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I attended a very good lecture this week on contemporary views of countertransference. \u00a0It inspired me to write a brief overview of the concept here, with more to follow.<\/p>\nI attended a very good lecture this week on contemporary views of countertransference. \u00a0It inspired me to write a brief overview of the concept here, with more to follow.<\/p>\n
To understand countertransference, it helps to tackle transference<\/a> first. \u00a0As I’ve<\/a> discussed<\/a> previously<\/a>, transference was a word coined by Sigmund Freud<\/a> to label the way patients “transfer” feelings from important persons in their early lives, onto the psychoanalyst or therapist. \u00a0Psychoanalysis was specifically designed to encourage transference. \u00a0Intentional opacity and non-disclosure<\/a> by the therapist promotes transference; the patient naturally makes assumptions about the therapist’s likes and dislikes, attitude toward the patient, life outside the office, and so forth. \u00a0These assumptions are based on the patient’s experiences with, and assumptions regarding, other important relationships, such as childhood relations with parents. \u00a0In this way the patient’s formative dynamics are re-created in the therapy office for both participants to observe. \u00a0Patients discover that some of their assumptions about others, and themselves, are unfounded or outmoded and do not serve them well. \u00a0This is an important type of insight that can lead to lasting psychological change.<\/p>\n Freud realized that transference is universal, and therefore could occur in the analyst as well. \u00a0He did not write much about this, except to say that “countertransference” could interfere with successful treatment. \u00a0The analyst experiencing countertransference should rid himself of these feelings by having further analysis himself.<\/p>\n Since the 1950s, psychoanalysts and psychodynamic therapists have held a more benign view of countertransference. \u00a0It is no longer seen as an impediment to treatment (at least not inevitably), but instead as important data for the therapist to use in helping the patient. \u00a0Countertransference can serve as a sensitive interpersonal barometer, a finely tuned instrument in the field of social interaction. \u00a0For example, a therapist who feels irritated by a patient for no clear reason may eventually uncover subtle unconscious provocations by the patient that irritate and repel others, and thereby keep the patient unwittingly lonely and isolated.<\/p>\n In using countertransference this way, the therapist must consider multiple sources of his or her feelings. \u00a0Some feelings, positive or negative, may be evoked by the patient. \u00a0These are particularly helpful ones to notice, especially when the cause is not immediately obvious, as in the example just given. \u00a0Often, however, feelings may be stirred up by irrelevant characteristics in the patient (e.g., the patient physically resembles the therapist’s sibling or spouse), by the prior<\/em> patient, or by factors unrelated to therapy (e.g., bad traffic getting to the office, a quarrel at home, an upcoming vacation). \u00a0This strongly argues for dynamic therapists to pursue such therapy themselves: It “tunes the instrument” to better distinguish countertransference evoked by the patient, versus similar feelings that arise from other causes. \u00a0Freud’s advice for analysts to seek additional analysis themselves in the face of countertransference is wise, although not for the reasons he gave.<\/p>\n I teach psychiatry residents to go through a mental checklist whenever they become conscious of possible countertransference:<\/p>\n (1) Is this feeling characteristic, i.e., does the resident have it much of the time? \u00a0If so, it may say a lot about the resident, but probably nothing about his or her patient.<\/p>\n (2) \u00a0Is the feeling triggered by something unrelated to the patient? \u00a0Feelings caused by hunger, one’s personal life, bureaucracy in the medical center, and so forth are not useful data for helping the patient.<\/p>\n (3) \u00a0Is the feeling related to the patient in an obvious way? \u00a0Feeling irritation toward a patient who is screaming obscenities and viciously destroying the office is countertransference of a sort, but not very illuminating. \u00a0And finally,<\/p>\n (4) Is the feeling uncharacteristic of the therapist, a reaction to one particular patient, and yet the exact trigger is not immediately obvious? \u00a0These are the most helpful feelings to notice in oneself, as they often shed light on subtle yet important dynamics in the patient.<\/p>\n Countertransference is not always helpful. \u00a0Particularly when it is unexamined \u2014 or, worse, unrecognized \u2014 it can indeed interfere with effective treatment. \u00a0This can occur even with positive countertransference, as when a therapist is so entertained by a patient’s jokes that the underlying bitterness is ignored, or when an attractive patient is never challenged because the therapist desperately yearns to be liked. \u00a0More often, though, countertransference is problematic when it is negative. \u00a0The therapist feels bored, irked, paralyzed, or contemptuous in the presence of a particular patient. \u00a0It is the therapist’s job to recognize these feelings and deal with them. \u00a0Occasionally a therapist must refer the patient to a colleague when the original therapist’s countertransference is unmanageable. \u00a0Fortunately, in most cases these uncomfortable feelings, once recognized by the therapist, can not only be understood but also used constructively in the treatment.<\/p>\n","protected":false},"excerpt":{"rendered":" I attended a very good lecture this week on contemporary views of countertransference. It inspired me to write a brief overview of the concept here, with more to follow.<\/p>\n To understand countertransference, it helps to tackle transference first. As I’ve discussed previously, transference was a word coined by Sigmund Freud to label the way patients […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[8],"tags":[37,20,24],"class_list":["post-269","post","type-post","status-publish","format-standard","hentry","category-psychotherapy","tag-countertransference","tag-therapist-disclosure","tag-transference","odd"],"aioseo_notices":[],"_links":{"self":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts\/269","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=269"}],"version-history":[{"count":8,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts\/269\/revisions"}],"predecessor-version":[{"id":279,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts\/269\/revisions\/279"}],"wp:attachment":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=269"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=269"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=269"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}