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The attempt to identify and classify distinct experiences falling under the common designation of countertransference has been labelled the specifist tradition. In this paper, a model describing two dimensions differentiating four components of countertransference experience is proposed. For each experiential component (subjective countertransference, objective countertransference, therapeutic attitude and emerging experience), a brief description based on previous literature from diverse theoretical fields is offered, along with clinical implications and illustrations and an account of empirical literature explicitly or implicitly addressing the specific component. In conclusion, the model is presented as a heuristic guide that can serve different purposes across different therapeutic orientations, with valuable implications for practice, training and supervision. [ABSTRACT FROM AUTHOR]

The technical aspect of managing the analyst's emotional responses to a patient has changed over the years, from Freud's position (1910, 1912, 1915), stating that emotions are a sign of an incomplete analysis from the analyst, to the recognition of this emotion as a communication between patient and analyst by Bion (1954). This recognition led to the acknowledgment of their importance as a diagnostic tool, while avoiding disclosure by Heiman (1950) and King (1978). More recently, consideration in the ways we can interpret these feelings during the analysis has been study (Winnicott, 1947; Little 1951; Casement 1986; Ogden 2018). This paper, advocates for the disclosure of such feelings (self‐disclosure) mainly when they are of a positive nature and the patient has a history of neglect. Also, there is a reflection on the advantages and disadvantages of doing so. Finally, there is consideration of the difference between a patient's need and a patient's desire before such disclosures. [ABSTRACT FROM AUTHOR]

This paper discusses the psychotherapy of a patient with autistic features and rigid resistance to free association. The patient often presented his experience as merely physical sensations. The paper juxtaposes two theories that illuminate the clinical picture. Tustin's theory of autistic objects identifies a defensive manoeuvre whereby sensation is actively substituted for the primary maternal object. Green's concept of the central phobic position describes a peculiarly rigid phobia of free association that functions to defend against awareness that a murder is felt to have taken place in the psyche. The author proposes that, in this patient, Tustin's substitution of sensation for the mother is Green's psychic murder. A therapeutic impasse that arose during the treatment was resolved following some working through in the countertransference. The patient's inability to free associate was subsequently ameliorated, and his previous inability to acknowledge oedipal reality shifted. He could then acknowledge, appreciate and identify with a paternal authority figure. This illustrates, the author considers, Scariati's observation that in the treatment of patients with impaired capacity for symbolization, countertransferential working through precedes the patient's acquiring a capacity for working through in the transference. Indeed, it facilitates this capacity. [ABSTRACT FROM AUTHOR]

This paper proposes meditation as an adjunct to psychoanalytic training by adapting meditation techniques to support the development of specific internal analytic settings to fulfil established training requirements (Hinze, 2015). Previous research has suggested how established meditation techniques engender some similar states of mind to those in various psychoanalytic theories (Cooper, 1999, 2014; Epstein, 1984; Hoffer, 2020; Pelled, 2007; Rubin, 2009). Building on this work, the author develops a novel framework to describe meditation using early Buddhist principles as a foundation (Thanissaro, 2012). This framework defines how different types of concentration and discernment can be developed by using mindfulness, alertness and ardency through meditation. As far as the author is aware, this is the first time these links have been explicitly made. This is followed by the analysis of the mental qualities required for evenly suspended attention, and the development and use of a greater awareness of countertransference, chosen as they point towards the analyst's functions of external listening and internal listening respectively (Parsons, 2007). Two meditation techniques are then described within the framework, to support development of these two internal analytic settings. A clinical example shows how these techniques can be utilized in the consultation room. [ABSTRACT FROM AUTHOR]

Authors aiming to conceptualize a 'cognitive countertransference' continue to search for the most effective way to integrate psychoanalytic theory, and a coherent definition for such a concept. This paper first argues that authentic attempts at integration of the concept of transference into cognitive‐behaviourism require a return to seminal work on Übertragung (transference) and Gegenübertragung (countertransference). References to these terms throughout the work of Sigmund Freud and Jacques Lacan are discussed in the context of the overall progression in the work of both theorists. With regard to two fundamental psychoanalytic concepts that underlie a Freudo‐Lacanian understanding of transference – the unconscious and repetition – this paper subsequently explores how a Lacanian logic may inform the emerging 'cognitive countertransference' literature. This paper contextualizes such thinking within the ongoing psychoanalytic debate regarding the utility of the analyst's participation in the transference relation. Ultimately, this paper argues that a cognitive countertransference may be redundant in favour of an understanding of shared cotransference, or transference relation, which begets simple theoretical conclusions, and technical recommendations. Implications for cognitive‐behavioural theory and practice are examined. [ABSTRACT FROM AUTHOR]

