Countertransference Experiences Research Articles

The Process of Case Writing: A Fourth Pillar of Analytic Training.

The educational and clinical effects of the process of case writing during analytic training have not been extensively studied, even though the case report, as a product, has prompted attempts to make it a more revealing and accurate document. Countertransference experiences during an analysis can constrain both the candidate's writing and the analytic work, while examining them during the writing process can deepen the candidate's analytic work. Three overlapping resistances to the writing, and their underlying anxieties, are described. These are publication resistances: concerns about the anticipated reception of the candidate's work by potentially critical readers; transference resistances: feelings toward the analytic institute that requires the writing; and countertransference or reimmersion resistances: fears of reawakening reactions from the analysis. These can interfere with finding a safe internal space in which to write. Examples are given of writing through of these resistances during case supervision, resulting in more open writing and in a deepening of the analytic work. As the case writing process can have direct and potentially profound effects on the candidate's current and future analytic work, it is proposed that the process of case writing is a fourth pillar of analytic training, in addition to the candidate's personal analysis, case supervision, and didactic seminars.

When the therapist's and the client's woundedness meet: Dialogical selves of Filipino self‐identified wounded healers

AbstractIntroductionThe dominant literature on wounded healers assumes that the healer must be healed of one's wounds to be an effective therapist and that countertransference, moments in therapy when a healer's wounds are activated, must be successfully managed. Lacking in the literature is an understanding of the internal dynamics of wounded healers as they navigate moments of countertransference. Veering away from a unitary and static view of the self, we argue for a shift in how we understand wounded healers using the lens of a multiple and dynamic self. Through Herman's dialogical self‐theory, we conceptualise the wounded healer as having multiple selves—the wounded self (WS) and the therapist self (TS). Each self is an I‐position with its own unique voices and narratives.MethodThrough in‐depth interviews with Filipino self‐identified wounded healers, we examine the internal voices of the WS and TS during moments of countertransference, as the WS meets the client's wounded self.FindingsResults show that the participants' characterisation of their WS, or where they are in their journey of healing or recovery, shapes their countertransference experience. Participants with recovered WS channelled the voices of calm recognition and differentiation. Voices of identification, re‐experiencing and differentiation surfaced among participants with recovering WS. Participants with emerging WS transitioned from a voice of not knowing to a voice of identification.ConclusionBeing aware of and listening to the voices of the WS alongside the TS is key in navigating countertransference. The implications of a dialogical understanding of wounded healers in clinical practice are discussed.

NAVIGATING THE COUNTERTRANSFERENCE EXPERIENCE: A TRANSTHEORETICAL SPECIFIST MODEL

AbstractThe attempt to identify and classify distinct experiences falling under the common designation of countertransference has been labelled the specifist tradition. In this paper, a model describing two dimensions differentiating four components of countertransference experience is proposed. For each experiential component (subjective countertransference, objective countertransference, therapeutic attitude and emerging experience), a brief description based on previous literature from diverse theoretical fields is offered, along with clinical implications and illustrations and an account of empirical literature explicitly or implicitly addressing the specific component. In conclusion, the model is presented as a heuristic guide that can serve different purposes across different therapeutic orientations, with valuable implications for practice, training and supervision.

Clinical Crossroads: Countertransference, Ethics, and Premature Termination

The literature extensively examines the clinical constructs of countertransference and premature termination through several theoretical orientations. It explores how countertransference is one of the most significant variables in successful therapy outcomes, and how premature termination is often an outcome of a poor therapeutic alliance stemming from the client’s insecure attachment to primary caregivers (Berg & Lundh, 2022; Westerling et al., 2019). However, few studies explore the interconnection of these two constructs and how clinicians process their countertransference when it interferes with their ability to provide effective treatment. Despite the gap in the literature, clinicians are bound to experience countertransference in their work with clients; thus, the literature must provide language to describe these experiences to lessen the feelings of guilt, shame, and uncertainty that tend to emerge through these processes. This clinical note aims to provide a review of these constructs through a case study to emphasize the clinical, ethical, and legal dilemmas clinicians encounter when they experience countertransference throughout the course of therapy. While experiences of countertransference are intimate and painful for the clinician, they are bound to happen; and it is the responsibility of the clinician to address them in the best interest of the client.

