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.     

Self psychology and the psychotherapy of psychotic patients: A case study

Self psychology has previously been employed in describing the treatment of narcissistic personality disorders. This article discusses the clinical application of concepts of self psychology to the psychotherapy of a psychotic patient. Empathy and the concept of empathic failure were very helpful in conceptualizing the therapeutic process. The two selfobject transferences of mirroring and idealization were both present in this case, and the recognition and interpretation of these transferences were critical in understanding the therapeutic process. The patient's delusional experiences receded and began to be less disruptive as the selfobject transferences emerged and remained in place. The resurgence of delusional material was usually indicative of a failure of empathy and a disruption of the selfobject transference. This patient's ability to regulate his anxiety and calm himself was considerably enhanced during the course of treatment. Self psychology and the understanding it provides proved to be of great value in the treatment of this patient and has wide applicability to the psychotherapy of psychosis.     

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.     

Psychoanalytic insights and empowerment in social work practice: evaluating the effectiveness of the ‘transference interpretation to the setting’ technique

This study evaluates the effectiveness of the ‘transference interpretation to the setting’ technique in psychodynamic social work practice. Aiming to establish the therapeutic relationship, the practitioner-researcher interprets client negative emotions towards him and the institution as a by-product of the ‘here-and-now’ situation rather than as a repetition of emotions rooted in primary relationships. Adopting the multiple case study method, this study provides an in-depth analysis of the process and the effectiveness of the ‘transference interpretation to the setting’ in clinical practice with six parental couples whose children exhibited separation anxiety disorder. The technique effectively dealt with parental resistance to bring the child for assessment, parental resistance to use the clinician's advice, couple relationship problems and emotional problems of the parents. The empowerment effects of the technique on the parents, and indirectly children, are demonstrated through parent and practitioner narratives. The study concludes that ‘transference interpretation to the setting’ is an effective intervention tool for the social work practitioner.     

The Role Of Empathy in Brief Therapy: The Overlooked but Vital Context

Brief therapy is widely perceived to be a very technique oriented and outcome focused endeavour, with limited interest in the fluidity of the relationship between the therapist and client. This perception exists despite the absolute priority brief therapy has always placed on building a cooperative relationship between therapist and client. Certainly, the brief therapy tradition has almost completely avoided talking about ‘empathy’ and the emotional realm, almost as if it is inappropriate for a brief therapist to discuss them. This paper suggests firstly that brief therapy is enhanced, rather than diminished, by engaging with both empathy and affect, and secondly, that the conception and practice of empathy can itself be enhanced by the rich tradition of skills and experience that brief therapy offers. Case material is used throughout this paper to illustrate the authors’ views.     

TREATING A HIGH-RISK MOTHER–CHILD RELATIONSHIP

In this paper, the author presents detailed clinical material to portray the experience of intensive therapy shared with a young school-aged boy and his very troubled mother. The therapy involved a challenging combination of triadic sessions along with dyadic child-therapist sessions observed by the boy’s mother from behind a one-way mirror. The discussion centers on the impact of complex transference and countertransference experiences and recommends conjoint sessions as the first option when treating young school-aged children in relationship with a highly troubled parent. I am indebted to Jacqueline Hanley for her support and encouragement, without which this paper might not have been written. Thanks are also due to Jack Howard MLS for his reference assistance.     

The Intersubjective Experience of the Physical Body in the Clinical Setting of Eating Disorders

This paper will illuminate one dimension of self-disclosure as it relates to the inescapable presence of the body in treatment, and the female clinician’s ability to bring her physical body into clinical discussions during an encounter with a female client with an eating disorder. Although the clinical literature on eating disorders validates that transference and countertransference issues are particularly powerful, it generally neglects the exploration of these issues specific to the body’s physical presentation. Since body dissatisfaction is increasingly normative for women today, female clinicians need to have a theoretical road map on which to rely when they encounter a shared body experience. Thus, in order to encourage discussions of the therapist’s body in clinical social work practice, the body needs to be situated in a larger theoretical framework within which it can be explained and located; this framework is object relations theory viewed through an intersubjective lens. Concepts from object relations theory will demonstrate the importance of the body in the clinical exchange by highlighting the parallel between Winnicott’s ‘good enough’ mother and the ‘good enough’ therapist’s body. When the therapist is able to judiciously invite discussions of her body into the clinical arena, the client is given the opportunity to move from object relating to object usage. A case presentation exemplifies how this conceptual framework can be applied to clinical social work practice, strengthening the relationship between knowing and doing.     

