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Mental health chatbots (MHCBs) designed to support individuals in coping with mental health issues are rapidly advancing. Currently, these MHCBs are predominantly used in commercial rather than clinical contexts, but this might change soon. The question is whether this use is ethically desirable. This paper addresses a critical yet understudied concern: assuming that MHCBs cannot have genuine emotions, how this assumption may affect psychotherapy, and consequently the quality of treatment outcomes. We argue that if MHCBs lack emotions, they cannot have genuine (affective) empathy or utilise countertransference. Consequently, this gives reason to worry that MHCBs are (a) more liable to harm and (b) less likely to benefit patients than human therapists. We discuss some responses to this worry and conclude that further empirical research is necessary to determine whether these worries are valid. We conclude that, even if these worries are valid, it does not mean that we should never use MHCBs. By discussing the broader ethical debate on the clinical use of chatbots, we point towards how further research can help us establish ethical boundaries for how we should use mental health chatbots. [ABSTRACT FROM AUTHOR]

In the fall of 2019, a much-publicized court case brought to national attention the issues of patient-doctor confidentiality when it comes to reporting the deaths of newborns in the United States. It is unclear whether the recent overturning of Roe v. Wade will lead to more cases like this. This article discusses issues of countertransference, as well as the ethical and legal implications were it to be a psychiatrist, in active treatment of such a patient, who would be required to make such a report. More specifically, as in the publicized court case, the patient could be a minor at the time, receiving treatment from a child psychiatrist. The implications of such a case include how countertransference affects the perception of fatal child neglect compared to intentional neonaticide; the ethical dilemma of generating a mandated report with the goal of child safety when such a report could lead to real legal consequences for a minor child; and considerations regarding continued treatment of a patient after such a report is made. It is likely that countertransference, shaped by attitudes toward mothers and idealized views on mothering, may play a large role in all these circumstances. [ABSTRACT FROM AUTHOR]

Collusion designates a specific type of transference-countertransference interaction between two or more persons, linked by an unconscious and shared unresolved issue, which they avoid on an intrapsychic level by externalizing it in the interpersonal space. To find a way to identify collusion and to delineate it from other transference-countertransference interactions. We conducted this study based on a case series approach. The study material consisted of audiotaped clinicians-centered supervisions with oncologists. The case series methodology involved the systematic examination of a purposive sample of supervisions, with the aim to understand how and why they differ from one another with respect to the relational dynamic between the physician and his/her patient. Four cases/supervisions were selected as they allowed to situate collusion on the spectrum of transference-countertransference interactions. We report on it by describing a countertransference reaction, two transference-countertransference interactions, and a collusion. The study reveals the challenges and pitfalls of research on collusion. The results allow to confirm the criteria of our working definition of collusion and to delineate collusion from other transference-countertransference interactions, which represents a first step for the empirical investigation of collusion. [ABSTRACT FROM AUTHOR]

The Oedipus complex is a phenomenon observed in both Eastern and Western cultures. It involves a transition from a child’s early connection with their mother to a more complex relationship that includes the father. The interpretation of this period has evolved from Freud’s idea of the father acquiring a “super-ego” to a modern understanding of acquiring masculinity, autonomy from parental authority, and developing the capacity for other loving relationships. Successfully navigating the Oedipus period requires not just a father figure as a source of fear, but a father who is supportive and willing to make sacrifices for their child’s growth. It is important to resolve any negative countertransference experienced by the father in this role, as it greatly influences the smooth completion of this period. To address the countertransference that inevitably arises during the Oedipus period, religious and philosophical ideas can serve a role similar to that of a supervisor in the analysis process. However, applying Eastern religious and philosophical ideas, such as Confucianism (Yu-gyo), may be challenging due to their emphasis on vertical relationships. Fortunately, the concept of “hyo” holds promise for the future, as it embodies a principle of mutualism that can be applied in a modern context, despite its seemingly vertical foundation. [ABSTRACT FROM AUTHOR]

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]

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]

