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Palliative care clinicians enhance the illness experiences of patients and their families through building therapeutic relationships. Many psychological concepts underlie a clinician's approach to a specific patient. Through high-yield tips, this article highlights ten selected psychological elements that palliative care clinicians often use to support patients. As we all (both clinicians and patients) bring our own histories and unique biographies to the work of palliative care, a more explicit focus on the psychological aspects of this work can enhance our own experience and efficacy as providers. With a thoughtful focus on the psychological aspects of how we engage with patients, palliative care clinicians can offer a more meaningful therapeutic encounter. [ABSTRACT FROM AUTHOR]

Trust is central to successful therapeutic work with adolescents, but establishing trust can be challenging, especially with adolescents with personality disorders. We present our understanding of trust in working with adolescents with and without personality disorders. We draw on complementary and overlapping perspectives, namely the attachment model, Kernberg's object relations model, and Fonagy's mentalization model. In Kernberg's object relations conceptualization, difficulties in trust experienced by patients with borderline personality disorders result from paranoia associated with splitting and identity diffusion. In Fonagy's mentalization model, epistemic trust is rooted in early experiences of being responded to and understood. We outline how techniques used in transference-focused psychotherapy for adolescents promote the development of the adolescent's capacity to trust by facilitating identity integration, thus reducing paranoia. Finally, we use two clinical case illustrations to demonstrate how trust unfolds in working with adolescents with and without personality disorders. [ABSTRACT FROM AUTHOR]

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]

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]

This article explores how the therapeutic relationship facilitates intrapsychic and behavioral changes in both the patient and the analyst. Key elements of the therapeutic relationship are reviewed, including transference, countertransference, introjective and projective identification, as well as the "real relationship." Special attention is paid to the "transformative relationship," which is a special kind of bond that develops between analyst and patient that is unique and transformative. It consists of mutual respect, emotional intimacy, trust, understanding, and affection. Empathic attunement is a key element in the evolution of a transformative relationship. This attunement optimally promotes intrapsychic and behavioral changes in both the patient and the analyst. This process is illustrated by a case presentation. [ABSTRACT FROM AUTHOR]

Many patients resist engagement in the therapeutic relationship because they fear the traumatic consequences of the mobilization of thwarted selfobject needs in what they fear will be a faulty, nonempathic environment. At times this resistance is manifest in "narcissistic rage" as described by Heinz Kohut. Providing opportunities for selfobject experience in work with these patients can be challenging. In his 1971 paper The Use of the Object, D.W. Winnicott described a developmental process in which the state of omnipotent merger with important objects undergoes a transformation in which the other is increasingly recognized as not only outside the self, but also in possession of a subjectivity of its own and thus can be made use of. In work with some seriously and persistently mentally ill, the client's capacity to make use of the clinician is poorly developed or highly conflicted. Given this the clinical process in which the client achieves the recognition of the worker and trust in their intentions—and hence can make use of them as a selfobject, is often prolonged and stormy. A case is discussed at length that illustrates this. The report documents the importance of holding, containment, management of the countertransference, and survival strategies for the clinician. It also shows the patient's growing ability to make use of the clinician as a selfobject as she struggles to understand and cope with changes in her life world and self-experience. [ABSTRACT FROM AUTHOR]

