Search

The treatment of consumers with eating disorders requires skilled clinicians due to the psychological and medical complexities of the illness. However, a volume of research shows that clinicians report negative feelings, such as anxiety, frustration and anger when providing care for consumers with eating disorders. Limited research explores mental health nurses' experiences working in a specialist eating disorder inpatient unit. This study aimed to explore early career mental health nurses' experiences working in such a unit in Australia. A descriptive qualitative method was used, incorporating a stage of theoretical analysis informed by psychodynamic concepts. A total of six nurses were interviewed. Two key themes emerged: (i) initial tension; (ii) understanding self and others through countertransference. In the first theme, participants commonly reported anxiety and frustration. Frustration often related to the struggle to empathise and feeling powerless to change life‐threatening eating behaviours. The second theme explored the understanding of self and others through countertransference. Participants described the inadequacy, anger and anxiety they felt during the interaction with consumers as the projection of another person's inner experience. Nurses' accounts also reflected identification of self to others, in the attempt to understand experiences of consumers. The phenomenon of re‐enactment of pre‐existing relationships was also raised. The study shows that working with consumers with eating disorders can elicit strong emotional experiences, which early career nurses were able to over time to more usefully explore as countertransference. It is recommended that nurses have appropriate opportunities to discuss and reflect on their feelings in order to develop their practice and professional resilience. [ABSTRACT FROM AUTHOR]

This article explores how bodily appearance impacts the psychodynamic transference and countertransference in the counselling relationship. It calls attention to the perplexing silence that pervades the field of psychology with respect to the importance of appearance in counselling. To elucidate these transferences/silences, the author delves into an intimate account of clinical work with a client called "Mrs. C", highlighting the power of appearance as well as its apparent silence within the field. Tying this with dominant philosophies, this article shows how appearance is political as discourses dictate how a body "should look," which impacts the way that client and counsellor relate to one another based upon past experiences. The author posits that appearance is a pivotal part of the transference and countertransference for counsellor and client and addresses the potential that congruent discussion of bodies in relationship can start to break the silence that can dictate such relationships. [ABSTRACT FROM AUTHOR]

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]

As in any quarterly journal, everything in this issue was in development, was finalized, and went into production before the global coronavirus crisis took hold. Sian was also a valued reviewer for the BJP, taking great care over her reports, mindful of the importance of writing in a fair and kindly way, especially when she was critical of a manuscript. Colin creatively contributed his long experience as a seminar leader, supervisor and programme manager responsible for developing and managing the Master's Programme at WPF Therapy, to the work of the Journal. [Extracted from the article]

The end of a therapeutic relationship is experienced in a unique way by each patient and triggers complex feelings relating to early attachment issues, losses and traumas. It is an immense rupture: a process of attachment and separation, intimacy and loss that is an emotionally intense experience for both participants. This case illustration provides insight into the difficulties experienced during the process of forced termination in an analytic community‐training clinic. Following a 2‐year treatment, Peter, a patient who had been severely traumatized in youth, had to tolerate the pain of another loss; having to say goodbye to a therapist. We describe the therapist's initiation and engagement of the termination phase. A series of measurements of patient personality, therapist attachment, and change in alliance and outcomes provide information on the impact of Peter's history and the therapeutic relationship. Clinical illustrations highlight different parts of the decision‐making process in terms of the patient's sensitivity to loss, as well as the therapist's uncertainty around self‐disclosure. We suggest ways therapists may facilitate endings by addressing positive and negative feelings, providing a good‐enough attachment experience, and stimulating an internalization of the therapeutic relationship. Implications for clinical practice, research and supervision are discussed. [ABSTRACT FROM AUTHOR]

Exploration of the patient-therapist relationship (transference work) is considered a core active ingredient in dynamic psychotherapy. However, there are contradictory findings as for whom and under what circumstances these interventions are beneficial. This study investigates long-term effects of transference work in the context of patients' quality of object relations (QOR) and therapists' self-reported disengaged feelings. Therapists' disengaged feelings may negatively influence the therapeutic process, especially while working explicitly with the transference since discussing feelings that are present in the session is an essential aspect of transference work. One hundred outpatients seeking psychotherapy for depression, anxiety and personality disorders were randomly assigned to one year of dynamic psychotherapy with transference work or to the same type and duration of treatment, but without transference work. Patients' QOR-lifelong pattern was evaluated before treatment and therapists' feelings were assessed using the Feeling Word Checklist-58 after each session. Outcome was measured with self-reports and interviews at pre-treatment, mid-treatment, post-treatment, one year and three years after treatment termination. A significant interaction of treatment group (transference work versus no transference work) by QOR by disengaged therapist feelings was present, indicating that disengaged feelings, even small amounts, were associated with negative long-term effects of transference work, depending on QOR Scale scores. The strengths of the negative association increased significantly with lower levels of QOR. The negative association between even a small increase in disengaged therapist feelings and long-term effects of transference interpretation was substantial for patients with poor QOR, but small among patients with good QOR. Copyright © 2016 John Wiley & Sons, Ltd. Key Practitioner Message Therapists' emotional reactions to their patients (countertransference) seem to have a significant impact on both the treatment process and outcome of psychotherapy., Therapists' heightened level of disengaged feelings over a treatment period shows an adverse impact on the effect of transference work for all patients, and especially so for patients with a history of poor, non-mutual and complicated relationships., For patients with a history of reciprocal, sound relationships the negative influence of therapists' disengaged countertransference is minimal., Higher therapist disengagement is strongly related to inferior therapists' skill for patients with a history of poor relationships and/or more personality disorder pathology., Training and supervision should provide direct feedback and focus on therapists' internal thought processes and emotional reactions., Therapists need to recognize and understand their feelings and attitudes in order to use the countertransference as a tool to understand the interpersonal process in therapy. [ABSTRACT FROM AUTHOR]

Observations from therapeutic practice and a series of empirical findings, for example, those on discontinuous change in psychotherapeutic processes, suggest modelling the therapeutic process as a self-organizing system with stable and critical instable phases and abrupt transitions. Here, a concept of psychotherapeutic change is presented that applies self-organization theory to psychodynamic principles. The authors explain the observations and considerations that form the basis of the concept and present some connections with existing findings and concepts. On the basis of this model, they generated two hypotheses regarding the co-occurrence of instability and discontinuous change and the degree of synchrony between the therapist and patient. A study design to test these hypotheses was developed and applied to a single case (psychodynamic therapy). After each session, patient and therapist rated their interaction. A measure of instability was calculated across the resulting time series. Sequences of destabilization were observed. On the basis of points of extreme instability, the process was divided into phases. Local instability maxima were accompanied by significant discontinuous change. Destabilization was highly synchronous in therapist and patient ratings. The authors discussed the concept and the methodological procedure. The approach enables the operationalization of crises and to empirically assess the significance of critical phases and developments within the therapeutic relationship. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message We present a concept of change that applies self-organization theory to psychodynamic therapy., We empirically tested the hypotheses formulated in the concept based on an extract of 125 long-term psychodynamic therapy sessions. We continuously monitored the therapeutic interaction and calculated a measure of the instability of the assessments., We identified several sequences of stable and unstable episodes. Episodes of high instability were accompanied by discontinuous change. On the basis of these episodes of high instability, we divided the process into four phases. Mean values of variables differed across these phases., Destabilization proved to be highly synchronous in therapist and patient ratings., The approach allows to empirically assess critical phases and developments within the therapeutic relationship. [ABSTRACT FROM AUTHOR]