Institutional transference is a phenomenon describing patients' attitudes toward the institutions where they receive mental health or medical care. While transference toward individual clinicians in palliative care has been described, attitudes of patients with serious illness toward the institutions where they receive specialized care have not been described. Here, we present three cases which demonstrate the phenomenon of institutional transference in patients with serious illness and the resulting clinical implications, which include countertransferential responses of clinicians caring for them. We consider three conditions: (1) the idealized reputation of the academic cancer center, often a tertiary referral center; (2) loss of an institutional connection during care transitions; and (3) countertransferential reactions to institutional transference. We highlight characteristics and personality styles of individuals with cancer that may complicate and intensify institutional transference and identify potential interventions to address common challenges associated with institutional transference. [ABSTRACT FROM AUTHOR]

Unprecedented changes in traditional psychotherapeutic practice arose from the lockdown restrictions associated with the COVID‐19 pandemic. These changes to practice included the imposed change to the therapeutic frame when transitioning clients from face‐to‐face meetings to delivery of psychotherapy sessions via videoconferencing (defined here as telepsychotherapy). The current study conducted qualitative interviews with 16 Australian psychologists who transitioned their existing adult psychotherapy clients from face‐to‐face therapy to telepsychotherapy and explored their novel experiences associated with countertransference reactions during this period. Thematic analysis of the interviews revealed several unique findings. The type of countertransference reactions towards existing clients was consistent across both face‐to‐face and online meetings; however, the felt intensity of countertransference reactions was reduced. Psychologists reported an increased hesitance to work with intense emotions during telepsychotherapy sessions and felt increased pressure to work harder during online sessions when compared to face‐to‐face meetings. Exposure to their clients' personal and home environments during telepsychotherapy sessions elicited several novel reactions towards their clients. These findings on countertransference and telepsychotherapy are informative for future practice and training. Awareness of these unique countertransference experiences is recommended prior to engaging in telepsychotherapy or when transitioning clients to this modality. [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]

Therapists are expected to work therapeutically with increasing numbers of older adults due to the unprecedented global growth in older population. This work is considered emotionally challenging because it can evoke intense countertransference reactions in therapists. However, the field lacks empirically based practice recommendations on how to better identify and manage therapists' countertransference with older patients. This study explores therapists' experience of their countertransference in psychotherapy with older adults, using Hayes's (2004) structural model of countertransference as a guide. Semistructured interviews were conducted with 14 therapists and analyzed using grounded theory methodology. The findings are clustered around three themes: (a) unresolved conflicts related to therapists' own aging and death as well to their own parents are the sources of therapists' countertransference toward the older patient, (b) therapists' countertransference reactions are triggered inside therapy in response to the patients' health issues and the issue of death, and (c) countertransference is manifested as various affective and behavioral reactions to the older patient. Our findings indicate that therapists' unresolved issues related to the inevitable developmental phase of aging as well as to their own parents might be regarded as countertransference sources unique to psychotherapy with older adults. Our findings also demonstrate the wide range of emotional and behavioral countertransference manifestations in psychotherapy with older adults. Since effective management of countertransference is related to psychotherapy process and outcome, therapists should consider expanding their awareness of how countertransference origins are triggered and manifested in therapy with older adults, in order to engage in effective management strategies. Public Significance Statement: The present study suggests that therapists' unresolved issues related to their own aging and death as well as to their own parents are the sources of therapists' countertransference toward the older patient. These issues are then manifested inside therapy in response to certain triggers in the form of various emotional and behavioral reactions. These findings highlight the importance of being aware of unique countertransference issues when working with older adults. [ABSTRACT FROM AUTHOR]

Over the years, the psychiatric inpatient treatment paradigm has shifted to more brief stays focused on acute stabilization and psychopharmacologic-focused interventions, rather than individual psychotherapeutic engagement. Unfortunately, this has allowed patients with complex interpersonal dynamics, particularly borderline personality disorder, to slip through the cracks of effective treatment. This can contribute to repeated inpatient admissions, where both patients and clinicians feel trapped in a maladaptive, unhelpful cycle. In this article, we examine the evolution of inpatient treatment with de-emphasized psychotherapy practices, review the particular dynamics that patients with borderline personality disorder may evoke within an interdisciplinary treatment team, and provide a framework of clinically based vignettes for scenarios that may arise within inpatient treatment of this patient population. With attention to countertransference patterns and common pitfalls of communication, we offer alternative approaches and conversations with the hopes of improving outcomes and alliances in a new landscape of psychiatric practice. [ABSTRACT FROM AUTHOR]

