Shame and acting out in psychotherapy.

Reviews historical and contemporary views of shame and acting out and notes those aspects of the shame experience that make it likely to be defended against by the unconscious mechanism of acting out. A specific phenomenon is described that may occur during the course of treatment and that manifests itself as an apparently "shameless" form of acting out. The transference acting out in this instance represents an unconscious wish for the restoration of an early object in relation to whom shame was originally experienced. A case example of a 44-yr-old male patient illustrates this phenomenon. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Errors and misconstruals in the reporting of Freud's work: An illustration.

In an article published in this journal, Gornick (see record 1987-13536-001) discussed the situation of the female analyst or therapist and the male patient. In attempting to establish a "new narrative:" she made reference to Freud's ideas about transference. However, many of the references misstate or misconstrue Freud's position. This thesis is illustrated by a detailed examination of five errors contained in a brief section of Gornick's article entitled "The Erotic Transference." The article closes with a plea for scholarly accuracy in portraying the positions of those with whom one disagrees. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The real unconscious: psychoanalysis as a theory of consciousness

Inquiries into hallucinatory wish fulfillment and the unconscious converge and, by distinguishing the concept of the unconscious in psychoanalysis from that of cognitive psychology, serve to bring out what is most essential to the psychoanalytic conception. Freud's topographical model is used to stress that the psychoanalytic unconscious can be understood only in relation to theories of consciousness and wishing. Moreover, in contrast to the cognitive conception, psychoanalysis holds that the processing of thought in the human mind is inseparable from the activity of desire. This leads to further psychoanalytic reflections on the interrelation of conscious and unconscious, wishing and thinking, and, in consequence, on transference and the mechanism of unconscious fantasy.     

Measuring transference: Can we identify what we have not defined?

Transference is both a key concept and a complex phenomenon in psychoanalytic counseling. The Missouri Identifying Transference Scale is an important effort in measuring transference. The development of a tool to measure a theoretical construct, however, must rest on a solid definitional base; K. D. Multon, M. J. Patton, and D. M. Kivlighan (see record 199600458-001) need to provide such a base if their scale is to be maximally useful for understanding the relationships among transference as a concept, the measurement of transference, and clinical process and outcome. A wish list for the study and understanding of transference is included. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Shape of the communicated transference in difficult and not-so-difficult patients: Symbolized and desymbolized transference.

Describes differences between difficult and not-so-difficult patients based on the shape of their communicated transference, using 4 case examples. Transference originates in the communicative function of the dream, as a wish to impart the introjects into the consciousness of the listening analyst as object. Five variables or indices of symbolization are discussed. There appears to be an entity of difficult and not-so-difficult patient regardless of diagnostic category that exists not only in the subjective realm of a therapist experiencing the patient, but in the objective realm of coded text. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Identification and analyses of periodontal pathogens in Taiwan by microbiological tests

The effectiveness of transference interpretation in the psychodynamic psychotherapy of patients with borderline personality disorder has been highly controversial. Both highly expressive approaches that stress the value of transference interpretation and supportive strategies that eschew transference work have been advocated in the literature. We review this literature and identify three emerging trends in thought: (1) Primarily interpretive approaches should be reserved for patients with greater levels of ego strength. (2) Whichever technique is used, a strong therapeutic alliance is the foundation of treatment. (3) Expressive and supportive techniques should not be juxtaposed as polarized opposites; supportive interventions often pave the way for transference interpretation. Our psychotherapy process study revealed that transference interpretations tended to have greater impact--both positive and negative--than other interventions made with patients with borderline personality disorder. We conclude that such factors as neuropsychologically based cognitive dysfunction, a history of early trauma, patterns of object relations involving interpersonal distance, masochistic tendencies, and anaclitic rather than introjective psychopathology are among the patient characteristics that influence the impact of transference interpretation on the therapeutic alliance. Bias toward expressive technique and countertransference issues appear to be relevant to the therapist's difficulty in shifting to a more supportive approach when indicated.     

Ambiguity in speech

Ambiguity in speech during analysis is one manifestation of transference. Four types of ambiguity are illustrated. Each ambiguity communicates an unconscious wish or intention and the defense against this wish or intention. In each type of ambiguity, transference manifestations are expressed in the form of speech and not alone by its content, as we are accustomed to identifying the transference. Each type of ambiguity within the analysis expresses fear to responsibility and recrimination for libidinal or aggressive intentions. In some patients, the combinative ambiguity or malapropism expresses the fear of reprisal through the transformation into a self-inflicted injury. The pronominal ambiguity may express a feared and wished-for fusion with the analyst. The analyst's ambiguous interpretations are properly used to encourage associations, but at times may reflect lack of understanding and be a manifestation of countertransference.     

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)     

Assessment after extremely severe head injury in a case of life or death: further support for McMillan

This paper is a sequel to that of McMillan (1997) and describes further assessment of an extremely severely head injured patient. A combination of direct observations, structured interviews with staff, simple cognitive tests and questions with yes/no answers were used to assess communication and cognitive function in an extremely severely head injured patient with minimal ability to respond. Results confirmed the finding of McMillan and showed that the patient could understand and respond consistently to simple commands, could answer simple autobiographical questions consistently and clearly expressed her wish to live. The results of this study and that of McMillan confirm that valid assessment of minimally responsive patients is possible and that a number of different approaches are appropriate.     

Psychological differentiation and forms of pathology.

