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This paper hopes to enhance understanding about entrenched grievance in a couple of ways: (a) Initially, the paper reviews how entrenched grievance reflects melancholic states of mind in terms of its avoidance of the pain of loss and change. But the main contribution of the paper is likely to be found in (b), that is, via detailed clinical material, the paper illustrates how earnest efforts on the part of the analyst to bring understanding may lead to cognitive entrapments such as the convictions incumbent in the “knowing” analyst. Further, that this knowing analyst may need to become aggrieved, that is, narrow, impatient and concrete towards her patient’s entrenchment, and then to recogize this plight in herself before she can genuinely hear her patient’s grievance about her from a wider view, that is as a complaint from the “lively self”, deserving recognition. The clinical detail demonstrates that such recognition softened the patient’s grievance, allowing both members of the dyad to become more collaborative and open to the pains and growth available from mourning states of mind. [ABSTRACT FROM AUTHOR]

Measurement of countertransference (CT) has proven challenging throughout the history of studying this construct. We sought to determine the potential value of using a common measure of transference, the Core Conflictual Relationship Theme (CCRT) method, as a means of studying CT. The Relationship Anecdote Paradigm and the CCRT method were used to examine CT in two studies. In Study 1, we examined the correspondence between a therapist's wishes with significant people in her life (i.e., her parents and husband) and three long-term patients. In Study 2, we identified the interpersonal wishes of a different therapist and examined 14 of her sessions with 3 patients for evidence of how these wishes and needs were displayed in her clinical work. Analyses revealed that specific wishes in therapists' personal lives could be detected from projective interviews and these wishes were similar, but not necessarily identical, to wishes in therapists' descriptions of, and actual work with, their patients. Evidence of both chronic wishes and patient-specific wishes was revealed. These findings support the idea that the origins of CT reside in therapists' interpersonal wishes and that the CCRT may be a promising means of identifying CT in research, practice, and supervision. [ABSTRACT FROM AUTHOR]

Psychoanalytic theory and practice consider both transference and countertransference as cornerstones for understanding those complicated psychological phenomena which psychoanalysis and psychoanalytic psychotherapy bring to light. The relationship between a patient and a psychoanalyst has been the crucial point on which our attention and interest is focused. In the intersubjective space of psychoanalytic psychotherapy, all interactions between the patient and the analyst are considered to mutually influence each participant of the analytic dyad. Together with patients, clinicians get involved in ambiguous, uncanny and unavoidable enactments. The understanding of the latter requires from a psychoanalyst not only to contain the patient's anxiety and reflect on the patient's inner feelings but also to stay open to the gamut of feelings, anxieties and conflicts that arise from the professional's experience. I suggest that accomplishing the complicated task of understanding both the patient's and his own feelings and experience leads the analyst to the necessity of restoring links with himself. By means of clinical material, I make an attempt to show how the process of understanding an uncanny enactment becomes for the therapist a process of restoring the links in countertransference which, in turn, enables the therapist to interpret the patient's specific difficulties. [ABSTRACT FROM AUTHOR]

I explore some similarities between experiences of music and of analytic sessions. I focus on qualities of evanescence, the way that music – in contrast to many other arts – in one perspective only lasts as long as it is actually being played. Then it's over. The analyst-patient discussion in a session is similar. Yet the psychic reverberations of some transient, fugitive moments may last a lifetime. And even when no verbally profound understanding is occurring, nevertheless the patient-analyst encounter is emotionally significant. I illustrate this with a clinical example. I explore transference as illusion, and the relationship between truth and illusion in terms of Bion's O. I end with thoughts about the paradoxical value of the illusoriness of aesthetics and nature as considered by Freud in his short paper "On Transience" (1916), and the grin of Lewis Carol's Cheshire Cat, left hanging in the air. [ABSTRACT FROM AUTHOR]

Dissociative identity disorder (DID) is life-long, childhood-onset, posttraumatic developmental disorder where chronic early-life maltreatment and attachment disturbances prevents the child's development of a continuous sense of self across emotional states, relationships, and social contexts. As development proceeds, these self-states acquire a sense of themselves, a capacity for information processing, memory, emotion, and behavior. Conceptualizing DID involves paradoxes and apparent contradictions. DID has been categorized as a severe mental illness with major psychiatric comorbidities. Studies show that DID individuals have a unique personality organization with repeated, often covert posttraumatic reactivity, especially in relationships (e.g., therapy). Paradoxically, research shows that, during development, DID individuals preserve psychological resiliencies consistent with responsivity to long-term, psychodynamically informed treatment. These include, when not stressed, capacities for therapeutic alliance, reality testing, and observing ego. [ABSTRACT FROM AUTHOR]

