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This article considers daydreams as a means of understanding the patient and fostering the therapeutic relationship. Daydreams are considered along with fantasies and reverie. The usefulness of the therapist's reverie in response to the daydreams of a patient who is conflicted about being seen and known is explored. Daydreams are considered in relation to creativity—both analytic and artistic; and as a way of bridging inner life and external reality. [ABSTRACT FROM PUBLISHER]

The practice of psychoanalysis places the analyst on strong pressures - the analyst works alone in the consulting room in a medium of isolation, he has to be permanently open to what is coming from the patient, he is emotionally affected by his patients and he has the responsibility to keep and maintain professional boundaries of this relationship. Hate in countertransference could generate a particular conflict in the analyst - conflict between his need to repair, to help his patient, and the hate he feels toward the patient. There is another side of psychoanalysis as a profession, in addition to the clinical practice -the psychoanalytic institutions. Intolerance to diversity, dogmatism and the proneness to schism can be seen as institutional symptoms. Some authors offer explanations from different perspectives - political, sociological, and even religious. The author suggests that in order to understand conflicts in psychoanalytic institutions one must take into account the anonymous psychoanalytic patient who maintains the psychoanalysis as a profession, and argue that hate in countertransference could be seen as one of the sources of conflict between colleagues. [ABSTRACT FROM AUTHOR]

Infidelity is a serious problem with serious consequences for couples and creates substantial obstacles for couples counselors. At the same time, it is the most often cited reason that couples come for counseling. The good news is that couples counselors can be effective in these areas, but not without understanding the emotional, mental, and physical complexity of infidelity. Unfortunately, many couples counselors do not feel adequately prepared to handle the subject of infidelity. There are several "pitfalls" into which counselors commonly fall. By understanding the relevant research on the effectiveness of couples counseling approaches and paying attention to a counselor's own personal reactions, a practitioner can help couples navigate the difficult, painful emotions that stem from infidelity. [ABSTRACT FROM AUTHOR]

This paper discusses the consequences of the importance that recent 3 papers assign to the countertransference. When the latter acquires a theoretical and technical value equal to that of the transference, the analytic situation is configured as a dynamic bi-personal field, and the phenomena occurring in it need to be formulated in bi-personal terms. First, the field of the analytic situation is described, in its spatial, temporal and functional structure, and its triangular character (the present–absent third party in the bi-personal field) is underlined. Then, the ambiguity of this field is emphasized, with special weight given to its bodily aspect (the bodily experiences of the analyst and the patient being particularly revealing of the unconscious situation in the field). The different dynamic structures or lines of orientation of the field are examined: the analytic contract, the configuration of the manifest material, the unconscious configuration – the unconscious bi-personal phantasy manifesting itself in an interpretable point of urgency – that produces the structure of the field and its modifications. The authors describe the characteristics of this unconscious couple phantasy: its mobility and lack of definition, the importance of the phenomena of projective and introjective identification in its structuring. The authors go on to study the functioning of this field, which oscillates between mobilisation and stagnation, integration and splitting. Special reference is made to the concept of the split off unconscious ‘bastion’ as an extremely important technical problem. The analyst’s work is described as allowing oneself to be partially involved in the transference–countertransference micro-neurosis or micro-psychosis, and interpretation as a means of simultaneous recovery of parts of the analyst and the patient involved in the field. Finally, the authors describe the bi-personal aspect of the act of insight that we experience in the analytic process. [ABSTRACT FROM AUTHOR]

The analytic setting exists not only externally but also internally as a structure in the mind of the analyst. The internal analytic setting constitutes an area of the analyst's mind where reality is defined by unconscious symbolic meaning. Clinical examples illustrate how a secure internal setting allows flexibility in the external setting without sacrifice of its analytic quality. The internal setting can help analysts listen inwardly to themselves in a way that is free-floating with regard to their internal processes. This points beyond usual ideas of counter transference. An analytic encounter may stir up elements that belong to the analyst's psyche which, rather than impeding the analysis, can actively enrich it. Seamus Heaney's writings evoke comparisons between listening to poems and listening to patients, and a week in a patient's analysis is described in relation to these themes. [ABSTRACT FROM AUTHOR]

The author’s conviction is that a successful treatment is based on feelings of love by the therapist/analyst toward his or her patients. One should differentiate between love that is based on biological erotic-sexual drives and emotional love without erotic biological drive. The treatment process, especially for severely disturbed personalities, should be regarded as a process of new birth and new kind of development. Thus what the patient needs most is a kind of parental “primary love” (according to Balint). This paper presents a full report of a session through which the basic love to the patient is illustrated as enabling the treatment. [ABSTRACT FROM AUTHOR]

