Negative Countertransference Research Articles

DO CHILDHOOD MEMORIES INFLUENCE THE THERAPEUTIC RELATIONSHIP? AN EMPIRICAL BAYESIAN SEM APPROACH.

This study aims to explore the interplay of these concepts in a sample patients diagnosed with schizophrenia and related psychotic disorders. Hence, the potentially mediating role of countertransference in the relationship between recalled parenting styles, childhood trauma and therapeutic working alliance was examined. A total sample of 30 patients (Age: 38.60; SD = 16.37; 50% female) treated for psychotic disorders in an inpatient setting were assessed. Pathways between the variables Recalled Parental Styles, Childhood Trauma, Countertransference and Working Alliance were estimated via frequentist and empirical Bayesian Structural Equation Modeling (EBSEM). Both maximum likelihood and EBSEM derived results suggested direct effects of remembered parental style on childhood trauma, as well as of childhood trauma on negative countertransference. Positive and negative countertransference were associated with working alliance. Furthermore, the findings suggested indirect effects of remembered parental style on negative countertransference via childhood trauma, as well as remembered parental style with working alliance mediated via childhood trauma and negative countertransference. Childhood trauma showed a significant indirect effect on working alliance via negative countertransference. The results provide preliminary support for the idea that traumatic memories from the past influence the therapeutic relationship in the present. In correspondence to this, the clinical significance of concepts like reverie and containment are discussed.

The causes of negative countertransference in its cultural aspect among psychiatric residents in Tunisia

IntroductionNegative countertransference in psychiatry refers to the therapist’s unfavorable emotional reactions to the patient, such as anger and frustration, which can hinder the therapeutic relationship and the client’s progress. This is why it is imperative to study the causes of this negative counter-transference, such as cultural causes, to ensure effective treatment, appropriate care and better comfort for psychiatry residents during their professional practice.ObjectivesTo study the cultural causes of negative countertransference among psychiatric residents in Tunisia and their coping behavior.MethodsThis cross-sectional study was carried out among Tunisian residents working in psychiatric departments, using a questionnaire deployed via Google Forms.Results The study involved 26 residents with 23 females. The average age was 27.57 years with extremes ranging from 26 to 32. The participants were family doctors practicing in psychiatric wards (26.9%), first year psychiatry residents (15.4%), second year psychiatry residents (23.1%), third year psychiatry residents (19.2%), fourth year psychiatry residents (11.5%) and child psychiatry residents (3.8%). The majority of residents admitted having had a negative transference towards a patient (88.5%). The level of frustration felt by residents during this counter-transference on a scale of 100 varied from 1 to 100 with an average of 61.9. Substance abuse was the primary cause in 52.17% of cases. The second cause was the patient’s ideology, with a percentage equal to 43.47%. The same percentage of 17.39% was for traditions, socio-economic level and membership of a particular political group. In 82.6% of cases, residents tried to analyze this counter-transference and 65.2% of them managed to deal with their frustration. The feeling of guilt was experienced by 56.52% of practitioners and the same number of residents tried to avoid the patient. Among the participants, 43.47% discussed this difficulty with their supervising physician and only 4 residents asked to change patients.Conclusions In conclusion, our study identified the cultural causes of negative countertransference in Tunisian psychiatry residents, including substance abuse, ideology, traditions, socio-economic level and politics. Understanding these causes is essential to resident training but also to the delivery of quality care in psychiatry. By integrating this knowledge into training, we can help residents recognize and manage negative countertransference, in order to improve the quality of care they provide to their patients.Disclosure of InterestNone Declared

When the Psychiatrist Morally Disapproves.

The understanding of concepts like moral distress and countertransference in mental health settings has advanced over time. While organizational constraints and the clinician's moral values are conventionally thought to play a part in evoking such responses, certain behavioral transgressions might be universally deemed as morally unacceptable. The authors present case scenarios that took place during forensic assessments and routine clinical care. Clinical interactions evoked a diverse range of negative emotional reactions, including anger, disgust, and frustration. The clinicians struggled with moral distress and negative countertransference, which resulted in difficulty mobilizing empathy. Such responses could affect a clinician's ability to best work with the individual and could even affect the clinician's well-being adversely. The authors put forth several suggestions on how to manage one's own negative emotional reactions in similar settings.

Antisocial personality disorder in group therapy, kindling pro-sociality and mentalizing.