Introduction: Transference (meant in this context, as the patient relational patterns expressed towards the clinician) and therapeutic alliance play a crucial role in the treatment of personality pathology. To date, no empirical study examined the association between these two dimensions of the clinical relationship and patients' personality maladaptive traits in psychotherapy. Methods: A national sample of therapists (N = 100) of different theoretical orientations assessed dysfunctional personality features of a patient in their care using a comprehensive and empirically grounded dimensional diagnostic approach from the Shedler–Westen Assessment Procedure‐200 (SWAP‐200). Moreover, they filled in the Psychotherapy Relationship Questionnaire (PRQ) to identify interpersonal patterns expressed early in treatment by the patients and the Working Alliance Inventory (WAI‐T) to evaluate quality of therapeutic alliance. Results: Overall, the most severe and maladaptive dimensions of patients' personality were associated with more negative clinician–patient dynamics and poorer levels of therapeutic alliance in statistically significant and clinically relevant ways. Notably, the hostile transference was predicted by both SWAP Hostility and Psychopathy, whereas the SWAP Narcissism was the strongest predictor of the special/entitled transference. The latter was also predicted by SWAP Emotional Dysregulation; conversely, the SWAP Dysphoria was the most robust predictor of anxious/preoccupied pattern. The SWAP Schizoid Orientation and Psychopathy predicted avoidant/dismissing attachment pattern; moreover, they were strongly and negatively related to the SWAP Psychological Health that was the best predictor of positive transference and alliance. Conclusions: Findings support that therapists' careful understanding of patients' interpersonal ways during early treatment stages may meaningfully inform diagnostic and therapeutic processes. [ABSTRACT FROM AUTHOR]

Countertransference (CT) is considered a central component in the therapy process. Research has shown that CT management does not reduce the number of CT manifestations in therapy, but it leads to better therapy outcomes. In this study, we examined therapists' awareness of their CT using a structured interview. Our hypotheses were (a) treatments in which therapists were more aware of their CT would have a better outcome and (b) different definitions of CT would be related to different therapy outcomes. Twenty-nine patients were treated by 19 therapists in 16 sessions of short-term psychodynamic therapy. We used the core conflictual relationship theme to measure CT, a special interview was developed to study CT awareness. Results show that awareness of CT defined as the relationship with the patient moderated 10 outcome measures and awareness of CT defined as the relationship with the patient that repeats therapist conflicts with significant others moderated three outcome measures We present examples from dyads in this study and discuss how awareness can help the therapist talk to and handle patient challenges. [ABSTRACT FROM AUTHOR]

The Interpersonal Dynamics (ID) consultation is a structured method of group reflective practice which helps staff mentalize transference and countertransference dynamics with patients. We present a detailed ID consultation of a female patient in an inpatient therapeutic community for people with severe personality disorders and demonstrate how this method sheds light on this patient's internal world as externalised interpersonally with staff in the treatment setting. The resulting enactments are discussed in relation to several psychoanalytic theories and concepts, including Bion's theory of containment and Ogden's interpersonal definition of projective identification. We conceptualise our population of patients based on their use of primitive psychological defences such as splitting and projective identification and on the idea that they live at the border between what Klein described as the paranoid-schizoid and the depressive positions. We argue that the ID consultation functions as a container for staff and patients by bringing together and integrating the parts of the patient which are split off and projected into different staff members. Furthermore, the ID consultation is an invaluable triangular space that facilitates the move from difficult dyadic subjective experiences with patients to triadic objective perspectives and from passive reactions to responsive thinking and understanding. [ABSTRACT FROM AUTHOR]

Furthermore, the authors conclude that the characteristics of patients and therapists and their relationships seem to determine how effective the therapists' interpretations can be. To relate to the patient's first-person singular perspective, a dedicated therapist cannot abandon his or her own first-person singular perspective because each therapy requires open subject-to-subject dialogue. Kegerreis explains that when therapists sort out what generates their feeling and spurs their actions and how they can co-create the therapeutic reality with patients, they make the best use of themselves as therapists. [Extracted from the article]

In this paper I explore questions around the role of the therapist's own history in their clinical work. Based on my own experiences and those of other practitioners, I look at the way in which recent developments in the field have changed how this is theorised and worked with, influenced by relational psychotherapy and by a greater understanding of the importance of the real relationship alongside the transference relationship. I consider how our own history influences what we emphasise or overlook in the work and how this connects with ideas about countertransference. I discuss issues around self-disclosure in the light of these considerations. I give particular attention to the role of our own adolescent experiences and to how work with adolescents brings these issues into especially sharp focus. [ABSTRACT FROM AUTHOR]

