Transference Countertransference Research Articles

On misreading and misleading patients: Some reflections on communications, miscommunications and countertransference enactments

This author focuses on an aspect of transference countertransference interaction that enacted covertly is often overlooked. He argues that conflicts, needs and biases that may go undetected for lengthy periods of time are not infrequently contained within the analyst's accurate and technically correct interventions and that for defensive reasons, patients often suppress, deny or rationalise their accurate perceptions of these countertransference elements and fail to confront their analysts with them. The mistakes, miscommunications and misperceptions that arise as a consequence of the unconscious collusions that develop between patient and analyst can have a profound effect on the analytic work. Several clinical examples are presented to illustrate the operation of such covert communications in analysis and their impact on the treatment process.

The Interplay Between Therapy and Supervision

This paper examines the relationship and interplay between therapy and supervision; and how the therapist who has particular similarities to the patient brings her own armentarium of defenses as well as life problems into the therapeutic and supervisory space. The paper explores how unconscious factors from childhood become reenacted in the therapeutic space and produce emotions that affect both patient and therapist. The paper describes in detail an upward as well as downward parallel process acted out by the therapist and patient in the transference–countertransference encounter along with the supervisor's conscious and unconscious role in this process. The paper concludes by offering recommendations to beginning analytic therapists.

Seeking an Analytic Identity

Rothstein has stimulated all analysts to rethink how we can better commit ourselves to our analytic work. In this paper I focus on factors in analysts' personalities and experiences in their training and practice that contribute to or distract from establishing an analytic identity. First, I explore analysts' background and motivation. In admissions to psychoanalytic institutes we look for candidates who can see psychoanalysis as an intellectual puzzle to be solved and an emotional involvement to be experienced. We look for earlv conflicts that the candidate can sublimate in the service of analytic functioning. We assume that the capacity to sublimate is only partial and that analysts in their development continue to recognize conflicts in transference—countertransference reactions. Second, I give some examples of experiences from analysts' training that stimulate the formation of their analytic identities. These include transient identifications and counter-identifications with the training analyst, supervisor, seminar leader, and favorite analytic authors. Third, I discuss more external factors that influence the development of analytic identity. These include the climate in training and continuing education at the institute. How much does the institute support its members in immersion in psychoanalysis? Economic factors continue to he an important factor in determining individual choice in this immersion. Finally, I review studies on the effectiveness of psychoanalysis. Dedicated analysts with considerable experience believe that analysis works despite some limitations. Part of high motivation to continue analytic work includes understanding how analytic results differ from the simpler solutions achieved by nonanalytic therapies.

Black and White Thinking: A Psychoanalyst Reconsiders Race

This paper begins with an analysis of race as a social construction and then follows the argument that, at a deep structural level, race and racism are organized by the same rational–irrational polarity of Enlightenment philosophy that informs psychoanalytic structural theory. The heart of the paper is formed by two case examples, one from my own practice and one from Leary (1997). I argue that unconscious racism is to be expected in our clinical work at this point in history and that truly reparative efforts depend on an acknowledgement of racism in the transference–countertransference matrix.

Making a Memorial Place: The Photography of Shimon Attie

Assisting the analysand in making the past a living present held within a bearable yet unpredictable future is what psychoanalysis is so much about. Events of the past can never be redone, or fully repossessed, but they must be reconstructed in the context of the transference–countertransference experience of the analytic relationship. In order to make the past a useful present and presence, we need metaphors to give it shape—metaphors that capture the memorial activity linking the past with the present and future in a meaningful manner. In this paper, I explore the ways in which the work of the American photographer Shimon Attie creates a memorial place in which the past is not simply remembered but instead is actively mourned. In The Writing on the Wall, Attie collects broken fragments from prewar German-Jewish life in Berlin, and, by projecting these found shards of former lives onto the buildings in the Berlin Scheunenviertel, which once housed these people, he creates a potential space in which a present can suddenly come alive by the superimposition of a past that was supposed to have been obliterated. In this transitional realm, the spectator is given a wide realm of to-and-fro movements between past and present that permits the creation of an object world that did not exist before. I suggest that Attie's intricate weavings of past, present, and future serve as instructive models for the psychoanalytic process in which the analyst can find himself in a similar position of opening up a playground where the past can be brought into the present and where the presentness of the past can come alive. The ability to move back and forth between the present and the past suggests a link to the Freudian concept of deferred action, later taken up by Lacan under the notion of après-coup, where the impression (Prägung) of an earlier event, having lain dormant for a long time, breaks through into the present through a retroactive action that then completely reshapes the present impression. I draw comparisons to psychoanalytic practice, in which the superimposition (the stacking on top of one another) of recollections, dreams, and associations pries open in the analysand's mind a psychic space in which memories of a seemingly insignificant past absorb a sudden sense of urgency when revisited through this retroactive process.

