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This article explores the problems of the frequent loss, in the course of treatment, of the initial goals and motivation for treatment by both patient and therapist, and the connected lack of clarity of the real initial motivation for treatment on the part of both participants. It is strongly proposed that a true coincidence of at least one important initial motivational goal of patient and therapist is essential to assure the success of psychotherapy and that particular care is required to establish such agreement. On this basis, the goals of therapy may be expanded in the course of the therapist's experience, countertransference, and the patient's changing reality during treatment, and the existential and philosophical value systems of the therapist may play an important role in such widening of the therapist's expectations for the patient. [ABSTRACT FROM AUTHOR]

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]

The numbers of people with the time, interest and economic resources to commit to psychoanalysis as a patient and/or as a candidate are dwindling, and psychoanalysis is an ageing profession. Others have sought to maintain that it is not appropriate to ask these kinds of questions of psychoanalysis (e.g. Hoffman [13]; Stern [25]), but it is hard to deny that the relative lack of an evidence base has contributed to the declining status of psychoanalysis. " Psychoanalysis, Psychoanalytic Psychotherapy and Supportive Psychotherapy: Contemporary Controversies." The concept of identity seems only latterly to have become a concern for psychoanalysts. [Extracted from the article]

Background: In order to comply with the 2020 health restrictions, many psychotherapeutic approaches have begun to hold online sessions, including psychodynamic psychotherapy, for which this modality marked a new procedure. The authors are psychologists with a psychoanalytic background, who mostly work with bereaved people. They considered it essential to initiate research, not only on online psychodynamic psychotherapy, but also on the scientific results regarding this practice used explicitly in cases of bereavement. For these reasons, two literature reviews were conducted according to the PRISMA protocol concerning: the use of online psychodynamic therapy in general (1), and its use in cases of bereavement (2). Methods: The databases used were PubMed, Cochrane Library, and Google Scholar, Eric and Web of Science. Inclusion criteria contains peer-reviewed scientific articles published in English from 2010 to 2022, with a focus on online psychodynamic psychotherapy and bereavement cases. Exclusion criteria included non-peer-reviewed studies, non-English articles, systematic reviews, quantitative scale validation studies, research protocols, and studies primarily focused on training. Compared with the research on the effectiveness of psychodynamic psychotherapy conducted online with all the different types of patients (1), only 5 research papers were selected from 842,103 articles. Out of 431,372 articles on the use of psychodynamic teletherapy with bereaved patients (2), in the end no articles were selected. Results: The results suggest that online psychotherapy involves a dynamic process very similar to faceto- face therapies. The small number of articles selected for both reviews underscores the need for further research on this topic. Conclusions: Since psychodynamic psychotherapy is based on concepts that are difficult to standardize (such as countertransference or free association), it is possible that clinicians and researchers have not yet found specific ways to validate it online. [ABSTRACT FROM AUTHOR]

Taking the liberty of imagining the lawyer in Melville's "Bartleby, the Scrivener" as narrator/therapist and Bartleby as patient, this article, written with the therapist/reader in mind, traces the vicissitudes of countertransference and speculates on what constitutes a "good enough" therapeutic effort. [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 therapeutic encounter with psychotic patients presents therapists with moments in which they may regress, together with the patient, toward primitive and psychotic areas of experience. Within this shared psychotic world, therapists might feel persecuted, as if the ground is slipping from beneath their feet. The author suggests that the psychotic part of the personality, as argued by Bion, is inherent to all of us and may come alive in the psyche of the therapist in response to patients in psychotic states. The psychotic dialogue that emerges between patient and therapist, which involves projective identification and counter-transference mechanisms, must be worked through. Therapists' capacity to survive the psychosis forced upon them and to move through and beyond it is highly significant. By examining clinical material from therapy with a patient diagnosed with schizophrenia, the author discusses this unique countertransference phenomenon, which he terms induced psychotic countertransference. [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]

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]

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]

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.

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]

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]

