Unconscious Transmissions Between Patient and Pregnant Analyst

When two people in close proximity both experience processes of heightened perceptiveness, the likelihood of unconscious communication increases. In analysis, coconstructed emotional configurations of transference–countertransference further contribute to the interplay. The analyst's pregnancy offers a window on bilateral processes of unconscious communication, often obscured in psychoanalytic theorizing. The unconscious dialogue has three constituents: a) effects of the analyst's pregnancy on the patient (her liminality, disclosure of sexuality, two-in-one numinosity, and archaic, life-bearing, death-dealing powers); b) effects of pregnancy in the therapist herself (heightened intuition, slippage, and introspective preoccupation with “procreative mysteries,” anxieties of formation, containment-preservation, transformation and separation). c) the impact of patients on the pregnant analyst (her susceptibility to, and defensive def lection of, intrusive projections into her inner world). Focusing on generic anxieties broadens the discussion beyond synchronization of the intra/interpsychic dynamics of a particular two some.     

Kinship Support,Family Relations,and Psychological Adjustment Among Low‐Income African American Mothers and Adolescents

The association of kin social support with mothers' adjustment and family relations was assessed among 204 African American mothers and adolescents who were on average 14.45 years of age. Also examined was the association of mothers' adjustment with family relations and adolescents' adjustment. Findings revealed that kin social and emotional support was positively associated with mothers' optimism. Poor relations with kin were positively associated with mothers' depression. Kin advice and counseling and kin social and emotional support were positively linked to family routine. Poor relations with kin were positively associated with parent/adolescent communication problems. Mothers' optimism was positively associated with family routine and mediated the association of kin social and emotional support with family routine. Parent/adolescent communication problems were positively associated with adolescents' depression. The findings were discussed in light of their support for theoretical and empirical work on family processes among poor African American families.     

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.     

Supportive Psychotherapy for Borderline Patients

SUMMARY

An imagined conversation between a clinician/teacher and a beginning therapist conveys the concept of a psychoanalytically informed supportive psychotherapy for borderline patients and incorporates the major hypotheses as to the origin of the disorder. Within a basically developmental point of view, the treatment recognizes the contributions of genetics, animal studies, neuroscience, early interpersonal relationships and the object relations that derive from them. The psychodynamics of a typical case are considered from all of these viewpoints, while the student-therapist is encouraged to keep in mind the basic concepts of psychoanalysis. These include: unconscious mental activity, transference, and the internalization of the therapist's attitude of respectful listening, which leads to the capacity to listen in that way to oneself and others.     

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 self-image in the therapeutic dyad: A case example of mutual growth

The therapeutic relationship is seen as a mutual experiencing of self and other which is growth-promoting for the therapist as well as the patient. Work with a borderline woman during a period of two years evoked strong countertransference reactions in the therapist who, at times, experienced the patient as a mirror. A beginning sense of cohesion in the patient's highly fragmented sense of self found a parallel in this beginning therapist's developing professional identity.     

Countertransference Bias: Self-Examination,Not Cross-Examination

ABSTRACT

In reply to T. Tippins (2007, this issue), we take issue with his claim that recognition of the biasing impact of custody evaluators' countertransference opens the door to “evidentially legitimate” fishing expeditions through evaluators' private lives on cross-examination. We clarify the distinction between self-examination for counter-transference bias as a heuristic for improving the sensitivity and objectivity of expert testimony and its use as substantive evidence. We argue that countertransference bias is a highly personal, emotionally charged kind of bias, unlike the cognitive biases more frequently discussed in the child custody literature. We conclude that recognition of the insidious emotional influences that threaten our objectivity in working with families in high conflict divorce is an important ethical responsibility.     

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.     

Rescue Fantasies in Child Therapy: Countertransference/Transference Enactments

When the focus of the child treatment is on the therapist being a good object, this can accentuate a possible countertransference difficulty of the therapist becoming the protector of the child from the bad object. This countertransference can often resonate with rescue fantasies in the child. This paper will explore the topic of rescue fantasies in child treatment, while addressing the issue of coinciding fantasies existing unconsciously in both the therapist and child, leading to their enactment. A case of a nine-year old boy is presented which demonstrates how interpretation and resolution of rescue fantasies can lead to a deepening of the treatment.     

Group therapists' countertransference reactions to multiple deaths from aids

Group therapists for those with HIV Related Diseases are becoming the “professional” survivors of this world-wide epidemic. From their experiences we may learn a great deal more about the effects of multiple deaths on mental health care professionals. As therapists they are constantly eliciting and listening to the fears, hopes, agonies and terrors of those with this disease. They become the bereaved. Witnesses to the deaths of many of their group members, they struggle with a wide range of emotional responses while at the same time assisting surviving group members in their struggle to live with these deaths. Mourning reactions and countertransference phenomena are in abundance as these therapists grapple with these group processes. This article identifies and examines these therapists' responses by focusing on clinical illustrations drawn from their bi-weekly supervision sessions.     