S.H. Foulkes's paper concerning the Oedipus situation—published some 40 years ago—is still relevant in current group analytic practice. Main phrases of the Foulkes article, such as 'regression', 'infantile sexuality', 'Oedipus conflict', the 'Sphinx-like mother' and 'transference' are examined. Based on a case report about sexual pairing in group psychotherapy, the author depicts the course of events before analysing the enactment of the protagonists, the role of the group, somatic sufferings during the group process, boundary violations and countertransference factors, and discusses diagnostic and therapeutic implications as well as the need for further research on the special topic in group analytic psychotherapy. [ABSTRACT FROM AUTHOR]

This paper describes a method for investigating clinical process, Layered Analysis, which combines therapist countertransference reports and multi‐faceted microanalytic research approaches. Findings from the application of Layered Analysis to video‐recorded micro‐events of rupture and repair in four psychoanalytic parent–infant psychotherapy sessions are presented. Layered analysis showed that countertransference and observation are complementary perspectives, which enable concomitant study of interactive events, conscious internal experiences, as well as nonconscious and unconscious elements of therapeutic interaction. Interactional rupture and repair were found to constitute co‐constructed micro‐events that occurred fleetingly and often implicitly, and differed in the structure, coherence and flow of interactions and in the relationship between verbal and nonverbal communication. Furthermore, interactional ruptures were found to sometimes 'get into' the therapist and transiently disrupt their self‐organization, such that the therapist became a locus of disruption for the patient(s), actively contributing to the rupture, which thus became embedded in the therapeutic system. Interactive repair was found to be most often initiated by the therapist and to be underpinned by the therapist re‐establishing self‐regulation, through metabolizing embodied and verbal aspects of the rupture. Studying such processes can enhance our understanding of clinical process, inform therapist training and clinical supervision, and contribute to clinical outcomes. [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]

In the context of the socio-political instability that exists in Ukraine, the problem of stress resistance among psychological service professionals has emerged. The aim of the research is to analyse the professional activity of psychologists in Ukraine at the present stage under the influence of stress factors. The following methods were used to study the nature of stress and its impact on the personality of a psychologist: analytical and synthesis methods, statistical, comparative, survey and interpretive methods. The research results theoretically reveal the peculiarities of the concept of stress, the stages of stress development, and identify the main stressors of professional activity. An empirical study of the stress resistance of psychologists was conducted. The influence of stress on the quality of psychological care was determined. Professional qualities in the psychologist's personality structure were identified, the phenomenon of professional exhaustion, the role of countertransference in counselling were studied, the importance of the code of ethics for psychologists and its violation in the course of practice were revealed. The importance of interventions and supervision as a means of psychological support for the professional development of psychologists was investigated, and statistical indicators of the level of stress were analysed. The practical significance of the research is determined by the current coverage of the problem of the impact of stress on the professional activity of a psychologist and in the creation of effective ways of emotional self-preservation and development of stress resistance, which provide the search for their resources for self-healing and effective work. [ABSTRACT FROM AUTHOR]

Apprehending the full range of one's countertransference presents a challenge for the new therapist and psychiatry resident. Experiencing negative or aggressive feelings while also striving to consolidate one's professional identity and self-experience as a good, helpful, and competent doctor feels dissonant and contradictory. Developing and practicing the skills of countertransference awareness and analysis are crucial aspects of psychiatry and psychotherapy training. These skills can help the trainee navigate difficult clinical interactions through reflection on their own anxieties, as well as the unconscious social and personal biases and motivations that shape their countertransferences. This article examines some of the countertransference reactions that may be colored by social and personal stigma toward patients with substance use disorders. Acknowledging and exploring such countertransference reactions in training not only can provide valuable insights into the psychodynamic experiences of the patient and the treatment dyad, but also can sharpen a lifelong tool, helping the trainees weather powerful and disorienting countertransference currents, untangle their personal motivations and prejudices, and recognize the times when supervision may help to provide containment and clarity throughout their careers. [ABSTRACT FROM AUTHOR]

