Management Of Countertransference Research Articles

Origins, consequences, and management of countertransference: A case study.

Insight into the construct of countertransference may be gained by studying the relationships among its constituents. Toward that end, a single therapy dyad was analyzed for 13 sessions. Client verbalizations predicted to trigger countertransference reactions were studied in relation to their possible consequences, and the potential mitigating role of countertransference management was explored. Results suggest that when client material touches upon a therapist’s unresolved issues, it may affect the therapist’s avoidance behavior as well as the working alliance, session impact, and the therapist’s perceptions of his or her own social influence attributes. Effective countertransference management may enhance session depth and client perceptions of the working alliance. Findings are discussed in light of implications for therapy, theory development, and future research. Since Freud’s (1910/1959) initial identification of countertransference as a pivotal factor in therapy, countertransference has been theoretically defined, dissected, and conceptualized in dozens of ways (for informative reviews, see Hayes & Gelso, 2001; Orr, 1954/1988; Wolstein, 1982). Despite the definitional controversy that has perpetually surrounded countertransference, there is widespread agreement about its clinical significance. Consistent with current theoretical and empirical literature (Gelso & Carter, 1994; Gelso & Hayes, 1998), for the purposes of this study, we defined countertransference as “those responses to the patient which, while prompted by some event within the therapy or the therapist’s real life, are primarily based on [the therapist’s] past significant relationships; basically, they gratify [the therapist’s] needs rather than the patient’s therapeutic endeavors” (Langs, 1974, p. 298). Inherent in this definition is the recognition that countertransference may be acute or chronic (Reich, 1951). Acute countertransference occurs “under specific circumstances with specific patients” (Reich, 1951, p. 26). It may be likened to “state” countertransference that arises sporadically in the therapist. Chronic countertransference, on the other hand, is more typical for a particular therapist. Such countertransference is played out frequently, almost indiscriminately, with a multitude of clients; it is akin to “trait” countertransference. Historically, it was believed that countertransference behavior was to be avoided at all costs (Freud, 1910/1959). In contemporary

Origins, consequences, and management of countertransference: A case study.

Origins, consequences, and management of countertransference: A case study.

Psychodynamic Psychiatry in Clinical Practice, 3rd ed.

Psychodynamic Psychiatry in Clinical Practice, 3rd ed.

“It takes a village to heal a child”: Necessary spectrum of expertise and benevolence by therapists, Non-Governmental Organizations, and the United Nations in managing war-zone stress in children traumatized by political violence

This article highlights the post-traumatic stress responses in some war-zone children who were exposed to political violence—witnessing unspeakable horror, maimings, brutal beatings, torture, and murders. Children inducted into rebel military units to serve as child-soldiers further traumatized self and others by raping and killing children and adults. Additionally, some children go without food, shelter, and adult protection, while finding themselves as refugees in a foreign country. This article advances some conceptual, technical, and practical issues in intervention with these children and provides a model of intervention that seeks to integrate established international policies of the United Nations (UN) and Non-Governmental Organizations (NGOs) along with cognitive, behavioral, and psychodynamic clinical approaches in the context of cultural/racial sensitivity and indigenous folk medicine. The child's adaptational strengths are discussed, and the recognition and management of transference and countertransference are not ignored in the treatment of traumatized children. Basically, the author's point of view is that Western models of interventions are very useful, but that the personal, cultural, social, spiritual, and economic resources of the child's homeland or village probably constitute the best system for healing and integration after brief or continuous exposure to political violence.

Book Review: Management of Countertransference with Borderline Patients

Book Review: Management of Countertransference with Borderline Patients

Management of Countertransference with Borderline Patients

Management of Countertransference with Borderline Patients

Management of Countertransference With Borderline Patients

Back to table of contents Previous article Next article ArticleNo AccessManagement of Countertransference With Borderline PatientsRICHARD D. CHESSICKRICHARD D. CHESSICKSearch for more papers by this authorPublished Online:1 Apr 2006https://doi.org/10.1176/ajp.152.2.286AboutSections ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail "Management of Countertransference With Borderline Patients." American Journal of Psychiatry, 152(2), pp. 286–287 Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - American Journal of Psychiatry $35.00 Add to cart PPV Articles - American Journal of Psychiatry Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited ByNone Volume 152Issue 2 February 1995Pages 286-287 Metrics History Published online 1 April 2006 Published in print 1 February 1995

Love in the Analytic Setting

The phenomenon of love and the various forms it takes can be illustrated by looking at the specific forms manifesting themselves in the transference situation. The author sets out these various forms of "transference love", classifying them not only in terms of different diagnostic types of patient but also in terms of sex-specific features. He describes how, over time, transference love seeks a love object outside the psychoanalytic setting for the fulfillment of the desires awakened in the course of the therapeutic relationship. In addition, Kernberg illuminates the way in which the analyst and his/her counter-transference is involved in this process. The dynamics of the interplay between transference love and the counter-transference process is then discussed with reference to a specific case.

The ill therapist: therapists' reactions to personal illness and its impact on psychotherapy.