Patients with antisocial personality disorder (ASPD) are known for being difficult to treat. Treatment for ASPD is debated and lacking evidence. Among several reasons for treatment difficulties concerning ASPD, negative countertransference in health personnel is one central topic. Mentalization based treatment (MBT) is a reasonable candidate treatment for ASPD. From an ongoing pilot-study on MBT with substance using ASPD patients, we explore therapist experiences. Four experienced MBT therapists together with the principal investigator performed a focus group together. The therapists were themselves involved in performing this study and analyses are made as an autoethnographic study, with thematic analyses as methodological approach. As this study involved a qualitative investigation of own practice, reflexivity of the processes was performed. The aim was to explore in depth: therapist experiences and therapist wellbeing in MBT-ASPD. We found four main themes on therapist experiences: i) gaining safety by getting to know them better; ii) gaining cooperation through clear boundaries and a non-judgmental stance; iii) shifting inner boundaries; and iv) timing interventions in a high-speed culture. These four themes point to different therapist experiences one can have in MBT-ASPD. Our findings resonate well with the clinical literature on ASPD, the findings imply that clinical teams should have a focus on therapist countertransference and burnout, ensure that therapists uphold boundaries and open-mindedness in treatment of ASPD and that therapists experience vitalizing feelings in this line of work.

Beyond Fear and Pity.

This essay attempts to expand the traditional model of negative countertransference by giving it a Lacanian twist. The author uses theories and concepts from Freud, Winnicott, and Lacan in order to explore the affective dimension of countertransference in two cases of trans-identified patients. In the first case, the author shows that wanting to do good was counterproductive, while in the second vignette maintaining a position of neutrality allowed the author to go beyond fear and pity, which led to a dynamic resolution.

Peningkatan Pemahaman Kepribadian Diri Mahasiswa Bimbingan dan Konseling dengan Penugasan Essai Refleksi

The learning strategy of giving evaluation quizzes is considered less appropriate in increasing students' understanding of personality psychology course material. Based on the results of the evaluation quiz scores for the post-presentational group presentation, it is known that an average of 85 students scored below 70. This condition confirms the failure to achieve the learning objectives of the personality psychology course, namely providing insight into understanding as well as providing the counselor with basic skills of self-reflection to be able to empathize with various types. own personality. Classroom action research (CAR) successfully conducted a SWOT analysis of the implementation of the development of self-reflection essay assignments on 85 students of Islamic guidance and counseling. Self-reflection essays are recommended in personality psychology classes. Students are given many challenges to see their strengths and weaknesses. Self-reflection essays can also be an opportunity for prospective counselors to identify and recognize issues of self-unfinished business in order to avoid negative transference countertransference personal issues. Suggestions for further PTK researchers include being able to try out the method of assigning self-reflection essays to other subjects that are still of the same scientific background, such as the introduction of the basic competencies of a guidance and counseling counselor and the counselor's code of ethics.

The Use of Interpretive Dynamic Transactional Analysis Psychotherapy (IDTAP) in Facilitating Structural Integration When Working With Reenactments of Developmental Trauma in the Psychotherapeutic Setting

The author considers how through reenactments, early developmental trauma and potential impairments in personality functioning may manifest in the psychotherapeutic relationship and how such reenactments may be underpinned by the individual’s need to control the intrapsychic dynamics through the use and control of interpersonal relationships. Some of the common transference manifestations are considered along with how they present fertile ground for resolution of the underlying internal conflicts. The article addresses this mainly through the theory and clinical examples from clients presenting with some level of personality impairment. In terms of psychotherapeutic technique, the author falls back on what he refers to as interpretive dynamic transactional analysis psychotherapy (IDTAP). There is a particular focus on reenactments of the destructive internal parts embedded in the client’s attachment to the internal bad object. The dangers of the therapist’s intention to provide the reparative relational experience are addressed along with the importance of analysis and resolution of the idealizing transference. The importance of the therapist’s function to endure and contain the negative countertransference is also discussed. Some potential interventions aimed at improving personality functioning are considered as are the implications of working with extratransference.

Empirical support for the use and further study of the countertransference construct in the clinical care of patients with bipolar disorder.

We thank Andrew Shaw and colleagues for their recent paper1 inBipolar Disorders, highlightingthat theeffectivetreatment of patients with bipolar disorder requires a good therapeutic alliance,which is related to the clinicians' countertransference reactions and their management. The authorssuggestthat the integration of a psychodynamic approach into the biological paradigm in psychiatry might be helpful to increase countertransference awareness in clinicians, andpotentially improvingdyadic communication,resolution ofalliance ruptures, and treatment adherence. Theyalsomention that although the theoretical literature on countertransference is well developed, no good empirical studies exist that investigate the countertransferential responses experienced by mental health clinicians involved in the care of individualsduring acute phases of bipolar disorder. We would, however, like to add some examples of empirical evidence for the use (and further study) of the countertransference in the clinical care of these patients.

