Countertransference and empathy: The complex relationship between two divergent concepts in counseling.

Examined the relationship of 20 male counselor trainees' empathic ability (the Barret-Lennard Relationship Inventory) to measures of countertransference behavior and countertransference feelings toward 20 undergraduate female clients. It was expected that empathic ability would be negatively related to the manifestation of countertransference behavior, operationalized as the withdrawal of personal involvement, but positively related to self-reports of openness to countertransference feelings. Empathy was found to be negatively related to countertransference behavior with seductive female clients but not with hostile or neutral clients. Counselor empathic ability was positively related to counselor reports of openness to countertransference feelings. Findings suggest, however, that there was a limit to how often countertransference feelings could be experienced in a given counseling session without spilling over into countertransference behavior. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Meaning and management of attraction: Neglected areas of psychotherapy training and practice.

Develops a conceptual framework for understanding sexualized transference and countertransference that will enable clinicians to employ these feelings to advance and enrich the therapeutic process. Unrecognized, such feelings may lead to therapeutic failures or harmful enactments by patients or therapists. A helpful therapeutic stance is described, and the varied meanings of sexual feelings and countertransference are discussed. Guiding principles for interventions, "real" attraction in therapeutic relationships, and patients' sexual feelings and behavior toward therapists are addressed. Case illustrations of commonly occurring transference–countertransference dilemmas are examined and discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Managing countertransference feelings: An interactional model using awareness of feeling and theoretical framework.

An interactional model was presented of how counselors manage countertransference feelings based on their levels of awareness of feelings and theoretical framework. To test the model, 58 graduate students enrolled in American Psychological Association (APA)-accredited doctoral training programs were first assessed for their levels of awareness of countertransference feelings and theoretical framework during the counseling hour. Then, subjects were asked to listen to two audiotapes of actresses portraying clients in ongoing, insight-oriented psychotherapy. An index was taken of withdrawal of involvement, a countertransference behavior. A repeated measures analyses of variance identified main effects for awareness of feeling and tape type, and an interaction effect between the awareness of feeling and theoretical framework variables. These results suggest that greater awareness of feeling relates to less withdrawal of involvement and that the combination of high awareness of feeling with high theoretical framework provides the least withdrawal of involvement. The role of countertransference in the counseling process and on the potential training implications based on this line of research were discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Identifying and reducing risk factors related to trainee–client sexual misconduct.

Sexual misconduct involving therapists-in-training and their clients is addressed. Personal and situational factors that may constitute risk factors for the development of inappropriate sexual activity between trainees and their clients are identified. Although there may be certain characteristics that put particular students at risk for such involvement, the authors believe this risk is more strongly related to systemic, programmatic, and pedagogic characteristics of the environments in which students train. Examples include, respectively, the decline of concern over transference and countertransference, failure to include education about client–therapist sexual attraction and the consequences of sexual misconduct in graduate psychology curricula, and the reluctance of supervisors to deal straightforwardly with trainees' sexual feelings. Suggestions for reducing risks for client–therapist sexual misconduct are directed toward these situational factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

The body in analysis: authentic movement and witnessing in analytic practice

This paper will describe a form of active imagination called authentic movement, in which attention is given to the somatic unconscious. In authentic movement, patients are encouraged to focus inward and attend to any bodily sensations, images and feelings which may arise. In the process of focusing inward on one's bodily-felt experience, images, somatic memory and the accompanying feelings which arise are then available to be explored as a communication from the patient's unconscious. Authentic movement supports the individual in linking image with affect in that the individual re-experiences the somatic aspect of symbolization. What was previously conserved on the somatic level as unmentalized experience, can now begin to be taken up into the mind, thought about, and made available for analysis. In authentic movement, the analyst acts as a silent witness to the patient's explorations. The quiet focused attention of the witness helps to create a secure containing environment in which the person moving can experience a sense of feeling held and seen. The function of the witness is to hold the patient's experience in his own mind, particularly what is not yet mentalized. The witness utilizes his somatic countertransference, including any images, feelings and bodily responses which are generated by what is being communicated non-verbally, as a means of understanding and responding to the patient's material.     

