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COUNTERTRANSFERENCE_educationsession

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COUNTERTRANSFERENCE_educationsession

  1. 1. Luis Gustavo Vechi, PhD
  2. 2. 1. To treat our clients, we all need to, at some extent, develop a relationship with them. 2. Sometimes, this can be quite challenging. 3. What we call transference/countertransference partially accounts for that.
  3. 3. • “The essential impact of schizophrenia on carers is the apparent meaninglessness of the person’s behaviour (…). That incomprehensibility is shared by the patient; without his proper sense of identity, his experiences are incomprehensible for him too.” (Hinshelwood, 2013)
  4. 4. Countertransference concept Jungian Psychodynamic Perspective of Personality
  5. 5. Countertransference concept • First introduced by Sigmund Freud in 1910. • Noted that the patient’s influence on the analyst’s feelings can interfere with treatment
  6. 6. PLUS
  7. 7. Empirical Research A. Testing correlation between specific patient health issues (i.e. personality disorders, trauma) and staff emotional response (Book et al, 1978; Colli, Tanzilli, Dimaggio et al, 2013; Sansone & Sansone, 2013) B. Developing and testing countertransference inventories (Fuertes et al, 2015; Friedman & Gelson, 2010; Kachele et al , 2015) C. Testing training/education/ supervision on countertransference (Cartwright et al. 2015; Ponton & Saurheber, 2014)
  8. 8. (Colli, Tanzilli, Dimaggio et al, 2013) antisocial personality disorder • Mistreated/ Criticised borderline personality disorder • Overwhelmed /Disorganized avoidant personality disorder • Protective /Parental
  9. 9. a natural psychological process Takes place in everyday relationships Ordinary relationship: use the term “projection” Staff-client relationship: use the word “countertransference”
  10. 10. Because of the nature of our PERSONALITY
  11. 11. Our Personality (Samuels, A, 1989, 1993, 2001).
  12. 12. THE PLURAL PERSONALITY (Samuels, A, 1989, 1993, 2001).
  13. 13. THE PLURAL PERSONALITY (Samuels, A, 1989, 1993, 2001). Persona Shadow Potential
  14. 14. EXAMPLES OF QUALITIES OF OUR PERSONA Rational Minded Inner critic Impersonal judgmentalpleaser obliging prosocial
  15. 15. EXAMPLES OF QUALITIES OF OUR SHADOW angry frivolous selfish irresponsiblefearful lazy sad antisocial
  16. 16. (Samuels, A, 1989, 1993, 2001). PERSONA POTENTIALSHADOW
  17. 17. • LIMITED TO BE LIKE WHAT SOCIETY WANTS FROM USPERSONA • DISOWN SOME OF OUR QUALITIESSHADOW • OVERLOOK NEW POSSIBILITIES TO BEPOTENTIAL
  18. 18. WHAT IS DISOWNED…
  19. 19. What may happen, then, in clinical practice? Distort the perception that we have of our clients
  20. 20. Countertransference becomes an issue for clinical practice “While clients might exert ‘pulls’ on the therapist, it is the ‘hook’ in the therapist that leads to his or her countertransference response. ” (Gelso & Hayes, 2007, p. 82).
  21. 21. 1. intense emotional reaction. 2. distorted perception of the client 3. staff needs are prioritized 4. therapeutic role relinquished IMPACT ON TREATMENT OUTCOME (Cartwright et al. 2015; Epstein & Feiner, 1979; Fuertes et al, 2015; Friedman & Gelson, 2010; Kachele et al , 2015) Countertransference becomes an issue for clinical practice
  22. 22. Scenario 1 of countertransference Feeling overwhelmed and exhausted by a patient who seemed rigid and “stuck,” I was reminded of my mother not listening to any other point of view. Feeling overwhelmed by the feelings of helplessness to make change. (Cartwright, C. et al., 2015).
  23. 23. Scenario 2 of non-countertransference Felt amused when a depressed client told a joke. It was funny, I laughed and it was good to see his smile. (Cartwright, C. et al., 2015).
  24. 24. Scenario 3 of countertransference Client has a history of his emotional needs being attended to by his parents and, subsequently, by his wife. From the beginning of our time together, I had a sense of needing to help him and to attend to his needs. (Cartwright, C. et al., 2015).
  25. 25. And, then what?
  26. 26. Why should I do that? Underpinning principles: 1. “Your vision will become clear only when you can look into your own heart. Who looks outside, dreams; who looks inside, awakes.” 2. “Knowing your own darkness is the best method for dealing with the darknesses of other people.” 3. “Everything that irritates us about others can lead us to an understanding of ourselves.” 4. “Whatever is rejected from the self, appears in the world as an event.” Carl Gustav Jung
  27. 27. THE ROUND TABLE IMAGE: connecting with your different selves The plural nature of our personality requires regular dialogue between EGO and the different SELVES.
  28. 28. SELF-REFLECTION AT WORK Exercise 1 MAPPING MY SHADOW