This paper is a presentation of the concept "transference" in psycho-analysis. In Freud's thought, transference movements are new editions, copies of tendencies or phantasies that are the repetition of infantile prototypes, relived with a lively feeling of actuality. The text shows Freud's reflection on transference, and the importance of the countertransference which has been much developed by the post-freudians authors. Then, the principal forms of transference are presented, for example passionate transference, or transference by reversal. The psychoanalytic reflection about transference leads to study the analyst's neutrality, and to pay attention to the setting of the sessions. André Green emphasizes that the transference that is addressed to the analyst is at the same time a transference on the setting and on to speech. In the complexity of the "analytic situation" (Donnet), speech is transformed under the effect of the transference address (Rolland). [ABSTRACT FROM AUTHOR]

This brief introduction gives an historical outline of the development of the concept of transference in the different psychoanalytic traditions. It goes back to the various meanings of the German term "Übertragung" – transference, transcription, transmission, transposition and assignment – and how they were accentuated by the different psychoanalytic schools. The paper depicts the transition from a mainly intrapsychic understanding of transference as repetition to a more bipersonal and intersubjective approach exploring the different meanings of "intersubjectivity" and the forces that operate within the analytic field. Major developments arose from a new understanding of the role of the analyst's countertransference and the detection of transference mechanisms in narcissistic, borderline and psychotic states. The exploration of different forms of splitting and projective and introjective identification deepened the understanding of the analytic communication and led to concepts like "acting in", role-responsiveness, "actualization" and "enactment". As the author tries to show, all these approaches can find a legitimization in Freud's original writings, but the main differences concern technical issues, i.e. the interpretation of transference. [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]

In this article, I write of an 11-year odyssey with a patient who despite our best efforts, remained mired in emotional deadness, anomie, and depersonalization. The journey led me to question my core assumptions about co-creating an effective therapeutic alliance as well as my competence as an experienced psychotherapist-psychologist, well-trained in empirically validated treatments. What I realized was a failed treatment, that led me to pursue psychoanalytic training. In the process, I grew to understand that our parallel traumatic life histories, and my inadvertent and unconscious reluctance to acknowledge my own countertransference, kept me from joining with him in the intersubjective experience of profound grief – that which, in retrospect, I believe would have made all the difference in his treatment. [ABSTRACT FROM AUTHOR]

The objective of the paper is to explore countertransference in qualitative research. Specifically, through the examination of a study which explored the experiences of mental health professionals working with refugee and immigrant families with infants and young children, the paper aims to demonstrate how the monitoring of countertransference can be transformed into a useful research tool. Countertransference movements are examined on multiple levels, in the mental health worker-immigrant/refugee dyad, in the researcher-participant dyad, and at the institutional level. The importance of thinking about a whole research process in terms of the process of countertransference is discussed. [ABSTRACT FROM AUTHOR]

We investigate the relationship between clinicians' inclination toward treating patients at risk for suicide (PRS), and self-reported countertransference (CT). We consider these observed group differences to explore two competing interpretations for observed CT patterns from a primary study; whether CT patterns are more consistent with defensive attitudes or an adaptative CT montage. We used one-way ANOVA, Tuckey post-hoc, and t-test, to compare clinicians (n = 267) grouped by self-ratings of positive, neutral or non-positive inclination toward working with PRS, with regard to their level of endorsement of the Therapist Response Questionnaire (TRQ) with PRS. We hypothesized that positively inclined clinicians would demonstrate greater CT literacy skills than other clinicians, reflected in lower endorsement of negative/hindering CT and higher endorsement of positive/facilitating CT to PRS. Compared to non-positively inclined clinicians, positively inclined clinicians endorsed significantly lower levels of two potentially negative/hindering CT dimensions, factor 1: entrapped/rejecting and, factor 5: protective/overinvolvement, and higher levels of the only positive/facilitating CT dimension, factor 2: fulfilled/engaging. Neutral clinicians reported similar CT patterns to positively inclined clinicians. Hypothesis of greater CT literacy from positively inclined clinicians appears supported. Observed differences in CT endorsement by inclination group tend to support the CT montage interpretation of our original findings more than the defense mechanism interpretation proposed. Similarities in CT patterns between positively inclined and neutral clinicians suggest that positive inclination to PRS, as assessed in this study, may not be countertransferential per se. [ABSTRACT FROM AUTHOR]

In the context of the treatment of perpetrators of violence, psychodynamic discourse has often focused on individual aggression and other related emotions and mental phenomena, such as anger, rage, cruelty, sadism and brutality. Psychodynamic theory has been less explicit, however, about how to address an individual's actual violent acts within the psychotherapeutic setting. This article aims to address this gap. It illustrates how psychoanalytic theory – most notably through Winnicott, Fonagy and Glasser – can be used to inform thinking about, and interventions with, men who use violence against their children and partners, using a clinical case that describes psychotherapeutic work with a perpetrator of domestic violence. The article concludes that the psychotherapist's countertransference is an important tool in working with men who use violence, and highlights the importance of the therapist's capacity for impulse regulation, emotional understanding, and handling of his or her own aggression. [ABSTRACT FROM AUTHOR]

