12 Slices
Medium 9781855750289

12. Some transference-countertransference issues of the supervisory situation: a dream about the supervisor

Athina Alexandris Karnac Books ePub

Grigoris Vaslamatzis

A supervisee’s dream about the supervisor is presented in this chapter. The dream coincides with the patient’s reverting to her earlier symptoms during the termination phase. As a result of this the psychotherapy had to be prolonged.

Unfortunately, little is seen in the literature on the dynamics and dysfunctions of supervision. In his important paper, Pedder (1986) indicates the difficulties that may arise when transference problems occur in psychotherapy supervision towards the supervisor. Heising (1976) and Sandell (1985) also pointed out the threat of the negative influence that supervision might have on the therapeutic outcome.

The objective of this study is to elucidate further the trans-ference-countertransference issues that arise between trainees and supervisors, as well as their consequences on the psychotherapy.

The supervision

Dr D was a third-year psychiatric resident, married, in her mid-thirties. She was considered a very intelligent young physician, and everyone felt that she was pleased to present the material of her cases. She was very enthusiastic to have her first patient in psychotherapy, and after the termination she asked to be assigned a second case of brief psychoanalytic psychotherapy (Vaslamatzis & Verveniotis, 1985). Her second case was a female patient who presented with anxiety attacks and somatic symptoms. She was single and clung to relationships with motherly-behaving older men. The patient’s mother had died three years previously, and it was at that time that her symptoms had first appeared. The evaluator had been the supervisor himself, who had decided about the patients suitability for brief psychotherapy (up to 30 sessions). The patient had agreed to this limit.

See All Chapters
Medium 9781855750289

3. Countertransference and the concept of projective counteridentiflcation

Athina Alexandris Karnac Books ePub

Leon Grtnberg

I have made a fairly thorough study of the disturbances caused in analytical technique by the excessive intervention of projective identification on the part of the analysand, which gives rise in the analyst to a specific reaction for which I suggested the term “projective counteridentification”, and these have been published in various articles (Grinberg, 1956, 1957, 1958, 1962, 1979).

It is known that the psychoanalytical process is conditioned by a series of factors of different types. Among them it is important to single out the continual interplay of projections and introjections which develops during the analysis, on the part of both the analysand and the analyst. Starting from the approach of the latter, we can consider two co-existing processes: in one, the analyst is the active subject of those mechanisms of introjection and projection; in the other, he becomes the passive object of the projections and introjections of the analysand.

Reprinted and expanded from Leon Grinberg, The Goals of Psychoanalysis (London: Karnac Books). By permission of the author.

See All Chapters
Medium 9781855750289

10. The patient-therapist fit and countertransference reaction in the light of frame theory

Athina Alexandris Karnac Books ePub

Hector Worries

Bion has captured the concept of the frame in his metaphor of the artist in whose painting “something has remained unaltered and on this something recognition depends” (Bion, 1977, p. 1). The invariants of a painting by an impressionist and a realist would convey different meanings. The frame has been compared by Bleger (1966) to the mere background of a Gestalt that may evolve into a figure. The background would be the constant, the invariant factor or the non-process, and the figure the transformation, the variable or the process. The frame is therefore the invariant element that is “the receiver of the symbiosis” (p. 513) and in that sense expresses the maternal configuration. The analytic process itself is pregnant with ambiguity and multiple meanings and does not contain the symbiotic experience. The frame acts as a support of the analytic process but does not accept its ambiguity. It is similar to the child’s symbiosis with the mother, which enables him to develop his ego in a background of safety and support. Within the frame or the container, there is a space and an analytic atmosphere, which may have certain characteristics—that is, optimal distance, refusal to play a role, neutrality, self-effacement, and benevolence. The analytic frame is deliberately unbalanced in order to activate unconscious meanings. The frame of transference expectations usually finds sufficient fit with what is transpiring in the analytic frame.

See All Chapters
Medium 9781855750289

8. Projective identification, countertransference, and hospital treatment

Athina Alexandris Karnac Books ePub

Otto K Kernberg

My principal purpose in this chapter is to illustrate the pivotal function of projective identification within the therapeutic milieu of the hospital. What follows is a detailed description of crises in the treatment of two patients undergoing long-term inpatient psychiatric treatment. These patients suffered from very different psychiatric illnesses; hence their cases illustrate some features of hospital treatment that cut across different types and degrees of severity of psychopa-thology.

Lucia

Lucia was single and in her late twenties—an attractive and intelligent but emotionally unstable Latin-American musician who had been educated in this country [United States) and whose very wealthy parents financially supported her and her artistic career. She had a history of chronic drug and alcohol abuse, repeated serious suicide attempts, and chronic interpersonal difficulties at work and in intimate relations.

Lucia was the youngest of three children; her older brothers had left home many years earlier, and for all practical purposes her parents treated her as their only and major concern. Father was seductive rather than loving in his interactions with Lucia and basically controlled by her mother, clearly the dominant personality in the family. Mother was a highly emotional, extroverted, charming yet also intrusive person, who, in subtle ways, attempted to control Lucia’s life while yet remaining strangely indifferent or even hostile to her at a deeper level. For example, Lucia suffered from an allergy that prevented her from eating certain types of sweets; mother periodically sent her packages of those very sweets from Latin America, even after the hospital psychiatrist initially assigned to the case had discussed the issue with her.

See All Chapters
Medium 9781855750289

2. The analytic management and interpretation of proj ective identification

Athina Alexandris Karnac Books ePub

Thomas H. Ogden

Projective identification is not a metapsychological concept. The phenomena it describes exist in the realm of thoughts, feelings, and behaviour, not in the realm of abstract beliefs about the workings of the mind. Whether or not one uses the term or is cognizant of the concept of projective identification, clinically one continually bumps up against the phenomena to which it refers—unconscious projective fantasies in association with the evocation of congruent feelings in others. Resistance on the part of therapists and analysts to thinking about these phenomena is understandable: it is unsettling to imagine experiencing feelings and thinking thoughts that are in an important sense not entirely one’s own. And yet, the lack of a vocabulary with which to think about this class of phenomena seriously interferes with the therapist’s capacity to understand, manage, and interpret the transference. Projective identification is a concept that addresses the way in which feeling-states corresponding to the unconscious fantasies of one person (the projector) are engendered in and processed by another person (the recipient)—that is, the way in which one person makes use of another person to experience and contain an aspect of himself. The projector has the primarily unconscious fantasy of getting rid of an unwanted or endangered part of himself (including internal objects) and of depositing that part in another person in a powerfully controlling way (Klein, 1946, 1955). The projected part of the self is felt to be partially lost and to be inhabiting the other person. In association with this unconscious projective fantasy there is an interpersonal interaction by means of which the recipient is pressured to think, feel, and behave in a manner congruent with the ejected feelings and the self—and object—representations embodied in the projective fantasy (Bion, 1959; Ogden, 1979). In other words, the recipient is pressured to engage in an identification with a specific, disowned aspect of the projector.

See All Chapters

See All Slices