Countertransference and the analytic instrument.

The concept of countertransference may have reached a point where it is too broadly defined. This article differentiates the inner states of the analyst, conceptualized as "the analytic instrument," from his or her behavior in the treatment. It further differentiates between behavior that only hampers an analysis because it permits the transference neurosis to remain intact (simply put, bad therapy) and a different kind of behavior (countertransference proper) that has the potential to destroy an analysis because it seriously damages the transference neurosis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The use of the dollhouse as an effective disclosure technique.

Presents an overview of use of the dollhouse to facilitate disclosure. The patient was a 6 yr old albino male, diagnosed as developmentally delayed who suffered physical abuse from his father and an older brother. The goal of the therapy was to assist the child in the processing and healing of his trauma. During 4 sessions the child was able to disclose his trauma and produce solutions with the aid of the therapist and dollhouse. The child's choice of metaphor, the dollhouse, assisted him in overcoming to a degree, the sense of helplessness and isolation he felt during the abuse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychoanalysis and the disenfranchised: Countertransference issues.

This article examines basic psychoanalytic principles and their applications to the understanding and treatment of individuals not historically included in psychoanalytic formulations. It looks at the impact of culture, ethnicity, and class, but particularly poverty. The hope is to develop successful application of psychoanalytic theory and technique to the psychological problems of people living in poverty. Careful examination of their psychological reality may offer a unique opportunity to broaden vision of assessment to what constitutes dysfunctional condition, the concept of adaptation, the development of the working alliance, the nature of resistance and transference reactions, and the like. The analyst's personal discomfort, motivations, and stubborn adherence to specific theoretical and technical stances are considered the most damaging obstacles in this endeavor. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Countertransference in the treatment of the borderline personality

The emotional pressure and transferences of patients to their physicians and other caregivers are natural, inevitable occurrences that are not restricted to therapeutic situations in which one is using a dynamic approach. Transferences are present in all relationships but are scrutinized in intensive dynamic psychotherapy. This article presents clinical examples that illustrate the intense pressures, often near-psychotic, exerted by certain borderline patients, which are unconsciously targeted to force a specific type of response from the therapist.     

Countertransference in the treatment of pathological narcissism.

Explores literature on countertransference reactions experienced in psychodynamic work with narcissistic clients, examines the various therapist–client variables involved in these reactions, and briefly suggests approaches to understanding and resolving them. Common types of narcissistic transference and countertransference include responses to the mirroring transference, idealizing transference, twinship transference, and negative transference. Underlying principles in understanding and effectively utilizing one's countertransference feelings in psychotherapy include differentiating subjective vs objective countertransference and determining whether to interpret these feelings with regard to both the client's developmental needs and phase of treatment. This is especially important in treating narcissistic clients whose self-esteem is fragile and who are, thus, prone to experience shame and rage reactions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Love in the Countertransference: Controversies and Questions.

The aim of this article is to bring discussion of the analyst's loving feelings toward his or her patients into open professional dialogue. Several controversies are examined: (a) countertransference love versus love in real life; (b) purposeful self-disclosure of the analyst's loving and sexual feelings; and (c) "falling in love" with one's patients. In each of these areas a personal clinical vignette and selective relevant literature are discussed. As befitting the subject matter, the author's writing style is as close as possible to the experience of the analytic couple, with minimal use of technical and abstract language. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive strategies and the client conceptualization process.

Used perspectives from cognitive psychology to (1) examine the manner in which 27 doctoral-level counseling psychology students formulated conceptualizations of a client and (2) describe cognitive strategies employed to accommodate additional information about, and observations of, the client over time. Ss read a brief paragraph about and viewed a 5-min videotape of a client being interviewed. Ss then answered questions about the foci for counseling this client and the questions they would ask. Convergent or divergent conceptual strategies were identified and were found to be associated significantly with Ss' amount of previous counseling experience and with the extent of their formal training. Ss with more experience showed greater early convergence. Ss' confidence in their conceptualizations was related significantly to gender and to amount of exposure to the client. Females were consistently more confident than males. Findings are discussed in terms of cognitive capabilities and of students' self-perceptions and expectations. (7 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Degree of client disclosure as a function of past disclosure, counselor disclosure, and counselor facilitativeness.

Examined the relationship between a client's past disclosure rate, specific situational variables, and client disclosure rate in counseling. College students receiving individual counseling services (36 male and 64 female) served as Ss. Each S received 2 questionnaires that contained 3 forms of the Jourard Self-Disclosure Questionnaire and a revised form of the Relationship Questionnaire. Results do not provide total support for any 1 theory of self-disclosure in counseling. A client's past tendency to self-disclose was significantly related to present tendency to self-disclose in the counseling relationship; however, present disclosure rate was also strongly related to certain situational variables, including client perception of counselor self-disclosure and counselor facilitativeness. The relationship between client perception of counselor facilitativeness and client perception of both client and counselor self-disclosure appears to occur through the client's perception of the counselor as warm and empathic, not through perception of the counselor as genuine. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Countertransference in the nurse-patient relationship: a review of the literature