Background Ruptures in the alliance are co-constructed by clients and therapists, reflecting an interaction between their respective personality configurations [Safran, J. D., & Muran, J. C. (2000). Negotiating the therapeutic alliance: A relational treatment guide. Guilford Press]. In order to work effectively with ruptures, therapists should be aware of their own feeling states, acknowledging the subjectivity of their perceptions [Safran, J. D. (2002). Brief relational psychoanalytic treatment. Psychoanalytic Dialogues, 12(2), 171–195. https://doi.org/10.1080/10481881209348661]. Lack of such awareness may be a product of countertransference (CT), which has been shown to be inversely related to outcome. However, when effectively managed, CT contributes to positive outcome [Hayes, J. A., Gelso, C. J., Goldberg, S., & Kivlighan, D. M. (2018). Countertransference management and effective psychotherapy: Meta-analytic findings. Psychotherapy, 55(4), 496–507. https://doi.org/10.1037/pst0000189]. Objectives: The present study examined the associations between types of CT and therapists' reports of ruptures and resolutions. Method: Data were collected from 27 therapists, who treated 67 clients in yearlong psychodynamic psychotherapy. CT patterns were assessed based on therapists' Core Conflictual Relationship Themes with their parents, which were repeated in narratives about their clients [Tishby, O., & Wiseman, H. (2014). Types of countertransference dynamics and their impact on the client–therapist relationship. Psychotherapy Research, 24(3), 360–375. https://doi.org/10.1080/10503307.2014.893068]. Results: Negative CT patterns were associated with more ruptures and less resolution. Positive patterns predicted resolution when the therapists repeated positive patterns with parents, but predicted ruptures when they tried to "repair" negative patterns with the parents. These results point to the importance of therapists' awareness of their CT in order to deal effectively with ruptures and facilitate resolution. [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]

According to our clinical experience, children who were neglected or maltreated at a young age show a peculiarity in psychodynamic play psychotherapy: they often play in and with the dark. How can children who often experience traumatic situations in the dark be so keen to sneak into it to play? As far as we know, no author has pointed out this characteristic of maltreated children's play, and there is very little literature on the general subject. The purpose of this article is fourfold. Firstly, it aims to explore the symbolic value that the dark might have for these children. Secondly, it aims to describe some typical psychological mechanisms of the psychic functioning of traumatized children, which may explain why the dark has become a useful play space for them. We suggest that darkness became a transitional space in which they can ignore the environment to avoid their imagination being hampered by the constraints of physical reality. Thirdly, the article elaborates on the technical characteristics and counter-transference issues related to playing in the dark. Fourthly, it uses several examples to illustrate how playing in the dark unfolds, and how the dark can become a decisive factor in the play of traumatized children. [ABSTRACT FROM AUTHOR]

This paper seeks to be a perspective of psychodynamic psychiatry, an attempt to explain the delirium of a patient with schizophrenia over 30 years old, who has lost his home, identity card and inner coherence of the Ego. He lives in a space - as real as it is symbolic - inside a psychiatric polyclinic and expresses his free consent to expose his personal perspective, an interpretive one on his own life, in which we glimpse fragments of former truths, through cosmogonic delirium. The paper also describes the countertransference reactions aroused in the participants in the working group, and, especially, the importance of unconsciously supporting such a patient with multiple hospitalizations in psychiatric departments, so as superimposed to the antipsychotic background he can be able to recompose his old personality. [ABSTRACT FROM AUTHOR]

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]

Repetitive self-mutilation or non-suicidal self-injury (NSSI) refers to the intentional destruction of one’s own body tissue without suicidal intent and for purposes not socially sanctioned. Common examples include cutting, scratching, and hitting. Although NSSI generally has been considered a characteristic symptom of borderline personality disorder, its onset and prevalence typically occur in mid-adolescence, whereas the typical onset of borderline personality disorder is in early adulthood. Therefore, NSSI should be considered separately from borderline personality, but also from a psychodynamic perspective. From the classical psychoanalytic viewpoint, self-mutilation is associated with the failure to control aggressive drives. In ego psychology, self-mutilation is seen as an attempt of the fragile ego to re-establish boundaries with the external environment and avoid being overcome with uncontrollable emotions. In object-relation theory, it is seen as an effort to reconstruct unclear boundaries between ego and object or ego and reality by cutting the skin-the fundamental separation between them. Self-mutilation- can interfere with the psychotherapy by increasing or decreasing transference or causing strong countertransference. The therapist might experience helplessness or anger at repetitive self-mutilations and, with an adolescent patient, might be conflicted about telling the facts to parents or maintaining the patient’s confidentiality. In conclusion, consideration of various psychodynamic aspects is important in understanding and treating patients with NSSI. [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]

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]

Although Blatt's two-polarity model of depression has suggested that patients' interpersonal styles may shape countertransference phenomena in psychotherapy, empirical research on this topic has remained scarce. This article provides an in-depth study of countertransference processes in clinical work with dependent (anaclitic) depressed patients using a qualitative methodology. Thematic analysis of narrative material of psychodynamic therapists discussing patient cases during supervision (n = 7) resulted in four recurrent themes: "empathy, compassion, and support," "anxiety, feeling overwhelmed, and protection," "frustration, irritation, and confrontation," and "inadequacy, incompetence, and fatalism." We found that these countertransference processes mainly revolved around perceived adaptive and maladaptive aspects of patients' relational functioning. Regarding clinical practice, our study suggests that therapists can use countertransference to determine in which position they are maneuvered by patients, although we caution against the exclusive use of subjectively informed data as a benchmark in the diagnostic and treatment process. We conclude that further in-depth research on countertransference and personality styles is needed to identify pitfalls in the treatment of depression. [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]