  29. 29. Exercise 1 – Mapping my shadow Facilitate exploration of selves and their qualities Become aware of selves and their qualities Clarify selves needs and intentions Promote space to manage these selves and their qualities
  30. 30. BE MINDFUL OF MY INTERACTION PATTERNS WITH CLIENTS • Transactional Analysis: contributions to awareness of interaction patterns in clinical practice. (Berne, 1961)
  31. 31. Interaction patterns in clinical practice • The Transactional Analysis offers a graphic opportunity to reflect on possible patterns of interaction driven by countertransference and transference. • It proposes to analyse interaction considering three basic possible positions in an adult relationship (Berne, 1961) ADULT position PARENT position CHILD position
  32. 32. Interaction patterns in clinical practice CHILD • Respond to the here and now driven by the past. • Echo of our earlier version of the self / how we responded in the past. (unware of that). PARENT • Respond to the here and now driven by the past. • Behave as if we were one of our parents (unware of that). ADULT • Responds to the here and now driven by a realistic perception of the present. • It is the neo-self and deliberately • ie. Appropriately acting like Parent like (being protective, nurturing, controlling, critical and punishing) or Child like (being spontaneous, creative).
  33. 33. Example 1 – PARENT STAFF – CHILD CLIENT
  34. 34. Example 2 – CHILD STAFF
  35. 35. Example 3 – CHILD STAFF
  36. 36. Keep a balance in the interaction
  37. 37. THE GOALS IS TO KEEP A BALANCE IN THE INTERACTION/ HAVE FLEXIBLE PERCEPTION
  38. 38. GOAL- ADULT position
  39. 39. SELF-REFLECTION AT WORK Exercise 2 MAPPING INTERACTION
  40. 40. Exercise 2 – Mapping interaction Recognize interaction patterns with the client Become aware of the impact of these patterns on clinical practice Promote space and distance to manage interaction patterns Opportunity to learn new interaction patterns to promote client’s recovery
  41. 41. Wrapping up… • Countertransference is... • A strong emotional reaction, • A compelling need to act in a certain way, • A distorted perception of the client, • A distorted perception of myself, • An inability to see the diversity of the client and to identify the different levels of his needs/potentials/strengths/difficulties.
  42. 42. REFERENCE • Betan, E; Heim, AK; Conklin, CZ; Western, D. (2005). Countertransference Phenomena and Personality Pathology in Clinical Practice: An Empirical Investigation. American Journal of Psychiatry, 162, 890–898. • Berne, E. (1961). Transactional analysis in psychotherapy. New York, NY: Evergreen. • Book, H; Sadavoy, J; Silver, D. (1978). Staff countertransference to borderline patients on an inpatient unit. American Journal of Psychotherapy, v 32(4), 521-532. • Cartwright, C; Rhodes, P; King, R; Shires, A (2015). A Pilot Study of a Method for Teaching Clinical Psychology Trainees to Conceptualise and Manage Countertransference. Australian Psychologist 50, 148–156 • Colli, A; Tanzilli, A; Dimaggio, G; Lingiardi, V. (2014). Patient Personality and Therapist Response: An Empirical Investigation. American Journal of Psychiatry, v. 171, 102-108. • Friedman, SM & Gelso, CJ (2000). The development of the inventory of countertransference. Journal of Clinical Psychology, vol. 56 (9), 1221-1335. • Fuertes, JN; Gelso, CJ; Owen, JJ; Cheng, D. (2015). Using the countertransference inventory behaviour as an observer-rated measure. Psychoanalytic Psychotherapy, vol. 29 (1), 38–56. • Gelso, C., & Hayes, J. (2007). Countertransference and the therapist’s inner experience: Perils and possibilities. Mahwah, NJ: Lawrence Erlbaum.
  43. 43. REFERENCE • Jung, C G (1963). The Psychology of the Transference, USA: Princeton University Press. • Hinshelwood, R D (2013). Suffering the impact: psychosis and the professional caregiver. In: Gumley, A; Gilham, A; Taylor, K and Schwannauer, M (2013) Psychosis and emotion: the role of emotions in understanding psychosis, therapy and recovery. London/New York: Routledge. p. 84- 97. • Kachele, H.; Erhardt, I. Seybert, C. & Buchoolz, M. B. (2015). Countertransference as object of empirical research? International Forum of Psychoanalysis, v. 24, 2, 96-108. • Mayers, A. M. (1996). The manifestation and management of staff countertransference on a pediatric AIDS team. Bulletin Of The Menninger Clinic, 60(2), 206-218. • Ponton, R F & Sauerheber, J D (2014). Supervisee Countertransference: A Holistic Supervision Approach. Counselor Education & Supervision, v. 53, 254-266. • Samuels, A., (1989). The Plural Psyche: Personality, Morality & The Father. London: Routledge. • Sansone, RA & Sansone, LA (2013). Responses of Mental Health Clinicians to Patients with Borderline Personality Disorder. Innov Clin Neurosci. 2013;10(5–6), 39–43

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