Search

In I The Analyst's Vulnerability i , Karen Maroda elucidates the reasons therapists need I not i hide from ourselves and our patients. The Analyst's Vulnerability: Impact on Theory and Practice: edited by Maroda Karen J. (2022). Discussion Maroda makes a strong case for embracing and sharing our vulnerabilities appropriately with patients in order to create richer, deeper treatment experiences with our patients and become more effective clinicians. The analyst as clinician In Part I, Maroda points out that Searles wrote about the need to view negative countertransference and flaws in our character as a means to helping patients. [Extracted from the article]

While humans are hardwired to avoid pain and seek good feelings, it has become imperative to override this proclivity in order to properly address the socio-cultural atrocities which are at the heart of the crumbling of American society. This paper delineates the psychosocial reasons why people avoid psychic pain, the multitude of bastions available which enable, aid and abet this shielding, as well as negative consequences of these systemic dynamics. The case for bearing and holding psychic pain and suffering is made with regard to positive personal consequences and social justice dialectical reverberations. The many ways in which the therapist or analyst hold power and privilege within the dyad is reviewed. Bearing sociocultural pain in the therapist's own transference and countertransference is reviewed and linked to clinical illustrations. Implications for socio-cultural and therapeutic repair are delineated. [ABSTRACT FROM AUTHOR]

In the treatment of trauma survivors, analysts often find themselves befuddled and disturbed by their clients' unpredictable and self-destructive behavior. One or more dissociated self-states, initially hidden behind the patient's high-functioning presentation, may eventually make themselves known in the treatment. The analyst is then challenged to find ways to forge a healing alliance with a disavowed part of the patient's personality that has previously existed only in the context of a perpetually abusive internalized object relationship. Not only must the multiple self-states learn to communicate with each other, but the unformulated components of the trauma survivor's childhood experience must be formulated with the analyst in the interpersonal field. At the same time, the analyst's dissociated self-states and unformulated experience are interwoven in the therapy, creating their own confusion and blind spots. A case study illustrates how the client's and analyst's vulnerabilities intersect in the shared unconscious of their work. Psychoanalytic theories on multiple self-states, dissociation, transference-countertransference configurations and unformulated experience all combine to shed light on the difficulties faced by wounded healers treating traumatized patients. The analyst's countertransference dream is pivotal in exposing her previously inaccessible reactions to her patient. [ABSTRACT FROM AUTHOR]

This article introduces the concept of “developmental moments,” which are moments throughout a session where the clinical material, along with the therapist's countertransference, provide guideposts for assessing the patient's immediate developmental need. When integrated with modern analytic contact styles, the developmental moment helps the analyst identify which maturational tasks are likely to play out in the interpersonal field at any given time and when interventions are most likely to help the client progress in treatment. [ABSTRACT FROM AUTHOR]

The aftermath of complex trauma deeply impacts one's self-organization and interpersonal relationships, often resulting in clients who present to therapy with borderline characteristics and are typically labeled as difficult to treat. Further clinical complications with paranoid features may quickly place the therapist at a loss with respect to managing perceived and/or actual threats to client safety. Using psychodynamic theories, especially Kleinian understandings of psychosis and Winnicottian approaches to early disturbance and its impact on the emergence of self, this article provides a detailed case illustration that explores how a critical reflection of countertransference as “enactment,” “communication,” and “imagination” can help the therapist to understand the client's unconscious symbolic psychic struggles and to guide treatment selections in the therapy process. [ABSTRACT FROM PUBLISHER]

Attachment theory has been instrumental in identifying insecure disorganized attachment as a developmental pathway that leads to severe psychopathology in adults. Psychotherapy with these patients is challenging, offering a confusing pattern of relatedness, difficulties in mentalizing, problems expressing affect, utilizing dissociative defenses, and trying to gain an understanding of their subjectivity. This article provides a theoretical overview of disorganized attachment focusing on its etiology and how it presents throughout the life span. It reviews important therapeutic guidelines that help navigate the relationship with adults and presents a case study highlighting some clinical challenges. [ABSTRACT FROM PUBLISHER]