Narcissistic personality disorder is a pleomorphic entity that requires the psychodynamically oriented therapist to tailor the approach to the characteristics of the individual patient. Psychodynamic principles encompass a broad range of interventions depending on the patient's specific characteristics. The therapist's interventions range from interpretation of the transference to supportive approaches that emphasize empathic validation and direct advice. In the absence of systematic data on these variations, this article attempts to offer clinically based principles. Several themes are emphasized: the experience of shame, the predictable transference-countertransference developments, the role of comorbidity with other personality disorders and traits, and the approach to resistances. [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]

The psychodynamic treatment of dying cancer patients is a relatively neglected area in practice and the literature. Death anxiety in these patients often results in countertransferences that lead therapists to exclude dying patients for treatment or avoid discussing their patients' concerns about dying. This article offers the reader an exposure to a clinician's immersion in the psychodynamic treatment of cancer patients for over 40 years and offers recommendations that meet the needs of patients facing death. Interventions that may lessen the patient's death anxiety and the therapist's countertransferences include: advocating for the patient's quality of life, taking a common sense approach to denial, helping the patient accept "uncertainty" regarding prognosis, providing a flexible approach that includes support and medication, validating the patient's life contributions, elevating the patient's self-esteem, and exploring the patient's concerns about dying. In addition, the article will also provide many case examples of meaningful psychotherapeutic work at the end of life, including mastering longstanding psychological conflicts, forgiving oneself for past mistakes, establishing a legacy, and healing relationships. [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]

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 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]

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]

While the construct of countertransference has been established in psychodynamic theory since its inception, it has received relatively little attention from cognitive-behavioral theorists. However, it is generally agreed that therapists’ reactions to patients powerfully influence treatment, for better or worse. Suicidal patients in particular are likely to evoke negative reactions in therapists. In this paper, we briefly review the theoretical literature on countertransference, with particular attention to suicidal patients, from standpoints of psychodynamic and cognitive-behavioral theory and research. We argue that the cognitive-behavioral perspective, together with the RAIN model proposed by mindfulness authors (Recognition, Acceptance, Investigation, and Non-Identification), opens avenues to assess, distance from, and perhaps modify cognitions that could lead to counter-therapeutic emotions and behaviors in working with suicidal patients. We conclude that, while work with suicidal patients can be challenging, cognitive-behavioral therapists can potentially improve effectiveness and enhance their own well-being by managing their reactions in a manner consistent with their theoretical orientation. [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]

Originally a psychodynamic concept, the therapeutic relationship (also therapeutic alliance, helping alliance or simply alliance) has become a pan-theoretical model for the professional relationship between a therapist and his or her client (Kivlighan, 1995). With the development of this concept in the latter half of the 20th century, psychotherapeutic theory and practice saw a paradigm shift away from strict adherence to technique with little room for responsive, individual behavior from the therapist and toward the 'authentic' human relationship at the core of therapy. This meant that more consideration was given to the idea of mutual influence from patient and therapist to the success of therapy (Safran & Muran, 2006). This article aims to provide a comprehensive overview of the complex and shifting research on the therapeutic relationship to promote a greater understanding of the concept. [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]

An NHS Mental Health Trust Medical Psychotherapy Consultation Service using psychoanalytic psychiatry to help the patient and professional is described. The Consultation Service established in 2000 is offered to secondary acute and community mental health teams and primary care. The service was evaluated as a basis for regional and national development. Between 2006 and 2013, 87 consultations from 210 were sampled to ascertain demographic and diagnostic profiles and outcomes of the consultation process. We conducted an online survey of local consultant psychiatrists' views about the service, and undertook a thematic analysis of the free text comments. We also conducted a survey of members of the Royal College of Psychiatrists' Medical Psychotherapy Faculty to ascertain whether similar consultation services existed elsewhere in the UK and had been evaluated. The Leeds model of psychoanalytic consultation – a 'consultation sandwich' – is described. From a psychoanalytic perspective, the work of consultation is seen as an extension of the dynamic field of the analytic situation. This paper develops the concept of a bastion – an omnipotent reserve in and between the patient and professional derived from adhesive identifications leading to stuck relationships. The adhesive identification in the patient and professional acts like a 'grievance glue' – a mutual manifestation in a last bastion of painful limitations not faced, losses not grieved. [ABSTRACT FROM AUTHOR]