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]

Ted has been teacher, colleague, and friend to me throughout my professional life. There was something about Ted's person that resonated with me. I felt his presence when I began training at Albert Einstein College of Medicine, where I did my internship and clinical fellowship, and again as I was going through training at NYPSI. Once I graduated, I had the good fortune of being invited to a study group with Ted, Charlie Brenner, and many other senior analysts. I was most impressed with his ways of thinking, his humanity, which came across vividly in his work and in his responses to others. He had an openness and dedication to finding ways to reach each individual patient. I especially admired his emphasis on turning to the evidence from the patient, and his focus on really helping his patients with what was central to them, not having to stick to analytic rules. He was courageous in his willingness to present his careful analytic work when his focus on countertransference was not considered appropriate at the time, with much backlash from others. In terms of Ted's importance to psychoanalysis, starting in the 70ʹs, he focused in on an area of psychoanalysis that was quite undeveloped at the time – the analyst's use of his self, except for a few strong voices from the Kleinians (Heiman, 1950, Racker, 1953), though of course many others later. Ted could see the limitation of focusing only on the transference, omitting countertransference. He focused on "what's happening between us" before any concept of the "analytic third" or "co construction" had been born. So much focus was on the intrapsychic – the only focus of a "true" analyst, at a time when the interpersonal was viewed as "nonanalytic." He brought his analytic lens, studying the analytic data in the countertransference, to the benefit of the psychoanalytic community, a focus quite different from relational analysis and interpersonal analysis. His influence on my own work was powerful. The shared background of training in a place with many gifted and talented people, who all were seriously involved in trying to learn analysis and apply the work to patients, but with an openness to new ideas, to valuing the data from the patient above loyalty to a particular theory, the lens on one's own feelings, thoughts, fantasies, attitudes to facilitate the most full understanding of the patient, all have enriched my understanding and appreciation of the analytic process. [ABSTRACT FROM AUTHOR]

A review of a clinical report by Harold Searles, attending to Searles' ways of working with psychotic patients, his influences and those he influenced, as well as contemporary thinkers (Laplanche), who speak as Searles did, of the power of the other in the construction of psychic life. [ABSTRACT FROM AUTHOR]

This study explored psychoanalytic supervisees' conceptualization of good supervision. Fourteen registered psychoanalytic psychotherapists recognized by the Irish Council for Psychotherapy were interviewed. Using Interpretative Phenomenological Analysis, interviews were analysed, and this process yielded two superordinate themes encompassing five subordinate themes. The superordinate theme providing illumination encapsulated the participants' experiences of illuminating the self and illuminating the client. The superordinate theme helping with emotional management referred to the participants' conceptualization of supervision as containing participants' difficult emotions, normalizing clinical difficulties and feeling accompanied. The findings are discussed in light of their implications for practice and theory. Of particular interest is the relief that participants felt when their fears and anxieties were addressed and worked through in supervision. In addition, the study builds a foundation for future research studies to explore the supervisee insight and identify more specific types of insight. [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]

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]

Countertransference, it is widely agreed can either deepen awareness of personal and relational dynamics to the benefit of the work or it can distort and become an impediment through the adoption of defences. The aim of this study was to explore what supported the development of countertransference awareness in an organisational context through a qualitative study. Semi-structured interviews were conducted with 15 therapists either face to face or online. The findings indicate that participants followed one of two pathways, a reflective pathway, where they developed their countertransference awareness to the benefit of the work, and a defensive pathway, the focus of the present paper. Here, the findings suggest that when the organisational setting, the supervisory relationship, and the adopted theoretical framework, did not support the thinking about the relational dynamics, including countertransferential responses, it resulted in the adoption of defences, to the detriment of the work with the client. The implication of the findings, including the limitations of the study and avenues for further research, are also discussed. [ABSTRACT FROM AUTHOR]

Why is so little written about the female analyst's sexual desire? Presenting a case where an older, cisgendered, heterosexual female analyst is unmoored by erotic stirrings toward her younger, cisgendered, heterosexual male patient, de Peyer challenges cultural and gender prohibitions against the acknowledgment of female analytic erotic arousal. Can the female analyst be both maternal and sexual? Engaging the complexities of an intersubjective collision between the analyst's desire and the patient's apparent absence of desire, this paper explores the emergence of dissociative transference-countertransference dynamics, along with culturally embedded associations to gender, power, the incest taboo, and the potential for ethical boundary violation. [ABSTRACT FROM AUTHOR]