This paper is based on the premises that the conscious, active and purposeful use of self by the therapist in the therapeutic process is an essential aptitude in establishing an effective therapeutic relationship, and that this therapeutically purposeful use of self can and should be incorporated in the training of all therapists in a explicitly systematic manner. The paper will attempt to identify the contributions of the "what and how" the use of self by therapists contributes to the therapeutic process. First of all, therapists' use of self is meant to be viewed as a Common Factor as defined by Sprenkle, Davis & Lebow (2009), which is a perspective about the effectiveness of therapy that "asserts that the qualities and capabilities of the person offering the treatment are more important than the treatment itself" (p. 4). Secondly, the use of self by therapists emphasizes developing the skill set of the therapist in the conscious, active and purposeful use of self as is in the moment of the therapeutic engagement with clients, and does so without denying the importance of therapists working to resolve personal issues of theirs that may interfere with the therapist's professional effectiveness. Therapists' use of self gives particular emphasis to the purposeful use of self as is in therapy's relationship, assessment and interventions whatever the therapy model (Aponte & Kissil, 2016). Thirdly, the use of self represents an aptitude that can be developed and refined through well elaborated structures for schooling therapists in the therapeutic use of all they bring of their personal selves to the therapy relationship including through the use of their human vulnerabilities as they exist at the moment of empathic engagement with clients. [ABSTRACT FROM AUTHOR]

In this essay, the author will explore the use of countertransference in the therapeutic process, with particular emphasis on Oedipal love. We begin with countertransference as conceptualized by interpersonal psychoanalytic theorists, who immediately pointed out the technical relevance of the therapist as a person, and the importance of the use of the therapist's feelings, thoughts, life experiences, and states of mind in the therapeutic relationship. Just as dreams, slips of the tongue, peripheral thoughts, and physical gestures are useful in reading the patient's unconscious experience, accepting, examining, and exploring countertransference become useful in reading the analyst's unconscious experience. The author will then identify a more radical and contemporary conception of countertransference as representative of the analyst's unconscious receptivity to the patient within the enactments in which transference and countertransference reciprocally affect each other. Finally, the author will concentrate on the Oedipal feelings experienced by the therapist and their importance in treatment. A clinical case will illustrate the clinical ramifications of these hypotheses. [ABSTRACT FROM AUTHOR]

In the article, the author discusses the important role played by social workers in advocating for their patients and families and in educating medical staff about their possible racist comments about their patients. Also cited are how transference can enable natural empathy among clinicians to provide great and empathic care, and the alleged possible implicit bias by White clinicians in caring for their young patients of color.

This article presents the core ideas of bibliotherapy as an integrative psychotherapeutic channel, exploring the ways in which it integrates new meanings into psychotherapeutic modalities, concepts, and principles. The unique aspect of the bibliotherapeutic relationship is that it is based on a triangular mode of therapist-text-patient. It supplements this with the creative processes of reading, writing, and the development of the capacity to narrate. Bibliotherapy uses many of the same concepts as other psychotherapeutic treatments, such as transference, countertransference, potential space, and the capacity to play. The integration of various kinds of texts within the clinical context, such as children's literature or adolescent poems and songs, makes bibliotherapy different. The text will be integrated according to the developmental stage of the patients. This article introduces the theoretical background of bibliotherapy and places bibliotherapy within the Winnicottian context and parent–child therapy. Examples of different clinical experiences within bibliotherapy are discussed. [ABSTRACT FROM AUTHOR]

