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The author considers how through reenactments, early developmental trauma and potential impairments in personality functioning may manifest in the psychotherapeutic relationship and how such reenactments may be underpinned by the individual's need to control the intrapsychic dynamics through the use and control of interpersonal relationships. Some of the common transference manifestations are considered along with how they present fertile ground for resolution of the underlying internal conflicts. The article addresses this mainly through the theory and clinical examples from clients presenting with some level of personality impairment. In terms of psychotherapeutic technique, the author falls back on what he refers to as interpretive dynamic transactional analysis psychotherapy (IDTAP). There is a particular focus on reenactments of the destructive internal parts embedded in the client's attachment to the internal bad object. The dangers of the therapist's intention to provide the reparative relational experience are addressed along with the importance of analysis and resolution of the idealizing transference. The importance of the therapist's function to endure and contain the negative countertransference is also discussed. Some potential interventions aimed at improving personality functioning are considered as are the implications of working with extratransference. [ABSTRACT FROM AUTHOR]

LGBT Arab clients who enter psychotherapy typically wish to change their sexual orientation. This article draws on writings by Winnicott and Ogden and on current discourse about sexuality in the Arab world to explore how LGBT Arab clients responded to initial phases of therapy with an Arab, traditional, psycho-dynamically trained female therapist. We focus specifically on the notions of true and false self, transitional space, and on role of naming in creating safe transitional therapeutic space where Arab, traditional LGBT clients came to express their unique thoughts and desires related to their non-heterosexual orientations. We also illustrate how clients came to share and experience 'unlived' parts of their sexual identities and describe common aspects of the transference and countertransference relationships. Change, experienced differently by clients and the therapist, was a central theme in the early transference and countertransference relationship. Names became an important port of entry and facilitated the creation of a safe transitional space with my clients. Words helped to humanise what had been unspeakable and unbearable experience and allowed clients to begin to openly accept and share the realities of their sexual orientations even within the confines of severe social and cultural demands. [ABSTRACT FROM AUTHOR]

Transference-focused psychotherapy (TFP) is an empirically validated psychodynamic psychotherapy for borderline personality disorder (BPD), based on object relations theory, that has clinical utility for individuals with narcissistic personality disorder (NPD). Given the effectiveness of TFP for patients with BPD, including a number of patients with comorbid NPD, we have adapted the tactics and techniques of TFP with specific modifications for patients with NPD or narcissistic traits. TFP for NPD (TFP-N) retains core elements of the treatment, including a contracting phase and an interpretive process designed to identify and modify maladaptive mental representations of self and others that underlie the affect and behavioral dysregulation in those with personality disorders including NPD. The major goal of TFP-N is the focus on disturbed interpersonal patterns of relating in the here-and-now of the therapeutic interaction as a vehicle to effect enduring changes in personality organization and real-world changes in the areas of love and work. [ABSTRACT FROM AUTHOR]

Residential child care is an inherently distressing and multi-layered endeavour undertaken by staff who are often poorly trained and supported. In addition, the children, and the adults who care for them, can provide a convenient receptacle for the split off negative feelings of professionals, politicians and the public. The complexity and difficulty of this work is often unrecognised and a simplistic response based on a programmatic, behavioural framework, reinforced by performance-based management and an audit culture, is common. This paper argues for the usefulness of a different approach, drawing on psychoanalytic and open systems thinking, to provide a more nuanced understanding of what is happening in these volatile settings that can guide interventions which match the complexity of the work. Alongside advocating the use of key psychoanalytic and systems concepts to improve understanding, it argues for the importance of providing a containing and reflective environment for staff. [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]

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]

Research from several domains indicates that genetic factors, childhood environment, and later interpersonal experiences are important sources of how patients relate to their therapists (transference). Transference work, a core specific technique in psychodynamic psychotherapy, focuses on exploring the patient-therapist relationship, with the idea that this may lead to improvement of the patients' relationships outside therapy. Many psychotherapy researchers hold the position that specific techniques do not contribute much to the outcome of psychotherapy. However, more than 30 studies have reported significant associations between transference work and outcome. These findings indicate that transference work interventions are indeed active ingredients (for better or worse). Naturalistic studies suggest that a high frequency of transference interventions may have negative effects. Randomized clinical trials indicate that transference-based treatments and alternative treatments work equally well with regard to symptom improvement. However, transference-based treatments appear to be much more effective with regard to interpersonal relations and other measures of personality functioning. The average between-groups effect size for the experimental studies listed in this article was large. Contrary to common clinical wisdom, transference interventions seem to be most important for (mainly female) patients with difficult interpersonal relationships and more severe personality pathology. Gain of insight may be a specific mechanism of change in dynamic psychotherapy, but only one treatment component study has linked transference work directly to gains in insight and subsequent improvement in interpersonal functioning. Research that examines how transference phenomena may be responded to in non dynamic therapies is scarce. [ABSTRACT FROM AUTHOR]