The topic of countertransference (CT) has been a controversial one over the decades, and its various, often conflicting, definitions have made it difficult to gather clear and consistent empirical evidence about the phenomenon. The growing awareness that CT occurs across theoretical orientations has fueled the need for research on CT, its effects, how it emerges in treatment, and how it can be used to enhance psychotherapy. In this paper, we reflect on three studies published in the special section on CT that we believe advance the field of CT research. We also provide future directions for CT theory and research, including attending to CT definitions and their rationale in empirical studies, striving for methodological diversity, differentiating acute and chronic CT, and continuing to investigate CT management. [ABSTRACT FROM AUTHOR]

Objective: The aim of this work was to investigate the relationship between therapists' techniques (supportive/expressive intervention level – ESIL), therapists' countertransference (CT) and patients' defense level of functioning (ODF). We hypothesized that CT could play a mediating role in the relationship between patients' ODF and therapists' ESIL. Method: 65 psychotherapy sessions were rated by two different raters each with the Psychodynamic Interventions Rating Scale and the Defense Mechanisms Rating Scale. Clinicians used the Therapist Response Questionnaire to provide information on their CT. The 65 sessions referred to 65 clinicians (25 = females, 40 = males; 38 = psychodynamic, 27 = cognitive). More than half of the patients (n = 40; 61.5%) had a diagnosis of personality disorder. Among clinical disorders the most frequent were mood (n = 12) and anxiety disorders (n = 11). Five patients had no diagnosis. Results: Four CT responses (parental; positive; criticized; overinvolved) completely mediated the relationship between patients' ODF and therapists' ESIL, while no effect resulted in relation to overwhelmed, helpless, sexualized and disengaged CTs. No effect of theoretical orientations on mediation pathways was found. Conclusion: Both positive and negative CT feelings seemed to play a crucial role in the relationship between therapists' interventions and patients' ODF. [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 paper illustrates features of psychoanalytic psychotherapy with a young adolescent who had experienced adverse childhood events, culminating in cumulative trauma. This led to the atrophying of her 'sense of place' and 'place identity', both integral to the development of a sense of self. The patient's memory of places seemed to have been pulverised and required the contact and containment of the adult mind of the therapist to find recomposition. A therapeutic relationship developed, thanks to the sharing of objects and places which had become fragmented in the patient's mind. There was a need for locations, paths, places, indeed entire nations needed to be emotionally recomposed in the transference, to assume rudimentary but thinkable forms. The psychotherapy made it possible to find part of my young patient's memory through play, and the value of intensive but short-term work became evident. Psychotherapy allowed partial repair of the capacity for place attachment, which facilitated the exploration of the external world, the possibility of attachment to new places, and the construction of new place identities, alongside her developing sense of herself. [ABSTRACT FROM AUTHOR]

This paper examines ethical principles and their application to erotic or romanticized transference and countertransference. Transference is identified as unconscious feelings of a client that are felt for another individual of significant importance such as a therapist. Countertransference describes the feelings a therapist may develop for clients they are working with throughout the course of therapy. Ethical principles that are explored consist of autonomy, beneficence, nonmaleficence, fidelity, and justice. We explore how those principles relate to romantic or sexual feelings in therapy and discuss what therapists can do to appropriately and ethically handle those feelings in therapy. [ABSTRACT FROM AUTHOR]

A key element of suicide education, training and clinical supervision is enhancing emotional awareness about mental health professionals' countertransference reactions, as emotional responses to patients' suicidal behavior (SB) that may be unbeneficial to care. This study aimed to explore emotional responses to patients' SB in mental health nurses (MHNs) according to a psychodynamic perspective. Twenty-eight Italian MHNs (61% females, Mage = 52 years) were interviewed to examine their deep feelings about attempted suicides or deaths by suicide of patients with mental illness. Computer-aided thematic analysis was performed on the verbatim transcribed interviews, adopting Emotional Text Analysis (ETA) as a research framework to explore affective symbolizations underlying narratives, beyond intentional and explicitly reported contents. Some statistical multidimensional techniques were carried out, allowing th.e detection of shared symbolic domains (Cluster Analysis) and latent factors organizing the contraposition between them (Multiple Correspondence Analysis). Five symbolic domains emerged which were respectively referred to as: hyper-vigilance (21.97% of the overall textual corpus), resentment (17.86%), rationalization (34.50%), resignation (5.54%) and mourning (20.12%). Four latent factors explained the overall data variance: strive for reparation (F1), lack of control (F2), ambivalence toward care (F3) and complicated grief (F4). Some clinical recommendations were derived suggesting to balance issues of risk assessment/management and staff's reflective practice, to work on the subjective sense of hopelessness resulting from turning against oneself the hostility evoked by patients, to consider rationalization processes and implicit beliefs leading to risk underestimation and to address some basic conflicts contributing to a complicated grief in mourning suicidal events. [ABSTRACT FROM AUTHOR]