The narcissistic injury that may be caused by physical disability in infancy and the possible familial traumatization may block the integration of the infant's body and self-image, and can consequently hinder the child's identity formation. This article presents how an adolescent boy with cerebral palsy in short-term psychoanalytic psychotherapy works through the mental impact of his physical disability using a story. Transference and countertransference reactions are discussed. The positive impact of short-term psychoanalytic psychotherapy highlights the importance of caring for the mental health of children with physical impairments. [ABSTRACT FROM PUBLISHER]

When working with severely damaged, neglected, and deprived patients, the analyst relies on the faith that the intersubjective analytic space can be the site of a live relationship. In this regard, the unique technique of “reclamation” might be used with patients in a moment of imminent danger or of a sense of psychic death and involves an active response to the sense of emergency in countertransference. Reclamation is based on the analyst/therapist's ability to conduct intersubjective dialogue between the various spaces of internalized object relations, and the author attempts to extend the possibility of its technical application by considering reclamation as intersubjective. [ABSTRACT FROM PUBLISHER]

Transference-love in supervision remains a relatively unexplored subject in psychotherapy. This article describes and analyzes an incident of the supervision of a student whose dress code raised a question regarding the existence of transference-love. The role of the institution in maintaining a protective envelope is shown to be significant in the satisfactory resolution of what appeared to have been an impasse. In addition, multicultural and gender issues are examined to illustrate the complexity of the subject. [ABSTRACT FROM PUBLISHER]

One of the characteristics of psychotherapeutic work with children and adolescents is parental presence, which introduces additional parameters into the setting and function of the therapist. Parental presence makes the existence of the external world constantly present, increasing the risk of bias in interpreting and understanding the intrapsychic world. Interference is common in the therapeutic setting, and mostly challenges the therapist's tolerance. Meetings with parents may trigger fantasies in the therapist's mind, which interfere with the game of identifications with the child and the fantasized parents. The common bond with the child creates conscious and unconscious reactions, and there is always the risk of the therapist being overwhelmed and losing his or her capacity to understand object relations and transference phenomena. The therapist's function may be influenced either through weakening of the symbolizing capability or through hampering the capability to understand the child's function of fantasy. Parents are always present, while the therapist's countertransference movements evolve. Given that the technique of interpretation is not always available, the main goal is to use countertransference challenges in the service of the child's psychotherapy, by understanding the child's internal reality, resistance, and experience, as well as the intensity and nature of external experiences within the family. [ABSTRACT FROM PUBLISHER]

In this article, I describe the case of Dan, an Israeli citizen in his late thirties, born and bred in Argentina. I focus upon some psychological effects of exile as played out and repeated in the transference, leading to an instance of an articulation of hishuman idiom(Bollas, 1989). During the course of his therapy, through the working of elements in the transference paradigm, it became possible that Dan's existential gloom and despair, accompanied by various physical symptoms, were the traces of the imprints of his exile from Argentine. Those traces were linked to the articulation of deeply buried sensations and once recognized allowed him to explore instances of unresolved mourning. The mourning process thus resumed and allowed him to regain his positive outlook. In conjunction with this, I describe the impact that Julio Cortázar's (1914–1984) posthumously published book,Diary of Andrés Fava(2005), had upon him. The reading of that book served Dan and me as an unconscious object. This object could be represented by Ogden's (2004) termThe Analytical Third, and was a part of the therapeutic relationship where he was able to discover, express, and elaborate upon his unique idiomatic sense of self. [ABSTRACT FROM PUBLISHER]

This article considers daydreams as a means of understanding the patient and fostering the therapeutic relationship. Daydreams are considered along with fantasies and reverie. The usefulness of the therapist's reverie in response to the daydreams of a patient who is conflicted about being seen and known is explored. Daydreams are considered in relation to creativity—both analytic and artistic; and as a way of bridging inner life and external reality. [ABSTRACT FROM PUBLISHER]

Drawing on recent theory of the origin and development of gender orientation, this article explores the dynamics in the treatment of a 16-year-old female to male transgender adolescent. The debate over whether surgery, to change the body, or psychotherapy, to change the mind, is the appropriate treatment became a central conflict for the therapist in understanding the dynamics of her transgender patient whose goal was to be “cleared for surgery.” [ABSTRACT FROM PUBLISHER]