The "unobjectionable" positive countertransference

Even though Freud said that "the secret of therapy is to cure through love," the "unobjectionable" positive countertransference has remained a neglected topic in clinical and theoretical writings. This paper explores a number of personal and historical reasons to account for this avoidance. A case vignette is presented to highlight the facilitating and therapeutic role of the positive countertransference. It also demonstrates the analyst's struggles with his loving feelings and some of the reasons behind this conflict. The case is then used to explore the functions that the positive countertransference serves for the analysand, the analyst, and the analytic process. In conclusion, a number of questions are posed for an emerging model of psychoanalytic technique that would encompass the analyst's noninterpretive contributions to the process.     

Love and hate in the countertransference supervisory concerns.

Addresses common misunderstandings of countertransference love and hate based on work with 15 therapists who engaged in sex with patients. Almost all of these cases involved some misunderstanding of love and/or hate in the countertransference. Training for most therapists fails to address these misunderstandings. Common misunderstandings involve (1) the tendency to confuse countertransference love with the positive and warm feelings associated with the therapeutic alliance, (2) therapists' need of a positive view of themselves, and (3) the tendency to view countertransference love as synonymous with empathy. Some misunderstandings may have dynamic origins and serve to rationalize the emergence of what the therapist believes to be countertransference love, but which is actually more a manifestation of countertransference hate. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapists' differential countertransference reactions toward clients with major depression or borderline personality disorder

The purpose of this study was to examine psychotherapists' differential countertransference reactions toward either clients diagnosed with either Major Depression or Borderline Personality Disorder. Specifically, psychotherapists' personal perceptions and emotional reactions to these clients were assessed utilizing the Impact Message Inventory and the Stress Appraisal Scale (N = 155). Direct feelings, action tendencies, cognitive attributions, and perceived anxiety were evaluated. Results indicated that clients with Borderline Personality Disorder are perceived as significantly more dominant and hostile, whereas clients with Major Depression were considered significantly more submissive, friendly, and salient. In addition, it was found that as clinicians' years of experience increased, degree of countertransference decreased. These results suggest that countertransference reactions can be measured empirically, that differential countertransference reactions are evoked toward clients manifesting different symptoms, and that awareness of countertransference may be important for positive therapeutic outcome.     

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)     

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)     

Countertransference management.

The empirical literature on countertransference (CT) and, in particular, CT management as they relate to immediate, proximate, and distal treatment outcomes, is examined. Although there is a paucity of research connecting CT and its management to distal outcomes, the existing empirical literature strongly supports the idea that the acting out of CT hinders therapy, whereas effective CT management aids treatment. A theory of five factors that are central to CT management has received provisional empirical support and is described here. These factors are self-insight, self-integration, anxiety management, empathy, and conceptualizing ability. Further research is needed on the relation of CT and its management to distal outcomes, and on how CT management operates and affects treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Measuring countertransference and attitude in therapeutic relationships.

Significant results were obtained establishing a relationship between the therapist's attitude of liking or disliking for his or her clients and countertransference. If strong feelings of liking are present, clients are viewed as having personalities closer to the therapist's personality than are the client's measured personalities. When strong feelings of disliking are operative, the therapist's distortion of the client's measured personality runs in the opposite direction and is viewed as more dissimilar from the therapist's personality than it is measured to be. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Amnioinfusion in the management of oligohydramnios

Marital therapy for infidelity may bring up intense countertransference feelings in the therapist. Biases and identifications with one or the other spouse, moralism, and feelings of anger, helplessness, and hopelessness often surface while working with clients dealing with extramarital affairs. When the reactions are conscious they are less likely to interfere in the couple therapy, but when unconscious the work may be negatively affected. This article discusses some pitfalls in marital therapy with infidelity.     