Counselling and Psychotherapy: Is There a Difference? Does It Matter?

The terms ‘counselling’ and ‘psychotherapy’ are often employed in a loosely interchangeable way, especially in Australia. Where distinctions are made, there has been little agreement on what each term should cover. This article examines several axes on which ‘counselling’ might potentially be distinguished from ‘psychotherapy’; the most promising basis for such a distinction seems to be whether or not the mode of work attempts to access the unconscious. On this basis, several modalities currently termed ‘therapy’ would in fact be classed as types of ‘counselling’, including those modalities of family therapy which aim to engage clients at the level of conscious behaviour change and restructuring. Consideration of how new professionals are trained lends support to a continuum, with short‐term, problem‐focused conscious‐oriented approaches at one end, and longer‐term, transference‐focused, unconscious‐oriented approaches at the other, the dividing line coming at the point where trainees learn the skill of ‘immediacy’.     

Transference and countertransference reactions in the psychotherapy of pathological gamblers

Traditionally, in psychodynamic forms of treatment, the patient's relationship with the therapist is central to eliciting and exploring the patient's characteristic ways of thinking, feeling and behaving. Research has increasingly demonstrated the significance of the therapeutic relationship to the treatment outcome. Since little has been written about the therapist-patient relationship in the treatment of pathological gambling, we shall describe what we have found to be some of the common and problematic transference and countertransference reactions and interactions. Both positive and negative transferences and countertransferences will be discussed not only as obstacles to successful therapy, but as tools for understanding patients' conflicts, defenses and reasons for gambling.     

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.     

Breaking the race barrier

Through the reflective process of analyzing one's own feelings and reactions to the ethnic minority patient, the white therapist develops an inner clarity that serves as a resource to cope with the unique conflicts one must confront in interracial practice. Only when the therapist has come to some resolution of his or her own feelings about the plight of ethnic minorities in this country can this acumen develop. Although the therapeutic skills applied in psychotherapy with ethnic minorities are in no way different from overall therapeutic skills, certain techniques may be especially useful in interracial practice. For instance, a discussion of the meaning of race and ethnicity in the relationship may curtail racial distortion, prevent stereotyping, and lead to the creation of a therapeutic alliance. When dealing with transference and countertransference issues, the therapist must be particularly attentive to the representation of these same distortions and stereotypes. Formulating clinical problems from dual perspectives, theoretical and sociocultural, is an arduous, but necessary task. Finally, the white therapist must be able to view ethnic minority patients as individuals. Although these patients cope with special problems which must be acknowledged and dealt with in therapy, the therapist must realize there is a common ground on which to communicate. On this common ground, therapists discover the foundation of interracial clinical practice is the ability to accept and respect their patients and themselves as individuals who may have similar anxieties, problems, experiences, and goals. It is through the recognition and sharing of the fundamental human bond that ethnic and racial differences, which may have detrimental effects on interpersonal relationships, are transcended.     

Incorporating Struggles with Racism and Ethnic Identity in Therapy with Adolescents

Ethnic and racial minority adolescents enter therapy with the behavioral, emotional, social, familial, and educational problems common to clinical practice. However, therapy with these youth necessitates attention to the effects of racial discrimination on their psychological functioning and to matters of how their ethnic or racial identities are integrated. Of the myriad issues that become part of therapy with minority adolescents, the profound effects of racism and the process of ethnoracial identity development can be seen in adolescents' sense of self and behavior. Experiences with racism and with their own ethnic reference group and others may have led to distortions and partial understanding of their identities that may affect adaptation and functioning. In this paper, the author draws from experiences in clinical practice with minority youth to highlight issues of racism and ethnic identity emergent in treatment. Three cases illustrate discussions of struggles with racism and ethnic identity as they emerged in therapy. In each case, the struggles were made salient by the therapist's purposeful eliciting of them to clarify issues of transference, family relations, peer group relations, and achievement.     