Psychosis can be understood as, in part, a disorder of the self. The various factors that contribute to the development of psychosis and the consequences of psychotic symptoms potentially impede the development of the patient's subjectivity, and can lead to a complete breakdown of the patient's ability to accurately represent their subjective experiences. The development of paranoid delusions partially functions to compensate for the patient's inability to make sense of their subjective experiences in relation to an acknowledged other, in this case the psychotherapist. When the patient confronts the psychotherapist with their paranoid delusion and implicates the psychotherapist as a dangerous object, the psychotherapist is potentially exposed to a complex and disturbing dynamic where their own subjectivity may be drawn into question. This paper aims to explore the psychotherapist's experiences of this dynamic in a clinical setting by making use of a composite narrative of a psychotic patient with paranoid delusions that implicate the psychotherapist. The psychotherapist's experiences are discussed via the following three themes: constructing the patient's subjectivity; the psychotherapist's use of their own experiences; and holding the balance between opposing realities. [ABSTRACT FROM AUTHOR]

The double session is evaluated here as a treatment option in a once‐weekly psychodynamic psychotherapy. The double session is defined as two 50‐minute sessions back‐to‐back, a single 100‐minute session. I discuss how the double session came to be chosen and practiced with one particular male client. I discuss previous literature on the use of the double session, elucidating the rationale, clinical thinking, indications and contraindications in these papers. I analyse my own clinical experience and thinking in the use of the double session in the context of the many objections; I attempt to argue positively and reflectively with this seemingly controversial adaptation of well trodden once‐weekly work. I address therapists' resistance to the double session. Using other examples of extended session work I examine how the therapy can be enhanced by its intensity and I argue for further research and use of the double session in an endeavour to deepen and enhance once‐weekly work. [ABSTRACT FROM AUTHOR]

This paper is intended to offer a foundation for comparison of the approaches of Wilfred Bion and Donald Winnicott. In particular, I try to plot the oscillation of Bion's clinical method from his early Group period at the Tavistock Clinic (up to around 1950) when he emphasized countertransference; his part‐object interpretation method in the 1950s after his analysis with Klein when he and colleagues were experimenting with the psychoanalysis of people in psychotic states (1953–59); and then his return to his investigation of the intuitive approach to clinical data, around 1965–70. [ABSTRACT FROM AUTHOR]

The paper describes and discusses some aspects of the countertransference in relation to two patients whose state of mind could be described as psychotic during treatment. The clinical work took place in the context of a private psychotherapy practice, but some aspects of the countertransference became evident in relation to external, but related figures connected with the treatment. It was not until the treatment with both patients had ended, and the author had done a considerable amount of work on her own processes, that she was able to acknowledge, think about, and eventually write about, the ways in which the two patients had impacted upon her own psyche. In order to achieve this aim of understanding, the author undertook a research degree at MA level as the frame in which to study psychotic processes in more depth, along with studying the transference and the countertransference. As she worked upon her degree thesis she became more aware of, and less embarrassed about, the countertransferential processes that taken place. The paper makes particular use of Stephen Purcell's contributions to identifying the countertransference and Harold Searles's work with psychotic patients. [ABSTRACT FROM AUTHOR]

Contemporary psychoanalysis views the countertransference as equally important to the therapeutic endeavour as its counterpart, the transference. This paper focuses on a particular kind of countertransference phenomena: those which are bodily in form and perceivable to the patient. It begins with a brief rehearsal of some of the fundamental psychoanalytic principles related to bodily symptoms, and then reviews the developments and changes that have occurred in the understanding of the concept of countertransference. The focus then shifts to theoretical developments around somatic countertransference in particular, and the division seen in the literature between authors who locate the source of the phenomenon of somatic countertransference in the patient's unconscious, and those who locate it in the therapist. The paper will argue that exploring the uniqueness and specificity of the therapeutic dyad will reveal important information about the dynamics at work in the therapy. A clinical example illustrates the specificity of the form that a somatic countertransference takes in a particular therapy. It then proposes that in order to make sense of the rich information that this unique response provides, the therapist must mentalize and make meaning of her particular somatic experience by way of a therapeutic analysis of reverie. [ABSTRACT FROM AUTHOR]

Increasingly, cognitive therapy ( CT) authors are paying attention to understanding and managing countertransference reactions. This paper critically discusses the recent assimilation of countertransference theory and technique evident in the literature. It begins by examining the factors responsible for CT's interest in countertransference, before going on to discuss the cognitive conceptualization of countertransference. Case material is used to illustrate parallels between schema-focused CT and relational psychoanalytic models. However, despite manifest similarities, it is argued that CT's rejection of the dynamic unconscious means that the respective approaches to how countertransference is understood and worked with are essentially incompatible. The psychoanalytic theory of countertransference is underpinned by a model of mind and associated therapeutic stance, the analytic attitude, which differs fundamentally from the therapeutic stance of CT. The paper concludes with a discussion of a published cognitive case study ( Ellis, 2001), which is used to illustrate inherent limitations in the cognitive approach to countertransference. [ABSTRACT FROM AUTHOR]