Countertransference can instigate poor or even iatrogenic treatment effects. This study investigated the extent to which psychotic symptoms, inpatient violence and disruptive behavior, and psychopathic/antisocial personality traits are associated with countertransference. Eighty-nine patients with psychotic disorders in a forensic medium-secure unit were assessed twice for countertransference using the Therapist Response Questionnaire. We found that psychopathic/antisocial personality traits had a larger impact on countertransference in patients than did psychotic symptoms and inpatient violence and behavior. Although differences existed between psychologists/psychiatrists and nursing personnel, all patient-related variables were associated with increased negative countertransference and decreased positive countertransference. Differences in association magnitude and clinical implications are discussed. [ABSTRACT FROM AUTHOR]

Leading mother-infant observation seminars is often imbued with anxiety and uncertainty. While there is a significant body of literature, notably by Bick (1964), Harris & Bick (2011), Magagna (1997), Saltzberger-Wittenberg (1997) and Miller et al. (1989) , which examine the endeavour and reflect on it, interested practitioners have seldom been formally trained; this was the author's experience. The article examines the parallels between the growth and development of an effective seminar leader and the early growth and development of the human infant's parents. There is a parallel in the lack of formal preparation and the considerable anxiety evoked. The article reflects on the seminar leader's role in containing the seminar group and individual observers as each learns from the experience of grappling with primitive, unconscious feelings, including the transference to the observer and her countertransference. Bion's (1963) concept of container-contained is apposite here as are the notions of so-called 'maternal' and 'paternal' functions and the position of the psychoanalytic third. [ABSTRACT FROM AUTHOR]

This article chronicles an extended psychoanalytic treatment of a bipolar gay man who suffered from unremitting suicidal depression, mania, paranoid psychosis, and psychic fragmentation due to severe complex trauma and developmental deficits in attachment and cohesive self-structure. Following his initial hospitalization within an inpatient psychiatric facility after a suicide attempt, I present his course of treatment in outpatient practice over a four-year period that highlights the psychodynamics of the case, the treatment parameters, and the multiple crises that led to chronic suicidality, re-hospitalization, manic psychosis, and an eventual incarceration in prison for criminal theft and fraud due to an unconscious death wish and need for self-punishment for being homosexual. In atypical clinical honesty, I discuss the various countertransference enactments I engaged in as I struggled with the treatment, such as encouraging the permeability of the treatment frame, offering unsolicited self-disclosure, visiting his house, running personal errands, taking him to the hospital, giving him a gift, precipitously accepting and returning phone calls, engaging in lengthy, ongoing email discussions, and letting the patient run up a large debt. It is for these reasons that it becomes instructive to consider just how far one should go in the name of therapy. Implications for clinical discourse in countertransference are discussed. [ABSTRACT FROM AUTHOR]

A psychotherapeutic relationship that can legitimately be referred to as psychoanalysis has expanded considerably since the tempering of the Freudian and ego-psychological hegemonic definitions originally imported to America by European analysts fleeing the Nazis and lasting until the middle 1980s. To some extent, pragmatic considerations have gradually supplanted older metapsychological, though the latter still carry all too much weight in the way analytic practice is conceptualized. [ABSTRACT FROM AUTHOR]

Objective: Understanding and managing countertransference (CT) is challenging for therapists and more so for trainees. This study aimed to understand more about trainees' experiences of CT; and to consider the usefulness for reflective practice of a five component model of CT (origins, triggers, manifestations, effects, and management) and the importance of feedback. Method: Trainee psychologists in Australia and New Zealand took part in a CT training and were invited to take part in the study. Trainees were randomly assigned to 1 of 2 conditions in which they received regular feedback or feedback at the end of the study. Nineteen trainees completed 93 reflective logs. Data from the logs were analysed using thematic analyses. Results: Most trainees perceived their CT originated from formative experiences and personality qualities and were triggered by client concerns and behaviours. They described a wide range of CT manifestations; and perceived the effects of CT as mainly negative. More trainees in the regular feedback condition, compared to post-completion, engaged with the activity. However, there was no difference in themes that emerged in the two groups. Conclusions: The five-component model of CT provides a method for reflecting on CT and could be used to enhance trainees' reflective practice. Key Points What is already known about this topic: (1)Little is known about trainee psychologists' experiences of countertransference although there is evidence that trainees experience difficulties understanding and managing their countertransference reactions. (2)Understanding and managing countertransference supports positive therapy outcomes. (3)Hayes' (1995) model of countertransference proposes five components – origins, triggers, manifestations, effects, and management. What this paper adds: (1)The study provides greater insight into trainees' views of the five components of countertransference. (2)Hayes' (1995) model of countertransference appears to provide a useful model of reflective practice that could be used in post-graduate psychology training. (3)This model is also likely to be useful for psychologists and clinical supervisors in their own practices. [ABSTRACT FROM AUTHOR]

