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This paper explores how the process of learning to harness one's creativity in analytic listening can be analogous to the process of learning to do so in painting. It draws on clinical work with one client divided into two vignettes. The first describes the author's attempts to listen analytically by paying attention to form and content; narrative structure and use of language; and by paying attention to transference and countertransference communications. The second vignette explores what happened between therapist and client as the author had grown sufficiently confident to respond more intuitively to her client's communications. It describes how the process of becoming sufficiently familiar with theory was, paradoxically, what enabled her to respond to unconscious communications more loosely and creatively in the analytic encounter. It then explores what happened when she communicated this back to the client. The paper also describes how, as a result of the training and personal therapy, a parallel process of learning to let go and play was unfolding in the author's experience of painting. It concludes that learning to harness creativity in the therapeutic encounter can have an unexpected and welcome impact on the therapist's own artistic endeavours. [ABSTRACT FROM AUTHOR]

Deborah was referred to me for psychoanalytic psychotherapy following a suicide attempt and depression. We began a fascinating journey spanning more than 10 years. During therapy, many questions arose concerning the suicidal episode, which she could not register consciously. I tried to understand the reasons for her depression and the attempted suicide through the unconscious process in the therapeutic relationship and through the music and poetry that she brought to sessions. In this paper I describe the process of listening for the signifiers of semiotic and symbolic language, both metaphoric and metonymic, as revealed in poetry and music according to the theories of Kristeva and Lacan. The poetry enabled the patient to retrieve childhood memories, experience the movement from unconscious to conscious, and mourn through the experience of transference and countertransference in the therapeutic relationship. Also illustrated is the transition from singing the music to more symbolic language, turning the patient's sensory experience into language, and connecting her personal experience with the culture of her past. The patient's mourning and the lost love objects are discussed through the prism of classical and object relations theories. [ABSTRACT FROM AUTHOR]

Chapter 7, on the patients apparent deadness and obsessionality, takes further Bergstein's conviction that nameless experiences, those that should have been registered and represented by the primary object, can still be registered (adequately for the first time) through the countertransference - thereby becoming tangible to the patient. One of the strengths of the book is how it combines a good balance of theoretical discussion with detailed work from Bergstein's encounters with his patients, which he uses to illustrate his argument. Bergstein also draws our attention to an important paper by Jim Rose ([8], p. 113), which is still under-recognized, and under-appreciated, but very relevant to the case Bergstein is making. [Extracted from the article]

This paper arises from the shift, following the start of the 23 March 2020 lockdown in Britain, from clinic‐based to online psychotherapy within National Health Service (NHS) psychological treatment services. The paper draws on previously published observations about privately funded online psychotherapy. It also provides a snapshot of my own and my clinical psychology colleagues' experience of providing clinic‐based and online NHS‐funded psychotherapy before and soon after the March 2020 lockdown began. I use these impressionistic data to illustrate transference and countertransference issues involved in online psychotherapy. In addition, I note problems relating to its setting or frame, and ways in which this form of treatment can obstruct empathic mirroring and the patient's experience of being contained. I conclude by noting limitations of this study based as it was on the immediate reaction of myself and my colleagues to the transition from providing clinic‐based to online psychotherapy, not on interviews with patients about their experience of this transition nor on any measure of the relative effectiveness of online compared with clinic‐based psychotherapy. [ABSTRACT FROM AUTHOR]

When a patient presents for psychotherapy having accessed illegal images of children online, it may be impossible to know at the outset whether this reflects an enduring sexual interest in children, or the transient emergence of paedophilic sexual interest associated with a breakdown in ego functioning. Concerns about risk and the emotive nature of paedophilia may undermine the therapist's or analyst's capacity to tolerate uncertainty and maintain analytic neutrality, leading to premature assumptions about the nature of the underlying pathology. This paper describes the treatment of a patient who had a conviction for viewing indecent images of children online, and the challenge of suspending judgement and maintaining analytic doubt while exploring the meaning of his actions. There was a pressure towards a sadomasochistic transference in which the therapist would be perceived to be cruel if doubting him, but weak and naive if not questioning him. Analytic work over seven years led to a formulation of his acting out as reflecting, not enduring paedophilia, but a 'paedophilic breakdown'. Changes were evident in his psychic functioning and his external life, as well as in the quality of the therapeutic process. The countertransference challenges of this work are discussed. [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]

