Countertransference

from Wikipedia, the free encyclopedia

In psychoanalysis, countertransference is a form of transference in which a therapist reacts to the patient (or to the patient's actions and utterances resulting from transference phenomena) and in turn directs his own feelings , prejudices , expectations and wishes towards him. The therapist leaves his neutral position for various reasons - usually temporarily. Therefore, in the early days of psychoanalysis, countertransference was seen as a disturbing influence that the therapist had to become aware of and eliminate. Modern psychoanalysis also sees the therapist's feelings towards the patient as a "soundboard" through which he gains information about the patient.

term

The observation of this phenomenon goes back to Sigmund Freud , who found that a transference is not only itself an echo of previous relationships, but in turn evokes an echo in the therapist. Freud demanded to fight against it in the therapeutic session and to exclude it ("recognize in oneself and cope with"). At first he saw the transference of the patient to the therapist as an obstacle to therapy, the benefit of which he later recognized for therapeutic work. On the other hand, it was left to Paula Heimann to make the central importance of countertransference for psychotherapeutic work understandable and accessible.

Just like transmission, it is a common phenomenon that is widespread in a social context and - so to speak, "on a small scale" - occurs in almost every interpersonal contact. Like transference, countertransference is practically ubiquitous, as people who deal with one another unconsciously trigger emotions in the other that have to do with their own story. In psychotherapy countertransference may constitute an obstacle, but at the same time also be a very valuable and sensitive diagnostic tool. The prerequisite for this is that the therapist has sufficient self-awareness in which he could get to know his own conflicts, vulnerabilities, etc. (see training analysis ). Only against this background can the therapist recognize and distinguish what he has brought with him from his own life story and what is part of the patient's problem, of which he is and must become part temporarily. Undetected in the long term, countertransference can lead to entanglements and endanger the therapy, which does not necessarily have to be iatrogenic in the sense of a disorder originating from the therapist, but is caused by the weakness of the therapist whose defense mechanism would form an alliance with that of the patient .

Closer relationships or friendships between therapist and patient make therapeutic work impossible, as this requires sufficient emotional distance. Such relationships are therefore not compatible with the professional ethos of psychotherapists (see abstinence rule ).

A balance between closeness and distance is also indispensable in educational work , especially as this is based on an even clearer strength-weakness dynamic than in the psychotherapeutic context. People who are in a weak position are dependent on objective and impartial treatment by a stronger person.

Example of a countertransference

A patient feels well understood by his therapist and has friendly or tender feelings for her (transference), gives her gifts and invites her to coffee (acted transference). She finds him likable and has a tendency to respond to the offer (countertransference). If she actually accepted it and accepted the invitation, she would act her counter-transference and thus violate the principle of abstinence .

Meaning of "countertransference"

The term "countertransference" is used in different and contradicting ways in the literature:

  • all feelings and attitudes of the therapist towards the patient
  • the therapist's unconscious neurotic response to the patient's transmissions
  • the therapist's healthy complementary reaction to the patient's transference (example: father - son, parent-me - child-me)
  • the therapist's own infantile / neurotic transference to the patient

This repeatedly leads to misunderstandings and contradictions in the discussions.

Michael Lukas Moeller suggested a distinguishable terminology:

Countertransference = adequate complementary response to the patient's transference
Transfer = neurotic transfer (also one from the therapist to the patient)
Working alliance = result of the tension between fear and trust
Real relationship = adult ego feelings between therapist and patient

The countertransference always contains a mixture of a) feelings from the patient's unconscious self, i.e. a recognition of his being, and b) feelings from the transference role that the patient ascribes to the therapist. Often only one side is considered.

Positive and negative countertransference

In principle, as with transference, a distinction can be made between positive and negative countertransference, depending on whether the focus is on pleasant or unpleasant feelings.

The forms of countertransference are very diverse. They range from affection , social, or affectionate desires to negative feelings, aversions, or derogatory thoughts and expressions that the therapist may express towards the patient.

Concordant and complementary countertransference

Countertransference can be a counterpart ( complementary ) to the transference as well as contain similar ( concordant ) feelings. Two examples from the educational field:

  • Concordant countertransference (similar emotional reaction that corresponds to the experience of the other person): An educator feels treated by a child as the child is otherwise treated (or how it feels treated).
  • Complementary countertransference (opposite emotional reaction, that is, identification with a caregiver of the other person): An educator feels in the parenting role, for example like the “overprotective” mother or the “punishing” father.

Transfer and countertransference in group psychotherapy

In group psychotherapy , the complexity and plurality of the transference and countertransference between the participants and the group therapist and vice versa is a great professional and personal challenge for the group therapist. Countertransference in the group is therefore always multiple, composed of the countertransference to different participants. The participants themselves also develop countertransference to the transmissions of the other participants. With his countertransference, the therapist also responds to the behavior of the group as a whole, Moeller speaks of a “group countertransference”.

Dealing with countertransference problems

Dealing with the countertransference represents one of the greatest challenges and opportunities for psychotherapists, doctors, educators, etc. in their work. It is not uncommon for the ideas and secret wishes of the patient to be discussed in psychotherapeutic sessions to be inadequate according to everyday judgment and by idealizations or Perversions headed. However, this is an expression of the psychological problems for which the patient seeks help and the task of therapy is to resolve. The therapist is prepared for the situation to arise and does not react (like the patient's social environment) personally affected, but with friendly neutrality.