Taking the liberty of imagining the lawyer in Melville's "Bartleby, the Scrivener" as narrator/therapist and Bartleby as patient, this article, written with the therapist/reader in mind, traces the vicissitudes of countertransference and speculates on what constitutes a "good enough" therapeutic effort. [ABSTRACT FROM AUTHOR]

This study aimed to examine the role of attitudes towards psychotherapy and countertransference dimensions as predictors of professional quality of life and burnout among psychotherapists in Iran. Participants were 259 psychotherapists who worked in mental health centres in Tehran (Iran), and they completed the Professional Quality of Life questionnaire, the Therapist Response Questionnaire and the Therapist Attitudes Scale. Professional quality of life was associated with countertransference dimensions and attitude towards psychotherapy. This study concludes that psychotherapists can benefit from working on their specific countertransference issues and re‐evaluating their basic attitudes towards psychotherapy to achieve the highest levels of professional satisfaction. Culture may play a role in a specific therapist's attitude and difficulties in addressing certain aspects of countertransference. [ABSTRACT FROM AUTHOR]

In both graduate classrooms and field placements, social work student interns are increasingly taught empirically-supported, behaviorally-focused models as the primary way to engage in ethical practice. They are less prepared, however, to handle the personal impact of powerful psychodynamic processes active in therapeutic settings. In adolescent group treatment environments, the combination of novice therapists with dual-diagnosed, involuntary/mandated teens sets the stage for both behavioral and transference/countertransference issues to arise. Although supervision at the field setting is expected to ameliorate emergent issues, the behavioral and group-level focus of field supervisors may not be enough to identify and overcome deeper psychodynamic challenges. Student interns, as they provide professional treatment to their clients, may therefore have to self-navigate emotionally charged inter- and intra-personal conflicts and attempt to metabolize their own reactions to trauma and dysfunction. This paper presents a detailed post-treatment review of a student intern's struggle to metabolize individual countertransference dynamics in a group setting in the service of a client, and provides supervisory insights on his approach to highlight the challenges and possibilities in such an environment. [ABSTRACT FROM AUTHOR]

Given some of the challenges beginning therapists experience in the development of their new roles, they may be more susceptible to becoming overwhelmed by their countertransference, lack the awareness to track all of the processes taking place in the therapy room (e.g., projective identification, transference/countertransference dynamics, etc.), and have a propensity to be pulled into enactments. This paper explores how therapy processes, client trauma, and clinician levels of experience intersect therapeutically with the dyad's identity features and may impact the therapist's ego functions. A case is discussed that explicates how racial identities in a dyad can create enactments resembling those of marked historic and cultural imbalances in Western society, taking away the minority therapist's ability to think and speak in English due to the intense projective identification and countertransference experience of inferiority and incompetence in the presence of a patient with various identities of privilege. The role of internalized racism within the minority therapist is also explored in rendering them unable to process the deeper dynamics evoked in the therapeutic and supervisory dyad with the patient when the patient used racially charged language. [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]

Working through the different faces and vicissitudes of the death drive in the countertransference, and especially through projective identification, is a very challenging process. A thorough and versatile process of containment and working through of the manifold threatening expressions and influences of the death drive is required, experienced most specifically and deeply in the arena of projective identification. This paper demonstrates how each aspect that unfolds in the analyst's countertransference sheds light on a particular layer of anxiety and internal object relations related to it. The creation of a new meaning to the differing expressions of the death drive gradually lessens the compulsion to repeat and enables a better integration between the life and death drives. This process will be illustrated by a prolonged clinical case that involved intense internal working through of the death drive in the analyst's countertransference. [ABSTRACT FROM AUTHOR]