Taking up Bion's idea of a continuum between the psychotic and non‐psychotic parts of the mind, this paper looks at clinical moments where the primitive part – psychotic and 'autistic‐contiguous' – mimes language and takes over the analytic field. The patients discussed seem to intuit the analyst's blind spots and a pseudo‐language takes over as primitive parts of the patient collude with those of the analyst. The three patients discussed here use registers of speech which vary from over‐abundant to quicksilver and dried. However, it is not as much a communicative use as it is evacuative and adhesive. Verbal language offers familiar moulds in terms of unfree associations, pre‐existing narrative structures, syntax, figures of speech (symbols, metaphors, paradoxes) and common psychoanalytic tropes (dreams, primal scenes). Primitive parts of the mind nestle in these moulds rather than disturb them. It is only through examining the countertransference and abjuring collusions that the analyst may be able to contact the terrifying or enclosed parts in the field. 'Death', for instance, represents the limits of language and as it is unpacked, it comes to acquire a range of meanings which allow the recovery of thinking. I have tried to demonstrate the experience of verbal language as a seductive screen that analyst and analysand collaboratively create to make bearable the incomprehensibility of the encounter. In doing this what emerges is a 'thick description' that helped and reflects on different kinds of collusion. The paper tries to capture the experience of collusion as well as a return from it. [ABSTRACT FROM AUTHOR]

In this paper, I explore the topic of primitive bodily communications and countertransference enactments, with a particular focus on the part played by bodily odour. To explore this topic, I discuss a two‐year treatment with a patient who presented with a mix of borderline and narcissistic diagnostic features. I describe meaningful aspects of the difficulties faced in countertransference work when receiving and making sense of the patient's use of primitive defences and I highlight their expression through a very uncomfortable symptom: an extremely unpleasant bodily smell. My thesis is that the smell communicated preverbal and unsymbolized experiences of early physical and emotional neglect, as well as evacuating the toxicity of those experiences. In this way the smell acted both as a bridge, which could help me reconstruct my patient's early traumatic past, and as a drawbridge, to keep me at distance and maintain his past dissociated. The invasive and aversive nature of the smell can also be seen as representing the approach‐avoidance dilemma typical of a disorganized attachment state of mind, acting both as a bridge and as a drawbridge to attachment and relating. [ABSTRACT FROM AUTHOR]

In introducing Sally Arthur's paper, I will try to first of all share my thoughts about Gemma (the observed baby) and her family, and then comment on what I see as the tasks of infant observation and how these relate to the process of becoming a psychotherapist. Indeed in thinking about the importance of siblings we should note the extract Sally gives of Gemma at 25 weeks when she, following some rough treatment from her brother, turns her attention to the beads. Sally reports that 'At 25 weeks Helen has disconnected from her and chats to me about a difficult experience, Gemma squeezes her breast hard, and regains her attention'. [Extracted from the article]

Ongoing studies in psychoanalysis have been broad and progressive, and have dealt with a number of different phenomena. Many thus foster the identification of intersubjective aspects that characterize therapeutic relationships today, including enactments. The concept of enactment first appeared in the literature in the mid‐1980s and was defined as a manifestation where, in the analytic situation, both analyst and patient unconsciously 'play out' psychic conflicts that must be worked out therapeutically. Resulting from unconscious forces activated mutually by the members of a therapeutic dyad, enactments are characterized by transferential and countertransferential dynamics. They are based on the mechanism of projective identification, which is interpersonal and intersubjective. In preparing the present systematic review, PUBMED, PsycINFO and LILACS databases were consulted, a process that generated a total of 59 articles. This paper gives an account of articles published on enactment, including authors, journals, year, type of study and diagnoses, as well as the gender and age bracket of patients mentioned in the literature investigated. We specifically describe how the authors of the respective articles understand and identify the concept of enactment and how they deal with this phenomenon in their clinical work. [ABSTRACT FROM AUTHOR]

Attachment theory was built by Bowlby as an attempt to link psychoanalysis with the wider world of ethology, cybernetics and evolutionary theory. Initially rejected by the psychoanalytic establishment there has been a gradual rapprochement. This paper attempts to accelerate this process by laying out the points of overlap and distinction between the attachment and psychoanalytic perspectives on clinical treatment. It summarizes the main tenets of attachment theory and then looks in detail at the therapeutic alliance, classification, transference/countertransference, and interpretation and mentalizing from an attachment perspective. A clinical example illustrates how insecure and secure attachment play out in the consulting room, and the paper ends by suggesting that attachment provides a suitable evidence base for the relational/Independent psychoanalytic approach. [ABSTRACT FROM AUTHOR]