Aspiring to Partnership. The Signs of Safety approach to child protection

There is a worldwide trend towards increased collaboration in child protection practice which is primarily driven by researchers and policy makers. This sees child protection workers with the task of finding ways to implement the policy and build partnerships with the families they work with. The Signs of Safety approach to child protection casework, which was developed by the authors in conjunction with child protection workers in Western Australia, is designed as a practical method to foster a cooperative relationship between workers and families. This approach draws extensively on the ideas and experience of ‘brief therapy’ and is designed to be used in child protection practice from the intake and investigation stages through to case closure. This paper presents the different practice elements of the approach, the thinking that informs it as well as its application to assessment and case planning. Some case material describing the application of the approach is also presented. © 1997 John Wiley & Sons, Ltd.     

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 Gap Between Couple Therapy Research Efficacy and Practice Effectiveness

Meta‐analyses of randomized controlled trials of couple therapy find large improvements in couple adjustment, but published evaluations of the effectiveness of couple therapy in routine practice find only small‐to‐moderate effects. The current study analyzes possible explanations for the research‐efficacy to practice‐effectiveness gap and offers suggestions for enhancing couple therapy effectiveness. Major recommendations are that therapists should clarify whether couples’ therapy goal is to clarify commitment to the relationship or to improve the relationship; use standardized assessment of the individual partners and the relationship; and use systematic monitoring of therapy progress and the therapeutic alliance. It is also possible that the greater use of evidence‐based therapies when treating couple relationship distress could enhance couple therapy outcome.     

Has Social Work Heeded the Call? Sex Offender Content in Social Work

The relationship between theory, research and practice in the contemporary UK social work curriculum is examined in the context of the New Labour Government's insistence on making explicit the connections between knowledge, research, standards and ‘best practice’ in its regulatory discourse. The argument suggests that far from being obvious, settled or predictable in the way in which this discourse suggests, the relationship between research, theory and practice is highly contentious and certainly unresolved. The article then goes on to look at concepts of theory and research. ‘Theory’ is seen as having evolved with little reference to evidence and ‘research’ is seen as having established a new intellectual hegemony without having engaged with or contributed significantly to the development of practice theory. The article concludes that the trend towards a professional and intellectual fragmentation of the social work discipline needs to be reversed if students are to develop their own ‘research mindedness’.     

Exploring the Therapeutic Relationship A Case Study

This paper is focused on the topic of the therapeutic relationship in systemic therapy. It is structured around the discussion of my experience of work with a particular family where the engagement issues were complex, and where there was the potential for a negative therapy sequence. The psychoanalytic concepts of transference, countertransference and projective identification are chosen to discuss my dilemmas — however, the differences between the analytic and systemic contexts of work are noted. Through the discussion of this case study, the potential benefits of using these analytic ideas to understand the therapeutic relationship in specific situations in systemic therapy are identified.     

A Kleinian approach to psychotherapy

This paper explores how certain key ideas of Melanie Klein regarding transference, separation, the significance of internal phantasy, the phenomenon of splitting internal objects, and experiences of greed, envy, and gratitude relate to the practice of psychotherapy. Problems of differentiating between persecutory and depressive anxieties as well as the defenses against specific anxieties, based on Klein's notion of the infantile roots of anxiety tied to loss, are discussed. The importance of attending to negative transference phenomena is elucidated. Implications of Kleinian theory for clinical social work practice and extended possibilities of work with asocial borderline and psychotic states are explored. How the therapist functions as a model of the biological mother is illustrated by case material of a borderline individual.     

Michael,part two: crisis and resolution in the transference

This is the second of two linked papers seeking to trace certain processes in a social worker/family relationship. ‘Michael, part one: a boy of twelve in conflict with the school authorities’, recounted two discussions of a case presented to a practice seminar led by the author. This paper describes a third seminar presentation and discussion of ‘Michael’. Michael's central problem of an insecure, unstable and ambivalent relation to his father, to which he reacted with difficult behaviour, was repeated when the social worker was inadvertently embroiled in the family's interactive strategy. In the ensuring crisis the boy was excluded from school. The social worker contained the crisis and paved the way for a deeper understanding of the central problem when she acknowledged that something had gone wrong in the relationship with herself. The view that limited unwitting collution with the central problem and subsequent acknowledgement of the error is potentially facilitating, in the context of otherwise steady consistency, accords well with Mattinson and Sinclair's (1979) research. Conceptually, the author draws also on oedipal and transference theory. The ‘third position’ aspect of oedipal theory is applied variously to the function of the father, the social worker and the seminar.