If there are difficulties in the transference-countertransference structure, support from a third party is often necessary to resolve the situation, for example reflective discussions, intervision or supervision with colleagues and, if necessary, psychotherapeutic help. If the countertransference is successfully processed, the therapist not only receives a deeper insight into the patient's difficulties, but also into central issues of his own person. ( See also : Balint Group )

A special field of research on (counter) transference is currently developing in the field of psychosomatic practice. Here, the countertransference phenomena can become stressful for therapists, for example when the therapist feels the pain in his own body in patients with chronic pain symptoms or when clients with chronic hypertension change symptoms.

Thure von Uexküll also writes of the therapist's difficulty in constantly dealing with the symptom without being able to get through to the patient. Gerd Rudolf refers to this topic as the "problematic patient", while Karl König even turns dealing with the psychosomatically ill patient into a general interaction problem, in which the therapist's personality can aggravate or alleviate. Bernhard Schlage points to the diagnostic importance of the countertransference feeling in the first contact with psychosomatically ill patients and calls for an expansion of research and further training for colleagues working in the psychosomatic field of the health system. The study "Mental health at work in Germany" also points out the special burden and the consequent improvement in the workplace situation of therapeutic workers. ( Additional literature: )

Demarcation

While with the transference the patient reacts emotionally to the person of the therapist, it is the other way around with the countertransference.

The projective identification is a special transmission mechanism, in which the patient involves the therapist in his individual conflict constellation. The therapist is supposed to solve unresolved conflicts on behalf of the patient , which in turn often triggers violent countertransference feelings in the therapist. Countertransference and projective identification therefore often appear together in a therapeutic relationship.

Countertransference and the methodology of the social sciences

Since the unconscious is active not only during sleep and in the analytic situation, transference and countertransference are universal phenomena that can always occur when people meet, e.g. B. also in school between teachers and students. The ethnologist and psychoanalyst Georges Devereux drew methodological conclusions from this for the social sciences.

In Anxiety and Method in Behavioral Sciences , Devereux suggests rethinking the question of the relationship between the observer and the observed, using the model of psychoanalysis as an orientation. According to Devereux, the classical methodological principle, which tells the researcher to observe from a strictly objective point of view, is unfeasible and any attempt to achieve this is downright counterproductive. Instead, the observer should put himself in the middle of the process and note that what he observes is always influenced by his own observational activity .

More precisely, the only givens the observer has at his disposal are what he actually perceives, his own reactions to the reactions that he himself triggers. For Devereux, the observer must think about his relationship to the observed as the psychoanalyst thinks about the relationship to his analysand. This must be done in every investigation that deals with the subjectivity of humans (or even animals).

See also

Further literature

  • Siegfried Bettighofer: Transfer and countertransference in the therapeutic process . Kohlhammer, Stuttgart 2016
  • Andrea Gysling: The analytical answer: A story of countertransference in the form of author portraits . edition diskord, Tübingen 1995 (408 pages) (this is a revised and expanded version of your medical dissertation, written in 1985 at the University of Basel under Gaetano Benedetti ).
  • Hans-Peter Hartmann, Wolfgang E. Milch (ed.): Transfer and countertransference. Further developments in psychoanalytic self-psychology . Psychosocial, Giessen 2001

Web links

Individual evidence

  1. ↑ Sigmund Freud: The future chances of psychoanalytic therapy. In: Collected Works . Fischer, Frankfurt / M. 1910, Vol. VIII, pp. 104-115.
  2. ↑ Sigmund Freud: On the dynamics of transmission. In: Collected Works . Fischer, Frankfurt / M. 1912, Vol. VIII, pp. 364-374.
  3. ^ Paula Heimann: On countertransference. In: International Journal of Psychoanalysis . Vol. 31, 1950, pp. 81-84.
  4. ^ Heinrich Racker: Transfer and countertransference. Ernst Reinhardt, Munich 1970.
  5. ↑ Michael Lukas Moeller: Countertransference in Group Analysis , in: Arbeitshefte Gruppenanalyse 2/96 , Münster 1997, ISBN 3-930405-60-1 , pp. 40–73.
  6. ↑ http://www.bernhardschlage.de/literatur/items/blanche-wittmanns-vollversion.html
  7. ↑ Thure von Uexkull; Psychosomatic medicine ; Munich 1998; Pp. 513-515 / Gerd Rudolf; Psychosomatic medicine and psychosomatic medicine ; Stuttgart 2000; P. 352ff / Klaus Dörner, Ursula Plog; To err is human ; Bonn 1996; Pp. 287–322 / Karl König; Countertransference and the personality of the psychotherapist ; Frankfurt a. M. 2010; Pp. 166–216 / Bernhard Schlage; Blanche Wittmann's breasts and medical high blood pressure in: magazine 'Energie & Character' No. 35/2011; CH-Buehler; P. 67–77 / Full version of the article: Introduction to the special features of the transmission process in psychosomatic illnesses Shortened version of the psychosomatic article Blanche Wittmanns Busen ... appears in the association magazine of the German Society for Alternative Medicine / DGAM, December 2011 Professional Association of German Psychologists ; Mental health at work in Germany; Berlin 2008; Pp. 31-36
  8. ↑ cf. Heiner Hirblinger, Introduction to School Psychoanalytical Education , Würzburg: Königshausen & Neumann, 2001.
  9. ^ Georges Devereux, Anxiety and Method in Behavioral Sciences , Frankfurt am Main, Berlin, Vienna: Ullstein 1976.