Using a Jungian perspective, this paper considers the psychological figure of the witch in analytic work with two male patients. The witch emerged as a personification of the patient's complexes in the transference and countertransference, and in the content of dreams, images, and other objects of association. The witch presided over experiences of captivity and captivation, an object of fear for one man and a seductive figure for the other. The witch was also a potential transformative agent and path of psychological development, revealing the creativity of the archetype in the core of the complex. This dual function is highlighted with reference to the Grimm story of Hansel and Gretel and Jung's concept of the transcendent function. The clinical material gives some consideration as to whether or not the witch can be engaged for a therapeutic development involving the integration of the complex. Both men were seen for up to two years in an NHS psychotherapy service. [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]

abstract This paper was written in an effort to process rather extreme countertransference reactions to an 'absent' patient, i.e. one who attended her twice-weekly psychotherapy only sporadically. At times she did not come for up to several months and consequently a serious debt would accrue. However, it was not so much the amount owing but rather the constant cancellations, with seemingly 'rational' excuses about her non-attendance that would provoke an intense frustration accompanied, at times, by furious, almost sadistic countertransference feelings. The patient kept her therapist 'dangling in uncertainty' (), which the author considered to be a reflection of the patient's inner sado-masochistic object world. The author attempts to make sense of her countertransference in the light of the patient's early relationships and subsequently forms a hypothesis that the absences have been necessary to convey, very powerfully, experiences that may not have been communicated by regular attendance. Finally, the author offers her 'Afterthoughts' in the light of developments since the patient has read the paper and given her permission for publication. [ABSTRACT FROM AUTHOR]

This paper describes enactments in the countertransference -- spanning fantasies, actions, words and sexual responses to patients. It will explore the origins and reverberations of the analyst's enactments in an effort to understand whether they have obstructed progress or created special moments in the therapy where shifts in the patients' inner world, or further understanding on the part of the analyst could be created. Clinical vignettes will be used from work with several patients, although the analyst will focus mainly on work with patients who present with hysterical personality. The paper is an endeavour to tease out what, if any. differences there may be in working with hysterical patients, as opposed to patients with other personality types, in the nature of countertransference enactments. The author examines the role of rescue fantasies in the creation of an enactment. [ABSTRACT FROM AUTHOR]

This paper addresses a very familiar subject, with a particular focus on the psychotherapist's contribution to the transference-countertransference unconscious dynamic. It summarizes some of the many discussions on countertransference drawing from the vast literature on the subject. A case study is also given to illustrate the concept in clinical practice. The paper returns to the literature to trace the key elements that characterize it, and highlights the reiteration of different formulations of the same basic ideas. It then moves on to wonder about the reasons for this abundance of literature, proposing a parallel between the unravelling of countertransference in psychotherapy and the creative act, both based on the experience of personal discovery, where the production of an artefact does not require new subject matter but a fresh and personal reinterpretation. [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]

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]

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]

There have been many debates about psychoanalytic and Jungian views of homosexuality. As part of these it has often been recognized that analysts have appeared reluctant to comment on their own countertransference responses to gay patients. Yet these responses must inevitably have a significant bearing on the way the work is conceptualized and undertaken. This paper highlights ways in which homophobia and related countertransference difficulties influenced the author’s ability to engage with one male patient. It traces the process by which the analyst became aware of his own discomfort and the nature of his struggle to find a more helpful and reflective position in the analytic work. The process was prompted by a dream which depicted some of the difficulties the analytic pair was experiencing and by a heightened scrutiny of the countertransference. The progress of the work is marked by three further dreams which trace the development of the analytic relationship. [ABSTRACT FROM AUTHOR]

This paper discusses three distinct countertransference-based interventions that took place at the Arbours Crisis Centre with a young man who had become verbally inarticulate and emotionally frozen. As we shall explain, each of the authors worked with this man at different points during the course of his finding his voice and discovering at least some of his feelings. [ABSTRACT FROM AUTHOR]

This paper focuses on experiences of fascination in the transference and countertransference. It suggests that fascination arises through the projection of an internal state where an unconscious content has intruded into the ego. Using clinical examples, it outlines a distinction between fascination as a facilitative process in psychotherapy, and fascination indicative of defence and destructiveness. In the former, fascination is linked to an exploration of symbols and their subsequent release of meaning. In the latter, fascination is considered as an end in itself: a powerfully persuasive fantasy that reality can be dispensed with. The Analytical Psychology concept of the ego-self relationship is briefly outlined with a view to establishing a theoretical base from which to support this distinction, and to suggest that the ego's fascination is elicited through an unfolding archetypal process. The conclusion summarizes these findings and their implications for clinical work. [ABSTRACT FROM AUTHOR]

This paper explores crying in the clinical setting and offers a perspective on the nature of the emotional link which is formed with the crying narcissistic patient. Crying is an ordinary and familiar experience in the clinical setting which is generally characterized by the therapist feeling emotionally moved with a deepening of empathy. In contrast narcissistic crying can be associated with an absence or lack of emotional fit between the therapist and patient. The nature of this lack of fit throws an important light on the underlying difficulties of the patient which must be lived out in the therapeutic relationship and, more importantly, tolerated in the countertransference, before interpretation can be realized. [ABSTRACT FROM AUTHOR]