Countertransference Responses Research Articles

The Question of My German Heritage

The following is an attempt to describe how my Holocaust research and my German heritage intersect. I claim a space for my work with the video testimonies of Holocaust survivors, which is not created by my guilt feelings, but as an intellectual pursuit. This pursuit is nonetheless haunted by overwhelming feelings and deep silence. It tries to integrate the nameless affect via a careful analysis of countertransference responses and to invent a new language emanating from survivors’ memories and images. I also discuss some biographical details and the difficulty of living with the absence of a dialogue, one that never happened, between the Jews and Germans of the first generation.

A Pilot Study of a Method for Teaching Clinical Psychology Trainees to Conceptualise and Manage Countertransference

There is evidence that therapists' countertransference responses can affect the therapeutic relationship. There is also evidence that trainee therapists can experience difficulty understanding and managing countertransference. This evidence suggests the need for greater focus on countertransference in the training of professionals, such as psychologists, for whom therapy is a core activity. However, little is currently known about the best way of providing such training or the impact of such training on recipients. This pilot study examined clinical psychology trainees' responses to a teaching and learning method for conceptualising and managing countertransference. The method was designed to be accessible to a range of psychology trainees including those in cognitive behavioural therapy programmes. This article outlines the method and its pilot evaluation. An anonymous online questionnaire was completed by 55 trainees pre‐intervention and 40 post‐intervention. Qualitative methods were used to examine changes in trainees' analyses of countertransference pre‐ and post‐intervention, and their reports of understanding and managing countertransference. Trainees also rated the intervention. The majority of participants who completed the post‐intervention questionnaire reported that training increased awareness of or the ability to conceptualise countertransference. They reported strategies for managing countertransference, although they were less confident in this area.

Mindfulness meditation and countertransference in the therapeutic relationship: A small‐scale exploration of therapists' experiences using grounded theory methods

AbstractBackgroundDifficulties with containing or processing emotions brought up in the countertransference response have long been understood as having the potential to cause a rupture in the therapeutic relationship, often with damaging results for the client. As increasing numbers of psychotherapists are becoming interested in mindfulness meditation, and as evidence is building to suggest that mindfulness meditation is an effective way of relating to one's thoughts and emotions in a non‐judgemental and non‐reactive fashion, the effect this may be having on the processing of countertransference material seems a worthy area of investigation.MethodThis study explores the countertransference experiences of five psychotherapists who practised mindfulness meditation, using semi‐structured interviews. Data were analysed using a grounded theory methodology.ResultsA tentative conceptual understanding of the data was developed, indicating that therapists who practised mindfulness meditation were relating to countertransferential responses with an observing stance, a compassionately curious attitude and a holding of emotion, which brings them into the present moment, resulting in the experience of a deeper therapeutic relationship.DiscussionThe implications for training and practice are discussed, through the potential of practising mindfulness to cultivate a therapeutic attitude towards countertransference responses.

Countertransference in Trauma Therapy

Countertransference in Trauma Therapy Background: Trauma is perceived as a highly subjective experience depending on personal resources and resilience. The therapeutic relationship in trauma psychotherapy seems to be a special one due to the powerful, emotional charged process of revealing and working with memories of traumatic experiences. This qualitative study explored the countertransference in trauma therapy by means of applying a special protocol in interviewing therapists from various cultural backgrounds. Methods: Seven trauma therapists were interviewed following a specific in-depth protocol where the method of emergent scenarios was applied. In this method, the therapist describes a client’s traumatic event, thereby triggering various countertransference responses, which are registered and analysed in clusters. Results: Participants indicated the exceptional use of defence mechanisms, such as minimisation of the clients’ traumatic stories and the presence of reactions such as: affective disconnection, absorption by the scene, use of metaphors, being invaded by the scene, identification with specific feelings, blank-out, confusion of feelings, dreaming and emergent scenario’s appearance. The findings indicated that therapists, who have experienced trauma in their life course and/or genealogy, showed stronger countertransference emotions and reactions. Therapists who did not experience trauma and who were still in the beginning of their career, showed relatively low emotional and physical countertransference responses. The therapists indicated the application of self-healing and other coping strategies to deal with the countertransference feelings and reactions. Conclusions: The vivid descriptions of the participants gave deep insights into and highlighted the specificity of the therapeutic relationship in trauma therapy. This was presented in the stories of the therapists, which reflected personal aspects of their life experiences. Several participants mentioned silence surrounding personal trauma posed major challenges in trauma therapy. Moreover, the therapists indicated several measures to deal with countertransference issues, such as supervision, specialization and support.

Does the severity of psychopathological symptoms mediate the relationship between patient personality and therapist response?

