Issues of Psychoanalytic Technique With Adoptees

Treatment issues relevant to the psychoanalytic treatment of the adoptee are presented; clinical formulation is encouraged within broad ego-diagnostic parameters. The adoptee's internal cathexis of the biological mother is identified as a core dynamic and the binary transference involving the adoptee's displaced relation to a dual set of parental representations is described. A metapsychological bias, predicated upon differential perceptions of the status of self and object representations is described and related to the adoptee's treatment. Various transference/countertransference dyads are discussed, as are corresponding technical considerations.     

The Adoptee's Journey

The subject of adoption has often been mired in wishful thinking and denial. Because of the secrecy in the system, adopted children have been forced to repress their need to know about their origins; many feel invisible because an essential part of them is unacknowledged by their adoptive parents and society. The purpose of this article is to help mental health and legal professionals, as well as those in the extended community, to see what is specific about the formation of the adoptee's inner world. It introduces the concept of cumulative adoption trauma and discusses the adoptee's need to dissociate feelings of loss, grief, and anger. The struggle to form a coherent sense of self may eventually lead to the adoptee's need to search out the birth parents in order to integrate the past and the present and move on into the future.     

Blocked Creativity and Inhibited Erotic Transference

In this paper, I pursue the relationship between erotic transference and creativity. Erotic transference is not solely a resistance to treatment; treatment can involve a resistance to erotic transference, the dynamics of which can have parallels in the inhibition of creativity. Although it is certainly true that erotic transferences may be defensive against other layers of material, there has been a virtual neglect of the deleterious impact of resistance to erotic desire and romantic love for the analyst. The feeling seems to be that erotic transference is a problem to be analyzed when it exists in overt form. The absence of erotic transference in many treatments is often taken for granted, not thought of as constituting a problem or as indicating anything in particular about the patient's psyche that might benefit from analysis. As clinicians, we favor creative expression and promote the psychoanalytic process as facilitating this potential, but we are often ambivalent about a similar approach to erotic transference. A clinical example illustrates the connection that I have in mind between erotic transference and creativity. I have chosen a same-sex case in which the transference was homoerotic, but the larger point I am making has general application to any of the gendered treatment dyads. After focusing on the dynamics of the case, I discuss more generally certain shared features of erotic transference and creativity, as well as inhibitions on the part of clinicians.     

Institutional transference: a new look at an old concept

In reviewing the early development of institutional transference, the concept was defined as the patient's identifying the treatment relationship with a clinic rather than with an individual therapist and a form of "distancing." More recently, the literature reflects a debate about whether the phenomenon is an outcome of patients' inability to maintain an individual relationship or their adaptation to changing therapists within a clinic over time. In our clinical experience, we have observed that institutional transference is strongly associated with the clinical outcome. In the clinical examples, we demonstrated that being aware of the potential for institutional transference and allowing it to develop can facilitate the development of a more trusting relationship between the patient and clinic staff. Institutional transference can coexist with individual transference and help facilitate rather than hinder the development of a therapeutic relationship. In our experience, the sense of a relationship with the clinic or treatment center is an important aspect of care. Therefore, recognizing institutional transference enables the clinician to pace the development of the relationship with the patient.     

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.     

Clinical work with adolescents and their parents during family transitions: Transference and countertransference issues

This paper describes specific transference and counter-transference issues that commonly emerge in therapeutic work with adolescents and parents who are in the midst of family transitions such as divorce and remarriage. Psychoanalytic understanding and definitions of transference and countertransference are applied to short-term family-centered cases in which the parent-adolescent relationship is at particular risk. Case vignettes are presented in order to illustrate how transference and countertransference may guide or interfere with clinical interventions that are especially indicated with adolescents whose family structure has changed. Such interventions as well as the use of consultation are briefly described.At the time this paper was prepared, Ms. Springer was Associate Director and a senior clinician at the Center for the Family in Transition in Corte Madera, California. Funds for the research and clinical work that provided the basis for this paper were supplied by grants from the San Francisco Foudation. An earlier version of this paper was presented at the 66th Annual Meeting of the American Orthopsychiatry Association, New York City, March 31–April 4, 1989.     