This paper examines the potential countertransference problems therapists face when they become ill. Personal illness creates conscious and unconscious dilemmas for therapists, and the psychotherapy relationship may be strongly affected by the ways in which the dilemmas are managed. Psychotherapy is a relationship based on trust. A therapist's illness does not necessarily damage the trust that has been developed; however, the handling of the illness and interruption can create a major rupture in the relationship. Alternatively, the therapist's illness can create a useful opportunity for therapeutic work. Successful management of countertransference is a crucial ingredient for the latter outcome. Relatively little has been written until recently on countertransference aspects of therapist illness. Available literature has noted such defenses as denial, omnipotent fantasies, and reaction formation against dependency and weakness. Illness has been seen as a problem for "older" therapists, but, in fact, illness can occur at any age. Illness may cause a defensive withdrawal from one's patients and in its most serious instance lead to total empathic failure. Clinical concerns for the ill therapist fall into two categories: how much (if any) information to give patients about the illness and how to work therapeutically with patients' reactions. While there are no clear guidelines, we recommend a flexible, common sense approach with the central focus always on the patient's reactions to information or to changes in the therapy. The foundation for decisions about information and for subsequent processing of reactions must be the therapist's own awareness of countertransference. We recommend consultation with trusted colleagues or supervisors. In addition, we emphasize the ethical responsibility every therapist has to provide for patients in the event of an emergency ahead of time. Finally, we surveyed a small number of experienced therapists who were known to have had personal experience with illness. The results indicated that decisions about giving information were not difficult. However, the countertransference reactions of anxiety, denial, sadness, and avoidance (of patient anger) were often troublesome. We recommend that psychotherapy training include management of therapist illness. We also recommend that supervisors be familiar with the countertransference aspects as they may be called on suddenly to give consultation. Our conclusion is that therapist illness is as big an event for the therapist as it is for the patient, and we hope that a body of literature will be developed on this important topic.

The practice of psychotherapy and spiritual direction

The author compares and contrasts insight-oriented psychotherapy, supportive psychotherapy, and spiritual direction in relation to goals and methods; management of resistance, transference, and countertransference; and selection criteria. The enhancement of spiritual formation through insight-oriented psychotherapy and supportive psychotherapy is also discussed.

Managing Countertransference: What the Experts Think

The present study attempted to assess the importance of five factors theorized to play a central role in managing countertransference: Self-integration, Anxiety Management, Conceptualizing Skills, Empathy, and Self-insight. 33 experts provided ratings of 50 characteristics of therapists as to the importance of each in managing countertransference. Analysis indicated that each factor is at least somewhat important to management of countertransference, with two of the factors, Self-integration and Self-insight, rated as playing a particularly important role. Clinical implications are discussed.

Patient-Therapist Codocumentation: Implications of Jointly Authored Progress Notes for Psychotherapy Practice, Research, Training, Supervision, and Risk Management

This paper describes patient-therapist codocumentation, a method of creating and using jointly authored treatment-progress notes. Codocumentation has five basic elements: (1) Patient and therapist agree to share responsibility for documentation of treatment. (2) During the last several minutes of each session, the patient records, by dictation, his or her views about the important issues covered, while the therapist listens. (3) The therapist can then dictate his or her comments, in the presence of the patient. (4) The notes are transcribed from tape-recorded to written form between sessions. (5) The typed transcriptions are available for joint review by patient and therapist during subsequent sessions. Sharing responsibility for documentation of treatment using this method promotes bidirectional feedback between patient and therapist. Several examples illustrate how jointly authored progress notes can help in the management of countertransference, as well as transference components of common problems in psychotherapy. The implications of patient-therapist codocumentation for psychotherapy research, training and supervision, and risk management are potentially significant. Further experience is necessary to refine the indications for, and limitations of, patient-therapist codocumentation.

Countertransference and the reputedly excellent therapist.

STEVEN L. VAN WAGONER CHARLES J. GELSOJEFFREY A. HAYES ROBERTA A. DIEMERUniversity of MarylandThe extent to which therapists whowere reputed to be excellent differ fromthe therapists in general is examined,with respect to five qualities theorizedto be important in the management ofcountertransference feelings—self-insight, integration, empathy, anxietymanagement, and conceptualizingability. A sample of experiencedpsychotherapists (n = 122) evaluatedtherapists they selected as excellentsignificantly more positively thantherapists in general on all five of thetheorized qualities. Contrary toexpectation, reputedly excellentpsychodynamic, learning, andhumanistic therapists were generallyrated as equivalent on these theorizedqualities. Reputedly excellentpsychodynamic therapists, however,were rated more favorably thanexcellent humanistic therapists onconceptualizing ability.

Combined group and individual treatment for the borderline patient

This article discusses the attenuating mechanisms of group psychotherapy that support and enhance analytic work with borderline patients in combined group and individual psychotherapy. A group case study is presented which addresses the manifestations and management of transference and countertransference in a combined treatment approach. Combined treatment was observed to respond effectively to both the intrapsychic and interpersonal difficulties of borderline patients. A multidimensional model for treating these patients in a community mental health setting is proposed.

Management of sexual counter transference

One of the major problems faced by psychotherapists undertaking active treatment of adult and adolescent patients has been in the area of sexual counter transference. Particularly as the treatment of psychotic and borderline patients proceeds successfully, this often becomes increasingly apparent. With developing maturity the infantile behavior and appearanee of the patient decreases and his need for a