Psychotherapy and Schizophrenia: The Mirror of Countertransference

The relationship between psychotherapy and schizophrenia has undergone pronounced changes over the last several decades. The advent of psychiatric medication led to remarkable breakthroughs that obscured the existential issues inseparably tied to the lived experience of illness and overshadowed the role of psychotherapy in the treatment of schizophrenia. Recent years have brought renewed scrutiny of the place of psychotherapy in the treatment of persons with major mental illness but much less attention has been shown to matters of countertransference. The complex legacy of loss and grief assumes a special dimension in the therapeutic relationship and touches the lives of client and clinician alike. Both travel a common path and share privileged moments. It is the intersection of these life experiences, and how their confluence shapes the course of therapy that is the focus of this essay.     

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.     

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.     

The Evolution of Sexual Pleasure

Abstract

Sexual pleasure is an innate component of human sexuality. Although disdained throughout history by religious groups and variably explained by theories, philosophers, and societies, sexual pleasure permeates human experience. Traditional evolutionists explain this preoccupation via the development of sexual mating strategies and the human desire to propagate one's genes; however, here I will argue that the saturation of sexual pleasure suggests that sexual activity is no longer pursued solely to ensure reproductive success. Rather, humans engage in sexual behavior to achieve sexual pleasure—a proposition supported by widespread non-procreative sex in mammals, divergent cultural norms, and humans' evolved capacity to experience heightened sexual pleasure. I will address the nature and evolution of sexual pleasure with a cross-cultural findings culled from ethology, anthropology, primatology, and evolutionary theories.     

The Value of Hate in the Countertransference

The author looks at the experience of hate in the countertransference and develops the idea that hate can be of particular value to the treatment process. He begins with an exploration of the therapist’s needs and discusses how unmet self-regulatory needs sometimes lead to feelings of frustration and rage toward the patient. The author explores these ideas as they are connected to Winnicott’s (1949, 1971) work on aggression and Jessica Benjamin’s (1992) work on recognition and destruction. The author espouses a difference between rage and hate, where rage is seen as indicative of unmet needs, and hate is seen as a force that can emancipate the therapist from the encumbrance of unmet needs. Case examples are provided to show the utility of this perspective. Laurence Green, M.S.W., Psy.D. is on the faculty and a member of the Institute of Contemporary Psychoanalysis. He is Co-chair of the History Committee of the International Federation of Psychoanalytic Education. He is in private practice in Los Angeles, California working with children, adolescents and adults.     

Money, Sex, and God: The Erotic Logic of Religious Nationalism

God is once again afoot in the public sphere. Politics has become a religious obligation. For a new breed of religious nationalist the nation–state is a vehicle of the divine. This essay seeks to accomplish four things. The first is to argue for an institutional approach to religious nationalism in order both to interpret and explain it. Second, I argue that religion and nationalism partake of a common symbolic order and that religious nationalism is therefore not an oxymoron. Third, the essay seeks to explain why religion has become such a potent political force in our time. And fourth—the task that will take up the bulk of the text—it seeks a principle of intelligibility in the semiotic order of religious nationalism that can comprehend its preoccupation with both women's erotic bodies and monies out of national control.     

What It Feels Like for a Whore: The Body Politics of Women Performing Erotic Labour in Hong Kong

This article seeks to investigate the complexity of the working experiences of female prostitutes in Hong Kong, using an oral history approach. Based on 13 in‐depth interviews, I depict my respondents as performing the skilled emotional labour of sex in exchange for their clients’ money. Looking at the ways in which the women manage the job, the self and the business, I argue that their major problem is not with the commercial transaction (that is, the content of the work itself), nor with the ‘conflict’ between their personal and work selves, but with the social stigma, surveillance and dangers at their workplaces. Inspired by a post‐structuralist conception of power and identity formation, I propose a women‐centred lived‐experience feminist approach in the hope of filling the gap between the bipolar imageries of ‘sexual slavery’ or ‘sex radical’ that have been thrown up in the feminist debate over the meaning of prostitution. This approach emphasizes the inter‐relationships among women’s lived experiences, the micro‐sites of social surveillance and the macro‐condition of wider society. Although Hong Kong female prostitutes are not ‘political’ in fighting for their rights and benefits, they have tended to take the path of micro‐resistance in combating societal domination. They negotiate an identity of the ‘prostitute’ that is sensitive and flexible to different institutional areas that seems to jeopardize the neat binaries of madonna/whore, good girl/bad girl, victim/warrior, conformist/radical. This allows them to create their own space to work and survive.     

