Countertransference in Psychoanalytic Psychotherapy with Children and Adolescents

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This collection of papers from psychoanalysts across Europe is intended to highlight the similarites and differences between approaches to working with children and adolescents. Part of the EFPP Monograph Series.

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CHAPTER ONE. Countertransference Issues In psychoanalytic psychotherapy with children and adolescents: a brief review

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Dimitris Anastasopoulos & John Tsiantis

The development of the concept of countertransference

The aim of this chapter is to present a selected review of the concept of countertransference and to follow its historical development, giving an overview of counter-transference phenomena as it applies to psychotherapy with children and adolescents.

The first reference to countertransference comes in 1910, in a short essay by Freud entitled “The Future Prospects of Psycho-Analytic Therapy” (1910d). Freud returns to the subject in the 1915 publication “Observations on Transference-Love” (1915a) In which he refers specifically only to erotic countertransference reactions. In both articles, Freud describes countertransference as an obstacle to psychoanalytic treatment and a “result of the patient’s influence on his [the therapist’s] unconscious feelings” (1910d, p. 144). It has been suggested (Brandell, 1992) that it was his work with hysterics and the Dora case (Freud, 1905e) (which included powerful erotic transference components) that led him to Identify erotic countertransference as a significant hindrance to the psychoanalytic process. Unfortunately, Freud never published an article specifically on countertransference.

 

CHAPTER TWO. Thoughts on countertransference and observation

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Judith Trowell

Countertransference has become one of the most Important and most useful tools In psychoanalytic work. In order to work effectively with children, young people, adults, groups, or organizations, one needs to know, understand, and be able to use one’s countertransference. Others still question the whole concept, either on the basis that It has no meaning or no clarity of meaning, or that It Is used so extensively and Is applied so widely that everything can be taken as part of the countertransference. It is likely that this questioning and distancing from the ideas of countertransference would mean that, In the clinical setting, important material or Issues are not given the significance and importance they merit if one Is trying to treat the whole person.

Freud struggled with the idea of countertransference. He felt that the feelings aroused In the analyst by the patient were due to the analyst’s own unanalysed emotional issues and that these needed to be acknowledged by the analyst and worked through but kept separate from the work with the patient. This Is in contrast to the transference, where feelings of the patient related to earlier or external relationships are transferred on to the therapist. Initially Freud also saw this as an Impediment, a hindrance to the analytic work, but later he came to see this same transference phenomena as a useful therapeutic tool. Countertransference, he remained clear, was to do with the analyst’s own Issues. This view prevailed for some time, and some very eminent analysts—for example D. W. Wlnnlcott and Melanle Klein—remained of the view that countertransference relates to the analyst’s own Issues, although both of them made major contributions to our understanding of the psychic processes and mechanisms occurring between patient and therapist.

 

CHAPTER THREE. Reflections on transference, counter-transference, session frequency, and the psychoanalytic process

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Alex Holder

The somewhat clumsy title of my chapter serves the purpose of drawing attention to a number of factors and phenomena in our clinical practice which are correlated In specific ways, and which I would like to explore here. It Is my contention that the number of sessions we work analytically with a child or adolescent during a week has a crucial bearing on the development or emergence of transference phenomena and on the corresponding Intensity and depth of countertransference responses, and thus frequency influences and determines the kind of analytic process that evolves in the course of time.

If at all possible, I would like to avoid any value Judgements of the kind that four or five sessions a week are better than one or two, although I realize that It is difficult to avoid such implications altogether. My aim is, rather, to explore the differences that arise In different settings—differences in the quality of the relationship between child and therapist which develop, differences in the momentum that the psychoanalytic process gains and the depths that it reaches, and differences In the realm of the trans-ference-countertransference dynamics and, with it, the therapist’s ability to get In touch with her patient’s unconscious to promote the process of understanding and Interpretation.

 

CHAPTER FOUR. Some problems In transference and countertransference In child and adolescent analysis

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Anne-Marie Sandler

In this chaper it will be possible to do Justice to only a very small part of this crucial area of psychoanalytic psychotherapy. The topic Is essentially a clinical and technical one, rather than a theoretical one, and the analysis of the transference and the understanding of countertransference are central elements in the analysis of both adults and children. However, the concepts of transference and countertransference have changed over the years, and I want to give a very brief theoretical Introduction before going on to focus on one or two of the problems that arise In connection with transference interpretations and, to a certain extent, to comment on the relevant counter-transference reactions.