Transference N countertransference dynamics in the assessment process1

SUMMARY In this paper I consider the uses of the transference and countertransference dynamics in the assessment process. Patients referred to an NHS Outpatient Psychotherapy Department are discussed. In the Department the assessor will usually not be the patient's therapist. In this situation I suggest that the transference relationship is not the sole or central focus of interpretation, unless the transference is manifested as a resistance to the exploration of the patient's unconscious conflicts underlying the presenting symptoms and difficulties. However, the transference relationship and countertransference responses alongside the patient's history form the basis of the assessor's understanding and dynamic formulation.

Transference, the transcendent function, and transcendence

People in analysis come into direct contact with the transcendent – that which surpasses not only our ego consciousness but the whole psyche – through the transcendent function working in the transference–countertransference field. Reductive and synthetic methods of interpretation of transference, in both objective and subjective levels of meaning, inaugurate moving the ego out of center stage into the process of relating to the Self. The transcendent function is the means of enlarging psychic space in the transference field to make room for coinciding opposites and a ‘creative solution’ that arises from their conversation. That solution, or set of symbols, addresses us with such compelling authority that Jung likens it to ‘the voice of God’, A clinical case illustrates the connection of transference, the transcendent function, and the experience of the transcendent which, I believe, we must identify as such in order to go on relating to it.

The evolution of a failed interpretation

Descriptions of clinical work tend toward the linear thus omitting the shifting intricacies of the known and the unknown inherent in the work. This essay, both in its form and its content, attempts to capture more closely the often kaleidoscopic complexity of the lived experience of the analytic process. The paper describes the emergence of multilayered transference—countertransference contributions to a single moment in clinical time.

The clinical use of the dream in interpersonal psychoanalysis a dream specimen

I hope to convey to the reader through the analysis of a dream specimen how I as an interpersonal psychoanalyst apprehend and process a dream in the context of an actual session; how the dream evokes in me thoughts, images, associations, and affective responses; and how these are shared in dialogue with the patient. I find the patient's dream important because it vividly expresses in imagery, affect, and narrative her modes of coping with interpersonal anxiety by selective inattention and dissociation. It is my view that this dream was triggered in response to a therapeutic impasse. My response to the impasse led to increased activity and a concordant effort on my part to engage the patient in the here and now, which led to a transference—countertransference enactment represented in the dream. The analysis of the dream allowed the recognition of what I had until then not been able to perceive. Sharing with the patient my associations to her dream permitted an in‐depth dialogue to take place. I have attempted to reconstruct my personal reactions to the dream as they unfolded, the clinical decisions I made, and why I made them.

Maintaining the complexities a reply to Crews, Brenneis, and Stern

Our article is about dissociative phenomena in the transference—countertransference patterns that emerge in patients known to have been sexually abused as children [Davies and Frawley, 1992, p. 94].

Neutrality, resistance, and self‐disclosure in an intersubjective psychoanalysis

The development of the clinical theory and technique of intersubjective psychoanalysis requires reconceptualization of the core concepts of neutrality, resistance, and self‐disclosure. Current and historical usages of the concept of neutrality are examined in an attempt to deconstruct the role of neutrality within a hierarchical and gendered system. Neutrality is then reconceptualized as a relational event within the analysis that stands apart from transference‐countertransference enmeshments. Neutrality is understood as a mutual achievement that cannot be claimed in an a priori manner by the analyst. Resistance is similarly reconceptualized as an aspect of a relational unconscious designed to maintain transference—countertransference configurations. This phenomenon is termed intersubjective resistance and, as a jointly held state, is most apt to reveal itself when the analyst breaches normative conduct. It is at these junctures that the analyst's self‐disclosure and mutual exploration of the enactment be...

Interaction in psychoanalysis a broadening horizon

To view all that occurs in the analytic arena, including verbal exchange, as interaction broadens the horizon and affects our understanding of the analytic process, transference—countertransference, therapeutic action, and theory of technique. This paper focuses particularly on implications of the organization model of transference: the process of illuminating transference, the mutual interactional shaping that occurs in the analytic relationship, and the distinction between the content and the process of communications. Defining countertransference as the analyst's experience of the patient, the paper proposes that all analysts, regardless of persuasion, use their experience of the patient (that is, countertransference) as the central guide to analytic exploration and understanding. Differences in analysts’ experience of their patients arise not only because of different models and respective subjectivities, but also because of the variable use of two principal listening perspectives: listening from with...

