Self-nurturing: A cognitive behavioral treatment approach for the borderline client

Self-nurturing is a cognitive behavioral treatment approach specifically developed and used in clinical work with borderline clients. The client is taught to recognize and differentiate both the underdeveloped reality ego and developmentally arrested child components of the spilt-ego structure by their affective and behavioral characteristics. The therapist systematically lends ego strengths to the underdeveloped reality ego which is utilized as the good enough parent to re-parent the child ego state. The reality ego is strengthened in the process and the client's maladaptive behaviors dramatically decrease.     

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.     

Countertransference and Zebras: Forensic Obfuscation

ABSTRACT

Responding to Daniel Pickar's article entitled “Counter-transference Bias in the Child Custody Evaluator” (this issue), the authors opine that attaching new labels to familiar dynamics fails to contribute to an understanding of interpersonal dynamics with which all participants in the custody evaluation process are already familiar. The position is advanced that, in examining the reports and testimony of evaluators, biases are only relevant when they are manifested in identifiable behavior. Such behaviors include the application by the evaluator of different standards in examining and commenting on the actions of the two parents; the use of insulting terminology in describing the non-favored parent; the use of glowing terminology in describing the favored parent; assignment of minimal importance to possible parenting deficiencies in the favored parent; the assignment of much importance to reported flaws in the non-favored parent; an apparent unquestioning acceptance of the favored parent's perspective; and an apparent rejection of the non-favored parent's perspective.     

The Use Of Shame and Dread in the Countertransference

Much has been written about paranoid anxieties as these occur in the patient. Less, however, has been written about primitive experiences as these occur in the therapist during the session. This paper recounts a patient's correct articulation of the therapist's self-perception, which, because of its accuracy, initially flooded the therapist with shame and dread. Nonetheless, the patient's perception was able to be used in a way that clarified, in the countertransferance, a piece of the patient's early experience in relation to her mother and strengthened the therapeutic relationship.     

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.     

The triangle: The worker,the client,the agency

The power of the agency and its ability to enhance or detract from therapeutic work is discussed in relation to therapeutic failures. Most commonly a triangle involving the worker, the client, and the agency confound the problem. The historical base of this problem and present day influences on worker and client are reviewed. Suggestions are made for system changes to increase the power of the worker and to improve therapeutic work.This article is a revised version of a paper presented at the annual meeting of the Illinois Society of Clinical Social Work, April 25, 1981.     

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 Guilty Pleasure of Erotic Countertransference: Searching for Radial True

Although the use of the analyst's countertransference remains a point of controversy, it is a rare analyst who would not consider countertransference feelings useful fodder at least for the analyst's private reverie. But when the affective valence leans erotic, countertransference becomes once again taboo. This article explores the erotic meanderings of an analyst in relation to several patients with the aim of illustrating how erotic countertransference can be used to further the clinical process in each example. Cases include patients of both genders. Material is considered from within contemporary relational formulations, including the assumptions of multiplicity, the dialectic between relationality and autonomy, and judicious clinical technique that respects the complexity of clinical process.     

Compassion Fatigue and Countertransference: Two Different Concepts

There has been considerable conceptual confusion about the differences between compassion fatigue and countertransference. This often results in them being treated as the same phenomena, both in the literature and clinically. This paper maintains that these are, in fact, two different concepts that derive from different sources and serve different functions. Each of these two concepts requires different kinds of interventions as well.     

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.     

Politics in the Consulting Room: Hate in the Countertransference Revisited

This paper focuses on the way political ideas infused the psychoanalytic treatment of Mr. N., a man who struggled with low self-esteem, paranoia, and rage. Mr. N. became increasingly identified with Republican political goals and attacked what he considered my Democratic political views and legislative advocacy. The way that his anger became focused on my political activity had a profound impact on me, leading to strong countertransference feelings of depression and hate. The ways that I tried to accept and use this countertransference in the treatment are summarized, in the context of D.W. Winnicott’s paper on “Hate in the Countertransference” and others. During the course of the treatment Mr. N. became less judgmental of others and himself, learned to give and accept love, and developed the capacity for self-reflection through use of the therapeutic relationship.     

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.     

Countertransference and its potential for abuse

The definition of countertransference ranges from pathological and inappropriate responses of the psychotherapist/psychoanalyst based on inner issues and conflicts (hence an obstacle to cure) to a position that countertransference feelings and reactions provide useful information in understanding the patient and contribute constructively to the curative process. This later definition can enhance and expand the analytic inquiry. However, with this expanded conceptualization, abuses of countertransference can have damaging impact on the patient. This presentation will undertake to explore one aspect of such abuse and speak to the specific influences that contribute to the misuse of countertransference in the therapeutic situation.     

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.