Trading Later Rewards for Current Pleasure: Pornography Consumption and Delay Discounting

Internet pornography is a multi-billion-dollar industry that has grown increasingly accessible. Delay discounting involves devaluing larger, later rewards in favor of smaller, more immediate rewards. The constant novelty and primacy of sexual stimuli as particularly strong natural rewards make Internet pornography a unique activator of the brain's reward system, thereby having implications for decision-making processes. Based on theoretical studies of evolutionary psychology and neuroeconomics, two studies tested the hypothesis that consuming Internet pornography would relate to higher rates of delay discounting. Study 1 used a longitudinal design. Participants completed a pornography use questionnaire and a delay discounting task at Time 1 and then again four weeks later. Participants reporting higher initial pornography use demonstrated a higher delay discounting rate at Time 2, controlling for initial delay discounting. Study 2 tested for causality with an experimental design. Participants were randomly assigned to abstain from either their favorite food or pornography for three weeks. Participants who abstained from pornography use demonstrated lower delay discounting than participants who abstained from their favorite food. The finding suggests that Internet pornography is a sexual reward that contributes to delay discounting differently than other natural rewards. Theoretical and clinical implications of these studies are highlighted.     

Pleasure and Danger: An Appreciation of Muriel Dimen

ABSTRACT

In this essay I recall a 40-year experience knowing and working with Muriel Dimen. This is a reminiscence of a shared activist life in the late 1970s and 1980s and later our lives emerging in psychoanalysis and relational psychoanalysis after the mid-1980s. It is an appreciation of the particular turns and potent hot spots in Muriel Dimen’s evolving theorizing of sexuality and power, body and gender and culture from this point in the mid-1980s to her death in 2016.     

Resisting Amnesia in the Countertransference: A Clinical Strategy for Working with Lesbian Patients

Seldom emphasized in clinical writings are the ways in which lesbians construct and revise multiple narratives to create and navigate their lesbian identity within the clinical relationship. Case material is presented to show how the examination of the psychic meaning of the move from lesbian child to lesbian woman can be explored retrospectively through the collaborative therapeutic relationship set forth in the constructivist approach. To address the potential countertransference problems for clinicians working with this population, the concept of countertransference amnesia is introduced to describe a particular type of forgetting that reproduces within the clinical relationship the subtle forms of discrimination that restrict lesbian expression within the culture at large. This work also seeks to liberate lesbian identity formation from previous explanations and to demonstrate the construction of a lesbian identity as a psychically organizing process, which integrates inner and outer experience and allows the girl or woman to adapt to the social world.     

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.     

Searching for wages and mothering from Afar: The case of Honduran transnational families

This article draws on data from a 2‐year two‐country study that included 157 people to explore the survival strategies of poor Honduran transnational families. I argue that transnational families, defined as those divided between two nation‐states who have maintained close ties, depend on a cross‐border division of labor in which productive labor occurs in the host country and reproductive labor in the home country. This article bridges the literatures on transnationalism and families. The transnationalism literature tends to focus on macro processes, whereas the literature on families assumes proximity. This research helps fill the gap in both literatures, exposing the ways in which processes of economic globalization have radically altered family form and function.     

Women's Erotic Rape Fantasies: An Evaluation of Theory and Research

In an online study, measures of subjective sexual experiences in one's current relationship were compared across four groups: Men and women in mixed-sex (i.e., heterosexual) and same-sex (i.e., homosexual) relationships. Results indicated far more similarities than differences across the four groups, with groups reporting almost identical sexual repertoires, and levels of sexual communcation with partner. Men reported experiencing somewhat more sexual desire than women, while women reported slightly higher levels of general sexual satisfaction than men. Those in same-sex relationships reported slightly higher levels of sexual desire than those in mixed-sex relationships. Compared to the other three groups, heterosexual men reported deriving somewhat less satisfaction from the more tender, sensual, or erotic sexual activities. Implications of these findings for sex therapists are discussed.     

Enacting Gustatory Pleasure on Behalf of Another: The Multimodal Coordination of Infant Tasting Practices

Tasting as a social practice can be enacted on behalf of others through precisely positioned nonlexical vocalizations as gustatory mmms. This paper uses multimodal interaction analysis to detail the coordination of parents and infants while starting to feed solid foods; data are from families in Scotland. The analysis focuses on the organization of parental mmms in relation to eye gaze, sequentiality, and the temporal coordination of hands, food, and mouths to demonstrate their use in beginning, continuing, and refocusing on taste. The paper proposes that in order to fully understand the sociality of tasting, infant feeding research should include real‐time vocal and embodied behavior, which is also key to the functional analysis of sensoriality‐related vocalizations at the margins of language.     

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.