The trainee and the borderline client: Countertransference pitfalls

Acknowledging and overcoming hostile countertransference is a major problem in treating borderline personalities, especially for clinicians in training. Borderline personality dynamics and transference/countertransference phenomena are described, and a compendium of trainess' negative countertransference reactions is offered, following Maltsberger's and Buie's (1974) schema. Myths of omnipotence, seen as antecedents to countertransference reactions, are discussed briefly. A case example illustrates some of the ways that a trainee may inadvertently foster a negative transference/countertransference experience; it also discusses the roles of supervision and consultation in explicating the particular difficulties that the therapist and patient created. The necessity for and nature of limit-setting with borderline patients is noted.     

Countertransference issues for the consultant when a colleague is critically ill (or dying)

This report illustrates how countertransference issues emerged for a consultant therapist whose guidance about practice was sought by an ill and dying colleague. The detechment necessary for consultation was difficult to maintain. Denial, avoidance, and isolation operated for both. Ambivalence about directive behavior developed. Unexpressed grief, shock, feelings of inadequacy, and identification with the colleague intruted but were managed. The occurrence of such countertransference phenomena can be anticipated and understood in a consultation process that represents one valuable, underutilized, and important means of encouraging quality clinical practice under extremely painful circumstances.     

Fetish: A Graphic Essay

This paper explores the realm of the patient's intuitive knowledge of the analyst and its expression in the matrix of tranference–countertransference through dreams, enactments, and other sometimes uncanny phenomena first observed by Ferenzci, who referred to psychoanalysis as a “dialogue of unconsciouses.” Such phenomena are discussed in historical perspective and in the context of Suchet's case study of her work with a patient whose dreams appeared to reveal direct intuitive knowledge of her analyst's inner world.     

Compassion Fatigue and Countertransference: Two Different Concepts

There has been considerable conceptual confusion about the differences between compassion fatigue and countertransference. This often results in them being treated as the same phenomena, both in the literature and clinically. This paper maintains that these are, in fact, two different concepts that derive from different sources and serve different functions. Each of these two concepts requires different kinds of interventions as well.     

A model for the diagnostic and therapeutic use of countertransference

The definitions of countertransference are examined and a new definition is offered. A model is suggested that facilitates exploration of countertransference data.We have become aware of the countertransference which arises in [the physician] as a result of the patient's influence on his unconscious feelings... and have nearly come to the point of requiring the physician to recognize and overcome the countertransference in himself. (Freud, 1910, pp. 144–145)     

Countertransference and its potential for abuse

The definition of countertransference ranges from pathological and inappropriate responses of the psychotherapist/psychoanalyst based on inner issues and conflicts (hence an obstacle to cure) to a position that countertransference feelings and reactions provide useful information in understanding the patient and contribute constructively to the curative process. This later definition can enhance and expand the analytic inquiry. However, with this expanded conceptualization, abuses of countertransference can have damaging impact on the patient. This presentation will undertake to explore one aspect of such abuse and speak to the specific influences that contribute to the misuse of countertransference in the therapeutic situation.     

Resolving Some Therapeutic Impasses by Disclosing Countertransference

Clinical social workers have been shifting their conceptualization of countertransference from the traditional classical modal of a one-person psychology nearer to a two-person psychology, thereby moving the ideal of the blank screen model to one of participant observation. With a two-person psychology now more in vogue, clinical social workers feel much more inclined to share some of their countertransference responses with their patients. Where there is limited consensus is embodied in the question: “Under what circumstances is countertransference disclosure most helpful to our patients?” This paper is an attempt to demonstrate through case vignettes how countertransference disclosure can resolve certain types of therapeutic impasses.     

Containing and the patient's observation of the therapist's countertransference

Projective identification has received much attention for its ability to elucidate certain types of countertransference reactions. However, many severely disturbed patients are unable to benefit from the insight derived from interpretations based on projective identification. For many of these patients, the initial benefit of therapy is based on the containing provided by the therapist tolerating the countertransference rather than insight based on interpretation. Denis Carpy (1989) has written that the patient's observation of the therapist's tolerance of the countertransference helps to build psychic structure in the patient. In this article, the author reviews Carpy's position and then illustrates the value of the patient witnessing the therapist manage his countertransference using the case example of an adolescent in residential treatment.     

The Guilty Pleasure of Erotic Countertransference: Searching for Radial True

Although the use of the analyst's countertransference remains a point of controversy, it is a rare analyst who would not consider countertransference feelings useful fodder at least for the analyst's private reverie. But when the affective valence leans erotic, countertransference becomes once again taboo. This article explores the erotic meanderings of an analyst in relation to several patients with the aim of illustrating how erotic countertransference can be used to further the clinical process in each example. Cases include patients of both genders. Material is considered from within contemporary relational formulations, including the assumptions of multiplicity, the dialectic between relationality and autonomy, and judicious clinical technique that respects the complexity of clinical process.     

A peer supervision group: put countertransference to work.

1. As the nurse-patient relationship evolves through a series of ongoing interactions, both participants become "known" and stir in each other a range of positive and negative emotional reactions. 2. When working with severely psychologically disturbed patients, the nurse's affective and behavioral response can be valuable clues to understanding the patient's early experiences that contribute to the pattern of relatedness and to the formulation of change, enhancing therapeutic interactions. 3. The goals of the countertransference peer supervision group were to recognize unconscious countertransference reactions; unravel the origin and meaning of those countertransference reactions; and collaboratively develop therapeutic nursing interventions.     

