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Some patients are unable or unwilling to step into the difficult and uncharted explorations that psychoanalytic work entails; in this paper the author shows how the effort to establish analytic contact with each individual can provide a level of valuable support, containment, and growth for many patients. Such patients may display great resistance to the challenge of psychoanalytic treatment, subtly inviting the analyst, through projective identification processes, to succumb to countertransference acting out. These turbulent patients often leave treatment in very abrupt and unprocessed manners. It is suddenly all over and that is that. This abrupt dismissal is usually a continued expression of the remaining pathology and conflictual phantasies that had been played out in the transference throughout the span of the analytic process. We cannot always prevent this. Rather than seeing this as a complete failure, we can try to maintain ourselves within the depressive position by realizing we are being used by turbulent patients as provisional placeholders and temporary containers. This is a model of grieving in which we acknowledge and accept what we cannot have, what we are not, and what should be but is not. Struggling with these issues in the countertransference is critical to our ability to help such patients because these are the exact issues the patients cannot bear in their lives. And, if we cannot bear them, then the patient has no hope of ever surviving them. [ABSTRACT FROM AUTHOR]

In this paper, the case is made that providing therapy to a client can be therapeutic for the therapist. Therapist change is not intentionally sought nor professionally delivered, but is from those client interactions experienced as healing. The possible mechanisms of change for the therapist include exposure of much about him- or herself, being "on the line" in therapy, and the therapeutic relationship as a collaborative, two-way system. In the collaborative system, much might affect a therapist, including how the client understands and reacts to the therapist's disposition, motivation, self-disclosure, and skill and what the client reveals about his or her life that may lead the therapist to a new sense of her or his own life. [ABSTRACT FROM AUTHOR]

It is difficult to locate, understand, and interpret the transference state of some patients In the course of psychoanalytic treatment. This paper examines the use of the countertransference to assist in making "analytic contact," the analyst's attempt to engage the patient in an exploration of unconscious phantasies, transference patterns, defenses, and internal experience of the world. The goal of analytic contact is the identifying, understanding, and working through of core object relational phantasy states. Countertransference can be valuable in helping analysts find their way to the transference, especially when projective identification processes exclusively shape it. Case material, examined from a Kleinian perspective, is used to show work with patients exhibiting difficult to access transference states primarily determined by projective identification based phantasies. [ABSTRACT FROM AUTHOR]

Many types of non-professional, non-credentialed relationships are seen by laypersons as analogous to those occuring in psychotherapy. This paper takes a leap backwards several centuries and describes two examples of one such type of interaction as portrayed in artistic masterpieces. In Miguel de Cervantes' novel, "Don Quixote," an elderly, depressed man pursues a restitutive and grandiose delusion of being a heroic knight errant. In Ingmar Bergman's film, "The Seventh Seal," a disillusioned knight returns from the Crusades to face the lethal bubonic plague, and he uses obsessional means in an attempt to outwit death. Both men are accompanied by squires who try, with varying degrees of success, to help their masters relinquish their infantile needs for omniscience and omnipotence, accept their human limitations, and deal more appropriately with their surrounding realities. The powerful and inspiring insights of both works have much to teach contemporary therapists whose patients wear more metaphorical suits of armor. [ABSTRACT FROM AUTHOR]

Therapists who are accustomed to operating in a world where gender roles are becoming increasingly androgynous may underestimate how foreign the experience of psychotherapy can be to "traditional" men. This paper describes the occurrence of transference and resistance encountered by female therapists when seeing male patients at a Veterans Administration (V.A.) Medical Center who identify with traditional American male gender roles. The discussion is informed by recent advances in the theory of male gender identity development and yields new insights into the typical defenses men may bring to the early phases of psychotherapy. Case examples from the authors' practices illustrate strategies for intervening with resistance and enhancing the therapeutic alliance. Common countertransference issues encountered by therapists working with "traditional" men are also discussed. [ABSTRACT FROM AUTHOR]

Patients seek psychotherapy for relief of symptoms and resolution of problems in living. Yet, they sometimes balk at the prospect of having to choose a topic without being prompted by therapist questions. This paper suggests that this apparently self-sabotaging behavior represents an acting out of a fundamental existential dilemma for many individuals, i.e., to be or not to be an adult. Adulthood comes with the heavy burden of responsibility for making life choices, and the possibility of making the wrong choices. The psychotherapeutic situation, with its demand that the patient choose a topic, is a microcosm of the adult-adult relationship. The author proposes that the proper treatment for these patients is Generative Caring Psychotherapy, which promotes emotional growth and facilitates patients' transition from childhood dependence to adult responsibility. [ABSTRACT FROM AUTHOR]