Objective: Recently, studies have reported systematic relationships between the therapists' emotional response/countertransference (CT) during therapy and a variety of patient characteristics, speaking to the communicative potential of CT. Within an RCT assessing the role of transference work (TW) in psychodynamic therapy, we investigated whether therapist CT was related to patients' pre-treatment interpersonal problems, degree of personality pathology and motivation for psychodynamic therapy. Secondly, we explored if these relationships depended on whether the therapists used TW or not in sessions. Method: One hundred outpatients were treated with psychodynamic psychotherapy (with or without TW) for one year. Their therapists' emotional reactions after sessions (CT) were assessed with the Feeling Word Checklist-58 (FWC-58). Results: Four subscales of the FWC-58; Inadequate, Confident, Disengaged and Parental feelings were differentially predicted by patient characteristics. Some of the associations depended on treatment condition such that degree of PD pathology was associated with therapists feeling more inadequate in the non-TW-group. Patients' motivation for treatment was associated with less disturbing CT feelings, such as Inadequate and Disengaged CT (the latter especially in the TW group), and feeling more Confident CT. Conclusion: Patient factors predict therapists' emotional countertransference differently depending on whether therapists use transference work in psychodynamic therapy. Trial registration: ClinicalTrials.gov identifier: NCT00423462. [ABSTRACT FROM AUTHOR]

This article presents my responses to two Commentaries on my DBT case of "Jane" (Marks, 2022): one by Gillian Galen, Blaise Aguirre, and Julianne Wilner Tirpak (2022); and one by Allison Ruork (2022). While both Commentaries acknowledge that my therapy with Jane was ultimately quite helpful to her, both point to the turbulent and conflictual nature of a substantial portion of our therapeutic relationship. Galen et al. attribute this struggle in part to the DBT equivalent of "countertransference" dynamics in my therapeutic relationship with Jane; and Ruork attributes this struggle in part to my under use of the DBT concept of "secondary targets." I found both of these perspectives very on target, and they stimulated me to reconstruct a crucial theme in the therapy from excerpts of therapy process in sessions 14-24 of my case study of Jane. I end the article by reflecting on the value of writing up systematic case studies with sufficient descriptive clinical detail so that valuable secondary analyses can be conducted, like those by Galen et al., by Ruork, and by me based on the former two. [ABSTRACT FROM AUTHOR]

This paper describes a once-a-week psychotherapy with a young boy over a period of 18 months. The boy was removed from his biological parents at three years of age because of concerns about his birth parents' capacity to care for him and his younger brother. When the boy was seven years old a psychotherapy was sought to address a range of behaviours that were difficult for his adoptive parents to manage. The very early history of the boy was not known. Clinical vignettes from a beginning session, the middle and toward the end of the process are used to illustrate the importance and usefulness of careful attention to countertransference, particularly when the very early history of a child is unknown. The paper demonstrates that by being attentive to these dynamics, emotionally relevant themes may be reconstructed and reworked in the clinical setting. The unknown history is reconstituted and made conscious in the therapeutic relationship. The early emotional themes from the clinical work that rose to the surface include 'twos' -- two sets of parents, two emotional worlds, two siblings, two therapists; 'transitions' -- between his two families, between his worlds, between his adoptive mother's arms into the therapy room; and 'the dark' -- what lies beneath and between, what is unseen, what is unremembered. [ABSTRACT FROM AUTHOR]

To investigate how expert supervisors focus on various aspects of relationships and how commonly the relational discussions occur in theoretically diverse approaches to supervision, we operationalized five relational supervisory behaviors (Focus on the Therapeutic Relationship, Focus on the Supervisory Alliance, Exploration of Feelings, Focus on Countertransference, Attend to Parallel Process) from the Critical Events model of supervision. Our observational analysis showed a modest-to-strong use of these five key behaviors across the 11 demonstration sessions in the American Psychological Association's Master Supervision Video Series. Discussion focuses on using the results alongside the videos to train novice supervisors and the contribution of relational processes to supervision outcomes in future research. [ABSTRACT FROM AUTHOR]