Countertransference can be viewed as a source of valuable diagnostic and therapeutic information and plays a crucial role in psychotherapy process and outcome. Some empirical researches have showed that patients' specific personality characteristics tend to evoke distinct patterns of emotional response in clinicians. However, to date there have been no studies examining the impact of patients' symptomatology on the association between their personality and therapists' responses. This research aimed to (a) investigate the relationship between patients' symptom severity and clinicians' emotional responses; and (b) explore the possible mediated effect of symptom severity on the relationship between patients' personality pathology and countertransference responses. A sample of psychiatrists and clinical psychologists (N = 198) of different theoretical orientations completed the Shedler-Westen Assessment Procedure-200 and the Therapist Response Questionnaire on a patient currently in their care, who then completed the Symptom Checklist-90-Revised. The findings showed that patients' symptomatology partially mediates the relationship between their specific personality disorders (in particular, schizotypal, borderline, histrionic, and avoidant) and therapists' emotional responses, but in general, the impact of symptom severity is less sizable than one aroused by patients' personality style. Higher levels of patients' symptom severity are most associated with an intense feeling of being overwhelmed, disorganization, helplessness, and frustration in clinicians. These countertransference reactions are not accounted for by therapists' different therapeutic approaches and other variables (as gender, age, profession, and experience). The clinical implications of these results are addressed.

Psychoanalytically-informed clinical supervision of staff in probation services

At a time of considerable organisational change within Probation Services, the authors describe a new initiative to offer psychoanalytically-informed clinical supervision to frontline probation officers, linked to the development of a care pathway for offenders with personality disorders. An analysis of feedback forms from supervisors during the first months of this project highlighted the typical countertransference challenges of probation work. In subsequent months, concerns about organisational change were increasingly evident in supervision, possibly amplifying existing concerns about risk, formulation and management of countertransference responses. The complexities of offering containment and supervision to probation officers, at a time when they were anxious about the security of their organisational ‘container’, are explored.

The Impact of Family Therapists’ Adult Attachment Styles on Their Career Choice and Approach to Therapy: An Interpretive Phenomenological Analysis

Attachment theorists have highlighted the role of the therapist in providing a ‘secure base’ for therapy. This raises the question of how therapists with insecure as well as secure attachment styles manage the integration of their personal experience and their therapeutic work. This study explored the relationship between family therapists’ adult attachment styles, influences on their career choice and their approach to therapy. Participants’ (n = 11) attachment styles were previously assessed using the self-report Experiences in Close Relationship questionnaire. Three participants were assessed as having a ‘secure’ attachment style; three were ‘preoccupied’, three ‘fearful’ and two ‘dismissing’. They were interviewed about their practice and the impact of past or current relationships on their development as therapists. Interpretive Phenomenological Analysis was used to analyse the verbatim accounts into cluster of master themes and subthemes. The analysis identified two master themes: understanding one’s self and the impact of family of origin experiences, and the integration between personal experiences and therapeutic work. There were differences in responses relating to the therapists’ attachment styles. Therapists with ‘secure’ adult attachment styles were aware of their challenges and able to utilise their experiences in their practice and respond sensitively to their clients. Conversely, those with ‘insecure’ styles have difficulties in mentalisation and in using counter-transference responses in their practice. We suggest that family therapists, social workers and others engaged in therapeutic work with families should undertake an exploration of the ‘self’ of the therapist in the context of their own family relationships and adult attachment styles as part of their training and continuing professional development.

Shame in psychodynamic psychotherapy of post-traumatic states

Shame is a universal affect that everyone would like to avoid. Responses to trauma include profound experiences of shame, which re-emerge in the transference and can be recognized in reciprocal countertransference responses. Primitive defense mechanisms associated with borderline states such as projection, projective identification and splitting, are often encountered during the course of intensive psychotherapies involving traumatic shame. Attempts to avoid shame reactions may involve regressive reactions, even in non-borderline individuals. Shame avoidance may produce transference-countertransference enactments leading to a negative therapeutic reaction. Addressing shame-related issues may be difficult for both therapist and patient, but ultimately are essential for productive therapy and recovery from trauma.

Clinicians' Countertransference Is Related to Patients' Specific Personality Disorders

Although clinical lore suggests that patients with specific personality features might evoke distinct countertransference responses irrespective of

Please (Don't) Want Me

In certain clinical situations, desire and arousal are significant components of the intersubjective field. In these cases, the analyst's wish to bear witness extends to both mind and body. This article will explore the impact of absent, violent, or otherwise unavailable fathers on their heterosexual sons and the resulting longing for male attention, admiration, and love, which often includes a need to be admired physically and romantically in ways their fathers could not provide. When this desire emerges in the treatment, the male analyst who experiences an erotic countertransference response and can manage potential anxiety and shame is in a unique position to provide the patient with these necessary supplies. Two case examples will be considered.