The first half of this paper reconsiders the therapeutic work with a patient who had a troubled relationship with her older sister ( Coles 1998 ). In particular I explore the conflictual sibling transference and the countertransference anxieties I faced. In the second half of the paper I speculate about transgenerational conflicts between sisters and suggest that the patient's conflict with her sister, and her sense of lost identity when her sister died, may be linked to her mother's relationship with an older sister. I draw on literary sources which also illustrate the impact of sibling relationships. [ABSTRACT FROM AUTHOR]

This paper is about narcissism and particularly about the paradoxical way in which some narcissists use objects. In the classical perception of narcissism total disregard is shown for others with the narcissist taking himself or his own reflection as his only object, yet we also encounter the obverse position where the narcissist seems to be seeking relatedness by making seductive efforts to attract others into collusion with their needs. This has not been widely discussed but we believe it represents a major division of narcissism with the classical disregard of others being replaced by a seductive drive for their subversion. This strategy is represented by the myth of the sirens who by the beauty of their song lured sailors to forget their own lives and ultimately fall to their destruction. We consider the sirens' song and how the nature of its seductive lure is shaped by the therapist's own enactment in the countertransference. Previously narcissistic presentations have been thought of as movement along an axis of more or less grandiosity but we now propose that this concept is best broadened into a two-dimensional space where the second axis defines the degree of seduction employed. [ABSTRACT FROM AUTHOR]

This paper describes and discusses those aspects of the treatment of schizoid patients which present particular challenges and difficulties to the clinician, namely nonrelatedness, emotional unavailability and absence of curiosity, all of which mean that the psychotherapist has a considerable strain to bear. Bion and others have suggested how the aetiology of this particular state of mind might be understood in terms of infantile experience. Clinical material from the long-term treatment of a schizoid man is discussed to illustrate how, in the course of a session, moments of meaningful emotional connection can become possible, and the transference/countertransference factors which might facilitate this. Implications for the length of treatment are discussed. The problem of overextending analytic therapies with this patient group is also discussed. [ABSTRACT FROM AUTHOR]

In this paper the author looks at the significance of different forms of action in the psychoanalytic situation. He traces the development of related concepts, going back to Freud's early concept of a 'symptomatic act' and the introduction of his concept of 'acting out' with the Dora case, through to more modern and complex ideas of enactment. He shows that acting out can have a defensive as well as a communicative function. Actions can be a way of 'speaking' to the analyst, of communicating things that cannot be thought or put into words. On the other hand, speech itself can become an action rather than a form of symbolic communication, a way of putting pressure on the analyst to fit in with a projective phantasy. Important theoretical contributions to the concept of enactment, by Sandler, Joseph, Feldman and Tuckett, are described in some detail. Looking at Freud's Dora from such a perspective, the author argues that an enactment developed between Freud and his patient. Detailed clinical material is presented to show how the author uses these concepts in his own analytic work. Finally, the relationship between enactment and containment is discussed. [ABSTRACT FROM AUTHOR]

Freud was clear in his view that religion had no place in the consulting room, where the aim was to replace illusion with reality. More recently, many psychotherapists have become open to the possibility that religion and spirituality are welcome in psychotherapy. This paper presents clinical examples of what can happen when religion is allowed in the consulting room. The author uses the concept of the Winnicottian play space along with more recent thinking about play and playing along to consider what may be required to deal usefully with religious material in therapy and why this may prove difficult for some clients and some client-therapist dyads. She suggests that this difficulty, when faced, may be a source of insight. [ABSTRACT FROM AUTHOR]

A comprehensive understanding of eating disorders should include engagement with the role of contemporary cultural trends. Feminists and critical social theorists have made significant contributions in this regard. Using two clinical cases, this paper contemplates the relationship between culture and psyche in eating disorder, proposing a psychoanalytic conceptualization underpinned by John Steiner's (1982, 1987, 1993, 2011) theory of pathological organizations and psychic retreats. Two conceptual terms will be introduced, namely 'the normalized body order' and 'the abject body object' to develop the argument. One of the clinical cases will be used to explore a particular kind of therapeutic impasse that can occur when therapist and patient are both female. In this particular case, the normalized body order emerged temporarily obstructing therapeutic progress; the impasse was understood to be an example of the so-called anti-analytic third (Straker, ). [ABSTRACT FROM AUTHOR]