Clients or patients often come to psychotherapy to alleviate psychological symptoms and pain but, paradoxically, soon behave in ways that seem to interfere with the process and progress of therapy. As early as the 1890's Freud began calling this phenomenon resistance and immediately realised that he needed to understand and deal with this matter to achieve therapeutic goals. Our understanding and ways of dealing with resistance in psychotherapy have undergone several developments over the years. Initially, psychoanalysts understood resistance as an obstacle to the therapeutic task and relationship and sought "to remove" it. However, over time, it has been realised that this is impossible, and the resistance also has an important function. In other words, the appearance of resistance was seen as an opportunity to understand the subjective experience of clients and the relational context in which it occurred. Dr. Rhee Dongshick, the founder of Taopsychotherapy, added a wholly fresh perspective in keeping with more recent relational perspectives. He came to see resistance as a therapist-centred concept and that what a therapist feels as resistance is, in fact, the result of the therapist's countertransference, essentially a failure of the therapist's empathy. He fully understood the patient's anxiety about admitting and facing unbearably painful emotions. Therefore, Rhee Dongshick's approach was to "melt" resistances by empathising with the patient's most distressing nuclear feelings with sustained, deeply empathic inquiry. In this paper, the author would like to examine in detail the perspective and therapeutic interventions of Taopsychotherapy in the face of resistance. Hopefully, this will propose meaningful guidelines for the conduct of psychotherapy, comparing these with some other well-known Western approaches to psychotherapy. [ABSTRACT FROM AUTHOR]

In clinical hypnosis, the transference relationship, present in neurotic patients, becomes especially important in a psychotherapeutic process. It is pertinent that from the initial time of psychoanalysis, and throughout, the links are established either indirectly or directly. This was observed when working within a hypnotherapeutic orientation. The phenomenon of transference appears systematically, and the differences lie in the management of this situation. It is in the way of working, which distinguishes the hypnotherapist, who, by noticing in the "here and now", works with the orientation of therapy under clinical hypnosis, is never applying clinical methodology only to his patient. He observes it in its entirety, and from there, he can perceive a change in color, a repeated gesture, or a muscular contracture to interpret transference elements. [ABSTRACT FROM AUTHOR]

One of the more draining aspects of being a clinical ethicist is dealing with the emotions of patients, family members, as well as healthcare providers. Generally, by the time a clinical ethicist is called into a case, stress levels are running high, patience is low, and interpersonal communication is strained. Management of this emotional burden of clinical ethics is an underexamined aspect of the profession and academic literature. The emotional nature of doing clinical ethics consultation may be better addressed by utilizing concepts and tools from clinical psychology. Management of countertransference, the natural emotional reaction by the therapist toward the patient, is a widely discussed topic in the psychotherapeutic literature. This concept can be adapted to the clinical ethics encounter by broadening it beyond the patient-therapist relationship to refer to the ethics consultant's emotional response toward the patient, the family, or other members the healthcare team. Further, it may aid the consultant because a recognition of the source and nature of these reactions can help maintain 'critical distance' and minimize bias in the same way that a psychologist maintains neutrality in psychotherapy. This paper will offer suggestions on how to manage these emotional responses and their burden in the clinical ethics encounter, drawing upon techniques and strategies recommended in the psychotherapeutic literature. Using these techniques may improve consultation outcomes and reduce the emotional burden on the clinical ethicist. [ABSTRACT FROM AUTHOR]

The aim of this study was to conduct an in-depth exploration of therapists’ experiences of patients who affect them more than others and occupy their inner world beyond the context of therapy sessions. A phenomenological analysis was performed on semi-structured interviews with five relational therapists. All the therapists had a strong experience of a particular patient getting “under their skin.” In all these cases, the patient was a traumatized woman. The distinctive characteristic of the phenomenon was a sense of blurred or too permeable boundaries between the therapist and the patient. This was associated with fear and anxiety, but also with feelings of love. The therapists’ reactions to having a patient “under their skin” varied from resistance to symbiotic relatedness. The therapists’ ideas of their professional role influenced how the experience of carrying the patient’s suffering was interpreted. The phenomenon of the patient’s presence in the therapist’s representational world might be interpreted as a distinct countertransference phenomenon when working in a more “thin boundary” manner with particular cases. The therapists’ ability to effectively manage their vulnerabilities, activated in the countertransference, seems to be crucial for therapeutic progress. Implications for research, clinical practice, and training are discussed. [ABSTRACT FROM AUTHOR]