Differences in genetic counseling student responses to intense patient affect: A study of students in North American programs.

Research indicates genetic counseling patients often experience intense emotions. No studies, however, have investigated how genetic counseling students respond to patient affect. This survey study investigated student responses to patient emotions and select factors affecting their responses. One-hundred fifty-one genetic counseling students in North American programs wrote a response to each of three hypothetical prenatal scenarios, identical except for the patient affect expressed (anger, fear, or sadness). They also completed measures of empathy tendency and tolerance of negative affect and demographic questions. Multivariate analysis of covariance (MANCOVA), used to analyze the effects of major study variables on the types of responses given by participants, was significant. Follow-up univariate ANCOVAs indicated small to moderate effect sizes for student clinical experience, race/ethnicity, and relationship status within and across scenarios. For example, as number of patients counseled increased, participants used more feeling reflections and fewer self-involving statements. There were no significant differences in responses due to empathy tendency or affect tolerance. Most common responses were information provision and feeling reflections for the Anger scenario, information provision for the Fear scenario, and influencing responses for the Sadness scenario. Responses to each scenario typically involved multiple thoughts (range: 1-14; means ranged from 3.25 in the Sadness scenario to 3.62 in the Fear scenario). Most students (82%) reported the Anger scenario was the most difficult. Thematic analysis of reasons a scenario was difficult yielded four themes: Discomfort with situation/emotion, Positive countertransference, Uncertain how to respond, and Negative countertransference. Findings that clinical experience affects how participants responded to patient affect support the essential role of applied experience. Findings also support training and supervision to help genetic counseling students in North America learn ways to respond to strong patient emotions and recognize and manage countertransference.

Countertransference responses mediate the relationship between patients’ overall defense functioning and therapists’ interventions

Objective: The aim of this work was to investigate the relationship between therapists’ techniques (supportive/expressive intervention level – ESIL), therapists’ countertransference (CT) and patients’ defense level of functioning (ODF). We hypothesized that CT could play a mediating role in the relationship between patients’ ODF and therapists’ ESIL. Method: 65 psychotherapy sessions were rated by two different raters each with the Psychodynamic Interventions Rating Scale and the Defense Mechanisms Rating Scale. Clinicians used the Therapist Response Questionnaire to provide information on their CT. The 65 sessions referred to 65 clinicians (25 = females, 40 = males; 38 = psychodynamic, 27 = cognitive). More than half of the patients (n = 40; 61.5%) had a diagnosis of personality disorder. Among clinical disorders the most frequent were mood (n = 12) and anxiety disorders (n = 11). Five patients had no diagnosis. Results: Four CT responses (parental; positive; criticized; overinvolved) completely mediated the relationship between patients’ ODF and therapists’ ESIL, while no effect resulted in relation to overwhelmed, helpless, sexualized and disengaged CTs. No effect of theoretical orientations on mediation pathways was found. Conclusion: Both positive and negative CT feelings seemed to play a crucial role in the relationship between therapists’ interventions and patients’ ODF.

Countertransference in Forensic Patients with Psychosis: Associations with Symptomatology, Inpatient Violence, and Psychopathic Personality Traits

ABSTRACT Countertransference can instigate poor or even iatrogenic treatment effects. This study investigated the extent to which psychotic symptoms, inpatient violence and disruptive behavior, and psychopathic/antisocial personality traits are associated with countertransference. Eighty-nine patients with psychotic disorders in a forensic medium-secure unit were assessed twice for countertransference using the Therapist Response Questionnaire. We found that psychopathic/antisocial personality traits had a larger impact on countertransference in patients than did psychotic symptoms and inpatient violence and behavior. Although differences existed between psychologists/psychiatrists and nursing personnel, all patient-related variables were associated with increased negative countertransference and decreased positive countertransference. Differences in association magnitude and clinical implications are discussed.

Associations between countertransference reactions towards patients with borderline personality disorder and therapist experience levels and mentalization ability.

