2. “A Rock & A Hard Place:
Counter-transference Captivity ”
A Discussion Of A Piece Of Recent Therapeutic Practice,
Showing How My Art Therapy Experience
Helps Us Learn About An Aspect Of The Theory & Practice
Of Psychodynamic Psychotherapy
Presentation
Emma Allen
HCPC Registered Art Psychotherapist
Rampton Hospital, High Secure Hospital

3. “A Rock & A Hard Place:
Counter-transference Captivity ”
Aims & Objectives
•Providing case study material from forensic mental health setting.
•Drawing upon clinical applications of attachment theory, pathological, violent attachments.
•Looking at the potency of the first image made in a group setting.
•Considering counter-transference expression & “captivity” counter-transference.
•The importance of holding & containing & the centrality of the therapeutic relationship
(patient- image-therapist).

4. Joe
•Joe witnessed domestic violence from an early age – violent & abusive father.
•Left school at 15 to live in a hostel / Illicit drugs & alcohol misuse.
•Challenging & threatening behaviour at school / hospital admissions / bipolar affective
disorder.
•Barricaded himself in an attic – admitted to psychiatric hospital, drug induced psychosis.
•IO: Murdered girlfriend after days of torture – keeping her hostage for a number of days,
causing significant injuries.
•Violent in prison, deteriorating mental state/ months in his cell at a time. Delusions, acute
paranoia – believes he is a prophet.
•Threatening & abusive behaviour at Rampton.
•Hostile when challenged / defensive. Relationship difficulties – Controlling, domineering &
possessive of Art Therapist in a group setting.
•Therapist relates to victim.

9. •Drawing on attachment theory when thinking about the offence, presentation,
transference & counter-transference.
•Experiences from first relationships continue to influence throughout the life span -
experiences include pre & non-verbal interactions (Sobey and Woodcock).
•Patterns of relating that took root in early relationships (& make up the pt’s internal
world) are likely to surface quickly & strongly within the pt-therapist dyad in pt-led
psychotherapeutic work.
•Mary Ainsworth (1976): Securely attached, Insecure-avoidant, Insecure ambivalent.
•In cases where experiences have been destructive, the Art Therapist provides a
different experience of relating – working to create an environment that will promote a
less polarised & more secure attachment – consistency & reliability.
•It is thought that insecure attachment patterns play a significant role within many
emotional, behavioural & psychiatric disorders.
•Chronic emotional detachment in psychopaths (Bowlby, 1944) (Reid, Door, Walker &
Banner, 1986).

10. Violent Attachments
•John Bowlby (1907-1990) ‘father’ of attachment theory identified that abuse & neglect as factors in adult
psychological problems.
•‘A Secure Base’ (1988) Violence of parents a major contributory cause of a number of ‘distressing & puzzling
psychiatric syndromes’.
• ‘Violence breeds violence’; perpetuating itself from one generation to the next. Violent fathers – what has
Joe learnt from how others attach/relate to each other? Fears of being abandoned?
•Anger is often functional. Sado-masochistic projections/ relating reflect the way the offenders internal
model for relationships is organised & may be a way to master trauma.
•Many violent offenders have rarely had any experience of containment or boundaries.
•Maternal deprivation prevents containment.
•“This lack of emotional containment along with enduring trauma that later in life the forensic patient adopts
very complex, often dangerous defence mechanisms simply to survive their unbearable emotional
states”(p.109, Aiyegbusi, 2009).

12. “Many inmates have experienced & perpetrated damage & abuse with
recurring detrimental effect.
A poor sense of belonging, an inability to trust, fears of invasion or rejection,
theft or assault can all overrule the inmate’s capacity to engage in meaningful relationships.”
(Guidelines for Arts Therapists Working in Prisons, 2002).

13. Attachment & Psychotherapy
• Bowlby believed that attachment theory was central to both normative &
psychopathological development – relevance for psychotherapy.
•The therapist functions to “provide the patient with a secure base from which to
explore both himself & also his relations with all those with whom he has made or
might make, an affectional bond” (Bowlby, 1977 p.421).
•Providing a ‘temporary attachment figure’.
•Helping the pt examine the relationship with the therapist, & how this relates to
(past) relationships or experiences outside of therapy (Adshead,1998).
•Transference & counter-transference dynamics provide the opportunity to
negotiate multiple contradictory internal working models, helping pts to feel,
think, & act in new ways.
•The internalization of the bond with the therapist becomes a representational
safe haven the pt can turn internally in times of distress (Levy, K.N et al, 2012).