아동상담사의 역전이 경험에 대한 주관성 연구

Objectives This study applied Q methodology to type the subjectivity of child counselors' countertransference ex-periences and identify the characteristics of each type in order to identify the subjective perceptions and charac-teristics of each type according to the countertransference experiences of child counselors.
 Methods To this end, a total of 143 statements were derived through literature research and in-depth interviews for a total of 26 days from March 20 to April 15, 2023, and a total of 25 child counselors were selected as the P sample and Q classification was conducted. . The collected data were analyzed using the PC-QUANL Program.
 Results As a result of the study, the types of child counselors' countertransference experiences were classified into a total of four types, with type 1 being the 'countertransference self-reflection type' who believed that they experienced inner maturity and growth as a human being, and type 2 being the 'countertransference type' as an expert. ‘Countertransference management ability type’, who thinks they have experienced the need for the ability to manage themselves, Type 3 is the ‘Countertransference Active Acceptance Type’, who thinks they have experi-enced acknowledging and accepting countertransference rather than denying it, and Type 4 is self-managed. The 'reverse transfer professionalism improvement type' was found to have experienced improvement in expertise by encountering problems.
 Conclusions Through the results of this study, we focused on the perception of child counselors' counter-transference experiences, classified and confirmed the structure of child counselors' subjective perception of countertransference, and provided information on accessibility and ways for child counselors to manage and pre-vent countertransference. We hope it will be used as relevant basic data.

“Being affected by the other”: psychodynamic supervisors’ experiences of supervisory countertransference

This qualitative study investigated how psychodynamically-oriented supervisors experienced supervisory countertransference towards their supervisees and their understandings of this phenomenon. Seven supervisors located in the United Kingdom (UK) were recruited. Individual audio-recorded, semi-structured interviews were used to gather the participants’ subjective accounts of this phenomenon. Data was analysed using Interpretative Phenomenological Analysis (IPA). Most of the participants described experiencing supervisory countertransference towards supervisees who were not of the same gender as them. Although definitions of supervisory countertransference have linked this phenomenon to unresolved supervisor issues and blind spots, only one supervisor specifically referred to past experiences that shaped her supervisory countertransference response. Notably, some of the supervisors continued to be affected by their experiences many years after the supervision ended. The study’s findings underscored the importance of attending to and processing perturbing supervisory countertransference. Future research could explore the ways in which supervisory countertransference is shaped by gender dynamics and its contribution to supervisory discord.

중급상담자의 역전이 경험에 대한 현상학적 연구

This study is a phenomenological study conducted to deal in depth with counselors'understanding of countertransference, actual experience of countertransference in counseling,coping with it, and the growth of intermediate counselors, focusing on middle-level counselors. Tothis end, in-depth interviews were conducted with middle-level counselors with 4 to 10 years ofcounseling experience, how they experienced countertransference through meetings with clients inthe counseling field, and how they understood and coped with it. Finally, 117 configured semanticunits, 27 sub-themes, and 6 super-topics were derived. Upper themes include triggers that causeloss of balance, inadvertently revealed countertransference, the moment one becomes aware ofcountertransference, developing a counseling sense, using a crisis in a relationship as a therapeuticturning point, and transforming into a seasoned counselor after going through growing pains. Thesignificance of this study is that it presented the meaning of concrete and vivid experiences ofcountertransference through a phenomenological research method, explored the meaning andcharacteristics of countertransference experienced by intermediate counselors, and presentedcounseling implications based on this.