Although for many years—and this Is still very much the case at present—transference was seen as being a repetition of past relationships to Important figures In the child’s life (Fenichel, 1945), we have come to realize more and more that the repetition of the past does not mean that the child or adult recreates relationships exactly as they were in the earliest years. We know that what tends to get reproduced In the present are relationships that have been distorted—sometimes grossly distorted—during the course of development by the child’s fantasies, by his use of mechanisms of defence such as projection and externall-zatlon.

 

CHAPTER FIVE. The transference mirage and the pitfalls of countertransference (with special emphasis on adolescence)

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FrariQOis Ladame

Introduction

According to Freud, transference emerges from unresolved unconscious conflict. Treating neurotic persons analytically means being able to analyse the transference. From there, we progressively moved to the Idea that transference results from the analytic situation itself (analysis then is defined as analysis within the transference). Can we move yet one step further and view its beginning within the proposition of analysis itself, which means a move towards reopening closure that was necessary for the subject’s constitution?

At first despised, countertransference has become more and more prized, until now being recognized as the central tool of the dynamics of the analytical process: a meeting of the unconscious within Itself. From one extreme to the other.

Certain characteristics of the adolescent process, which give specific flavour to both transference and countertransference with adolescent patients, are also underlined in this chapter.

* * *

For a comprehensive grasp of the phenomena of transference, I recommend the recent paper by Abend (1993). I limit myself here to one particular viewpoint, though I want nevertheless to emphasize some of Abend’s warnings regarding today’s divergences with which I fully agree: the current Interest In sexual abuse leads to the overlooking of the central importance of conscious and unconscious infantile sexual theories, wishes, and fears, and their effect on transference. Theories of transference that are derived mainly from work with severely disturbed patients—as well as from a particular emphasis on non-verbal communication—should at least elicit reservations.

 

CHAPTER SIX. The Influence of the presence of parents on the countertransference of the child psychotherapist

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Jacqueline Godfrtnd

Introduction

The concept of countertransference Is far from unequivocal. More than any other notion relating to psychoanalytic practice, it has been marked by the development of the theory of technique. So before embarking upon the particular viewpoint that I have chosen to enlarge upon here, it seemed necessary to me to define the meaning that I am attributing to it. I am not concerned with the history of the concept, nor with the influence of the various schools of thought upon the meanings attached to It. All I wish to do Is to state briefly my personal position.

There has been an increasing Interest in countertransference since Freud, who limited its application to the influence of the patient on the unconscious feelings of the therapist—an influence brought about by the patient’s transference. It was understood in its negative aspect, as a generator of “blind spots” prejudicial to the analytic work and Inappropriate (Freud, 1910d).

Paula Heimann’s (1950) article was decisive in the widening of the concept. It will be recalled that she established its use in the regular work of the analyst, whereby the awareness of feelings and representations aroused by the patient gives access to new understanding of transference phenomena.

 

CHAPTER SEVEN. Different uses of the countertransference with neurotic, borderline, and psychotic patients

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Anne Alvarez

The Laplanche and Pontalls dictionary of psychoanalysis defines counter-transference as “The whole of the analyst’s unconscious reactions to the Individual ana-lysand—especially to the analysand’s own transference” (1973). Like Hlnshelwood’s A Dictionary of Kletnian Thought (1989), It comments on the controversy about how wide to make the definition—for example, whether to Include the analyst’s own private emotional contribution or whether to narrow the definition to only those feelings aroused or evoked in the analyst by the patient. I give my own definition a little later, and then go on to discuss the importance, for our clinical work, of considering, a particular question: namely, the effect of our counter-transference responses on the patient. We receive signals, but we also transmit them. The patient may project into us, but we then project something back into him. How does he lntroject this? The counter-transference, I suggest, may be unconscious, or conscious but not yet processed: either way, It needs, as Irma Brenman-Pick (1985) has pointed out, working through In rather the same manner as does the patient’s transference. What Is taking place Is a duet, not a solo. I do not here go into changes in the theory of transference as a result of the work of Blon, but partly also as a result of the findings from infant observation and Infant development research. Now, for example, a fascination with lighting fires might not necessarily be seen as expressing sexual or bodily fantasies, but at least partly as representing a need to make an Impact, to bring a light to some imaginary figure’s eyes—that is, to interest someone.