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.     

Past and present in the therapeutic action: The persistent influence of the primary object

Psychoanalytic literature has focused on the influence of the primary object during early development, and the transference is described as a repetition of these early object experiences. Yet, personality is informed by past and present experiences with primary objects and others. Thus, limiting our understanding of the transference to past object experiences does not fully demonstrate the complexity of this phenomenon, nor does it allow for the ongoing influence that a primary object may have on the patient's life. Using contemporary psychoanalytic theory, this paper looks at the way that adult interactions with their primary object figures and the attunement of their therapists to these present experiences also influence the therapeutic action.     

Family treatment of a borderline personality

This article discusses family therapy as a complementary treatment modality with the adult borderline patient. According to theory, the separation-individuation process is the underlying conflict of the pathological adaptation of the adult borderline patient and the goal of therapy is often considered to be separation of the patient from the family. Family treatment can facilitate the process of separation-individuation as it allows for the concomitant enhancement of the separateness of the parents. Family treatment can also reduce anxiety about separation, minimize the development of a premature intense transference, and prevent the battle for control between the therapist and the parents. Moreover, the process of the family treatment itself, described in this article, reflects the developmental phase of symbiosis, followed by the subphases of the separation-individuation process, i.e., differentiation, practicing and rapprochement, with the groundwork being laid for moving into object constancy. The ego functioning of all family members has the potential of being enhanced and strengthened through this process.     

The therapist at play and the patient who begins to play

This paper addresses the therapeutic challenge presented in the initial phase of therapy by patients who have trouble playing and dreaming, that is, patients who use action-discharge and concrete communication and who show a relative lack of derivative, symbolic communication. An approach is described which conceptualizes therapy as taking place in an intermediate area between inner and outer reality, and in which playing, dreaming and interpretable transference, the vehicles of therapeutic work, can be facilitated. There can be advantages, in some cases, of using such an approach in family sessions. Clinical material is presented from the treatment of an adolescent in her family.     

Spontaneous self disclosures in psychotherapy

The closeness and intensity of feeling that develops between therapist and patient raises complex issues related to the therapist's neutrality, the transference, the countertransference, the therapeutic alliance, and the very essence of the curative aspects of the relationship. The issue of the relationship of self disclosure and the evolving transference, countertransference complex is discussed. It is suggested that on some occasions, the pressure a therapist feels to spontaneously disclose something intimately personal is an indication that the therapeutic role has become reversed and the therapist is using the process to heal a vulnerability in himself or herself. The patient unconsciously participates in the interest of safeguarding the treatment process. In such instances the self disclosure need not interfere with the evolving transference. It may lead to great spontaneity in the process and to opening areas of affect previously unreachable. Self disclosures cannot be viewed as technical innovations to avoid stalemates in clinical practice. Rather, they are facts of our clinical life, facts that must be explained and understood rather than judged and condemned.     

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.     

Adolescent dual unity: Identification and differentiation in development and in treatment

This article traces the vicissitudes of identity formation beginning with the mother-infant dyad described originally by Mahler as a dual unity. The complementarity of early development and reenactments of conflict in the transference relationship with the young adolescent, who is simultaneously merging, separating, and individuating, are highlighted in an extended case discussion of the multiple meanings inherent in a fourteen-year-old's symptomatic stealing behavior. The author suggests that communication based on self psychology principles, applied to this age group's normative narcissistic preoccupations, will enhance the therapeutic alliance.     