The therapeutic encounter with psychotic patients presents therapists with moments in which they may regress, together with the patient, toward primitive and psychotic areas of experience. Within this shared psychotic world, therapists might feel persecuted, as if the ground is slipping from beneath their feet. The author suggests that the psychotic part of the personality, as argued by Bion, is inherent to all of us and may come alive in the psyche of the therapist in response to patients in psychotic states. The psychotic dialogue that emerges between patient and therapist, which involves projective identification and counter-transference mechanisms, must be worked through. Therapists' capacity to survive the psychosis forced upon them and to move through and beyond it is highly significant. By examining clinical material from therapy with a patient diagnosed with schizophrenia, the author discusses this unique countertransference phenomenon, which he terms induced psychotic countertransference. [ABSTRACT FROM AUTHOR]

The understanding of concepts like moral distress and countertransference in mental health settings has advanced over time. While organizational constraints and the clinician's moral values are conventionally thought to play a part in evoking such responses, certain behavioral transgressions might be universally deemed as morally unacceptable. The authors present case scenarios that took place during forensic assessments and routine clinical care. Clinical interactions evoked a diverse range of negative emotional reactions, including anger, disgust, and frustration. The clinicians struggled with moral distress and negative countertransference, which resulted in difficulty mobilizing empathy. Such responses could affect a clinician's ability to best work with the individual and could even affect the clinician's well-being adversely. The authors put forth several suggestions on how to manage one's own negative emotional reactions in similar settings. [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]

Courage requires us to persist and persevere despite fear. We make choices everyday—some are courageous, and some are not courageous at all. This dimension of psychoanalytic work is significant, yet relatively neglected in the psychoanalytic literature. Maintaining a courageous stance as an analyst can be challenging and threatening. Often, the therapist faces deeply rooted fears about abandonment, envy, competition, anger, or other forms of intense emotional arousal. This requires us to confront ourselves but also, at times, confront our patient's behaviors. It is crucial to think and act independently, and deal with their disapproval and opposition, despite the risks challenging patients present. Ultimately, we need to manage our vulnerable feelings while remaining authentic, rather than hiding behind an overly clinical stance. The author presents two patients who required and inspired the courage to face her own anxieties, ultimately contributing to the treatments' progress. [ABSTRACT FROM AUTHOR]

The author presents a clinical psychoanalysis in which his Jewish patient fears that her non‐Jewish analyst hates her for being Jewish. Antisemitic expressions of hate toward the analyst have been well‐documented, but a fear of the analyst's hateful transference to the patient has not been previously examined in a published report. This transference led to an impasse in the treatment and prompted exploration of countertransference on the analyst's part; was he, unconsciously, expressing any religious hatred? The author examines a technical question of whether such a transference can be analyzed in the usual way as a displacement of infantile trauma? Or do the antisemitic aspects of the transference need to be examined and understood in their cultural and religious implications first and then analyzed as a real aspect in the external world before its infantile roots can be exposed? In this particular case, the author concludes that the latter approach is necessary and useful to facilitating clinical progress. The author suggests that this approach may be applicable to other analyses where there are racial, class, or religious differences and the patient develops fears about the analyst's attitude. The author offers this case as an example of the necessary integration of cultural and sociological issues into the classical model of intrapsychic conflict. [ABSTRACT FROM AUTHOR]

Reactive countertransference is nontherapeutic, whereas responsive countertransference is an integral aspect of psychotherapy when the psychotherapist is attuned to the client's affect and needs. Personal examples are used to illustrate the concepts of responsive and reactive countertransference. Awareness and use of each form of countertransference is essential. The psychotherapist's stance of presence and involvement delineates the necessary elements of an effective relationally focused psychotherapy. [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]

The digital divide is defined as the distance between those individuals and communities that have access to digital resources such as high-speed internet and user-friendly, sophisticated computing interfaces and those that lack such resources. If empathy is understood as being fully present with another person without judgment, evaluation, or anything else added, then being present in the same physical space (such as a therapist's office) is arguably the optimum approach. Yet the genie is out of the bottle. This article engages with new forms of countertransference, parapraxes (slips), and breakdowns in empathy occasioned by taking psychodynamic therapy online including the advantages and disadvantages, the trade-offs, of each approach. It is just as misguided to require therapists exclusively to perform in-person therapy as it would be for everyone exclusively to perform online therapy. There is no turning back the clock. [ABSTRACT FROM AUTHOR]