MODES OF EXPRESSION IN FAMILY THERAPY: A PROCESS STUDY OF ROLES AND GENDER*

Twenty-two two-parent families with a referred adolescent were seen by 11 male and 11 female trainees in family therapy. Mothers, fathers, adolescents, and therapists were rated for verbal expression in affective, behavioral, and cognitive! attributional modes during the first session. Results clearly point to role and content difference in modes of expression. Of particular importance are differences by role which occured as a function of therapist gender. These differences suggest that therapist gender has an impact on family therapists' and family members' verbalizations in first sessions of family therapy.     

HIV/AIDS and constructs of gay community: Researching educational practice within community-based health promotion for gay men

This paper reports on the methodology of a comparative study of three gay communities in Australia as they struggle with HIV/AIDS. The study focused on the pedagogy and practice of HIV/AIDS education for disease prevention and for health maintenance for people living with HIV/AIDS, through the investigation of three problematics: (1) constructs of 'community'; (2) the centrality of gay community-based health educators; and (3) the relations of gay men within and to their communities. The study was conceived of as a critical ethnography involving a three-part sample in the three sites and using three related research methods: (1) individual and group interviews; (2) textual analysis; and (3) participant observation. The theoretical bases for the study and its design lay in notions of 'performativity', community and adult education, organizational and institutional processes, and the idea of a 'post-AIDS' sociality. The methodology is explained in detail, as are various consultative processes embedded in the design to facilitate and enable a productive relationship with the communities researched.     

(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 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.     

Vicarious resilience from attachment trauma: reflections of long-term therapy with marginalized young people

The concept of vicarious resilience captures the therapist's emotional growth occurring as a direct result of therapeutic engagement with traumatized clients. Three chronological case scenarios are presented for exploration of vicarious resilience in relation to attachment trauma. The purpose is to increase awareness and appreciation of the positive functions it serves for client mentalization, therapist skill and resilience factors for both parties. The reflective methodology considers the intrapsychic worlds of the client and the therapist and details how the therapist comes to experience the client's distressing projections. The potential for vicarious resilience begins from the outset of the therapist's actions of containment upon these projections. Advancing early ideas, it is advocated that vicarious resilience requires the therapist to have both the capacity and willingness to maintain a constant reflective stance.     

Reframing public relations: The evolution of a reflective paradigm for organizational legitimization

This article endeavors to understand the emergence, diffusion and dynamics of the social processes that activate and constitute public relations. By applying Niklas Luhmann's epistemological sociology, it identifies central problems of late modern society and shows how society deals with these problems through evolutionary learning processes and the development of a reflective paradigm. It concludes that the role of public relations can be seen as organizational legitimization in interrelation to different and changing forms of societal coordination.     

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.     

The puzzle of metaphor and voice in arts‐based social research

Research exploring the emotional responses to crime experienced by the citizens of several major European and North American countries has suggested that a significant proportion of the residents of these countries 'fear' or feel 'angry' about the possibility of criminal victimization. It has ceased to appear incredible to us that we are regularly finding that between a quarter and two thirds of our citizens are fearful or 'angry about crime' 'all of the time'. The argument put forward in this contribution to the work in this field is that the emotional responses to crime have been exaggerated by the inappropriate use of the survey as a measurement tool. Ethnographic and qualitative data suggest that experiences of 'fear' and 'anger' are less common. Suggestions for improving the ability of the questions used in surveys to accurately capture these emotional responses are advanced.     

The Influence of Family Environment Factors on Self-Acceptance and Emotional Adjustment Among Gay,Lesbian, and Bisexual Adolescents

Abstract

The quality of an adolescent's family environment has been shown to contribute to their self-acceptance and emotional adjustment. Studies suggest that sexual minority adolescents face unique challenges while negotiating family relationships but few studies have specifically examined the relationships between these family environments and the adolescent's psychological adjustment. This study examined general aspects of family functioning (family cohesion, family expressiveness, family conflict, parental support) and parental attitudes toward homosexuality as predictors of self-acceptance of sexual orientation identity and emotional adjustment among 102 gay, lesbian, and bisexual adolescents ages 15 to 19 years. Family variables did not predict a significant amount of variance in self-acceptance of sexual orientation identity. However, measures of general family functioning and parental attitudes toward homosexuality accounted for significant amounts of variance in emotional adjustment.     

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.