abstract Certain states of mind in a patient are difficult to remain with and tend to evoke defensive countertransference responses which, if enacted, obstruct therapeutic progress. The state of mind discussed in this paper is 'adhesive identification', a term that arose out of a conversation between Esther Bick and Donald Meltzer, when Bick said of certain patients: 'They are sticky, they stick . . .' The author presents an outline of 'psychic skin' defences (; ; ; ; ) followed by a more detailed account of 'adhesive identification' (). ) work on countertransference and integrity, based on her experiences in a neonatal intensive care unit, is described. These resources are employed as a framework for thinking about countertransference enactments arising in psychoanalytic psychotherapy with an adult, adhesively attached patient. Extracts from a session with the patient, 'Janine', are presented and discussed. In conclusion, the author returns to the proposed links between integrity in the sense of thoughtfulness and respect and integrity in the sense of the felt experience of being in one piece within a skin boundary. [ABSTRACT FROM AUTHOR]

abstract Historically there has been a struggle to understand the role of the body in a psychotherapeutic context and, although the status of bodily communications is an area of increasing interest and study, it remains one of the least understood aspects of therapy practice. Yet even when therapist and client ignore the body in their interaction, they are still confronted with the body as a metaphor for the whole self; as Freud stated: 'The ego is first and foremost a bodily ego' (, p. 26) so therapy with no body is impossible. Drawing on ideas from practice, theory and research this paper focuses specifically on borborygmi (tummy rumbling), a bodily phenomenon often considered inconsequential and intrusive in the therapeutic encounter. Data from a grounded theory study is presented offering a framework which reflects the processes involved in acknowledging and bringing embodied experiences into an open therapeutic dialogue. A clinical example is then given. [ABSTRACT FROM AUTHOR]

abstract This paper argues that anorexia may be understood to be a particular kind of autistoid psychic retreat: a defensive withdrawal to a primitive enclosed part of the self that has been damaged by early infantile trauma, the result of a disruption to the mother-infant pair. This damage can be envisaged as an enclosed 'cyst' or 'tumour,' defensively 'sectioned off' from the rest of the individual's psychic life. When a patient takes refuge in an autistoid psychic retreat she is typically experienced as emotionally 'cut off' by others, including her psychotherapist, thereby making it difficult to establish and maintain a 'living' therapeutic alliance. The resulting countertransference, a crucial diagnostic tool for establishing the existence of an autistoid retreat, simultaneously challenges the therapist with a range of unsettling feelings that require processing in order to access the anorexic's inner world. The case of a female adolescent anorexic in psychodynamic psychotherapy will be presented. There were two distinct phases in this therapy, the second phase suggesting emergence from the autistoid retreat. This material will be used to illustrate autistoid dynamics and their implications for treating such patients. [ABSTRACT FROM AUTHOR]

abstract The death of the psychotherapist in the midst of an ongoing therapeutic process is a topic frequently avoided by analytic literature. The scarcity of relevant material may be attributed to issues of denial and a compensatory sense of omnipotence arising when therapists are facing illness and mortality. This paper reviews individual and group therapy literature on the topic, and focuses on the experience of a 'bridging' group analyst, while working with a therapy group of patients still mourning the loss of their former therapist. The differences in leadership style, as well as emerging transference and countertransference issues that remained unresolved and led to the dissolution of the group, are discussed. [ABSTRACT FROM AUTHOR]

In this paper the author describes clinical work with forensic and anti-social personality disordered patients where the clinician is placed in a countertransference situation where, in the course of what is good therapeutic work, he experiences an overwhelming sense of having failed the patient. The author utilizes Glasser's idea of ‘identification with the neglector’ and Hinshelwood's writings on patients with disordered relations to care, to examine this experience, and he differentiates it from the concept of ‘identification with the aggressor’. Two clinical illustrations are used to highlight the issues discussed and show how with this patient group much of the clinical work is done in the countertransference. [ABSTRACT FROM AUTHOR]

This paper takes Bion's question ‘What sort of artists can we be?’ and begins the quest for an answer. In the light of the later aesthetic model posited by Bion and Meltzer, I consider first the nature and properties of symbols as containers for meaning, then the problem of how symbols are formed and metabolized by means of the transference–countertransference. Finally attention is drawn to the musical resonances of the ‘countertransference dream’ which have traditionally been overshadowed by verbal and visual considerations. [ABSTRACT FROM AUTHOR]

This paper highlights some key features of a Jungian approach to transference and countertransference and suggests that a Jungian model has crucial aspects in common with contemporary views in attachment theory on the nature of the analytic relationship. The analytic relationship is examined in terms of the fundamental processes of psychic development described in attachment theory and affective neuroscience, namely affect regulation and development of reflective function and of self-agency. The relative value of three analytic techniques, those of interpretation, new relational experience and regression, are discussed in relation to these processes. I suggest that each of the traditional psychoanalytic and Jungian analytic models concentrates on differing aspects of these psychic processes and analytic techniques. I construct a grid to illustrate this and to demonstrate how attachment theory and developmental neuroscience offer a theoretical basis on which we can develop an integrated model of the nature of the analytic relationship and tasks. [ABSTRACT FROM AUTHOR]