Analytic literature explains that the supervisee's countertransferential responses are shaped by the patient's transference and by the supervisee's unconscious internal conflicts and relational patterns. In this paper, I suggest that, rather than interpreting the supervisee's unconscious processes, the supervisor often struggles to expand the supervisee's capacity to sustain ambiguous and confusing inner experiences, perceptions, and thoughts that emerge in therapeutic interactions. I will elaborate on one approach to expanding the supervisee's containment of ambiguous and confusing therapeutic experiences: enhancing the supervisee's tolerance of ambivalence. Tolerating ambivalence enables supervisees to contain conscious contradictory feelings and intentions and unconscious personal and relational conflicts. Furthermore, the suggested approach may help the supervisor apply rich theoretical and experiential analytic knowledge adapted to the supervisory context to achieve a productive outcome. [ABSTRACT FROM AUTHOR]

The article highlights and illustrates several reflections on countertransference observed in the author's private psychoanalytic practice in Ukraine during the COVID-19 pandemic unfolding. The specific psychoanalyst's difficulties presented, associated with forgetting planned sessions, resistance to change setting agreements, becoming 'deaf' to transference, libidinal disinvestment, 'loss in advance' and 'the dead mother' countertransference, are discussed in the context of the situation with the novel coronavirus in Ukraine. The author has formulated several hypotheses for observed changes in countertransference in relation to disinvestment, regression, work of denial and work of grief due to real losses, as well as the possible previous distortions of psychoanalytic stance. Consideration, analysis and acceptance of the above-mentioned countertransference experience allowed for the observation of various patients' responses towards it and made it possible to continue clinical work, studying the new aspects of the psychoanalytic process from the revised viewpoints. [ABSTRACT FROM AUTHOR]

The traumatic political upheavals in Ecuador during the 1980s and 1990s left a scar on the psychosocial wellbeing of the nation and its citizens. Focus groups were conducted with victims of these political traumas, specifically with Ecuadorian survivors whose cases were investigated by the Truth Commission of Ecuador (TCE). These data comprise participant accounts but also my feelings and reflexive responses to the research process. More specifically, the significance of researcher reflexivity and countertransference in creating a supportive research environment with participants who have been traumatised is explored. The researcher's reflexive approach may offer a recognising experience for participants and has the potential to become a partially reparative and therapeutic experience. I also demonstrate how embracing my own vulnerability as a researcher meant latent and unconscious themes came closer to the surface, which led to enhanced research rapport and greater understanding in the data analysis phase. [ABSTRACT FROM AUTHOR]

The article describes the work of supervision of work, discussed in a group facilitated by a child psychotherapist in a Children and Families Centre in Italy. The supervisor describes the supervisory role and the usefulness of examining the transference and countertransference, in supporting the developing capacity for containment and reflection in the multidisciplinary group discussions. The paper continues with further sections written by different members of the group, including two teachers, a child psychotherapist and a social worker in which they describe their work and the understanding of it which has emerged through discussion. The region where this work takes place is generally socially deprived, with few work opportunities, quite a lot of substance abuse and intergenerational trauma. The supervisor encourages the group to look at the transference, and more especially the countertransference, and what is split off by children and adults and projected into the workers. The examination of the countertransference is seen as an important source of insight into what can be contained and understood in terms of working therapeutically with parents and children in contact meetings and in helping the Family Court to reach decisions about whether children should remain with their parents or not. [ABSTRACT FROM AUTHOR]

The Covid-19 global pandemic has, for the moment, upended the traditional setting for analysing transference and countertransference dynamics, vital components to the work of psychoanalytic child psychotherapy. The physicality of the customary treatment setting provides a basis for the experiences of containment and understanding, along with the corresponding and familiar technical considerations within that setting. The absence of these fixed physical elements when transferring cases to virtual and other non-conventional settings points to a new set of technical challenges. How do we understand projective identification, transference and countertransference with children when the modified setting does not inherently afford a child the physical means to make contact with the consulting room as a container? What resources do we have as clinicians for persevering through the psychoanalytic process, in the face of the current global uncertainties? In this paper, I outline some of the theoretical underpinnings in psychoanalytic child psychotherapy that elucidate the challenges to the work I have encountered with my child patients during the pandemic, and explore the clinical implications stemming from those challenges. [ABSTRACT FROM AUTHOR]