The aim of this article is to show how the plan formulation method (PFM), an empirically validated method for case formulation based on control mastery theory (CMT), can help clinicians make sense of and use what they feel during sessions to better understand and treat their patients. We give a brief overview of the main psychoanalytic conceptions about countertransference, provide a brief introduction to CMT, and describe the concept of the plan and the PFM. We then show, using several brief clinical examples, how the components of the plan (patient's goals, pathogenic beliefs, traumas, tests, and insights) may help understand clinicians' in-session feelings. [ABSTRACT FROM AUTHOR]

The author describes how his experiencing of the husband in a neurodiverse‐neurotypical couples therapy as narcissistic, led to a countertransference impasse. Using clinical material, he describes how his understanding of neuroscience helped him to view his patient as suffering from high functioning Asperger syndrome, and how this understanding helped in the resolution of the impasse. It is hoped that this clinical situation will emphasize the value of having a greater integration between our psychoanalytic and neurological understandings. [ABSTRACT FROM AUTHOR]

Emotional Freedom Techniques (EFT) has been rapidly gaining popularity over the last several decades. It's been a heady and exciting time for those leading the way in this cutting-edge healing field. Now EFT is coming of age with the establishment of Clinical EFT, which has been validated extensively in research studies to meet the designation of "evidence-based" practice. Extensive trainings in the methodology of Clinical EFT are being conducted all over the world, turning out fine practitioners, among them mental health clinicians, coaches, and lay people, who perform Clinical EFT in a technically excellent way. One area that has not yet been widely attended to, however, is that of the role of the healing relationship between practitioner and client. Many studies have shown the vital importance of the healing relationship in achieving the best treatment outcomes. This article is intended to explore one of the least understood aspects of that relationship: the interplay between client transference and practitioner countertransference. Many practitioners are not aware of the dynamic process of transference and countertransference that is present in the treatment room during EFT sessions. This article particularly focuses on the recognition and use of countertransference to help practitioners take advantage of the opportunities it provides and the pitfalls that should be avoided. [ABSTRACT FROM AUTHOR]

Background: The negative effects of the unmanaged countertransference on session outcome are well documented, but little is known about the impact of countertransference reactions on the in-session elaboration processes. This study investigated the impact of countertransference reactions on the quality of client and counsellor's in-session work as revealed by their linguistic style, assuming that linguistic style shows the quality of speakers' referential process, i.e., their ability to translate into words and reorganize the client's emotional experiences. Methods: To test this hypothesis twenty-three in-training psychotherapists were asked to rate their emotional reactions through the Therapist Response Questionnaire at the end of the first three counselling sessions with one of their clients, for a total of 69 sessions. These sessions were recorded, transcribed, and evaluated by three external observers who applied the Countertransference Behavior Measure. Finally, the transcripts were analyzed by applying the computerized linguistic measures of the referential process. Results: We found that countertransference reactions were associated to clients' specific speech styles characterized by a lower referential process especially in the case of dominant, helpless, overwhelmed, and parental countertransference reactions. For the counsellors, we observed a linguistic style marked by emotional distancing. Conclusions: This study confirms that linguistic indicators can capture the impact of countertransference reactions, which shows to hinder the emotional elaboration in the counselling sessions. [ABSTRACT FROM AUTHOR]

Using theory from philosophy and from race studies, the author explores the countertransference confusions and enactments that can arise in working with trans and gender nonbinary patients. Case material is presented to explore in vivo the potential for enactments and toxic anxiety in the analyst in work with patients exploring or inhabiting new forms of desire and identity. Primitive states of anxiety and dysphoria may inhibit the analyst's capacities to allow freedom and reflection in cases of complex gender construction. [ABSTRACT FROM AUTHOR]

The author focuses on trans-identities within the broader field of trans-subjectivities while arguing that subjectivity should be considered within the conceptual framework of a heterogeneous and plural subject. The analyst's eagerness to classify gender and sex or typify pathology in a Manichean manner is an inevitable consequence of binary thought. This provokes undesired countertransference effects and creates obstacles to listening in the analytic session. The following contribution reexamines several notions to offer a renewed perspective on the concept of the subject, the Oedipus complex, the desire for a child, the categories of difference and diversity, and the blind spots of binary logic, among others. This reconsideration may in turn elucidate our comprehension of gender and sexual diversities. In this context, the author stresses the need to approach trans-identities and trans-subjectivities with a nonbinary logic based on a rhizomatous way of thinking. [ABSTRACT FROM AUTHOR]