Disability and Countertransference in Group Psychotherapy: Connecting Social Oppression with the Clinical Frame

Psychoanalysis has paid limited attention to disability, and at times the approach has lacked political awareness. Over recent decades the international disability rights movement has argued that disabled people constitute an oppressed, systemically disadvantaged minority. Lately, a critical psychoanalytic view has connected disablist discrimination to universal unconscious conflicts evoked by impairment. Corresponding evocations emerge in the therapeutic frame, producing countertransference responses to the impaired body. Drawing on psychoanalytically oriented group psychotherapy with severely physically impaired adults, countertransference phenomena were studied in developing discussion on disability-related clinical work. The complex, uncertain role of psychoanalytic practice in combating oppression was also examined. Key issues include challenges to the traditional frame, the crossing of psychic boundaries, anxieties relating to not knowing, and the role of unconscious factors in marginalizing disabled experience.

CLINGING ON FOR DEAR LIFE: ADHESIVE IDENTIFICATION AND EXPERIENCE IN THE COUNTERTRANSFERENCE

Certain states of mind in a patient are difficult to remain with and tend to evoke defensive countertransference responses which, if enacted, obstruct therapeutic progress. The state of mind discussed in this paper is ‘adhesive identification’, a term that arose out of a conversation between Esther Bick and Donald Meltzer, when Bick said of certain patients: ‘They are sticky, they stick . . .’ The author presents an outline of ‘psychic skin’ defences (Bick, 1968, 1986; Briggs, A., 2002; Briggs, S., 1998; Mitrani, 2001; Turp, 2003) followed by a more detailed account of ‘adhesive identification’ (Meltzer, 1975). Cohen's (2003) work on countertransference and integrity, based on her experiences in a neonatal intensive care unit, is described. These resources are employed as a framework for thinking about countertransference enactments arising in psychoanalytic psychotherapy with an adult, adhesively attached patient. Extracts from a session with the patient, ‘Janine’, are presented and discussed. In conclusion, the author returns to the proposed links between integrity in the sense of thoughtfulness and respect and integrity in the sense of the felt experience of being in one piece within a skin boundary.

To Have and to Hold: Psychoanalytic Dialogues on the Desire to Own

This paper is an investigation into the psychodynamic and cross-culturally determined underpinnings of the desire to own and be owned as they manifest in our clinical work. We explore these issues in two voices: a female Israeli analyst and her male Israeli patients living far from their original homes, and also an American-born, Jewish male analyst with strong ties to, criticisms of, and longings for his ancestral homeland. Broadening our scope, we look beyond nationality and reflect on additional ways in which owning, very often related to gender and sexuality, serves as a means for processing personal, cultural, and mythological trauma, often the result of profound loss. Sharing the experience of co-writing this paper, we raise the question of how two people can create a “third” and still feel ownership both of their original ideas and the joint product. Can two parents equally own one baby? Can two nations equally own one land? We hope that an examination of these clinical, internal, and interpersonal struggles will help clarify patients' experiences in and out of treatment and clinicians' transference–countertransference responses around the desire to own and be owned.

Transference, countertransference, and reflective practice in cognitive therapy

Background: The concepts of transference and countertransference developed within psychodynamic paradigms. While there is an increasing interest by cognitive therapists in the therapeutic relationship, there is less discussion of the relevance of transference and countertransference. Understanding these concepts may be useful to cognitive therapists as part of reflective practice, especially in regard to understanding and managing countertransference responses.Methods: This article briefly examines the concepts of transference from a number of different perspectives, including social‐cognitive, attachment, cognitive analytic therapy, and schema perspectives. Two aspects of countertransference that are sometimes termed “subjective” and “objective” are also examined. A case example is given to illustrate a cognitive conceptualisation of countertransference.Results: There is some evidence that therapists' countertransference responses can provide insight into clients' experiences and patterns of relating to others. Cognitive therapists may therefore benefit from applying psychodynamic perspectives of countertransference in reflective practice.Conclusions: Transference and countertransference can be understood using cognitive perspectives. These concepts may be helpful for cognitive therapists to consider during reflective practice in self‐supervision and in clinical supervision. It seems important that cognitive therapists do not dismiss these concepts because of their origins but rather investigate the potential applications of these concepts within cognitive frameworks.

Relational Quandaries in the Treatment of Forensic Clients

This article examines the sources of relational difficulties inherent in clinical work with forensic clients. Left alone, common countertransference feelings, responses, and defense mechanisms can disrupt and ultimately derail treatment. Concepts relating to the management of countertransference offer a path with which to integrate therapists’ affective reactions as a mechanism of therapy. A relational framework utilizing the affective dynamics between client and therapist to develop and promote treatment goals is introduced and the process of formulating it is described. Practice examples are offered.