Some challenges to clinicians' use of their countertransference responses during the pandemic are explored, in relation to direct clinical work and supervision. Changes to the setting, shared existential anxieties, as well as a sense that authority figures may be compromised, affect the structure of the clinical encounter. It can be harder in this context to differentiate the anxieties and defences of patient, clinician and supervisor, making it more difficult to be guided reliably by countertransference feelings. [ABSTRACT FROM AUTHOR]

The therapist's mind can wander to daydreams, fantasies and preoccupations: mental events termed "reveries" in this study. As therapists attend to the current of their thought in the therapeutic encounter, the question of how to approach their reveries can arise. This qualitative study used semi-structured interviews with nine qualified psychodynamic therapists to investigate therapists' attitudes to reveries. The research design and analysis followed the principles of Charmaz's [Charmaz, K. (2006). Constructing grounded theory: A practical guide through qualitative analysis. London: Sage; Charmaz, K. (2014). Constructing grounded theory (2nd ed.). London: Sage] constructivist grounded theory. Results showed that therapists experienced diverse reveries sometimes felt to yield deeper clinical understanding. Reveries were also seen to have a "freeing-up" function for the therapist and patient, and to require mental freedom to operate. Implications for theoretical understanding and recommendations for clinical technique are discussed. [ABSTRACT FROM AUTHOR]

Discussion of the work of Alison Howard whose diagnosis of coronavirus, made public, became a complex part of the transference and countertransference. Clinical work under these difficult conditions was discussed in terms of contemporary clinical theory stressing the potency and necessity of change in the analyst, the work of Ogden and Levenson, in particular. [ABSTRACT FROM AUTHOR]

Introduction: In this article, the continuation of a previous study, we explored the phenomenon of echolalia in children with Autism Spectrum Disorder (ASD) from the perspective of one music therapist. Method: We micro-analyzed the music therapist's responses to the echoing of three clients in 40 interaction segments that occurred during music therapy, focusing on their musical and interactive characteristics. We interpreted these responses as stemming from countertransference reactions to the phenomenon of echolalia. Results: The music therapist's responses were interpreted and classified into six categories, according to their interpersonal and musical attributes: (a) ignoring the client's echolalia, (b) exhibiting boredom, hyper-activity, and/or despair, (c) attempting to control the situation, (d) attempting to teach the client, (e) using the echolalia to communicate with the client, and (f) showing empathy. Discussion: In the discussion, we attempted to interpret the findings as processes of countertransference and addressed the importance of mapping and understanding the therapist's reactions to the phenomenon of echolalia. Practical implications for caregivers working with children with ASD were suggested. [ABSTRACT FROM AUTHOR]

This paper explores the taboo of love in the case of children in care. Love can often become a taboo for these children, something they unconsciously forbid themselves from experiencing due to fears of further loss and pain. Love can also become a taboo for the adults working with looked after children, including psychotherapists. The author presents her work with individual looked after children and with the professional network around them. She proposes that love tends not to be a central theme in the care system, despite its relevance to children who have often not experienced adequate love in their early lives. The implication of this proposition is that such children, who may have never known love, or who may have had a distorted experience of love, may be at risk of remaining unloved within the care system, which could seriously compromise their development. The author calls for more support for professionals, so that they can be facilitated to perform their vital work in promoting a loving approach in the system around children in care. [ABSTRACT FROM AUTHOR]

Anorexia nervosa is the psychiatric disorder with the highest mortality rate. Anorexic patients admitted to inpatient eating disorder units are often critically unwell in both their physical and mental health. Underpinning working with these patients is a real feeling that they are close to death. Staff, and particularly nurses, in eating disorder units may find working with anorexic patients extremely challenging. It has been documented that working with such patients can give rise to strong and difficult to process countertransference feelings and reactions. The authors of this paper introduced a Balint group for the staff on an eating disorder inpatient ward to provide a space for the team to reflect on the work. This paper reports on the experience of running this Balint group and describes the themes that gradually emerged. These are then discussed and related to the nature of the disorder and the particular challenges of working with this inpatient population. [ABSTRACT FROM AUTHOR]

Unmentalized experiences comprise internal and external somato-sensory information that is not transformed into a mental representation and hence, cannot serve as substance for thoughts or feelings. Instead, unmentalized experiences, especially painful ones, are revealed implicitly through physical states, impulsive actions, or somatic symptoms. Therapeutic work with patients who lack mentalizing abilities presents therapists with the need to adjust their therapeutic thinking and interventions to help their patients develop the capacity to mentalize. This paper discusses some clinical implementations on the theoretical thinking of unmentalized experiences, by focusing on therapeutic work with children and the therapist's role. The author suggests that children are relatively closer to the unmentalized areas in their mind, due to their developmental stage, and because of their ability to engage in more primary means of expression and behaviour, making access to the unmentalized areas relatively easy. Hence, clinical work with children offers fruitful possibilities in modifying a patient's raw, vague, toxic unmentalized experiences into more structured and formed mental experiences. The therapist needs to immerse him or herself in primary mental functioning parallel to that of the child, in order to connect and transform the child's unmentalized experiences. Clinical illustrations from a case of child psychotherapy are presented. [ABSTRACT FROM AUTHOR]