This paper discusses the residues of a somatic countertransference that revealed its meaning several years after apparently successful analytic work had ended. Psychoanalytic and Jungian analytic ideas on primitive communication, dissociation and enactment are explored in the working through of a shared respiratory symptom between patient and analyst. Growth in the analyst was necessary so that the patient's communication at a somatic level could be understood. Bleger's concept that both the patient's and analyst's body are part of the setting was central in the working through. [ABSTRACT FROM AUTHOR]

LGBTI clients present specific challenges for the mental health profession with key issues for transgender people identified as including isolation, fear, stigma, and family rejection, all of which contribute to the transgender community's high levels of depression, anxiety, substance misuse, self-harm, and suicide. This qualitative research paper explores the experiences of Irish psychotherapists working with transgender clients to explore specifically the nature of the therapeutic relationship. Using an interpretive phenomenological approach, it examines the subjective experience of three participant psychotherapists and endeavours to make sense of the phenomenology that emerged from semi-structured interviews. The phenomenological analysis of the data collected resulted in three salient themes emerging: (i) Therapeutic identification, (ii) Maternal countertransference, and (iii) Confusion. It is hoped that these findings which relate to the therapeutic relationship will be of utmost importance to others working within the mental health profession where recovery is dependent on the strength of this relationship. [ABSTRACT FROM AUTHOR]

Given the recent studies promoting time-limited manualized therapies in the oncology setting, clinicians may be reluctant to offer traditional psychodynamic therapy to cancer patients. However, there are no studies directly comparing psychodynamic therapy and other therapy modalities in this patient population and no data suggesting harm from psychodynamic approaches. Therefore, it is inappropriate to draw the conclusion that psychodynamic therapy is inferior to manualized therapy from existing evidence. Manualized treatment, such as cognitive behavioral therapy, is generally short term and therefore may reduce the practitioner's own anxiety stemming from exposure to patients facing grave disability and death. However, manualized treatment is not fully effective in specific clinical scenarios. We present a case reflecting these limitations and advocate for a flexible treatment approach incorporating elements of psychodynamic therapy. [ABSTRACT FROM AUTHOR]

Patients with cancer can feel particularly vulnerable and need special attention and support, so clinicians' attention to transference reactions--theirs and their patients--is especially important. Mismanaged transference reactions can undermine the therapeutic alliance in the patient-clinician relationship and negatively influence treatment outcomes. In oncology settings, real and perceived needs of patients in serious distress can occasion modification of usual outpatient protocols, particularly when flexible scheduling or home or hospital visits are warranted. Here, we comment on a case in which transference reactions of a young woman with cancer prompt her to terminate treatment. We discuss the importance of clinicians' recognizing and managing transference and countertransference, maintaining boundaries, and responding with empathy and integrity to cancer patients' concerns. [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]

In this paper, we propose that therapist anxiety in the therapy room, especially anxiety stirred up by difficult or triggering clients, represents a challenge to effective therapy, and that effective management of this anxiety be considered as a necessary therapist skill for conducting quality couple and family therapy (CFT). We propose that effective therapists need to be able to manage their emotions, especially their anxiety, in order to truly help their clients. The failure to do this can lead to break downs in the alliance and the flow of therapy, and these deleterious effects can be prevented when therapists actively navigate their internal states through self-awareness and ongoing introspection. Bridging psychotherapy literature, we discuss specific strategies to this end, and make clinical recommendations for CFTs and CFT training programs. [ABSTRACT FROM AUTHOR]

The experiences of nine licensed mental health practitioners regarding their work with clients from low-income backgrounds were examined utilizing grounded theory methodology. Themes that emerged from the semi-structured interviews highlighted a rich narrative that portrayed the work as both deeply satisfying and inherently complex. Participants described the personal nature of this work, including countertransference elicited because of their own personal economic contexts and emotional reactions experienced within and outside the therapy room. Their stories acknowledged systematic challenges that act as barriers to treatment. Some participants noted that this has contributed to feelings of disillusionment toward the field as well as fears about the future of the mental health care. Based on these findings, we discuss implications for training, future research, and clinical practice. [ABSTRACT FROM AUTHOR]

An introduction is presented which discusses various topics within the issue including review of the book "The World Beyond Your Head: How or Flourish in a World of Distractin," child-care tragedies and psycho-physiological awareness to clinicians.