Generally a distinction is made between the disclosure of personal information and the disclosure of countertransference feelings to a patient. While this may be a necessary distinction to make in the interest of carrying on a coherent conversation on this question, I argue that there is a sort of vanishing point where the difference between "facts" and "feelings" merges. What I wish to suggest here is that, to a certain and necessary degree, the context and the framing of the question of self-disclosure determines what we define as a disclosure. I propose that thinking about a dialectical relationship between sameness and difference is a particularly useful way into the question of self-disclosures in contemporary clinical work. The question of disclosing personal information to patients became a pressing one for me when I found that in some cases it felt necessary to disclose my HIV seropositive status. Here is an example of a fact that is particularly laden with feelings, confounding the distinction between a factual and a countertransferential disclosure. As might be expected in considering the disclosure of personal medical information, I felt there were a variety of reasons to do so, each with specific context. In a long psychotherapy treatment with an HIV-negative man I found that tracking each of our senses of sameness and difference offered a way of understanding the changing meanings of the disclosure of my HIV seropositivity. But more importantly it became clear that it was the process of disclosure rather than the content that exerted the greatest influence on our work, ultimately contributing to a transformative experience for the patient. [ABSTRACT FROM AUTHOR]

The author discusses Gilbert Cole's "Disclosure, HIV and the Dialectic of Sameness and Difference." The dichotomy often made between the disclosure of countertransference affects and the disclosure of facts is an oversimplification. The disclosure of HIV positive serostatus is more than just a fact, and is filled with transcendental meaning. While there are aspects of having positive serostatus that are unique to that condition, the dialectic between uniqueness and commonality is also important in understanding this process. Cole appears to eschew a classical view of neutrality. The author briefly reviews some of the controversy surrounding historical views on self-disclosure. The author also reviews some of the psychoanalytic literature dealing with disclosure of a therapist's illness to a patient. The author sees Cole's disclosure of his positive HIV serostatus to his patient as inadvertent. Inadvertent disclosures occur often in the course of psychotherapy; however, once they occur, they should be dealt with directly in the treatment. The author sees inadvertent disclosure as entirely different from answering a question about a fact that a patient may fantasize about, but about which he has no actual knowledge. The author feels it is important to confirm for a patient something that the patient already knows, but does not want to know. To do otherwise is to potentially retraumatize a patient. The author discusses the tendency to avoid aspects of the real relationship between therapist and patient. In particular, she underscores the pervasive denial of death in analytic theories and in clinical practice. While the course of HIV infection has dramatically change din the last decade, it nevertheless carries association to and risk of a potential disease, and a potential disease that carries the threat of death. The author offers a vignette from her own clinical practice in which a patient responded to an unexpected absence due to illness. The author concludes by noting that while most inadvertent disclosures are less significant than the disclosure of HIV serostatus, they all have an important impact on clinical work. [ABSTRACT FROM AUTHOR]

This paper discusses Gilbert Cole's book, "Infecting the Treatment: Being an HIV-Positive Analyst." The author provides some personal reflections on the outbreak of AIDS and the impact it had upon his work as a psychotherapist. The paper addresses the importance of the cognitive schemata Cole provides to psychotherapists working with seropositive patients. This paper then addresses a powerful technique, a therapist's self disclosure to a patient, upon which Cole's work focuses. Using the example of psychoanalytic strictures regarding self-disclosure, the author argues that self-disclosure is more likely to be adhered to in theory than it is in practice. The author agrees with Cole that non-disclosure is often a technique used by analysts to hide, rather than provide a therapeutic field of action. The specific case of therapists hiding their antihomosexuality when working with lesbians and gay men is used to illustrate the author's perspective. A specific case presented by Cole in his book is then used to both compare and contrast Cole and this paper's author's use of self-disclosure. The paper commends Cole's study for opening a debate on how to use countertransference and self-disclosure as tools which widen and enrich the therapeutic relationship. [ABSTRACT FROM AUTHOR]

Mental pain is a common concern of psychoanalysts in their professional life. Combining her clinical experience with previous contributions by others, the author presents a personal overview of the patient-triggered mental pain of the analyst. Countertransference is considered to be the major source of the analyst's work-derived mental pain. This type of mental pain is not to be avoided or discarded by the analyst. Rather, the analyst will benefit from tolerating and even welcoming professional mental pain: in most cases, mental pain will bring with it rich clinical material that, upon interpretation, will help him or her to offer previously intolerable contents back to the patient in a transformed version that now becomes acceptable. The analyst's mental pain may emerge in his dreams; clinical examples of this phenomenon are presented. It is suggested that there is an increased chance of the analyst undergoing mental pain when treating patients suffering from severe psychopathology, and a clinical case is reported to illustrate this assertion. The author proposes that a lifelong effort is to be expected from analysts in terms of enhancing their threshold of tolerance to professional mental pain. In situations of mental pain, analysts must be particularly aware of the need to modulate their interpretations before transmitting them to the patient. The capacity of analysts to transform their mental pain (Ta, according to Bion) will depend on the plasticity of their container functions, the quality of their transformation abilities and, in particular, their threshold of tolerance to mental pain. [ABSTRACT FROM AUTHOR]