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Institutional transference is a phenomenon describing patients' attitudes toward the institutions where they receive mental health or medical care. While transference toward individual clinicians in palliative care has been described, attitudes of patients with serious illness toward the institutions where they receive specialized care have not been described. Here, we present three cases which demonstrate the phenomenon of institutional transference in patients with serious illness and the resulting clinical implications, which include countertransferential responses of clinicians caring for them. We consider three conditions: (1) the idealized reputation of the academic cancer center, often a tertiary referral center; (2) loss of an institutional connection during care transitions; and (3) countertransferential reactions to institutional transference. We highlight characteristics and personality styles of individuals with cancer that may complicate and intensify institutional transference and identify potential interventions to address common challenges associated with institutional transference. [ABSTRACT FROM AUTHOR]

A broad range of psychotherapies have been proposed and evaluated in the treatment of borderline personality disorder (BPD), but the question which specific type of psychotherapy is most effective remains unanswered. In this study, two network meta-analyses (NMAs) were conducted investigating the comparative effectiveness of psychotherapies on (1) BPD severity and (2) suicidal behaviour (combined rate). Study drop-out was included as a secondary outcome. Six databases were searched until 21 January 2022, including RCTs on the efficacy of any psychotherapy in adults (⩾18 years) with a diagnosis of (sub)clinical BPD. Data were extracted using a predefined table format. PROSPERO ID:CRD42020175411. In our study, a total of 43 studies (N = 3273) were included. We found significant differences between several active comparisons in the treatment of (sub)clinical BPD, however, these findings were based on very few trials and should therefore be interpreted with caution. Some therapies were more efficacious compared to GT or TAU. Furthermore, some treatments more than halved the risk of attempted suicide and committed suicide (combined rate), reporting RRs around 0.5 or lower, however, these RRs were not statistically significantly better compared to other therapies or to TAU. Study drop-out significantly differed between some treatments. In conclusion, no single treatment seems to be the best choice to treat people with BPD compared to other treatments. Nevertheless, psychotherapies for BPD are perceived as first-line treatments, and should therefore be investigated further on their long-term effectiveness, preferably in head-to-head trials. DBT was the best connected treatment, providing solid evidence of its effectiveness. [ABSTRACT FROM AUTHOR]

The increase in the number of people living beyond age 90 pose challenges to mental health professionals, many of whom still harbor ageist notions concerning the efficacy of psychotherapy for the oldest old. This paper demonstrates how integrated psychotherapy with an oldest old woman can provide opportunities for integration and personal growth. Integrated psychotherapy based on self-psychology psychodynamic approach, was provided to a woman from age 90 to 100 concerning age-related changes and losses and unresolved traumatic experiences in life. which troubled her notwithstanding previous efforts to resolve them. Over the course of almost ten years, the client came to terms with her aging losses, experiences, worked through the therapeutic process, and learned how to express and accept her deepest feelings, thereby achieving psychological well-being and internal peace. Psychotherapy for the oldest old may contribute to their well-being by offering significant opportunities to process and understand major events and unresolved issues along the life cycle. This study demonstrates that the older self is flexible and capable of growth, even as physical health wanes. Transference and countertransference reactions between therapists and clients can be instrumental in understanding and improving the well-being of the oldest old. [ABSTRACT FROM AUTHOR]

The article presents the discussion on therapeutic efficacy of all psychoanalytic techniques regardless of the theoretical orientation. Topics include achieving greater emotional maturity, loving unselfishly, having meaningful and satisfying sexual relationships; and increasing cognitive awareness through the insight or the interpretations about the analyst made to the patient.

This paper illustrates the beneficial effect of a positive benevolent transference in the development of an internalized representation of the therapist/analyst in a variety of patients in psychodynamic treatments ranging from consultation to psychoanalysis itself. This is described in patient presentations. In those who have had substantial early nurturant life experience and now find themselves in a dysphoric state due to crisis, the effect lies in the transference reactivation of these positive object relations that relieve their distress. In those who have been deprived of such early experience, the positive transference may emerge during the intensive work of psychoanalysis and may lead to the internalization of a new positive object representation of the analyst generated in the transference that persists after termination of treatment. In both of these situations, the patient discovers a sense of greater harmony with self and the world. The special conditions that permit and facilitate this process are described since this does not occur in all psychodynamic interventions. [ABSTRACT FROM AUTHOR]

In this paper, the work of psychoanalyst Jacques Lacan is examined with regard to career counselling. Lacan argued that the individual exists as the split subject engaged in a futile search to fill an inner void via the pursuit of a particular object. In this paper I will explore a number of Lacan's key concepts (Imaginary, Symbolic, Real, Lack, "objet petit a" and Jouissance). Next, I discuss Lacan in relation to career theory in general, followed by the presentation of a case study in which I attempt to elucidate some Lacanian concepts in a practical setting. [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]