The patient's dreams and the countertransference

Dreams reported in psychoanalysis may reflect not only the transference of the patient, but also the countertransference, counterresistance, and counteranxiety of the psychoanalyst. Because of the communicative capacity of dreams, the analyst may use the patient's dreams as supervision. Objective signs are described that may indicate countertransference interference in the analyst's dream interpretation. Through a process of reciprocal, interactive dream interpretation, the dream's meaning about the transference—countertransference matrix can be clarified. Usually, there is an intermediate stage in working on a dream, during which the dream meaning is enacted in the dream‐interpretation process. Clinical examples include the “Lovely Dream”; reported by Freud, along with examples from the casebook of Gill and Hoffman (1982) and from the author's own practice.

Love in the afternoon: A relational reconsideration of desire and dread in the countertransference

The psychoanalytic exploration of the analyst's erotic counter‐transference has remained a subject rarely addressed in open colle‐gial dialogue. This paper addresses this professional reticence as a manifestation of two interwoven resistences. The first, an avoidance of the physiologically based substrata of self and object organization growing out of certain preconceptions derived from a structural‐drive model. And the second, an unwillingness to view the parent/analyst as a full participant in the child's romantic oedi‐pal struggles. An alternative formulation based on a reconfigured, relational model of mental structures is suggested. Here the physical experience of self in relationship to a host of significant internalized others becomes a meaningful organizing component for both the patient and the analyst, one that must be incorporated into the ongoing exploration of transference—countertransference manifestations. Likewise, the unfolding oedipal situation between parent and child, patient and analyst, is viewed from the perspective of a two‐person model within which the shared symbolic participation of both becomes a necessary prerequisite for the kind of resolution that lays the groundwork for mature love. A clinical example in which the analyst felt it necessary to disclose the presence of erotic countertransference is explored from several perspectives.

Clinical clues in the breathing behaviors of patient and therapist

Verbal communications have dominated treatment theories and will remain a privileged source of communication. This paper directs the therapist's attention to some of the possible breathing behaviors in treatment which may, like verbal language, convey an unconscious or conscious message that is possibly interpretable. Breathing has meaning in the transference—countertransference intersubjective world. Behavior symbolized by breathing may be included in the earliest somatic, dyadic interaction and may therefore go with one through life and reappear in every new relationship. This paper directs the clinician's attention to some of the possible meanings and interpretations of breathing behavior during treatment. It calls attention to techniques for exploring the rich connection between breathing, body, object and somatization.

Gender as contradiction

A model of gender as a paradoxical and multidimensional structure is proposed. An extended critical reading of Freud's essay on a case of homosexuality in a woman undermines the notion of gender identity and sexual object choice as monolithic categories of experience. The Freud case is considered for its radical model of sexuality and gender, but also for its restrictive use of classical interpretation. Alternative interpretive lines and transference countertransference meanings are considered. With the use of contemporary clinical material, a model of gender identity and sexuality is proposed in which the unconscious and symbolic meaning of bodies and genders, rather than biological sex of the lover and the beloved, carries the interpretive weight.

Effects of therapist termination on group process.

Therapist termination, a frequent occurrence in training settings, represents a crucial issue within the realm of group process, and is a difficult experience for members and therapists alike. The entire group is thrust into a state of turmoil, painful feelings are evoked, and transference–countertransference issues related to separation and loss emerge. Predictable stages occur during therapist termination, each with its own set of phenomena. Based on a review of twelve therapist terminations over a six-year period in two ongoing dynamic outpatient psychotherapy groups, we have identified the stages, symptoms, and behaviors which typically occur, and have presented appropriate interventions. We have also identified strategies to facilitate the working through of therapists' issues and feelings centering around therapist termination.

Tutorial:a useful way to teach psychiatry to senior medical students.

The psychiatry course as given to senior Harvard Medical School students at the Massachusetts General Hospital has been briefly described, with special emphasis placed on the use of intensive individual tutorial. The tutor-student relationship is dynamic. It has education as its main goal and involves a transference counter-transference that must be recognized early by the tutor, handled with subtlety, and resolved successfully by the end of one month in order to facilitate learning. It also offers both the tutor and the student a unique opportunity for learning. The tutor must be careful, however, that tutorial should not devolve into psychotherapy. Thus, from our staff experience and student ratings, tutorial is considered a most useful way to teach psychiatry to senior medical students.