The role of the patient’s remembered history and unconscious past in the evolution of Betty Joseph’s ‘Here and now’ clinical technique (1959–1989)

The author historicizes one aspect of Betty Joseph’s ongoing technical contributions in terms of its originating London Kleinian context. Early on she drew upon both the patient’s remembered history and unconscious past, linking these experiences in past‐to‐present transference interpretations in order to effect psychic change. In evolving the technique of ‘here and now’ analysis, Joseph came to emphasize a communicative definition of projective and introjective identification as well as the significance of enactments while marginalizing the use of part‐object anatomical interpretative language. She gradually set aside directly linking the patient’s past with the present, compelled now by making direct contact with her patients. She now tracked how difficult patients acted in and responded to interpretations from moment to moment. The author maintains that the explicit and implicit conceptual work of Wilfred Bion as well as Joseph’s continuous group workshop for analysts led to an increased understanding of the patient’s projective impact on the analyst’s countertransference responses, and thereby increased the analyst’s capacity with ‘difficult to treat’ narcissistic spectrum patients described by her colleague, Herbert Rosenfeld. In recent work, while Joseph continues to elucidate what patients recall about their early past, she formats her understanding in terms of a direct analysis of the structure of the patient’s projected internal object relations in the transference. The analyst works with the patient’s communications and enactments, with a greater emphasis on a more ‘inside‐to‐outside’ understanding of transference in contrast to the earlier ‘past‐to‐present’ work associated with both Freud and Klein. This investigation concludes with one example of Betty Joseph’s significant impact on contemporary Kleinian technique by taking up some of Michael Feldman’s work. Now the analyst listens to the ‘past presented,’ the patient’s projected internal world, as well as tracks how the patient hears and subtly mishears interpretations for defensive, equilibrium‐maintaining purposes, as the analyst attempts to effect psychic change by widening the ego’s perceiving functions.

When Absence Speaks Louder than Words: An Object Relational Perspective on No-Show Appointments

The rates of no-show appointments in community mental health are reported to be as high as 50%. Yet there is a striking scarcity of clinical literature on this subject compared with the abundance of articles written from an administrative point of view. This paper describes a variety of countertransference responses to missed appointments. Drawing from object relations theory, the author maps out different pathways to guide thinking about the use of countertransference, listening to clinical material following a no-show appointment, and responding to organizational pressures. The paper aims to help practitioners make greater sense of the patient’s inner world and of what is going on in the transference-countertransference matrix.

Embodied female experience through the lens of imagination

In 1971, I made a film entitled Self Portrait of a Nude Model Turned Cinematographer in which I explore the objectifying 'male' gaze on my body in contrast to the subjective lived experience of my body. The film was a radical challenge to the gaze that objectifies woman - and thus imprisons her - which had hitherto dominated narrative cinema. Since the objectification of women has largely excluded us from the privileged phallogocentric discourses, in this paper I hope to bring into the psychoanalytic dialogue a woman's lived experience. I will approach this by exploring how remembering this film has become a personally transformative experience as I look back on it through the lens of postmodern and feminist discourses that have emerged since it was made. In addition, I will explore how this process of imaginatively looking back on an artistic creation to generate new discourses in the present is similar to the transformative process of analysis. Lastly, I will present a clinical example, where my embodied countertransference response to a patient's subjection to the objectifying male gaze opens space for a new discourse about her body to emerge.

Some Notes on the Epistemology of Empathy

The nature of the knowledge base in empathy is explored. The presumption is that empathic responses are active in both analyst and analysand. The variety of meanings of empathic experience is reviewed and aspects of its implementation discussed. Reservations regarding the accuracy, certainty, and limitations of empathy are considered. The subsequent analysis focuses on empathic affective attunement. The role of underlying mechanisms, both neurophysiological-nonconscious and psychological-unconscious, are explored. An attempt is made to integrate contributory functions of these processes in a provisional model of empathic attunement and its differentiation from countertransference responses in the analyst.

‘Peek-a-boo. How can you be there?’ Analytic work with a severely traumatised two-and-a-half-year-old girl

This paper traces the analytic work with a severely traumatised two-and-a-half-year-old girl Phoebe, whose early life was marked by chronic abuse and a violent murder she witnessed a few months prior to the beginning of treatment. Bringing the trauma in the room in a dissociative form, in line with post-traumatic stress disorder presentation, was Phoebe's unconscious means of communicating her pre-verbal encounters by projecting onto me the rage, shock and helplessness of her predicament. Thus, countertransference responses were a helpful window into her internal world, which was governed by cataclysmic losses and primitive states of fear. The importance of containment of the complex feelings aroused in the work and protecting against potential re-enactment of the abusive elements the patient, the family and often the professional network brought in the therapy is highlighted. The author hopes that this paper will encourage the offering of psychoanalytic psychotherapy to traumatised children particularly the under fives.