This essay attempts to expand the traditional model of negative countertransference by giving it a Lacanian twist. The author uses theories and concepts from Freud, Winnicott, and Lacan in order to explore the affective dimension of countertransference in two cases of trans-identified patients. In the first case, the author shows that wanting to do good was counterproductive, while in the second vignette maintaining a position of neutrality allowed the author to go beyond fear and pity, which led to a dynamic resolution. [ABSTRACT FROM AUTHOR]

Freud tarafından ortaya atılan aktarım kavramı hastanın geçmiş deneyimleri ve öznel yapısına bağlı olarak oluşan ilişkilenme biçimlerinin analitik süreçte tekrarlanması olarak tanımlanmaktadır. Karşı aktarım ise birçok farklı görüş olsa da hastanın terapi sürecindeki söyleminin terapistte çeşitli duygulanımlar, bilinçdışı çatışmalar ve tutumlara yol açması olarak betimlenebilir. Literatürde, karşı aktarımın bilinçdışı niteliğinin yanında bilinç düzeyinde de çeşitli biçimlerde kendisini gösterdiğini savunan ve bu kapsamda karşı aktarımı niceliksel olarak inceleyen birçok çalışma bulunmaktadır. Bu çalışmanın amacı, terapistlerin karşı aktarımlarını ölçmek için geliştirilen Duygu Envanteri (Feeling Word Checklist) ölçeğinin kısa versiyonu olan Duygu Envanteri-Kısa Versiyon (DE-KV; Feeling Word Checklist-Brief Version) adlı ölçeğin psikometrik özelliklerinin Türk örnekleminde incelenmesidir. Çalışmanın örneklemi, farklı ekoller temelinde psikoterapi uygulayan 184 psikologdan oluşmaktadır. DE-KV öncelikle Türkçeye çevrilmiş ve Türk örnekleminde faktör yapısını incelemek amacıyla yürütülen doğrulayıcı faktör analizi bulguları, ölçeğin orijinali ile benzer olarak üç faktörlü bir yapıya sahip olduğunu desteklemiştir. Yürütülen güvenirlik ve geçerlik analizleri, ölçeğin psikometrik özelliklerinin yeterli düzeyde olduğunu göstermektedir. Tüm bulgular psikanalitik literatür ışığında tartışılmıştır. [ABSTRACT FROM AUTHOR]

The use of the empathic mode for engaging and communicating with patients has become widely accepted by many psychoanalytic psychotherapists since Kohut's early formulations (Kohut, 1971; Atwood & Stolorow, 2014). However, diagnostic understanding based on ongoing empathic immersion with our patients is often complicated because it is continually being modified as we know them more deeply and as transference and countertransference factors influence our perceptions. To illustrate the complexity of diagnosis when it is grounded in ongoing empathic engagement with our patients, I describe in detail my treatment of an elderly woman who initially presented with severe and acute symptoms of psychological, cognitive, and physical impairment. As the treatment has progressed, my diagnostic understanding has been continually modified to include a combination of psychodynamic and organic factors including PTSD, intense unresolved grief, and extreme feelings of guilt and need for punishment. Adding further to this conundrum, I have been frequently challenged by my own responses to the fluctuations in her progress, especially to periods of hopefulness followed by periods of despair and regression. [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]

Learning how to identify and work with the countertransference is a cornerstone of any psychoanalytic training, yet it can't be taught solely through books or in the classroom. Experience of the countertransference and having it pointed out through supervision or a peer group is an essential component of this learning process. Nonetheless, countertransference can be missed as it's often an unconscious form of communication. This article explores, through the example of an infant observation, how an intense countertransference penetrated unchecked and unnoticed but was enacted through the creative act of knitting. The emergence of this countertransference is examined and is then considered through the lens of a 'creative block'. This idea gives a different way to think about unconscious processes and enriches the understanding of what is being communicated. [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]