Risk management challenges in psychiatry are made more complicated when they involve the treatment of patients with primary or co-occurring personality disorder pathology. Principles of transference-focused psychotherapy (TFP), a treatment empirically validated for borderline personality disorder (BPD) and with utility for patients with varying personality disorder presentations, are practical, commonsense measures that can guide clinicians in these difficult matters. Applied TFP principles are useful in this area even when clinicians are not engaged in an extended individual psychotherapy. Central to the TFP approach are: (1) an openness to identifying personality disorder pathology; (2) a deliberate process to assess personality disorder diagnoses with attention to severity of illness; (3) an emphasis on the informed consent process, which includes sharing fully with the patient the clinician's diagnostic impression with germane psychoeducation; (4) an expectation for timely contacts at the outset of treatment with prior practitioners and with family members, when indicated; and (5) the development and maintenance of a treatment frame. TFP stresses the active monitoring of three channels of communication (what the patient says, how the patient behaves, and the clinician's countertransference) as a guiding precept that informs clinical decision-making. TFP principles can serve as a useful risk management "checklist" by organizing a clinician's approach to inherently confounding material. [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]

Little is known about cross-cultural supervision dynamics between Black, female supervisors who provide clinical supervision of White supervisees. This study examined transference enactments which occurred between Black, female clinical supervisors (N = 57) and White supervisees. The results show that White supervisees' racist and sexist behaviors towards the Black, female supervisors demonstrated remnants of stereotypical images historically attributed to Black women (i.e., Mammy, Jezebel, and/or Sapphire). Moreover, the findings highlight the need to initiate multicultural awareness, knowledge, and skills to enhance clinical skills. The paper concludes with recommendations for cross-cultural supervisory dyads and implications for future research. [ABSTRACT FROM AUTHOR]

The current article focuses on client’s perspectives of the mechanisms of change in Dynamic Interpersonal Therapy (DIT), a brief psychodynamic therapy developed for the treatment of depression. Five participants were interviewed and the transcripts were analysed using Interpretative Phenomenological Analysis (IPA). The results point out four subthemes, capturing different active ingredients of DIT: therapy shedding light on previously sealed aspects of self; the relational exchange with the therapist challenging intimate fears; moving towards an interpersonal understanding of their difficulties; and putting the pieces of their lives together into a coherent narrative. Overall participants described an interplay between relational and insight-oriented mechanisms taking place. As part of the former mechanisms, participants reported the development of a secure attachment to their therapist and the provision of a new relational experience, partly via mechanisms corresponding to the concept of transference. Participants reported an increase in insight to have been achieved via an understanding of an interpersonal and emotional pattern as well as via the restoration of a coherent life-story. Processes that theoretically map onto the concept of mentalisation were also reported. The findings are discussed in relation to the DIT and psychodynamic theory about change and to relevant research literature. [ABSTRACT FROM AUTHOR]

This paper explores psychodynamic therapy with young women with Aspergers Syndrome through the use of a composite case study. It seeks to make sense of a female patient’s obsession with a figure from celebrity culture - ‘Tom’ from ‘Britain’s Got Talent’. The potential use of ‘Tom’ by the patient as an idealised object, an autistic object, a transitional object and a transformative object is considered. Drawing on Rosenfeld’s concept of pathological narcissism and Meltzer’s concept of ‘aesthetic reciprocity’, the paper seeks to make sense of both the defences that the patient utilises and the impact of the deficits she has experienced. Attention is given to the development of the therapy through the use of play and work in the transference. Gradually, the patient becomes more able to tolerate separateness and in doing so becomes more connected to her own internal world and the feelings of others. In so doing, she becomes more aware of her actual social marginalisation and gains a greater sense of awareness of her diagnosis. [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]

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]

Background: In psychodynamic psychotherapy, one of the therapists' techniques is to intervene on and encourage exploration of the patients' relationships with other people. The impact of these interventions and the response from the patient are probably dependent on certain characteristics of the context in which the interventions are given and the interventions themselves. To identify and analyze in-session effects of therapists' techniques, process scales are used. The aim of the present study was to develop a simple, not resource consuming rating tool for in-session process to be used when therapists' interventions focus on the patients' relationships outside therapy. Methods: The present study describes the development and use of a therapy process rating scale, the Relational Work Scale (RWS). The scale was constructed to identify, categorize and explore therapist interventions that focus on the patient's relationships to family, friends, and colleges Relational Interventions and explore the impact on the in-session process. RWS was developed with sub scales rating timing, content, and valence of the relational interventions, as well as response from the patient. For the inter-rater reliability analyzes, transcribed segments (10 min) from 20 different patients were scored with RWS by two independent raters. Two clinical vignettes of relational work are included in the paper as examples of how to rate transcripts from therapy sessions with RWS. Results: The inter-rater agreement on the RWS items was good to excellent. Conclusion: Relational Work Scale might be a potentially useful tool to identify relational interventions as well as explore the interaction of timing, category, and valence of relational work in psychotherapies. The therapist's interventions on the patient's relationships with people outside therapy and the following patient-therapist interaction might be explored. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Davanloo's Technique of Total Removal of Resistance and Optimum Mobilization of the Transference Component of the Resistance" by Catherine Hickey in volume 42, issue 4.