The connection between lipids and the rate of progression of chronic renal disease was retrospectively examined in 70 patients who were divided into 2 groups according to their baseline creatinine clearance (CCr): Group 1 (Gp1) contained 30 patients with CCr 60-40 mL/min followed for 40.0 +/- 13.3 months; Group 2 (G2) contained 40 patients with CCr 39-15 mL/min followed for 39.0 +/- 18.2 months. The following parameters were considered: basal and final CCr proteinuria per unit of CCr (UProt/CCr); the difference between final and basal UProt/CCr (delta UProt/CCr); the change in CCr/month (delta CCr); baseline triglycerides (TG), total (TC), HDL (HDLC) and LDL (LDLC) cholesterol, Apo AI, Apo B, Lp(a). Besides in basal CCr the 2 groups significantly differed in the final CCr, final UProt/CCr, delta UProt/CCr, delta CCr. No differences were observed concerning lipid parameters except for Lp(a) (G1 14.8 +/- 13.6, G2 28.7 +/- 27.4 mg/dL; p < 0.05). Baseline TG (G1 184.1 +/- 61.3, G2 187.5 +/- 72.1 mg/dL) and Apo B (only G2 1.05 +/- 0.32 g/L) were significantly higher than normal subjects and the Apo AI/Apo B ratio (G1 1.42 +/- 0.43, G2 1.33 +/- 0.45) were significantly lower than in normal subjects. delta CCr, while inversely correlated in both groups with delta UProt/CCr (p < 0.01), only in G2 did it correlate directly with the Apo AI/Apo B ratio (p < 0.05) and inversely with Apo B and LDLC (p < 0.05). Although a correlation between Lp(a) and delta CCr was not found, 20/22 patients (3/5 G1, 17/17 G2) with a level > 30 mg% ran a progressive course. A natural progression of CRI, heralded by an increasing UProt, is highly frequent when baseline CCr is < 40 mL/min; only then lipids seem to add a burden to the renal damage.     

The impact of therapist disclosure on patient disclosure.

Conducted a psychotherapy analog study with 90 female undergraduates to examine the effects of therapist disclosure on the S's disclosure to the therapist during a 1st interview. 3 levels of therapist disclosure, no disclosure, demographic disclosure, and personal disclosure, and 2 levels of therapist warmth were manipulated. Ss completed a modified version of the Jourard Self-Disclosure Questionnaire. Ss exposed to a warm therapist offering moderate self-disclosure (demographic disclosure) disclosed more to the therapist than Ss exposed to warm nondisclosing or personally disclosing therapists. No differences were found between nondisclosing and personally disclosing warm therapists. Ss exposed to a cold therapist offered uniformly low levels of disclosure regardless of the level of therapist disclosure. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Countertransference behavior and management with survivors of sexual assault.

Examined the impact of therapist gender on countertransference behavior toward rape survivors and tested a 2-step model of countertransference management. The model recommends awareness of countertransference feelings (ACF) followed by employment of theoretical framework to understand these feelings. 47 counseling and clinical psychology graduate students (aged 20–44 yrs) completed measures of ACF and of theoretical framework. 1 wk later, countertransferential "approach" and "avoidance" behaviors were assessed as Ss responded to videotapes of an actress portraying a client survivor of date rape. Based on hierarchical regression analysis, an interaction effect was identified between ACF and theoretical framework. A combination of high ACF and high theoretical framework yielded the least avoidance behavior. As hypothesized, male therapists provided significantly more avoidance responses to the rape survivor than did female therapists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The conceptualization of meaning in illness

The focus of this paper is the development of a conceptualization of meaning within the context of serious illness. It is based on a symbolic interactionist perspective, with the significance of the concept of meaning for the process of adaptation being a primary point of discussion. Meaning, as it is defined here, refers to the perceived nature of the relationship between the individual and his/her world that is developed within the context of specific events. It is comprised of two inextricably linked dimensions: meaning that pertains to one's identity and how that is affected by the event of the illness, and meaning which pertains to perceived characteristics of the event and to the social circumstances that surround it. Interviews with 38 persons living with the stress of cancer provide qualitative data that illustrate the concept as it is set forth in this paper. Four specific domains relevant to symbolic interactionism were explored in these interviews: (1) the individual's response to the illness; (2) changes that occurred relative to identify as a consequence of the illness; (3) the impact of cancer on the individual's relationship to the social world; (4) anticipated effects of the illness on the individual's future. Clinical implications of specific aspects of meaning are discussed.     

Impulsiveness and impulse control. On the psychological and psychopathological conceptualization

Facets of reading and language were examined in 131 9- to 12-year-old children for whom prenatal exposure to marijuana and cigarettes had been ascertained. The subjects were from a low-risk, predominantly middle class sample who are participants in an ongoing longitudinal study. Discriminant Function Analysis revealed a dose-dependent association that remained after controlling for potential confounds, between prenatal cigarette exposure and lower language and lower reading scores, particularly on auditory-related aspects of this latter measure. The findings are interpreted as consistent with earlier observations of an association between cigarette smoking during pregnancy and altered auditory functioning in the offspring. Similarities and differences between the reading observations and dyslexia are discussed. Maternal prenatal passive smoke exposure did not appear to contribute to either the language or reading outcomes at this age but postnatal secondhand smoke exposure by the child was associated with poorer language scores. Prenatal marijuana exposure was not significantly related to either the reading or language outcomes.     