This article discusses disability as a neglected aspect of cultural competency in the diversity literature. It identifies some of the sociocultural concepts that contribute to the avoidance of people with disabilities in the general population, the psychodynamic and psychoanalytic profession, literature, and discourse. Personal and cultural aspects of unanalyzed countertransference and transference are examined. The impact of those internalized sociocultural concepts on the clinical dyad is also explored. Through anecdote, parallel processing, and the literature, it will be shown how some of the transference issues toward the disabled clinician can become assets in the therapeutic alliance. [ABSTRACT FROM PUBLISHER]

“Doorknob comments” is a concept that is not well represented in the professional literature. Through three case examples the author develops the theory that doorknob comments can fall within the internal structure of the session or outside of such a structure. In the former case, giving the internal element precedence by extending the session length to address the comments may be warranted. In the latter case, helping a client by scaffolding their ability to structure experience may require that the comment be processed at a later session. In either case, the ability to structure experience, which is the process of elaborating meaning, is an important aspect of treatment. [ABSTRACT FROM AUTHOR]

This article examines the termpotential spacein the therapeutic session and the pathological situations in which this space collapses. The article suggests that such failures occur in the weaving of transference and countertransference between patient and therapist. The potential to free and repair this space can be found in emotional thinking that occurs between the therapist and the patient. When the object-therapist can play or dream, the infant-patient can do so too. Thus, a new shared experience may be created in the therapeutic session and in the patient's mind. This article reviews the different types of collapse of the potential space, as suggested by Ogden, and offers a new additional type. [ABSTRACT FROM AUTHOR]

The encounter with clients from diverse cultural backgrounds may stir in the practitioners intense counter-transferencial reactions, which if unexplored may obstruct the helping relationships and interventions. This article presents and demonstrates a cultural competence training where such countertransference can be worked through. The training applies a combination of narrative analysis that emphasizes the active participation of the listener in the sense-making process and of the exploration of group processes from a psychoanalytically oriented point of view. Presented are four vignettes that demonstrate different types of countertransference and of the group process. [ABSTRACT FROM PUBLISHER]

We have all been in situations in which others have retained their beliefs despite evidence to the contrary. Instead of treating beliefs as opinions that can be modified, they use beliefs as facts that limit their relationships and opportunities. In this article, a short literature review and three vignettes are presented that discuss and demonstrate how to work with and, when appropriate, modify counterfactual beliefs within the transference. Issues of self-determination, the unconscious, countertransference, and some Kleinian concepts such as the third, containment, and the paranoid-schizoid and depressive positions are also explored. [ABSTRACT FROM PUBLISHER]

In the course of a psychoanalytic treatment, many clinical situations create countertransference pulls or invitations to participate in enactments of various degrees. In these projective identification-based transferences, the patient is often successful in drawing the analyst into archaic object relational patterns of acting out. During these moments, the analyst must struggle to find a way to stay therapeutically balanced. The urge to rush to judgment with punitive, seductive, rejecting, controlling, or manipulative comments rationalized as interpretations must be managed. If these unavoidable countertransference enactments are managed and studied, they can provide useful information about the patient's internal struggles and can show the way to making more helpful and more therapeutic interpretations. Case material is used for illustration. [ABSTRACT FROM AUTHOR]

The life and theory of Sandor Ferenczi provide insight into both the historic admonition and the dangers of loving feelings in the therapeutic relationship. Ferenczi believed in the creation of mutuality in all analytic dyads. His refusal to subscribe to a hierarchical structuring of the treatment relationship led to his subsequent marginalization from the traditional psychoanalytic canon for nearly a century. On close inspection, however, he was a formative figure who laid much of the groundwork for current thinking about the intersubjective and relational approaches to treatment. Much of his life and theory can be understood through the lens of his relationship with Sigmund Freud. That relationship is closely scrutinized in the following historical examination. [ABSTRACT FROM AUTHOR]