 

CHAPTER EIGHT. Bisexual aspects of the countertransference In the therapy of psychotic children

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Didier Houzel

To each level of organization of the mind corresponds an aspect of blsexuality. In my view, we can distinguish three such levels, corresponding to successive stages of Individuation and construction of the child’s Inner world. The first relates to the frontier structures of the mind, which Esther Blck (1968) called psychic skin and Didier Anzleu (1986) was later to call the skin ego or psychic envelope. The second level Is that of part-object relations, and the third corresponds to whole-object relations. At each of these levels of mental organization, maternal and paternal functions Interact In a complementary manner. They are integrated with the corresponding structure, which as a result possesses bisexual features. Flaws in this Integration may give rise to various types of psychopathologlcal disorder; In therapy, we are continually faced with defective Integration of blsexuality. Before describing the nature of the problem encountered with psychotic children, I first distinguish the respective characteristics of blsexuality at the three levels of organization I have defined: psychic envelope, part-object relations, and whole-object relations.

 

CHAPTER NINE. Transference and countertransference Issues In the in-patient psychotherapy of traumatized children and adolescents

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John Tsiantts

Introduction

In this chapter, the phenomena of transference and countertransference observed during the application of psychoanalytic psychotherapy as part of the ln-patlent care of traumatized adolescents are presented and discussed.

My views represent an attempt to summarize some theoretical issues presented In the literature and to tender my observations made during the ln-patlent treatment of such children and adolescents (aged 8 to 15 years) in the ln-patlent unit of the Department of Psychological Paediatrics of the “Aghla Sophia” Children’s Hospital, Athens.

Laplanche and Pontalls, In The Language of Psychoanalysis, give the following definition of psychic trauma: “An event In the subject’s life defined by Its Intensity, by the subject’s Incapacity to respond adequately to It, and by the upheaval and long-lasting effects that It brings about In the psychical organisation” (1973, p. 465).

Laplanche and Pontalls contend that, In his early writings, Freud tended to put the concept of trauma In an economic—that Is, quantitative—perspective. Freud later said (1916-17): “We apply It (the term trauma] to an experience which within a short period of time presents the mind with an Increase of stimulus too powerful to be dealt with or worked off In the normal way, and this must result In permanent disturbance of the manner In which energy operates.” To put It another way, the psychological trauma Is any psychological event that suddenly floods the ego, preventing It from securing a minimal sense of safety, and hindering the Intact and Integrated functioning of the ego. As a result, the ego is overwhelmed with anxiety, while the sense of complete helplessness that Is also present contributes to bringing about an almost Inevitable change In the psychological organization. In other words, the trauma leads to disturbance of the functions of the ego In that It narrows the range of techniques and patterns of behaviour available for dealing with objects and the environment (Furst, 1986). The following points regarding psychological trauma should also be noted as of great Importance In understanding and coping with psychopathologlcal phenomena. It is very often the case that a truly traumatic experience Is Invested with the fantasies already existing In the mind of the child or adolescent, and so an experience of physical violence or punishment, or a surgical operation, can be experienced as castration, as punishment, or as masochistic gratification. Here, the fantasies already present will appear to have been validated and reinforced, and the younger the child Is, the greater will be the confusion between fantasy and reality. As noted by Kris (1978), the trauma also tends to become bound up with the events subsequent to It. He also observes that children and adolescents tend to confuse trauma and punishment. Psychologically traumatized children and adolescents are often convinced that they are “very bad”, and they tend to be strongly inclined towards self-censure with resulting guilt and low self-esteem. They very often identify with the aggressor, and also with the guilt and defence mechanisms of the parents. As a result, adolescents who have been physically or sexually abused tend to repeat the same acts with other persons, while at the same time having shared fantasies and defences with the parents or others who abused them, with whom they enter into a conspiracy of silence. Another consequence of traumatic experience is regression to earlier developmental levels of organization. This regression can be in the services of development or can lead to libldinal and genetic fixation points. Nor should we forget that sensitivity to the trauma and the consequences of the trauma will vary in accordance with the stages of development that have already taken place. Furst also argues, in connection with the relationship between trauma and development, that the developmental tasks of each subsequent period will be affected. In the case of adolescence, he contends that while trauma will Interfere with the developmental tasks of adolescence in a general way, the following specific vulnerabilities should also be noted:

 



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