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 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.     

The Clinician's Cultural Countertransference: The Psychodynamics of Culturally Competent Practice

The purpose of this paper is to define the presence of the clinician's cultural countertransference in the cross-cultural therapeutic dyad, and describe its impact on the delivery of culturally competent services. The recognition of the contributing role of the therapist's own subjectivity in psychodynamically oriented practice cannot be more vital than in the treatment of patients whose culture, race, or class markedly differ from that of the therapist. The cultural countertransference is viewed as a matrix of intersecting cognitive and affect-laden beliefs/experiences that exist within the therapist at varying levels of consciousness. Within this matrix lie: the clinician's American life value system; theoretical beliefs and practice orientation; subjective biases about ethnic groups; and subjective biases about their own ethnicity. The author proposes that these countertransference attitudes are often: disavowed by the clinician; exert a powerful influence on the course of treatment; and though unspoken, are frequently perceived by the client.     

A multidimensional typology of countertransference responses

Of all the countless phenomena intrinsic to psychoanalytic therapy, the construct of countertransference is one of the most conceptually and technically burdensome. As yet, no single theoretically consistent and universally accepted classification of countertransference responses exists. This article proposes a multidimensional typology of countertransference phenomena which can be employed to help monitor clinical practice.     

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.     

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.     

Introducing a Research Project into Social Work Practice—A Model for the Future?

In this article the author, a social work practitioner, suggests that the knowledge and experience of practitioners and researchers need to be harnessed so that innovative practice can be developed within local authority Social Services. The views of children and young people were sought as a way of enhancing service delivery. Young people were consulted through a Focus Group about the policy and practice of Child Protection Conferences. Interviews were also undertaken with 11 young people who had been the subject of a Child Protection Conference to find out what they thought about the preparation stage, the conference itself and the follow up they received after the conference.

The author concludes that young people can make a valuable contribution to the development of universal services and managers and social work practitioners need to find ways to routinely incorporate consultation with children and young people into social work practice. This has implications for social work education, not only in ensuring that consultation skills with service users are built into the curriculum, but in encouraging innovative practice in the workplace.     

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.     

Staying put in the Closet: Examining Clinical Practice and Countertransference Issues in Work with Gay Men Married to Heterosexual Women

Gay men married to heterosexual women seek psychotherapy for numerous reasons, not only to find a way out of their marriages. Therapists must identify their countertransference reactions to avoid pushing the patient either to commit to his marriage or leave it. The patient’s underlying problems should be addressed before the patient can explore the fate of his marriage. Therapists also need to be understanding of the patient’s attachment to his wife. In addition, therapists must be aware of the societal implications of homophobia on gay patients. This article discusses motivations for heterosexual marriage among gay men, examines two clinical cases, and addresses practice and countertransference issues. A version of this article was presented at the tenth national conference of the National Membership Committee on Psychoanalysis in Clinical Social Work on March 10, 2007.     

Out from under: Countertransference in the treatment of the masochistic youngster

The masochistic youngster tends to evoke in the treatment situation precisely the responses which impede progress. This article discusses countertransference issues and the dynamics of masochism, understood as a protection for a frightened ego rather than merely a willful manipulation. Difficulties in and approaches to dealing with the environment of children in residential treatment are presented.Ms. Smaldino is currently in private practice and supervisor of psychotherapy for the New Hope Guild.     

Views of a Structured Assessment Tool for Observing Practice

Assessment of learning in practice through observation is a key part of social work training in the UK. There is no evidence of systematic dissemination or evaluation of observation tools in social work training. The Assessment of Learning in Practice Settings (ALPS-CETL) programme developed observation tools intended to provide comprehensive assessment through the collection of analytic student reflection, alongside commentary from practice assessor, professional colleague and service user. These ALPS tools were further developed to include specific social work assessment criteria. The purpose of this study was to establish student and practice assessor views about how the tools had been used and to understand their effectiveness, or otherwise, in practice. Through analysis of student focus groups, practice assessor interviews and completed ALPS tools, this paper evaluates the use of the social work adapted ALPS tools on an undergraduate social work programme in an English university. The findings of this study support the view that the ALPS tools can be used to promote reflective writing and support students in obtaining formative and summative evidence of their progress. In addition the tools appear to promote a student-led process of observational assessment thereby potentially helping to address the issue of power in the student/assessor relationship.     

Harried by Harding and Haraway: student–mentor collaboration in disability studies

Exploring the friendships of disabled youth in forthcoming doctoral research raised many unsettling questions. Members of academic and disability communities thoughtfully asked how the researcher could legitimately understand, interpret and represent the experiences of disabled youth. The initial impulse was to rely on nearly two decades of clinical practice with children and youth with disabilities; however, the futility of this strategy quickly surfaced. Uncertainty about how to proceed arose. A colleague and mentor suggested that a careful reading of Sandra Harding, Donna Haraway and Mats Alvesson and Kaj Sköldberg might provide the conceptual tools required to address these concerns. This paper presents a student’s stumbling, hesitant and sometimes ‘harried’ attempts to grapple with their unfamiliar arguments while simultaneously exploring tentative connections with disability studies. The evolutionary cycle of queries, responses and reflections from a series of e‐mails demonstrate a transition in thinking about research and representation.     