Objective This exploratory study locates countertransference as a pan-theoretical concept, comprising of thoughts, feelings, and behaviors expressed or experienced by therapists toward their patients. It aims to understand the patterns of countertransference experienced in working with borderline personality disorder. Associations between countertransference reactions and therapist-related variables of experience and mentalization ability are also examined.Method Psychotherapists (n = 117) completed the Therapist Response Questionnaire to assess patterns of countertransference experienced with a representative patient diagnosed with borderline personality disorder. They also completed a measure of mentalization ability that examined self-related mentalization, other-related mentalization, and motivation to mentalize.Results The profile of responses across eight countertransference dimensions is discussed, with the most strongly endorsed reactions being positive/satisfying, parental/protective, and helpless/inadequate. More experienced therapists reported less negative countertransference reactions in select dimensions. Therapists’ self-reported ability to reflect on and understand their own mental states was negatively correlated with a range of difficult countertransference experiences. There were few associations between their ability to make sense of others’ mental states, the motivation to mentalize, and the strength of their countertransference reactions.Conclusion The implications for countertransference management as well as therapist training and development are highlighted.

Countertransference types and their relation to rupture and repair in the alliance

Background Ruptures in the alliance are co-constructed by clients and therapists, reflecting an interaction between their respective personality configurations [Safran, J. D., & Muran, J. C. (2000). Negotiating the therapeutic alliance: A relational treatment guide. Guilford Press]. In order to work effectively with ruptures, therapists should be aware of their own feeling states, acknowledging the subjectivity of their perceptions [Safran, J. D. (2002). Brief relational psychoanalytic treatment. Psychoanalytic Dialogues, 12(2), 171–195. https://doi.org/10.1080/10481881209348661]. Lack of such awareness may be a product of countertransference (CT), which has been shown to be inversely related to outcome. However, when effectively managed, CT contributes to positive outcome [Hayes, J. A., Gelso, C. J., Goldberg, S., & Kivlighan, D. M. (2018). Countertransference management and effective psychotherapy: Meta-analytic findings. Psychotherapy, 55(4), 496–507. https://doi.org/10.1037/pst0000189]. Objectives: The present study examined the associations between types of CT and therapists’ reports of ruptures and resolutions. Method: Data were collected from 27 therapists, who treated 67 clients in yearlong psychodynamic psychotherapy. CT patterns were assessed based on therapists’ Core Conflictual Relationship Themes with their parents, which were repeated in narratives about their clients [Tishby, O., & Wiseman, H. (2014). Types of countertransference dynamics and their impact on the client–therapist relationship. Psychotherapy Research, 24(3), 360–375. https://doi.org/10.1080/10503307.2014.893068]. Results: Negative CT patterns were associated with more ruptures and less resolution. Positive patterns predicted resolution when the therapists repeated positive patterns with parents, but predicted ruptures when they tried to “repair” negative patterns with the parents. These results point to the importance of therapists’ awareness of their CT in order to deal effectively with ruptures and facilitate resolution.

Countertransference in Forensic Inpatient Settings: An Empirical Examination of Therapist Responses to Patients With Psychotic Disorders.

Countertransference in forensic inpatient settings has received little empirical attention despite frequent emotional reactions in staff members, such as anger, disgust, or fear. In this exploratory study, we investigated countertransference in two forensic medium-secure units for patients with psychotic disorders. We measured countertransference using the Therapist Response Questionnaire and measured staff personality using the Ten-Item Personality Inventory. Our design allowed all staff members to participate anonymously. One hundred thirty-four Therapist Response Questionnaire forms, along with data on patient and staff characteristics, were collected. Staff characteristics such as profession, experience, and personality were associated with different countertransference reactions. Psychologists and psychiatrists tended to report more countertransference feelings than nursing staff. Patient and staff variables (such as patient having committed violent offenses or a diagnosis of personality disorder and staff experience or gender) were associated with more negative countertransference feelings and subscale scores as well as less positive countertransference feelings such as parental, protective, and satisfying countertransference feelings. Some patient and staff variables (such as patient cooperativeness, staff personality trait agreeableness) had the inverse effect on countertransference feelings. We discussed several conceptual problems inherent to measuring countertransference (in forensic inpatient settings) and the clinical implications of our findings.

The Effect of Didactic Group and Sensitivity Training Group on the Rate of Mistakes Caused by Negative Counter-transference of Counselors/Psychotherapists

The Effect of Didactic Group and Sensitivity Training Group on the Rate of Mistakes Caused by Negative Counter-transference of Counselors/Psychotherapists

Becoming an individual – integrating the working through in the countertransference

ABSTRACT This article presents a clinical case where the therapist experiences negative countertransference reactions that impair the sense of herself. The therapist feels totally controlled by her negative feelings activated by the patient; making her incapable to think her own thoughts and triggering a loss of her own subjectivity. The therapist’s countertransference reactions may appear due to a confusion between the self and the object in the patient which is further evoked in the therapist through projective identification. Essential for the therapy is the therapist’s working through in the countertransference to recover her own self in a relationship with the patient. A struggle for a true self and sounder object-relationships may be considered a goal in therapy in psychoanalytic theory. The movement from the paranoid-schizoid to the depressive position, the resolution of the oedipal situation and the creation of the Third all emphasize the importance of a realistic experience of the other, the two latter clearly demanding the creation of a third part in this process. This article argues that the appearance of a triangulation in the therapist’s mind and in the patient–therapist relationship was crucial for the therapist to contain her countertransference reactions and for her subjectivity to recover.