The phenomenon of an erotic transference has long been a difficult, if not mysterious, process within clinical psychoanalysis. Traditionally, the development of an erotic transference has been viewed as a negative clinical event fueled by the analyst's countertransference reaction. A much neglected dimension, the relationship between childhood seduction and the development of an erotic transference, will be introduced and examined. In three clinical cases our data suggest that actual sexual abuse in childhood is a causal factor in the manifestation of an erotic transference in the clinical interaction of an analysis. [ABSTRACT FROM AUTHOR]

In working psychoanalytically, it is common to encounter patients who need to carefully manage their immediate objects. This is evident in their stories about external life at home, at work, and with friends as well as in how it emerges within the transference. While a frequent theme in many analytic cases, the motives behind this need are varied. Case material is used to show how these reactions emerge when psychic retreats fail. When unable to find refuge in pathological organizations or psychic retreats, patients are exposed to the worst of paranoid and depressive anxieties with only a fragile foxhole to withdraw into or defend from. In such a precarious psychological state, fantasies of unbearable self and object danger emerge, leading to various forms of acting out, overreliance on projective identification, and perverted images of giving and receiving. These fantasies result in the desire for idealized objects, the drive to resurrect fallen objects, and the need to avoid cruel and attacking objects that have taken over and replaced the sought out ideal. [ABSTRACT FROM AUTHOR]

This paper uses object relations theory to conceptualize and manage the complexities of a home-based case that was followed for a period of six months. It discusses maternal depression in relation to the caregiver role, self-harm, and self-determination. The client's ambivalence issues are addressed, with particular emphasis on transference and counter-transference issues in the relationship and the use of transitional space and objects. Also discussed is the effect of maternal depression and ambivalence on mother-infant attachment, with the introduction of interaction-guidance as a treatment modality. An examination of cultural differences and the concomitant ethical implications that arose in the treatment process is provided. Finally, therapeutic implications and reflexivity are addressed. [ABSTRACT FROM AUTHOR]

This essay discusses the clinician's defense against and resolution of the experience of boredom in the countertransference as an incident of projective identification in the treatment of a woman with dissociative identity disorder. The essay details the inner mind of the therapist as she discovers both her own feelings and judgements of those feelings. As the essay progresses, she begins to grasp the significance of her discomfort in informing the therapeutic process. We watch as this material is made use of to move forward a stalled therapy into new territory. [ABSTRACT FROM AUTHOR]

Correction of the patient's distortion is often the focus of therapeutic treatment. However, the therapist's distortions, based upon pre-existing fears, which themselves are often rooted in greater societal issues and energized by the work with the patient (especially as they relate to issues of racial difference between the therapist and patient), can lead to clinical impasse. Just as an effective treatment relies upon the patient's opening up to correcting distortions, so too the therapist must be able to use transference response and become vulnerable to knowing and moving beyond his own fears and distortions. [ABSTRACT FROM AUTHOR]