14. Possessive Containment
•The therapist is ‘held’ & contained in therapy: Feeling stuck, trapped, ‘possessed’ by the pt.
•Art expression can reveal aspects of unconscious communication & offence-paralleling
behaviour.
•“Art is recognised as a process of spontaneous imagery, released from the unconscious, using the
mechanisms of repression, projection, identification, sublimation, & condensation” (Daley, p.xvi).
•For avoidant individuals holding is perhaps the key ingredient in therapy. Only when they feel
securely held can these pts begin to confront their inner world & put emotions into words.
•Domineering / Ownership “Since when have you become Emma? since when do you now speak
for Emma? Since when do you now start acting as if 'she's all mine not yours’?”
•Therapists need to contain not only the pt’s affects but also their countertransference responses
(Therapists can be possessive too).
•Therapist acts as a containing function if can tolerate the clients feelings & emotions through
transference & CT. Melanie Klein ( 1943, 1952).
•Central dilemma in the image: to hold or to let go?

15. Counter-transference Captivity
•“Moments of fear & suspense in the therapeutic relationship where the therapist may
feel pinned to the spot & alert to some unknown danger” (p.57 Greenwood, Wood,
2010).
•Like in the image, I identified with the victim.
•Therapist expected to hear about the offence – sometimes this can be frightening.
•“The attempted integration of subjective & objective ways of thinking in the pt or
the bringing together of empathic understanding & intellectual comprehension by the
analyst that is believed to cause a catastrophe” (R.Britton, 1998:43).
•Attempts to distance – intimacy threat to autonomy (Schaverien, 2006)
•Containment parallels with the experience of a developing therapeutic relationship
with a pt. Detoxifying (Bion, 1962). CT as key to the pt’s unconscious (Heimann, 1950,
Aiyegbusi & Clarke-Moore, 2009).
•Help as weakening / Envy / Growth of therapeutic relationship is defended against;
feelings of need, want & vulnerability are all intolerable (Greenwood, Rosenfeld,
1987).
•Fear is often a projection in the transference & counter-transference.

16. Fear in the countertransference (CT)
•The psychotic aspect of a pt cannot tolerate awareness of their vulnerabilities or
dependency, & wish to attack & kill off awareness of this reality by attacking the
perception, or the source of awareness of reality (Bion, 1957).
• Fear of an eruption of violence.
•This fear is justified: pt’s wish to kill off reality is real - have actually killed or
attacked the source of awareness of reality – their victims. (Aiyegbusi & Clarke-
Moore, 2009).
•Did he feel fear from violent father? Frozen with fear?
•Re-enactments: Victim, persecutor, rescuer (Karpman‘s Drama Triangle, 1968)
psychological roles playing out in the therapeutic alliance.
•The therapeutic alliance in forensic mental health is often complicated by
potential & actual risks the pt presents to others.
•Container paralysis. Feel hostage to pt (Greenwood, 2000).
•Managing CT in supervision & multidisciplinary working.

17. Klein (1975) described how the infant will want to get rid of unwanted parts of himself and will not want to
experience his mother in a way that leaves him with negative feelings about her, as this will cause him
anxiety & distress.
The infant gets rid of intolerable feelings by projecting them into his mother. The infant does this in order
to dominate & control her, take over her capacities & make them his own, & invade & destroy her.
The powerful defence mechanisms of projection & projective identification afford the infant the ability of
avoiding any awareness of his own feelings of separateness, dependence, admiration, feelings of envy,
loss or anger & acute anxieties of fearing death through annihilation. In ‘normal’ development, these
projections lessen as the infant learns to tolerate the ambivalent feelings of love, hate & dependence for
his mother.

18. •Forensic Art Therapy, as part of a
multi-disciplinary approach, can
contribute towards the assessment
of risk of further offending or the
understanding & treatment of an
individual’s offending behaviour.
•Behaviour observance – symbolic
offence paralleling behaviour
•The unspeakable can be
externalised, visualised, expressed,
communicated, shared &
symbolised.
•Vehicle for catharsis.
•Containment is fundamental:
offender patients can develop a
symbolic container inside
themselves through the medium of
art-making.

19. •The combination of ‘The Scream’ &
‘The Kiss’ makes for a very powerful,
first image.
•The potential significance of the
transference is embodied / held &
contained in the artwork.
•The image reveals his attachment
difficulties; suffocating, intoxicating.
•Conflict & resolution: Holding &
Letting go.
•Bridging affective states & memories.
•“Pictures offer a medium for relating,
first to the self and then to another
person” (p.140, Schaverien, 1995).
•Self-awareness & insight into their
impact on others, ways of relating &
attachment patterns.
•The image & Therapist as container.
•Wanting to capture you!

20. “A Rock & A Hard Place:
Counter-transference Captivity ”
Conclusion
•“Working with the Counter-transference” (Captivity), projections. ‘Pinned to the spot’ in fear,
may be the pt’s fear.
•Attachment Theory, Violent Attachments; Early attachment experiences help explain
emotional distress, personality disturbances, anxiety & anger (Bowlby) & helps us understand
the pt.
•Attachment needs exist throughout the lifecycle putting separation & loss central to
psychiatric disturbance/Relationships & Survival/ appropriate dependency.
•Impact /potency of the first image -“charged material” holding significant information.
Conflict & Resolution / Early (pre-verbal) experiences made visible & relevant to present day.
•Importance of holding & containing, safe therapeutic relationship – trusting & collaborative.
Supervision.