Countertransference, attachment, and the working alliance: The therapist's contribution.

This study examined the relationship among therapist attachment styles, countertransference behaviors, and working alliance. Fifty therapists in training and their supervisors participated in the study. Therapists completed a self-rated measure of attachment style and a measure of working alliance with 1 of their clients. Supervisors completed measures of working alliance and countertransference behaviors about their supervisee's relationship with the same client. Results indicate that therapist attachment style did not correlate with either countertransference behaviors or working alliance. However, negative countertransference was associated with poorer working alliances, and positive countertransference was related to a weak bond within the working alliance. Additional analyses indicate that disagreement among supervisors and therapists about the bond component was predictive of countertransference behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trichotillomania: current issues in conceptualization and treatment

Trichotillomania is a little-known disorder with wider prevalence and more significant consequences than previously believed. While sharing similarities with obsessive-compulsive disorder, compelling differences from it have also been noted. This fact, coupled with recognized overlap with other obsessive-compulsive spectrum disorders, has resulted in the ongoing evolution of our conceptualization of this illness. While empirical evidence supports the use of behavioral treatment and pharmacotherapy, considerable research is still needed before we can promise highly effective interventions tailored to the individual hairpuller. This review will summarize the evidence supporting, as well as challenging, a hypothesized link with obsessive-compulsive disorder. Current treatment approaches will be reviewed, as well as evidence for their efficacy. Suggestions will be made for future directions in this field.     

Transference and race: An intersubjective conceptualization.

Discussions of race-based transference in the psychoanalytic literature have been infrequent. When present, such transference has been described from the Freudian or Kleinian perspective, as either a manifestation of intrapsychic conflicts or projection of unwanted mental content onto the racial other. These views, although helpful in some situations, exclude other possible meanings of interracial transference. This article describes an approach based on contemporary intersubjective theories in which race-related transference is seen as one aspect of a person's ongoing construction of experience and understanding of the unique meaning of race for each patient is emphasized. The far-reaching influence of the analyst's race and culture in the development of transference is then described, and it is argued that the analyst needs to be aware of the culture embeddedness of her or his therapeutic endeavors. Treatment issues are discussed with clinical examples. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Field dependence and characteristics of conceptualization in identical twins

This study falls in the areas of both differential psychology and twin psychology. Using the EFT and the WCST (computerized version), we examined 11 MZFF pairs between 18 and 35 years of age. The aim was to establish the genetic and/or environmental determination of global-analytical cognitive style as well as some characteristics of conceptualization linked to field dependence. The research strategy consisted of introducing three other groups of the same size to control the weight of environmental factors different from those determined by subject selection. The results seem to support the hypothesis of genetic determination of field dependence of the MZFFs, probably linked to the XX chromosome combination. The "couple effect" and the attitude of parents and others toward two identical female subjects may contribute to full expression of the genome. The characteristics of conceptualization revealed by the WCST show that MZFFs persevere in errors typical of a global approach to experience.     

Toward a theoretical conceptualization of the Whitehorn-Betz A-B scale.

Administered the Whitehorn-Betz A-B scale, the Sundland and Barker Therapist Orientation Questionnaire, and a biographical information blank to 30 male doctoral level counselors. Results of analyses indicate that (a) the therapist's orientation was independent of his A-B disposition; and (b) A therapists were socially dependent conforming, while B therapists were socially independent nonconforming. It is suggested that the results support a complementary hypothesis in which "the counselor is able to model the interpersonal and intrapersonal skills the client lacks." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A developmental conceptualization of clinical problem solving

A taxonomy for assessing clinician development in three areas of problem solving based upon cognitive learning theory (Shapiro & Moses, 1989) was applied to the analysis of videotaped clinical sessions involving three student clinicians. The purpose was to evaluate, from a developmental perspective, the clinical performance of clinicians rated by their supervisors as performing at different skill levels. Three developmental profiles in three domains of problem solving (perspective taking, variables considered, and solutions generated during clinical problem solving) were derived from these analyses. The results supported the application of a developmental conceptualization to the assessment and facilitation of problem-solving skills in the professional preparation of speech-language pathologists.     

Countertransference as the analyst's experience of the analysand: Influence of listening perspectives.

Discusses countertransference as part of the analyst's larger experience of the patient, to capture the complexity of the analyst's involvement and correctly place it as a central guide for inquiry and interventions. The analyst's experience of the patient is shaped not only by the patient, but also by his listening perspective, models, and subjectivities. The analyst experientially can resonate with the patient's affect and experience from within the viewpoint of the patient (subject centered), or of the other person in a relationship with the patient (other centered). The analyst's listening from within and without, oscillating in a background–foreground configuration, can illuminate more fully the patient's experience of self and of self in relation to others. Case studies of 2 women and 1 man are included. (PsycINFO Database Record (c) 2010 APA, all rights reserved)