PERSONAL GROWTH EXPERIENCES OF COUNTERTRANSFERENCE AMONG MALAYSIAN COUNSELLORS: A PHENOMENOLOGICAL STUDY

Countertransference has become a multifaceted, multidimensional, all-encompassing clinical phenomenon. The current study aimed to understand the positive growth experiences of countertransference in six Malaysian counsellors by utilising a transcendental phenomenological design. Moustakas's eight data analysis steps were applied in the data analysis. The themes that emerged from in-depth interviews included (1) improved self-confidence, (2) skill enhancement, (3) acceptance, (4) openness, (5) self-kindness, (6) a deeper understanding of self, and (7) redefining the meaning. The findings demonstrated that the insights gained through the countertransference experiences added positive values to their professional and personal lives. This study also revealed in-depth descriptions of the positive transformations from countertransference among Malaysian counsellors. This study has significant implications for counselling practices holistically.

Ramifications of client’s use of projective identification, racism, and enactments of otherness: A nascent clinician’s struggle inhabiting her identities in the therapy room

Given some of the challenges beginning therapists experience in the development of their new roles, they may be more susceptible to becoming overwhelmed by their countertransference, lack the awareness to track all of the processes taking place in the therapy room (e.g., projective identification, transference/countertransference dynamics, etc.), and have a propensity to be pulled into enactments. This paper explores how therapy processes, client trauma, and clinician levels of experience intersect therapeutically with the dyad’s identity features and may impact the therapist’s ego functions. A case is discussed that explicates how racial identities in a dyad can create enactments resembling those of marked historic and cultural imbalances in Western society, taking away the minority therapist’s ability to think and speak in English due to the intense projective identification and countertransference experience of inferiority and incompetence in the presence of a patient with various identities of privilege. The role of internalized racism within the minority therapist is also explored in rendering them unable to process the deeper dynamics evoked in the therapeutic and supervisory dyad with the patient when the patient used racially charged language.

Mourning through Poetry: Discovering the Lost Love Object and Symbolization of Desire

Deborah was referred to me for psychoanalytic psychotherapy following a suicide attempt and depression. We began a fascinating journey spanning more than 10 years. During therapy, many questions arose concerning the suicidal episode, which she could not register consciously. I tried to understand the reasons for her depression and the attempted suicide through the unconscious process in the therapeutic relationship and through the music and poetry that she brought to sessions. In this paper I describe the process of listening for the signifiers of semiotic and symbolic language, both metaphoric and metonymic, as revealed in poetry and music according to the theories of Kristeva and Lacan. The poetry enabled the patient to retrieve childhood memories, experience the movement from unconscious to conscious, and mourn through the experience of transference and countertransference in the therapeutic relationship. Also illustrated is the transition from singing the music to more symbolic language, turning the patient's sensory experience into language, and connecting her personal experience with the culture of her past. The patient's mourning and the lost love objects are discussed through the prism of classical and object relations theories.

Therapeutic tool or a hindrance? A phenomenological investigation into the experiences of countertransference in the treatment of sexually abused children

ABSTRACT Since its inception in the 1900s, the concept of countertransference has been mired in controversy. Psychoanalytic literature is divided on its utility, significance and its clinical value in psychotherapy. While some psychotherapists have advocated for the importance of therapists’ expertise in the comprehension and processing of countertransference dynamics in the treatment of sexually abused children, others see no value in competency in countertransference in trauma treatment of sexually abused children. The purpose of this article is to explore whether countertransference is a useful therapeutic tool, or a hindrance in the treatment of sexually abused children. A qualitative paradigm, particularly interpretative phenomenology, was employed in this research to make meaning of the therapists’ experiences. The analysis of the results revealed the following five main themes that were supported by 18 superordinate themes. These themes reveal that therapists treating sexually abused children experience a myriad of feelings, including a) feeling emotionally overwhelmed, b) anger toward perpetrators and the need to protect and rescue their patients, c) the importance of social support and self-healing, d) feelings of empathy and identification with the client, and e) erotic countertransference. These findings reveal two contradictory findings. Firstly, they tell of variable utilisation of countertransference among participants and, secondly, they highlight a lack of application of countertransference in the treatment of sexually abused children. The implications of the current study are that there is a need to both highlight the importance of countertransference as a therapeutic tool and to incorporate it in the treatment of sexually abused children.