This study evaluates the effectiveness of the ‘transference interpretation to the setting’ technique in psychodynamic social work practice. Aiming to establish the therapeutic relationship, the practitioner-researcher interprets client negative emotions towards him and the institution as a by-product of the ‘here-and-now’ situation rather than as a repetition of emotions rooted in primary relationships. Adopting the multiple case study method, this study provides an in-depth analysis of the process and the effectiveness of the ‘transference interpretation to the setting’ in clinical practice with six parental couples whose children exhibited separation anxiety disorder. The technique effectively dealt with parental resistance to bring the child for assessment, parental resistance to use the clinician's advice, couple relationship problems and emotional problems of the parents. The empowerment effects of the technique on the parents, and indirectly children, are demonstrated through parent and practitioner narratives. The study concludes that ‘transference interpretation to the setting’ is an effective intervention tool for the social work practitioner. [ABSTRACT FROM PUBLISHER]

Attachment theorists have highlighted the role of the therapist in providing a ‘secure base’ for therapy. This raises the question of how therapists with insecure as well as secure attachment styles manage the integration of their personal experience and their therapeutic work. This study explored the relationship between family therapists’ adult attachment styles, influences on their career choice and their approach to therapy. Participants’ (n = 11) attachment styles were previously assessed using the self-report Experiences in Close Relationship questionnaire. Three participants were assessed as having a ‘secure’ attachment style; three were ‘preoccupied’, three ‘fearful’ and two ‘dismissing’. They were interviewed about their practice and the impact of past or current relationships on their development as therapists. Interpretive Phenomenological Analysis was used to analyse the verbatim accounts into cluster of master themes and subthemes. The analysis identified two master themes: understanding one’s self and the impact of family of origin experiences, and the integration between personal experiences and therapeutic work. There were differences in responses relating to the therapists’ attachment styles. Therapists with ‘secure’ adult attachment styles were aware of their challenges and able to utilise their experiences in their practice and respond sensitively to their clients. Conversely, those with ‘insecure’ styles have difficulties in mentalisation and in using counter-transference responses in their practice. We suggest that family therapists, social workers and others engaged in therapeutic work with families should undertake an exploration of the ‘self’ of the therapist in the context of their own family relationships and adult attachment styles as part of their training and continuing professional development. [ABSTRACT FROM PUBLISHER]

Background Difficulties with containing or processing emotions brought up in the countertransference response have long been understood as having the potential to cause a rupture in the therapeutic relationship, often with damaging results for the client. As increasing numbers of psychotherapists are becoming interested in mindfulness meditation, and as evidence is building to suggest that mindfulness meditation is an effective way of relating to one's thoughts and emotions in a non-judgemental and non-reactive fashion, the effect this may be having on the processing of countertransference material seems a worthy area of investigation. Method This study explores the countertransference experiences of five psychotherapists who practised mindfulness meditation, using semi-structured interviews. Data were analysed using a grounded theory methodology. Results A tentative conceptual understanding of the data was developed, indicating that therapists who practised mindfulness meditation were relating to countertransferential responses with an observing stance, a compassionately curious attitude and a holding of emotion, which brings them into the present moment, resulting in the experience of a deeper therapeutic relationship. Discussion The implications for training and practice are discussed, through the potential of practising mindfulness to cultivate a therapeutic attitude towards countertransference responses. [ABSTRACT FROM AUTHOR]