Are you sitting (un)comfortably? Action-based supervision and supervisory drift

AbstractAction-based methods such as behavioural experiments, role-play and (by extension) ‘chairwork’ are powerful techniques recommended in core supervisory texts for cognitive behavioural therapy (CBT). Despite this, experiential methods are seldom used by supervisors, suggesting that supervision often drifts from a ‘doing process’ to a ‘talking process’. A number of factors contribute to this divergence from best practice, including limited confidence and a lack of familiarity with experiential procedures amongst supervisors. To address this, the current paper presents a variety of action-based techniques for enhancing supervisees’ technical, perceptual, interpersonal, reflective and personal competencies. Behavioural experiments, empty-chair, multi-chair and role-playing exercises for maintaining treatment fidelity, enhancing empathic attunement, repairing therapeutic ruptures, resolving impasses and working through negative countertransference are described, amongst others. Further research is needed to establish the nature and extent of supervisory drift, as well as the efficacy of action-based methods.Key learning aimsAs a result of reading this paper, readers should:(1)Understand why supervision sometimes drifts from being a ‘doing’ process.(2)Appreciate the value of experiential, action-based supervisory methods.(3)Feel competent using action-based methods to enhance supervisees’ clinical skills.

Utilizing mindfulness strategies to manage negative countertransference and feelings of dislike while working with children exhibiting externalized behaviors.

Utilizing mindfulness strategies to manage negative countertransference and feelings of dislike while working with children exhibiting externalized behaviors.

Differences and similarities in instant countertransference towards patients with suicidal ideation and personality disorders

BackgroundPrevious findings showed that suicidal patients elicit mostly negative countertransference such as distress, hopelessness, feelings of inadequacy, and apprehension, and that a concurrent personality disorder is associated with more feelings of entrapment and mistreatment, among other adverse reactions. No studies were however conducted on instant countertransference (iCT), i.e., after a single encounter, for example in an emergency setting. We aimed to evaluate the impact of suicidal ideations, self-harm and presence of personality disorders on instant Countertransference (iCT). MethodsCaregivers rated their iCT with two validated and standardized questionnaires after a first emergency or outpatient consultation. Suicidal ideation, self-harm and personality disorders were tested as predictors for iCT in a multivariate and multilevel analysis. ResultsThirty caregivers rated their iCT towards 321 patients. Personality disorders and suicidal ideation, but neither recent nor past history of self-harm, predicted iCT. Common iCT included tension, lack of self-confidence and feeling of being tied. iCT specifically associated with suicidal ideation included distress, lack of hope, confusion, and sense that the patient's life had little worth. In contrast, iCT towards patients with personality disorders suggested tension in the therapeutic relationship (low affiliation with patient, anger, disappointment, devaluation). LimitationsCaregiver's characteristics were not considered in the analysis. Furthermore, while countertransference also includes unconscious phenomena, only conscious iCT was assessed. ConclusionsPatients with suicidal ideation and personality disorders elicit common but also specific negative iCT. Mental health institutions need to devote specific resources (such as clinical supervision and training) to help caregivers manage their iCT.

The Psychoanalysis Between Sándor Ferenczi and Elizabeth Severn: Mutuality, Unconscious Communication, and the Development of Countertransference Analysis

ABSTRACTThe psychoanalysis between Sándor Ferenczi and Elizabeth Severn was characterized by a controversial counterference analysis, in which the analysand, Severn, took an active lead. She can be seen as the co-creator of the Countertransference Analysis. In the two-person analytic dialogue that Severn and Ferenczi created to resolve the intractable therapeutic impasse in their analytic relationship, a dialogue of the unconscious emerged. Severn believed she was attuned to Ferenczi’s unanalyzed countertransference reaction to her. They had a special kind of relationship where attunement was at an unconscious level. In a sustained analytic encounter, she helped Ferenczi retrieve the experience of being sexually abused, which was the unconscious derivation of his negative countertransference to Severn.