Outpatient clinic structure as a complication to psychoanalytically-oriented treatment

Concepts of “adaptive context” and “holding environment” serve as a foundation from which to address the impact of typical outpatient psychotherapy clinic settings on the process of psychoanalytic therapy. Issues of transference and resistance, treatment boundaries, professional investment, and the patients' and therapists' perceptions of the therapy process are primary areas of consideration. The depth, intensity, and power of psychoanalytically-oriented psychotherapy is seen as potentially limited by the structure and policies to which clinic settings tend to adhere. Circumstances in private practice are used as a point of comparison and suggestions are made to minimize treatment complications.     

Transference and counter-transference in social work

Abstract

A contribution to the understanding of transference and counter-transference as they affect and may be used in social work relationships. Reference is made to case material illustrating various aspects of transference. The value of understanding unconscious interactions is emphasised, especially for those who are working with very disturbed and regressed clients, and cases in which babies and children are at risk of non-accidental injury. If there are two or more workers concerned in these cases, the split transference, evoking equally powerful responses, can cause serious negative interactions between the workers. It is proposed that the objective viewpoint of a supervisor or consultant is required.     

When the going gets rough ... difficult points in treatment: Identification,exploration and working through (panel)

This paper is a summarized report of a panel presentation made by three analysts on the topic of resolving difficult points in the treatment of three of their patients through the understanding of countertransference and transference issues. The first analyst presented a case in which a stalemate was broken by addressing three different kinds of countertransference. The second presenter addressed an impasse in the treatment of her drug addicted male patient which was caused by positive transference and countertransference. The third analyst discussed the resolution of a critical point in the third year of treatment of a female patient which was uncovered by addressing the parameter of appointment scheduling. The candor and honesty of these presentations takes the reader into the heart of practice issues and illustrates how stalemates are resolved and treatment deepened. Audience reaction indicated that more such presentations which illustrate how analysts really work would be welcome.     

Treatment of noncustodial fathers: Gender issues and clinical dilemmas

This article addresses issues involved in the treatment of fathers who do not have custody of their children. It reviews literature on demographic trends and discusses fathers' reactions to loss of child custody. Assessment and treatment guidelines are offered so that clinical practice may become more responsive to the needs of the population. Gender concerns, particularly as they relate to transference and countertransference, are also discussed.     

Self psychology and ego psychology: A historical perspective

This paper takes a historical perspective as to the current debate between ego psychologists and self psychologists. By looking at the psychological functions of the self, the ego, and the superego, one can see substantial areas of overlap between the theories. The two theories are described and compared along the lines of these psychological functions. They are then applied to six clinical issues; primary developmental crisis, transference variations, conflict and defecit, modifications in technique, developmental lines, and the relationship between the ego and the self. The conclusion is drawn that a more comprehensive understanding of the theories as they apply to clinical phenomena needs to be developed before a determination can be made as to their compatibility.     

JUMPING ON SHADOWS: CATCHING THE UNCONSCIOUS IN THE CLASSROOM

This article discusses case material from a psychoanalytically informed ethnographic research project where the author had a dual role as a teaching practitioner and researcher in an infant school. It suggests that practitioner researchers can deepen a concern with reflexivity in the research process by transferring elements of the practice of the psychoanalytic clinician — specifically, attention to ‘counter‐transference’ — to their research practice. The article reviews the concept of counter‐transference. It suggests that working out the difference between transference and counter‐transference may be connected unconsciously to working out the distinctions between ego and superego. The article then goes on to provide an illustration of the way in which the author attempted to use her own counter‐transference to inform her research into young children's learning, specifically in relation to her experience of being a teacher. The discussion connects this to the teacher's transferential place as a parental and ‘superego’ figure for pupils. Observational extracts are drawn from the case study of ‘Lutfa’, a Bengali girl placed at the lower end of the ability group range. The article concludes by suggesting that attention to counter‐transference dynamics as a form of reflexivity can provide the practitioner‐researcher with valuable information about the research subjects and about dynamics in the setting, particularly the participants' relationships to ‘superego’ figures.