Experiencing fear is a central feature of managing disturbed states of minds. In this paper, I will describe the experience of being terrified by a patient who was overtaken by extreme anxiety. Aetiologically, I will suggest that the lack of containment created terror in her mind. I will also describe my experience of leadership in a voluntary organisation. Using Hopper's concept of a fourth basic assumption, I will highlight the omnipresence of annihilatory anxiety in an example of organisational trauma. I will suggest that focusing on the issues of countertransference, working through experiences of being terrorised and paying attention to how you emotionally respond are crucial to lessening terror. [ABSTRACT FROM AUTHOR]

Working therapeutically with people who experience psychosis can be demanding, confusing and even terrifying for psychotherapists, yet there is very little research that has systematically investigated the experiences of psychotherapists concerning their engagement with psychotic phenomena. Theoretically, it has been proposed that managing countertransferential responses to a patient's psychosis is a crucial component of working psychoanalytically with such conditions. In light of this theoretical premise, the study reported upon in this article investigated some of the negative countertransferential dynamics observed by psychotherapists who engage in clinical work with patients presenting with psychotic states or conditions. Focused semi-structured interviews were conducted with eight psychoanalytically oriented psychotherapists. Two core themes emerging from the study are discussed: firstly, the psychotherapist's experience of madness; and secondly, the role of the body and somatic communication. The themes convey important aspects of countertransferential experiences related to the therapeutic encounter with psychosis. [ABSTRACT FROM AUTHOR]

The components of a tripartite model of the therapeutic relationship, namely the working alliance, the transference configuration (transference and counter-transference), and real relationship, were examined in terms of how they relate to one another and to the outcome of a psychotherapy session, from the therapists' perspective. Although previous studies have examined these components separately, no study to date has examined the components together in their relation to session outcome. Licensed psychotherapists (n = 249) were recruited from two Divisions of the American Psychological Association. Therapists completed measures for the last session they had with a client. Results revealed that from the therapist's perspective the real relationship and working alliance related positively to session outcome, and countertransference behavior related negatively to session outcome. The components related to each other mostly as predicted by the tripartite model, and a principal-axis factor analysis revealed the presence of four distinct factors resembling the components theorized to comprise the tripartite model. The components together accounted for 27% of the variance in session outcome and only the real relationship and the working alliance predicted session outcome when all the components were looked at simultaneously in a regression model. [ABSTRACT FROM AUTHOR]

Technological advances in the computer and communication fields (the internet, social networks, virtual realities,) have created a world in which most of our patients, especially pre-adolescents and adolescents, are immersed. In this paper we think about the meaning of ‘digital natives’ communication in the framework of the therapeutic relationship and the resulting countertransference. Interactions through technology, we argue, significantly reduce the difference between being together and being separate and can make it very difficult to experience a feeling of authentic intimacy or loss. Furthermore, exploring the world through the web does not provide children with the opportunity to ask questions and give voice to their doubts: it is a one-direction communication. These elements need to be considered in the therapeutic relationship with pre-adolescents and adolescents. In this paper we present three cases in which the world of internet enters into the sessions and we illustrate the countertransference this arouses and how it needs to be worked through. [ABSTRACT FROM AUTHOR]

This paper suggests that fear is a frequent emotional component of transferential and countertransferential experiences in analysis. It describes clinical situations that call for courage on the analyst's part, and illustrates some manifestations of fear in a long-term treatment. [ABSTRACT FROM AUTHOR]

Objective: There is evidence that awareness of countertransference (CT) in combination with a conceptualization of CT facilitates its management. This study examines the impact of a trans-theoretical training designed to make the construct of CT accessible to trainee therapists in programs oriented towards cognitive-behavioral therapy. The training aimed to enhance trainees' awareness, understanding, and management of CT. Method: Academics at five New Zealand universities introduced the training into their curriculum. Five academics and 54 clinical psychology trainees evaluated it, responding to open-ended questions on the impact of the training on awareness, understanding, and management of CT. They also rated the training's effectiveness. Results: The majority of trainees reported increased awareness and conceptualization of CT. They rated the training as useful for professional practice and reported increased commitment to monitoring CT. Academics also observed trainees' increased awareness and understanding of CT and openness to discussing it. Trainees and academics were less confident in trainees' abilities to manage CT in clinical practice, although trainees reported gains in this area. Conclusions: The training appeared to enhance awareness and conceptualization of CT, processes that support its management. However, future research into training models needs to examine the impact on CT management in clinical practice. [ABSTRACT FROM AUTHOR]

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