The emotions experienced by a supervisor—including even his private, 'subjective' fantasy experiences and his personal feelings about the supervisee—often provide valuable clarification of processes currently characterizing the relationship between the supervisee and the patient. In addition, these processes are often the very ones which have been causing difficulty in the therapeutic relationship and, because heretofore unrecognized by the supervisee, have not been consciously, verbally reported by him to the supervisor. This thesis is undoubtedly well known to many persons engaged in supervision, and in everyday use by them in this work; but my own experience indicates that it is far from universally recognized, and it has not been presented in the literature, to the best of my knowledge. It would be at least equally valid to express the principle in the following fashion: the processes at work currently in the relationship between patient and therapist are often reflected in the relationship between therapist and supervisor. But it makes for simplicity of presentation to present this material from the viewpoint of the supervisor. [ABSTRACT FROM AUTHOR]

The article offers the author's insight on the importance of giving compassionate care with the patients. Topics discussed include the author's experience of aiding his patient diagnosed with acute myelogenous leukemia (AML), the responsibilities of a social worker, and emotional attachment of social workers to their patients.

The different pathways chosen to efficiently and effectively provide relief to those struggling with mental health challenges reflect different assumptions about the human condition and have led to disagreements over which intervention strategies are best suited to particular individuals or populations. Evidence-based practice and culturally competent services, as discussed within the United States, have been characterized as opposites. However, neither approach captures all of the elements that embody the full treatment experience. This article offers a framework that includes the personal identity of the practitioner and the organizational context as two elements that serve as active agents in the helping relationship, although they have rarely been included in the discourse about evidence-based practice or cultural competence. Suggestions for practice, education, and research are included based on this analysis. [ABSTRACT FROM PUBLISHER]

Psychoanalytic theory offers a varied conceptual system for considering psychosis by providing a coherent representation of the anxieties and processes at work in adult patients. But at the practical clinical level, it is not enough simply to ‘think about psychosis’ and have a theoretical system in place. The therapist must also ‘have psychosis in mind’, that is, get to grips with its forms of logic, gain familiarity with its workings, and learn to understand and accept the effects it has on the therapeutic relationship and on their own expectations. Clinicians engaged in this type of work must be able to tolerate getting back in touch with processes deemed archaic at the core of their own psychological functioning, which will impact their ability to listen and think. These chaotic processes demand a change of approach since they cause a ‘desymbolisation’ that perturbs the internal mental structure of the therapist. This ‘desymbolisation’ is therefore the locus of the therapeutic work, which must attempt to render it comprehensible and represent it. A case study illustrates these processes. [ABSTRACT FROM PUBLISHER]

Prof. Richard Layard's influential advocacy for greater provision of ‘evidence-based’ psychological therapies, based in part on an economic rationale, has lead to greatly increased provision of cognitive behavioural therapy (CBT) and short-term therapies for depression, through the Increasing Access to Psychological Therapies (IAPT) initiative, whilst longer-term psychodynamic treatments are under threat, criticised as lacking an evidence base. This paper argues for the continuing provision of intensive thrice-weekly psychoanalytic psychotherapy treatments, time-limited to two years. It does so by describing such a treatment within an NHS psychotherapy department with a patient with a long history of severe personality pathology, including significant levels of perversity. The paper describes the patient's difficulties and his movement through the treatment, focussing on his difficulties making genuine emotional contact, his destructiveness of such contact, his acting out in the treatment, his perversity and the vital working through of the ending. The shifts the patient made are described, and follow-up information on the patient is given. The paper discusses the unique benefits of time-limited treatment and intensive psychoanalytic treatments for this ‘hard-to-help’ group of patients, and the economic rationale that can be made for such treatments. [ABSTRACT FROM PUBLISHER]

The article discusses how psychiatrists can effectively address erotic transference involving older patients. Topics explored include the need for therapists to recognize indicators of sexual transference, the expression of sexual feelings by older patients that suffered from sexual abuse in their childhood, and the cognitive impairments and psychological factors that clinicians need to identify and consider for proper transference management.