The popularity of mindfulness and mindfulness-based interventions (MBIs) has seen authors from various psychotherapeutic orientations proclaiming the mindfulness status of their respective approaches. Despite a long tradition exploring the parallels between psychoanalysis and Buddhism, few authors have critically examined the relationship between contemporary psychoanalytic therapy and MBI. Those who have addressed this issue tend to be integrative psychotherapists who promote active mindful interventions in psychoanalytic therapy at the expense of identifying those features that distinguish psychoanalytic treatment from mindfulness-based orientations. In this article, I argue that the analytic attitude is inherently and necessarily mindful insofar as it invites psychotherapy patients to observe and tolerate defensively avoided experience. However, psychoanalytic therapy goes beyond this by emphasizing the interpretive elaboration of experience in the context of the transference relationship and resistance to exploring this. The analytic attitude also runs counter to the prescription or teaching of meditative techniques, which may function in the service of the therapist's counter-resistance. A psychotherapy vignette is used to illustrate that while psychoanalytic therapy certainly includes a mindfulness component, understanding the unconscious significance of mindfully tolerated experience is the hallmark of the psychoanalytic process. This makes psychoanalytic therapy mindfulness-inclusive, rather than mindfulness-based. [ABSTRACT FROM AUTHOR]

Davanloo's Intensive Short-term Dynamic Psychotherapy has been the subject of various reviews. The first article in this series focused on a review of Davanloo's early work as well as a discussion of some of his most recent research findings. A case from the Montreal closed circuit training program was reviewed. This second article will focus on Davanloo's views on the transference neurosis and how its development should be avoided at all costs. There will be further exploration of the case presented in Part I from the Montreal closed circuit training program. There will also be a special focus on detecting the transference neurosis when present and the technical interventions needed to lay the foundations for removing it. [ABSTRACT FROM AUTHOR]

This article summarises the current position of evidence-based psychodynamic psychotherapies aimed at the treatment of borderline personality disorder - mentalisation-based treatment and transference-focused psychotherapy - noting the main challenges they face, especially in the area of dissemination. [ABSTRACT FROM AUTHOR]

The article discusses the author's views on the benefits of transference-focused psychotherapy training to psychiatry residents. She references and commends the study of Bernstein et al. on the practice of psychodynamic psychotherapy and discusses how it can build competence to effectively teach and learn psychiatry or to avoid alienating skeptical students. The author hopes the elective could be translated into a model residency curriculum in the field of psychiatry.

Competency in psychodynamic psychotherapy is a requirement for residency training in psychiatry. However, for a variety of reasons, learning psychodynamic psychotherapy is difficult for residents. In this article, we share our experience in an elective in Transference-Focused Psychotherapy (TFP), a manualized treatment for severe personality disorders. Originally, this elective was conceptualized as an advanced component of training, offering specialized training in treating a subgroup of patients with severe personality disorders with a specific type of psychodynamic psychotherapy. However, contrary to the expectations of the residents and the training director, the elective in TFP strengthened understanding of core components of basic psychodynamic psychotherapy with all patients, not just those with severe personality disorders. We discuss various challenges in learning psychodynamic psychotherapy and how TFP served to address them. Two case vignettes illustrate several key points. [ABSTRACT FROM AUTHOR]

Taking a two-person (Stark, 1999) and political approach to psychotherapy, the authors discuss the potential for multiple games occurring contemporaneously in the therapeutic dyad and illustrate the psychodynamics of such games by referencing ego state relational units (Little, 2006). The article describes how an overly simplistic approach to supporting autonomy can lead to an oppressive use of theory and the potential colonization of clients. Clinical examples and the idea of dilemma transactions are offered to demonstrate therapeutic options for working with multiple contemporaneous games. [ABSTRACT FROM AUTHOR]

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]

The article offers information on a study related to patients' representation of therapeutic dialogue and the outcome of therapy. Topics discussed include enhanced sustained improvement after termination is by positive representations of the therapeutic dialogue; use of Therapist Representation Inventory to assess the impact of dialogues in recovery; and the result of the study that showed no significant impact of conscious positive memory of the therapist on outcome.

The article presents a response by the authors of "Unmentalized Aspects of Panic and Anxiety Disorders," to the discussion by Michael Robbins, published in the Vol. 42, Number Two, June 2014 issue. Clarifications discussed include panic-focused psycho-dynamic psychotherapy (PFPP) being an evidence-based psycho-dynamic treatment for panic disorder, focused approach of PFPP on panic and anxiety disorders, and transference as central feature of PFPP.

The article presents the author's response to the views of Larry S. Sandberg and Fredric N. Busch regarding the author's critique of their work. Topics discussed include offering information not contained in the article such as transference as central feature of panic-focused psycho-dynamic psychotherapy (PFPP), assertions at odds with statements and practices found in the article and misrepresenting the author to claim sufficiency of classical techniques.