Research on cognitive styles and the broader dimensions of personality functioning of which they are a part has important implications for personality theory and research and problems of diagnosis and therapy. This is demonstrated through the global-articulated cognitive style (manifested in perception as field-dependence-independence) and the dimension of psychological differentiation of which it is the cognitive component. Different kinds of pathology occur with impairment of integration in more differentiated and less differentiated personalities. The differentiation concept and dimensions of cognitive style may help clarify nosological problems. In therapy, persons functioning at a more differentiated or less differentiated level are likely to differ in presenting symptoms, suitability for psychotherapy, nature of relation to the therapist (transference), and prospects for change. (2 p. ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A study of the dilemmas involved in work with schizophrenic patients.

Discusses some of the difficulties involved in transference and its handling with schizophrenic patients, using the treatment of a 22-yr-old chronic schizophrenic male as an illustration. Two major findings have emerged since Freud's contention that the schizophrenic could not form a transference relationship: The schizophrenic can form a transference relationship to the therapist, although (1) it may be of a different kind than that of the neurotic, and (2) for some therapists it is no longer the major tool of therapy. As the nature of the relationship changes from that of one whole person relating to another to that of a mother relating to a child, there is a shift in therapeutic technique. Whereas, in the former relationship, interpretation of the transference is primary, in the latter, the context or the setting for that interpretation becomes primary. The therapist must create a safe environment for schizophrenics as they regress to dependence. The therapist must be willing and able to merge with the patient, to be mother to the infant patient. This stance requires the utmost from the therapist, and thus countertransference acquires major importance in this work. (25 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Transference: Psychic reality and material reality.

This article explores the impact of material reality in the form of the analyst's unrecognized and enacted countertransference on a patient's psychic reality (PR) as it presents in the transference. PR refers to a patient's experience in the transference and to an organization of unconscious fantasies, encoded as compromise formations, that actively structures the present and can be inferred from the data of psychoanalysis. Clinical material is presented in support of the author's belief that PR plays the central role in the construction of the transference and that material reality can influence both the nature and form of the transference through the activation or inhibition of different sets of fantasies in the analyst and the patient. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The psychoanalytic process and Freud’s concepts of transference and transference neurosis.

The author investigates the concept of psychoanalytic process as it relates to the capability for defining the specificity of psychoanalytic treatments. The concept is traced back to its origin in Freud’s understanding of transference and transference neurosis. The author suggests that this process should be understood as an issue in which via “just-like-interpretations” contents of the patient’s transference enter into consciousness in the guise of a transference neurosis. These newly built substitutive formations are then removed by “just-like-it-was-interpretations” and changed into other substitutive formations. As this process can only be instigated by psychoanalytic measures, it is, therefore, the process itself that defines the specific difference of psychoanalytic treatments. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Capturing the subjective and other challenges in measuring transference: Comment on Multon, Patton, and Kivlighan (1996).

K. D. Multon, M. J. Patton, and D. M. Kivlighan (see record 199600458-001) have made a commendable attempt to develop a measure of transference and, in doing so, have struggled with one of the most difficult measurement tasks in therapy process research. This reaction to their work outlines the requirements of a useful measure of transference based on recent theory and research that views transference in terms of adult attachment patterns, cognitive interpersonal schemes, and inflexible patterns of interpersonal behavior. The Missouri Identifying Transference Scale is evaluated in terms of these requirements. Further avenues for refinement of the measure are suggested. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The specialty practice of cognitive and behavioral psychology.

What makes cognitive and behavioral psychology a specialty practice when many psychologists of differing orientations may inquire about a client’s cognitions and behaviors? Distinctive and unifying aspects of the specialty practice of cognitive and behavioral psychology are discussed as they relate to psychotherapeutic practice. A brief history of the field is given, and procedures in assessment, case conceptualization, and treatment planning are reviewed. Information regarding education and training is provided. Resources are suggested for individuals who wish to develop competency in cognitive and behavioral psychology. Psychologists who use cognitive and behavioral principles in assessments, treatment planning, case conceptualizations, interventions, or all of these are encouraged to pursue specialty certification in cognitive and behavioral psychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Integrating some mind and brain views of transference: the phenomena

Because understanding the underpinnings of transferential learning allows the analyst to more effectively exploit transference in the clinical situation, as well as to advance psychoanalytic theory, the functions and mechanisms of transference phenomena in learning are subjected to an interdisciplinary analysis. Through transference the brain creates hierarchical databases that make emotional sense of the world, especially the world of human relationships. Transference plays a role in defense and resistance clinically; less explored but equally important is the adaptive potential of transference and its effect on an individual's readiness for structural change through the activation of working memory. Most investigators within psychoanalysis have not considered the importance of similarity judgments and memory priming, especially as these help to explain why transference and its proper handling are effective in treatment. Yet there are complex relationships among transference, similarity judgment, and memory priming that tie together psychoanalysis, cognitive psychology, and neurophysiology. Evidence increasingly suggests a relationship between transference and the transfer of knowledge between various content domains (databases) of mind and brain, which is essential to cognitive and emotional learning. There are indications as well that transference decisively facilitates learning readiness ("windows") in general by means of two of its components: free association and spontaneous (self-initiated) activity. The important question of which mind/brain mechanisms motivate transference is not yet understood comprehensively. However, Vygotsky's work on the zone of proximal development (ZPD), M.Stern's teleonomic theory, schema theory, and neural network theory offer further insights into what motivates transference.