Based on the theoretical assumption and clinical observation that projective identification is a natural, constant element in human psychology, clinical material is used to illustrate how projective identification centered transference states create situations where acting out of the patient's phantasies and conflicts by both patient and therapist is both common and unavoidable. Because they are more obvious, some forms of projective identification encountered in clinical practice are easier for the analyst to notice and interpret. Other forms are more subtle and therefore difficult to figure out. Finally, some forms, whether subtle or obvious, seem to create a stronger pull on the analyst to blindly act out. In some psychoanalytic treatments, one form of projective identification might embody the core transference. In other cases, the patient might shift or evolve from one level of this mechanism to another. Some patients attempt to permanently discharge their projective anxiety, phantasy, or conflict into the analyst. There is a patent resistance to re-own, examine, or recognize this projection. Some of these patients are narcissistic in functioning, others are borderline, and many attempt to find refuge behind a psychic barricade or retreat (Steiner 1993). In other forms of projective identification, the patient enlists the analyst to master their internal struggles for them. This occurs through the combination of interpersonal and intra-psychic object relational dynamics. This "do my dirty work for me" approach within the transference can evoke various degrees of counter-transference enactments and transference/counter-transference acting out. Another form of projective identification, common in the clinical setting, is when a patient wants to expand the way of relating internally, but is convinced the analyst needs to validate or coach the patient along. This is why such a patient may stimulate transference/counter-transference tests and conduct practice runs of new object relational phantasies within the therapeutic relationship. Over and over, the patient may gently engage the analyst in a test, to see if it is ok to change their core view of reality. Depending on how the analyst reacts or interprets, the patient may feel encouraged to or discouraged from continuing the new method of relating to self and object. The patient's view of the analyst's reactions is, of course, distorted by transference phantasies, so the analyst must be careful to investigate the patient's reasoning and feelings about the so-called encouragement or discouragement. This does not negate the possible counter-transference by the analyst in which he or she may indeed be seduced into becoming a discouraging or encouraging parental figure who actually voices suggestions and judgment. All these forms of projective identification surface with patients across the diagnostic spectrum, from higher functioning depressive persons to those who are more disturbed paranoid-schizoid cases. Whether immediately obvious or more submerged in the therapeutic relationship, projective identification almost always leads to some degree of acting out on the part of the analyst. Therefore, it is critical to monitor or use the analyst's counter-transference as a map towards understanding the patient's phantasies and conflicts that push them to engage in a particular form of projective identification. doi:10.1300/J032v14n02_04 [ABSTRACT FROM PUBLISHER]

The author sets out to locate Bion's model of the mind within the developmental history of psychoanalysis, from Freud to Klein to Bion, using biographical material and clinical case examples, to illustrate Bion's concepts of container/contained, his understanding and use of projective identification, his extension of the use of the countertransference, and his differentiation between the psychotic and non-psychotic aspects of the mind. Links, and attacks against linking are discussed, as well as Bion's thoughts about learning versus knowing, being versus becoming and his emphasis on the essential importance of the development of the capacity to think. [ABSTRACT FROM AUTHOR]

This paper examines the case of a 39-year-old religious patient whose chief presenting complaint involved anxiety associated with his work performance. As Carl's treatment unfolded, other themes also gained prominence. Chief amongst these was Carl's pervasive and evidently characterological tendency toward self-denial, and the significant linkage between the patient's selflessness and his religious views. Transference as well as countertransference dimensions of this case are also considered. [ABSTRACT FROM AUTHOR]

Through projective identification and a variety of transference acting out dynamics, some analytic treatments are strongly marked by the patient's avoidance of any exploration or working through of core depressive anxieties and paranoid fears. Through counter-transference acting out, the analyst can become part of this unconscious effort to not explore the internal life. One case is used to show how the analyst can be supportive of the patient's external, environmental struggles, but collusive to the avoidance of more psychological, intra-psychic matters. Several other cases are used to illustrate the patient's need to not only avoid ownership of unacceptable psychic experiences, but to push the analyst to be the translator, holder, and spokesperson for their unconscious conflicts. This is the result of psychological conflicts involving desires to reveal, express, and work through difficult object relational issues that are matched by intense convictions about the danger or distaste to do so by oneself. So, the patient, via projective identification, enlists the analyst to do the undoable or the undesirable. Case material is used to show the importance of Consistent interpretation of these transference efforts. Various degrees of success are achieved, depending on the analyst's level of enactment and the patient's level of emotional standoff. [ABSTRACT FROM AUTHOR]

Managed health care policy has created dramatic changes in current clinical practice, and all too frequently, impacts the overall treatment plan. Clinicians making referrals for emergency hospitalizations can no longer rely on an in-patient, safe, holding environment. Rather the hospital's relationship and stance with managed care insurance providers determines the length of the hospitalization and the case management plan for patients, instead of the patient's need. [ABSTRACT FROM AUTHOR]

This article will introduce the theory of Control-Mastery, an empirically supported, cognitively oriented interpersonal theory of psychotherapy. Control-Mastery theory offers a distinctive approach to counter-transference in particular and suggests a unique way to understand unconscious functioning. The theory also provides specific guidelines for conducting psychotherapy as well as a useful framework for understanding the impact of familial as well as cultural context on individual psychological struggles. Control-Mastery theory offers a new way of understanding some old issues of particular relevance for social workers especially, given an of- ten difficult practice environment. It is a view of human dilemmas that preserves the dignity of people and provides empirically supported guidelines for how social workers can be useful to them. It suggests a different explanation for behavior that other theories might label as acting out, resistance, non-compliance, or dependency. It is especially powerful for working with people whose backgrounds differ from the therapist's as well as for understanding and making changes in the impact of oppression on clients.