A change in frame and countertransference experiences: Transitioning from face‐to‐face to telepsychotherapy

AbstractUnprecedented changes in traditional psychotherapeutic practice arose from the lockdown restrictions associated with the COVID‐19 pandemic. These changes to practice included the imposed change to the therapeutic frame when transitioning clients from face‐to‐face meetings to delivery of psychotherapy sessions via videoconferencing (defined here as telepsychotherapy). The current study conducted qualitative interviews with 16 Australian psychologists who transitioned their existing adult psychotherapy clients from face‐to‐face therapy to telepsychotherapy and explored their novel experiences associated with countertransference reactions during this period. Thematic analysis of the interviews revealed several unique findings. The type of countertransference reactions towards existing clients was consistent across both face‐to‐face and online meetings; however, the felt intensity of countertransference reactions was reduced. Psychologists reported an increased hesitance to work with intense emotions during telepsychotherapy sessions and felt increased pressure to work harder during online sessions when compared to face‐to‐face meetings. Exposure to their clients' personal and home environments during telepsychotherapy sessions elicited several novel reactions towards their clients. These findings on countertransference and telepsychotherapy are informative for future practice and training. Awareness of these unique countertransference experiences is recommended prior to engaging in telepsychotherapy or when transitioning clients to this modality.

Working with Trauma and Dissociation in the NHS

Using a composite clinical case, this paper describes working with complex trauma, non‐recent child sexual abuse and dissociative identity disorder within an NHS setting. The clinical work of an NHS trauma service is described in both historical and current terms. The case history elucidates the use of specialist group work for non‐recent child sexual abuse and then individual work within a trauma team setting as the diagnosis of dissociative identity disorder comes to light. The recognition of the role of shame in both non‐recent sexual abuse and dissociative identity disorder presentations serves to highlight the countertransference experiences of disbelief or inauthenticity. This is linked to the history in psychoanalysis of the shift away from external realities of abuse and to its exploration of the concept of dissociation. The question of acknowledging and attending to the reality of abuse continues to be an issue within many aspects of British psychotherapy and psychoanalysis and has perhaps added to the disbelief that the diagnosis of dissociative identity disorder often seems to engender. The consideration of setting in relation to the NHS and limitations on lengths of treatment is also addressed for these complex patients.

Schema therapists’ perceptions of the influence of their early maladaptive schemas on therapy

Objective: This qualitative survey aimed to explore schema therapists’ perceptions of how their early maladaptive schemas are activated in their therapeutic work, and how they manage their reactions. Method: An online qualitative survey was conducted with 22 schema therapists. Following brief demographic questions, participants were asked three open-ended questions about their schema activation and associated reactions. An inductive-deductive hybrid thematic analysis of the qualitative responses identified four superordinate themes and 12 subthemes. Results: Participants described several negative impacts on their therapeutic work, including avoiding limit setting, becoming argumentative or aggressive, detaching or avoiding, and over-functioning. An array of strategies for managing schema and countertransference reactions were identified, including refocusing on the client’s vulnerability, caring for one’s own vulnerability and connecting with one’s healthy adult self, and engaging in supervision, training, personal therapy, and self-care. Notably, several participants described how their internal reactions can be used advantageously to conceptualize and support clients, and to facilitate therapists’ personal development. Conclusion: The findings highlighted that although schema and associated countertransference experiences can be challenging, awareness and effective management of therapists’ reactions can benefit treatment and promote personal growth.

Mutative Action: From Insight to Productive Use of Uncomfortable Countertransference Experience

ABSTRACT The relative value of insight as a mutative factor in psychoanalysis has long been a central question in the literature. Most analysts of this generation believe that although insight has clear value, it isn’t normally sufficient to produce structural change in most patients. Alternatively, the tide has shifted strongly to the view that the analytic relationship per se, has more explanatory power in understanding why patients change. This essay attempts to deconstruct which elements of the analytic relationship might have the most mutative power. My argument reflects the belief that analysts’ productive use of uncomfortable countertransference experience is key to ideal therapeutic outcome, whereas failure to productively use countertransference experience, usually experience that is consciously recognized by the analyst, is the primary factor in contributing to compromised or failed analyses.

