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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]