Countertransference: A vehicle for reciprocal growth and repair in women psychotherapists treating women patients

In 1986 research the author described a constellation of gender related issues emergent in the transference and countertransference of women psychotherapists treating women patients. Shared gender-linked issues appear to foster special resonance between women psychotherapists and their patients. This paper posits that shared themes in the interplay of transference and countertransference can be reparative and growthful for the psychotherapist as well as her patient. Three examples from the author's clinical experience are used to demonstrate the process by which countertransference can give the patient greater access to unconscious material while simultaneously promoting growth in the therapist.     

Countertransference Bias in Child Custody Evaluations Is Just a Horse of a Different Color: A Rejoinder to Martindale and Gould

ABSTRACT

The authors' reply to Martindale and Gould's critique of Pickar's article (2007a, this issue), “Countertransference Bias in the Child Custody Evaluator.” Martindale and Gould's objections to considering an evaluator's countertransference reactions as a potential source of bias are addressed by focusing on these four areas: (1) Whether it is useful to introduce the term “countertransference bias” to identify a potential source of distortion in custody evaluations; (2) How the empirical literature on countertransference in the context of psychotherapy might apply to the child custody evaluation process; (3) Clarification of areas of agreement and disagreement with Martindale and Gould, and (4) The importance of evaluator attempts at “debiasing.” We conclude that gaining awareness of countertransference reactions can only enhance the evaluator's ability to provide the most objective custody evaluation possible.     

(Imagining) Erotic Mutuality: Negotiating Difference in Sexual Orientation in an Analysis

This article explores the clinical limitations of an exclusive adherence to the oedipal paradigm for the understanding of erotic material in the transference/countertransference in analytic treatments where the participants identify with differing sexual orientations. Its central argument posits that possibilities for recognizing developmentally significant, evolved connections with patients of all genders and sexual orientations is subtly circumscribed when understanding of these phenomena is partitioned chiefly by the “either/or” of a positive or negative form of oedipal desire.

The argument goes on to query and challenge formulations of a universal bisexuality as a satisfactory resolution to this conundrum, again, particularly when the 2 analytic partners claim different sexual orientations. Part object relations as residue of an early and ubiquitous polymorphous perversity are proposed as useful theoretical and clinical alternatives. Case material is also provided.     

Countertransference with adolescent clients of the same ethnicity

This article addresses countertransference in therapeutic relationships involving therapist and client from the same ethnicity. A case illustration of a Japanese adolescent and a Japanese therapist is used to develop the thesis that obvious similarities in race, or culture may lead to invalid assumptions about shared beliefs and values and subtle countertransference manifestations which have the potential to disrupt or prevent the development of a working relationship.in private practice.     

Self-disclosure in treatment: What therapists do and don't talk about

In contrast to the traditional view that sees therapist self-disclosure as a form of countertransference acting-out that either makes the therapeutic process more difficult or subverts it completely, this paper will present a self psychological rationale for the selected use of therapist self-disclosure in treatment. It will discuss the nature of therapist self-disclosure, issues in its use, countertransference issues, and its evaluation.     

Self psychology and countertransference in the treatment of children

The issues of countertransference in the treatment of children have received far less attention than those arising in the treatment of adults. This paper attempts to begin to redress this imbalance. Some of the major countertransferences in work with children are addressed, and the perspective of self psychology is presented. In the conclusion some thoughts are offered regarding some of the narcissistic injuries therapists must confront in dealing with issues of countertransference.     

A Strange Invitation: On the Ordinary Problem of Pornography

Pornography in the clinical psychoanalytic situation is an ordinary problem that is most effectively approached in the manner a psychoanalyst would any other part of a patient's experience that registers in the transference/countertransference in order to be worked with. However, because pornography often seems to do with sexual excitement, it may evoke more anxiety than other kinds of material in an analysis and so may lead to a transference/countertransference situation that can feel difficult to handle. This essay examines several aspects of pornography—how it produces its effects and what sort of product it is—but also discusses how an analyst works to regain what feels like a useful therapeutic stance when pornography has been part of the clinical dialogue. This involves the tension that grabs hold when ideas generated by applied psychoanalysis combined with volatile subjective experience of pornography produce a specific countertransference situation.     

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.     

Transference and countertransference in the treatment of adult survivors of abuse with a somatoform disorder

The understanding of transference and countertransference has changed a great deal since Freud introduced the terms. A case example indicates one way the patient’s and clinician’s past experiences and expectations interact to create a here and now relationship that is highly influenced by transference/countertransference. The understanding of both terms as aspects of a mutually constituted interaction has practice implications for the treatment of adult survivors of abuse who have a somatoform disorder.     

Envy in the transference and countertransference

This article defines envy and describes the various ways in which it may manifest itself, pointing out that there may be positive as well as negative effects of envy. These concepts are then applied to the psychotherapeutic situation, and the effects of envy in the transference, and particularly the countertransference, are discussed. Finally a case presentation demonstrates how the therapist's recognition and understanding of envy in the countertransference were used in a positive way and helped the therapy to proceed in a more productive direction.