The paper is a review of social worker Herbert S. Strean's book "Controversies on Countertransference." The book is about the countertransferential entanglements that embroil both the therapeutic and the supervisory relationships. Strean proposed throughout this volume that self-disclosure of the countertransference is the key to grid-locked treatments and grid-locked supervisory relationships. The first chapter provides a brief, highly readable introduction to the topic of countertransference and the arguments for self-disclosure. The second chapter describes how the supervisee's defensiveness can expand exponentially through the phenomenon of parallel process. The third chapter takes the discussion a step further by discussing parallel process and the evolution of the supervisory experience. The fourth chapter focuses on actual disclosure of the countertransference and Strean gives many instructive examples. The chapter serves as a good learning tool. The fifth chapter is perfectly placed, since Strean continues the evolution of his subject matter to discuss the added complexities created by the supervisory third. The sixth chapter presents Strean's observations regarding the frequency with which analytic candidates flounder shortly after graduation. The final chapter of this book is really an extensive case study of a man who literally would not reveal his name to Strean until the 217th session. Following on the heels of the previous chapters devoted to the therapeutic and supervisory processes, this case was no doubt intended as an example of what can be achieved.

Within social work, significant emphasis has been placed on the importance of ethical behavior. As professionals, social workers are expected to adhere to particular standards of practice clearly delineated in professional codes of ethics. Professional social workers have had an ongoing concern about their role as professional gatekeepers. As clients have become more informed about standards of practice and have joined forces with members of the legal profession, the profession has grown increasingly challenged by the need for monitoring and controlling the behavior of members. One ethical challenge of major concern involves boundary violations in the form of both sexual misconduct as well as dual relationships of a non-sexual nature. To facilitate the seeking of help, the social work profession must not only teach about key psychoanalytic concepts, it must also teach about humility and inherent vulnerabilities of clinicians. By presenting an open, nonjudgmental approach to seeking supervision, the profession hopefully will encourage clinicians to recognize the need for seeking guidance, especially in those clinical situations posing serious risks of sexual misconduct.

This article reflects my personal and professional dislocation resulting from the World Trade Center disaster. Through the act of writing and an active reading of the professional literature, I attempt to re-establish equilibrium, to restore confidence, and to rekindle a sense of purpose and meaning in the helping process, both for myself and for the reader. Examined is the literature related to memory and its connection to the phenomena of trauma, "psychache," compassion fatigue, vicarious traumatization, countertransference, and burnout. It concludes with guidelines for "being present" and for self-care. [ABSTRACT FROM AUTHOR]

The article presents an overview of papers on social work published in the September 2003 issue of the journal "Psychoanalytic Social Work." In this issue, there are three scholarly papers selected for the special section devoted to social worker Herbert S. Strean's work. In the first paper, ""Why is Marriage So Difficult?" A Psychoanalyst's Perspective," by author Morton Kissen explores the fascinating terrain of marital relations and marital conflict, candidly revealing the influence that Herb's ideas have had on his clinical work as well as in his own marital relations. Twice in psychoanalysis with Herb, Kissen is also able to offer a fascinating glimpse of Herb's actual therapeutic modus operandi. Author Ann A. Abbott's paper, "Understanding Transference and Countertransference: Risk Management Strategies for Preventing Sexual Misconduct and Other Boundary Violations in Social Work Practice," examines in detail one of the most provocative issues facing the clinical professions. Herb's last published work "Controversies on Counter Transference," is the focus of author Karen Maroda's wise and thoughtful essay. This issue concludes with author Caroline Rosenthal Gelman's timely and carefully researched article, "Psychodynamic Treatment of Latinos: A Critical Review of the Theoretical Literature and Practice Outcome Research."