To Coast or Not To Coast? Commentary on “Mutative Action: From Insight to Productive Use of Uncomfortable Countertransference Experience”

ABSTRACT Interpretation and insight are a valuable asset in the treatment, but not enough to generate change. Mutative change depends on the analyst’s being in the relation, rather than on his purposive doing. “Coasting” is when the process seems to flow easily and pleasantly, but nothing happens. The analyst is partly aware of it but does not act. This is solved when a new situation emerges unbidden in either or both parties. Relational freedom and therapeutic action are not chosen but emerge unexpectedly from the field and change it. Such non-causal approach is unacceptable for the orthodox versions of classical psychoanalysis.

Winners and Losers in a Dramatic Dialogue

ABSTRACT Atlas’s discussion argues that it is not only our conscious, but mainly our unconscious narcissistic and self-serving needs that prevent us from making productive use of uncomfortable countertransference experiences. It illustrates how privileging conscious awareness might repeat the same problem of keeping us in places that are too comfortable, especially when dealing with aggression and sexuality. Atlas presents a framework which highlights the generative function of enactment and emphasizes the ways analysts inevitably find themselves involved in dramatic dialogues as part of each and every treatment.

A Study on Countertransference Experience in Family Counselors - A Grounded Theory Approach -

A Study on Countertransference Experience in Family Counselors - A Grounded Theory Approach -

Compelling images: a contribution to the theory of aesthetic countertransference

In this paper, I describe my experience of the aesthetic countertransference in relation to one patient’s artwork in an Art Therapy group as part of a Therapeutic Community for people with a diagnosis of Borderline Personality Disorder within the NHS. The paper discusses how my practice became informed by Mentalization-Based Treatment which places a strong emphasis on clarifying intentional mental states. However, when looking at the artwork I encountered a situation whereby I could not easily put the experience into words. I provide a description of the patient’s overall trajectory within the treatment model, her progress in the Art Therapy group itself, and present a hypothesis for the function of the artwork which the patient produced. I draw upon a model of art therapy I have previously devised combining art psychotherapy theory, art critical theory, mentalization (MBT) and psychoanalytic theory. Drawing on Grotstein’s notion of formulations in the ‘Kleinian-Bionian mode’ I go on to elaborate my concept of the ‘art-psychotherapy object’ being the totality of the triangular relationship (creator/artwork/viewer), in itself unknowable, but the derivatives of which can be understood through the paradigm of transference-countertransference-projective (trans)identification-reverie, and used to explore the dimensions of its planes.

Mentalization-based psychotherapy practices in patients with borderline personality disorder

Introduction: Mentalization-based psychotherapy (MBT) develops with the importance of establishing attachment relations with patients. MBT focuses on internal mental processes that occur in the therapeutic process that actively improve patient-therapist relationships.Methods: A woman with preoccupied/anxious attachment is given mentalization-based psychotherapy. The goal of psychotherapy based on mentalization is to develop secure attachment relationships in therapy, use empathy and validation in reciprocal relationships, strengthen the patient's capacity to reduce emotional dysregulation and impulsive behavior, increase self-awareness, control of attention and flexible thinking in the context of emotions and relationships.Results: The patient has begun to form a secure base attachment. Patients' mentalization has improved along with the formation of secure base attachments, patients are better able to do self-soothing and regulate emotions properly.Conclusion: In the early years of life, patients have a pattern of interaction with caregivers who lack the need for mirroring. Furthermore, the patient develops into an insecure self and has an inherent preoccupied/anxious attachment. It has an effective representation and attention regulation system that is not functioning so that patients use existing stimuli as the basis of an insecure sense of self. Fonagy termed this condition with incoherent, disruptive "alien self" through controlling and manipulative behavior. The patient externalizes the alien self against the attachment figure. This externalization appears as a countertransference experience in a therapy session, if it can be appropriately managed it will emerge a feeling of coherence in the patient's internal world.