an instrument of choice for opening up an undeveloped psychic space in these pathologies.

Resisting Amnesia in the Countertransference: A Clinical Strategy for Working with Lesbian Patients

Seldom emphasized in clinical writings are the ways in which lesbians construct and revise multiple narratives to create and navigate their lesbian identity within the clinical relationship. Case material is presented to show how the examination of the psychic meaning of the move from lesbian child to lesbian woman can be explored retrospectively through the collaborative therapeutic relationship set forth in the constructivist approach. To address the potential countertransference problems for clinicians working with this population, the concept of “countertransference amnesia” is introduced to describe a particular type of “forgetting” that reproduces within the clinical relationship the subtle forms of discrimination that restrict lesbian expression within the culture at large. This work also seeks to liberate lesbian identity formation from previous explanations and to demonstrate the construction of a lesbian identity as a psychically organizing process, which integrates inner and outer experience and allows the girl or woman to adapt to the social world.

Reflections on Volatile Substance Dependency Treatment

A brief review of the causal and treatment literature relating to volatile substance dependency suggests the interaction between individual and system requires careful attention and understanding. A model is tentatively and provisionally adumbrated to help clarify the main factors involved from a dynamic biopsychosocial perspective. Ego boundary disturbances emerge from and reciprocally influence behaviour and social interactions. These disturbances can be avoided temporarily, although inevitably deepened in the long-term, by substance dependence. Two case examples, selected because they differ in many respects, including relative treatment effectiveness, illustrate this integrative perspective. The discussion focuses on explaining the differing outcomes in terms of the extent to which the inner-outer boundary is open to modification and how far it can be successfully negotiated and clarified. A major factor in differentiating between inside and outside is thought to be causal perceptions or "attributions." Successful differentiation tends to facilitate change, as opposed to reinforcing maladaptive homeostasis. Key issues for therapists overlap with addictions treatment in general, including emotional blocks or barriers in patients, difficulty engaging systems in a strategic manner, and countertransference problems. It is argued that these difficulties in therapy might respond to integrative psychotherapeutic responses, provided the differences in perspective are sufficiently understood.