POSITIVE PRACTICE IN FAMILY THERAPY

Positive practice, a brief integative approach to consultation with families, is described in this paper. A clear distinction is made between the stages of planning, assessment, therapy, and disengagement. Guideliness for progression from one stage to the next are provided. Frameworks for deciding who to invite to preliminary sessions and methods for planning and organizing lines of inquiry are incorporated into this approach to practice. A three-column model is used to construct formulations. The model allows therapists and clients to map information about the pattern of interaction around the presenting problem, beliefs that constrain family members from altering their roles in these problem-maintaining patterns, and factors that have predisposed family members to hold these beliefs. Positive practice offers methods for evolving new behavioral patterns and belief systems within sessions and for arranging homework tasks for clients between sessions. It also incorporates methods for dealing with resistnace, for managing therapeutic crises, for convening indivudial sessions and borader network meetings, for disengaging from the consultation process, and for recontracting for further episodes of therapy. This evolving approach to practice draws on ideas from many traditions within the family therapy field and takes account of recent research relevent to the practice of family therapy.     

Some theoretical considerations on confidential adoption part IV: Countertransference

Psychological self-awareness is as essential to the maturation of one's professional self as is the development of theoretical and clinical expertise in child placement. This paper represents a first published attempt at examining countertransference in adoption. The focus is within the context of confidential adoptions, which the authors believe is more child-focused and intrapsychically based than the current experimentation with open adoptions. A distinction is made between countertransference and non-countertransference issues. Countertransference responses are divided into Racker's three categories: the concordant; the complementary; and the disjunctive. Clinical data illustrates these responses in actual practice from the perspective of confidential adoptions.This paper was presented in 1985 before the Illinois Infant Mental Health Association, National Society of Clinical Social Workers, and the National Association of Social Workers National Professional Symposium.This is the last of a series. Parts I, II, and III were published in Vol. 2, Nos. 1, 2, and 3.     

Law in Social Work Education: Reviewing the Evidence on Teaching,Learning and Assessment

This paper presents the findings from a systemic review of knowledge relating to current practice in the teaching, learning and assessment of law in social work education. The research comprised an internationally conducted systematic review of the literature, together with a survey of current education practice in the four countries of the UK. Two consultation events sought the views of a range of stakeholders, including the perspectives of service users and carers. Set in the context of debates about the relationship between law and social work practice, this paper identifies the common themes emerging from the review and offers an analysis of key findings, together with priorities for future directions in education practice.     

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)     

The confidential patient: the social construction of therapeutic relationships in general medical practice

The interpersonal relationship between doctor and patient is fundamental to general medical practice. In this paper we explore the ways in which general practitioners make sense of the changing political economy of this relationship, as it is restructured by ideas about the patient as consumer, and as it increasingly constitutes the consultation as a point of interaction that may be intrinsically therapeutic. In particular, we explore the ways in which the consultation is the site of negotiated power relations between doctor and patient, and is the site of the doctor's negotiation of powerful discourses of professional and institutional identity.     

When Absence Speaks Louder than Words: An Object Relational Perspective on No-Show Appointments

The rates of no-show appointments in community mental health are reported to be as high as 50%. Yet there is a striking scarcity of clinical literature on this subject compared with the abundance of articles written from an administrative point of view. This paper describes a variety of countertransference responses to missed appointments. Drawing from object relations theory, the author maps out different pathways to guide thinking about the use of countertransference, listening to clinical material following a no-show appointment, and responding to organizational pressures. The paper aims to help practitioners make greater sense of the patient’s inner world and of what is going on in the transference-countertransference matrix.     

Managing Care and Joined Up Thinking in the Curriculum

This paper discusses the curriculum development of a level three undergraduate course in managing care. It was produced and is presented by The Open University. The course is aimed at frontline managers in health and social care. The course team made consultation with service users, carers and managers a priority in developing the curriculum. The paper discusses this consultation process and the learning gained from it. A major contribution was to clarify debates about how far the course should have one core curriculum and how far it should offer specialist options for managers in different settings. Service users and carers had strong views on the need for better co‐ordination of services and recognition of individual needs rather than divisions into service‐led categories. Managers stressed the importance of reflecting the reality of frontline management. This helped the course team to develop a framework that stresses the commonality in the work and the importance of ‘practice‐led’ management. Service users and managers were involved as critical readers of course texts to ensure that the consultation process continued through the course development. A second strand is the need for the course to be accessible to those not yet in management positions, and extracts from an interactive CD‐ROM which presents case study material demonstrate the innovative joined up and accessible approach taken to student learning needs.