Resolving Some Therapeutic Impasses by Disclosing Countertransference

Clinical social workers have been shifting their conceptualization of countertransference from the traditional classical modal of a one-person psychology nearer to a two-person psychology, thereby moving the ideal of the blank screen model to one of participant observation. With a two-person psychology now more in vogue, clinical social workers feel much more inclined to share some of their countertransference responses with their patients. Where there is limited consensus is embodied in the question: “Under what circumstances is countertransference disclosure most helpful to our patients?” This paper is an attempt to demonstrate through case vignettes how countertransference disclosure can resolve certain types of therapeutic impasses.     

TEACHING IN LITHUANIA—THE PERSONAL AND THE PROFESSIONAL

The aim of this paper is to demonstrate the central role of the countertransference as a catalyst for understanding for both teacher and student. During a week of teaching basic psychoanalytic concepts to Lithuanian university students in central Lithuania, I discovered that there was an absence or lack of understanding between the group I was teaching and myself. Our expectations were very different. On a political, cultural level, I was faced with a Lithuanian understanding of the world that is quite different from a Western European perspective. This personal narrative explores how I used my countertransference to the group, and their countertransference to their clinical work, as a tool to begin to explore the professional issues we have in common and to struggle to understand the differences. It was impressive to observe, through the lived experience of this work, the development of a well‐functioning group that had overcome not only the difficulties that accompany large groups but that had taken on board a new way of thinking and working. I returned in October 2004 for a further week's teaching and a continuation of a joint teaching–learning enterprise.     

Memory and meaning in the psychotherapy of the long-term mentally ill

After a long period when the treatment of major mental illness was under the decisive influence of the biological revolution in psychiatry, there are now growing signs of a revival of the role of psychotherapy in understanding the lived experience of psychotic disorders. Despite increased attention to the subjective world of persons afflicted with severe mental illness, considerably less has been written about the devastating effects of a loss of reality on memory and meaning and about the especially complex ordeals facing therapists who enter into long-term relationships with clients cut off from the past and the future. The ensuing quest for meaning amid the breakdown of memory is the focus of this paper.     

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.     

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.     

Exploration of Racial Enactments in an Interracial Therapeutic Dyad to Foster the Strengthening of Voice and Identity in African American Male Adolescents

The purpose of this paper is to examine the impact of systemic racism on an interracial therapeutic dyad between a white therapist and an African American adolescent male. Leary (2000 Leary, K. (2000). Racial enactments in dynamic treatment. Psychoanalytic Dialogues, 10(4), 639–653. doi:10.1080/10481881009348573[Taylor &; Francis Online], [Web of Science ®] , [Google Scholar]) operationalized the term “racial enactments” and made the important point that its “most common” manifestation “has been our relative silence about racial issues” (p. 647). It is the premise of this paper that the youth of color’s subjective experience of racial microaggressions and assaults experienced on a daily basis must be validated and explored prior to a meaningful intersubjective exploration in the clinical encounter. The emphasis in this paper is on the racial enactment that precedes the clinical encounter. A treatment vignette is used to highlight the intersection of social and psychic spheres of human experience and how an awareness of unconscious bias in the therapist can facilitate a more meaningful dialogue in which priority is given to the emergence of a powerful client narrative voice.