The patient's contribution to the therapist's countertransference feelings

Countertransference feelings of psychiatric milieu therapists toward their patients were studied by using a self-report feeling word checklist. The feelings were scored on subscales of feeling states in a circumplex model. By using an analysis of variance model, comparisons between reactions to patients individually and reactions to patients with different personality organizations and with different Health-sickness rating scale scores could be made. A total number of 244 therapists at 21 small treatment homes were studied. It was found that approximately 15% of the therapists' countertransference feeling reactions could be accounted for by recurrent reactions to patients individually. Surprisingly, the personality organization and the Health-sickness rating scale score of the patient accounted for almost no variance in therapists' feelings. The results are discussed, and possible explanations are evaluated.     

Therapist perspectives on countertransference: Qualitative data in search of a theory.

A consensual qualitative research strategy was used to examine data from 127 interviews conducted with 8 psychologists immediately following their sessions of brief therapy with 8 clients. Analyses revealed 3 domains relevant to countertransference: origins (including categories of family issues, needs and values, therapy specific issues, and cultural issues), triggers (including categories of content of client material, therapist comparing client with others, change in therapy structure or procedures, therapist assessing progress of therapy, therapist perception of client, and emotions), and manifestations (including categories of approach, avoidance, negative feelings, and treatment planning). The frequency of categories within and across cases was classified, and relationships among categories from the 3 domains were detected, generating hypotheses for future empirical research. Implications for practice, training, and continued research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The abuser and the abused: Sources of resistance to resolving splits in the countertransference in the treatment of adults who were sexually abused as children.

A primary challenge encountered in treating adult patients who were sexually abused as children is the experience of being divided between feelings of empathy for the patient as an abused person versus feelings that this person is sometimes being abusive and foiling or hurting us. This article examines some of the sources of what is seen as the collective difficulty of therapists in resolving the recurrent conflict between identifications with the abused and the abuser in countertransference toward these patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Toward more (and better) countertransference research.

This article addresses the definitional and measurement barriers currently inhibiting countertransference research and indicates new pathways toward meaningful and clinically relevant countertransference research. First, I review the countertransference definitional debate and advocate for the adoption of a moderate countertransference definition. Second, I review the extant countertransference research, with primary emphasis on measurement issues, and recommend new methods and instruments for assessing the construct. Finally, I conclude with a few remarks about clinical implications and directions for future CT research. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Treating substance-abuse patients with histories of violence: Reactions, perspectives, and interventions.

One of the more troubling experiences that occurs in the psychotherapy of addicted persons is when they relate stories concerning their involvements with past acts of violence. Whether these events are regretted or not, they often arouse strong feelings in therapists and can present both patients and clinicians with questions about how to proceed. Attribution theory can be a useful tool for understanding the feelings and countertransference that arises, and a combination of insights from the field of posttraumatic stress disorder (PTSD) treatment and existential therapy, along with a focus on the question of character, are a potential foundation for the development of therapeutic interventions. The relationship between substance abuse and violence, the importance of treatment context, and the interdependence of identity and action are explored. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Countertransference as a prototype: The development of a measure.

Countertransference is a concept that is widely acknowledged, but there exists little definitional consensus, making research in the area difficult. The authors adopted a prototype theory (E. H. Rosch, 1973a, 1973b; see C. B. Mervis & E. Rosch, 1981, for a review) to examine this construct because it conceptually fits well with constructs that elude explicit definition. In Study 1, 45 experienced psychologists highly agreed with the prototypicality of 104 different examples of countertransference providing support for the presence of a prototype. In Study 2, the usage of this prototype in a sample of 35 trainees was related to ability to perceive countertransference in a case example drawn from the literature and positively correlated with self-reports of their experiences of countertransference but not with their self-reported ability to manage countertransference once it was manifest. Implications for training and research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)