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Mentalizing countertransference? A model for research on the elaboration of countertransference experience in psychotherapy
Abstract
As a construct, the elaboration of countertransference experience (ECE) is intended to depict the implicit and explicit psychological work to which therapists submit their experiences with clients. Through ECE, defined as a mentalizing process of a particular kind, therapists' experiences are presumed to acquire and increase in mental quality and become available for meaning-making and judicious clinical use. In this paper, we claim that such an ongoing process facilitates engagement with common therapeutic factors, such as the therapeutic alliance and countertransference management, enhancing therapist responsiveness in psychotherapy. We synthesize relevant literature on countertransference, mentalization, and, in particular, therapists' mentalization, informed by a systematic literature review. As a result, we propose a model for assessing ECE in psychotherapy, comprising 6 diversely mentalized countertransference positions (factual-concrete, abstract-rational, projective-impulsive, argumentative, contemplative-mindful, and mentalizing), 2 underlying primary dimensions (experiencing, reflective elaboration), and 5 complementary dimensions of elaboration. Strengths and limitations of the model are discussed.
(article available at http://onlinelibrary.wiley.com/doi/10.1002/cpp.2177/full)
2019 APA Division 29 Donald K. Freedheim Student Development Award
... I nterpersonal interactions require individuals to mentalize, conceptualized as the ability to attend to and understand their own states of mind while being aware of others' states of mind, which enables people to make sense of behaviours. 1,2 Empathic engagement between client and therapist requires recognition and modulation of closeness and distance. 3 A therapist's ability to respond appropriately to these pushes and pulls is a relational skill which can be supported by their ability to mentalize. ...
... In psychotherapeutic work that involves rupture and repair processes, therapist's mentalization ability must be viewed as being relationship-specific and situation-specific instead of a trait-like capacity. 2 While therapists are required to take responsibility for the shared loss of mentalizing, it is not necessary that relational exchange is explained accurately. Genuine mentalizing requires a sense of tentativeness, which is what is required even when the therapist is making sense of deadlocks or impasses. ...
... Existing literature has shed light on the importance of therapists understanding their own needs, emotions, reasons, and processes within a session. 2,5 Although existing literature mentions steps to strengthen therapist mentalization within sessions, there is a need for enhanced empirical scrutiny of their utility and efficacy. ...
In the relational playground of psychotherapy, negotiating therapeutic distance is crucial for the process as well as the outcome of treatment. The challenge of navigating this closeness and distance may be accentuated during emotionally charged interactions in therapy. Therapist and client may get locked in complementary, rigid positions, leading to either submission or resistance to the others’ demands. The therapist’s ability to respond appropriately to these pushes and pulls is supported by their ability to mentalize, which is their ability to attend to and understand their own states of mind while being aware of others’ states of mind. Therapists are expected to maintain a mentalizing stance throughout and despite the relevance and impact of therapist mentalization, there is relatively less research, training, or practice-related guidance on how to maintain this balance. We use case illustrations to demonstrate therapeutic interactions that can trigger non-mentalizing for the therapist and reflect on ways of recognizing and addressing these patterns related to closeness and distance. We also share recommendations for reflective practice and supervision, training as well as research on therapist mentalization.
... In the psychotherapeutic context, thus, it seems useful to examine whether countertransference experiences challenge therapists' mentalizing abilities (Barreto & Matos, 2018), and how such processes may relate to therapists' attachment and the match of therapists' and clients' attachment organization. Attachment differences and their varying combinations within the dyad appear to importantly affect psychotherapy outcomes and the alliance in particular (e.g., Degnan et al., 2016;Diener & Monroe, 2011). ...
... The elaboration of countertransference experience (ECE; Barreto & Matos, 2018) is a form of therapists' self-oriented mentalization representing the implicit/spontaneous and explicit/ reflective psychological processes through which therapists make sense of their experiences with clients, in and between sessions. To study ECE, we created a rating system (ECE-RS) in which therapists' written impressions elicited after sessions are rated on seven dimensions/axes of elaboration. 1 Initial findings with the ECE-RS suggested that the seven dimensions could be organized in two latent factors. ...
... Rating System (Barreto & Matos, 2018) Rating system with seven dimensions of mental elaboration (see above). Assesses contextual (session-specific) "state" aspects of implicit and explicit psychological work reflected in therapists' postsession comments elicited by the instruction: (a) write down impressions, reactions, or associations triggered in you by this session as sincerely and spontaneously as possible; (b) write fluidly, in "stream-of-consciousness," avoiding corrections and concerns with text organization or linguistic inaccuracies; (c) what you write will NOT be regarded as a full account of your experience-you are not expected to present it. ...
Individual and combined attachment dimensions within the dyad may affect therapists’ experiences in ways that hinder mentalizing and threaten the alliance. Previous research on a particular therapists’ mentalizing ability named the elaboration of countertransference experience (ECE) suggests that attachment may affect therapists’ mental processes, which in turn are involved in alliance variations between dyads and over time. In this study, these findings are extended by examining therapist, client, and combined attachment dimensions as moderators of the association between ECE and working alliance. Forty-four assessments from the first 10 psychotherapy sessions of 12 independent dyads were examined. The ECE dimension of reflection/conjecture was positively associated with the alliance bond and total score in therapeutic dyads that differed more in attachment. Possible in-session dynamics at stake are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
... For the reasons stated earlier, therapist factors and processes involved in the formation of alliances may be at the core of differences in effectiveness, particularly with clients presenting greater interpersonal difficulties and, thus, trait-like tendencies for weaker alliances. Trying to add to the understanding of these processes, we recently used the term elaboration of countertransference experience (ECE; Barreto & Matos, 2018) to designate the implicit/spontaneous and explicit/reflective psychological processes through which therapists make sense of their experiences with clients, in and between sessions. 1 ECE can be viewed as a particular type of mentalization (Fonagy, Bateman, & Luyten, 2012), more directed toward self (therapists/countertransference experience) than others (clients). It has been our claim that, to the extent that most of the studied common factors explicitly involve therapists handling emotional states and relational processes in session (e.g., alliance development and rupture repairing, empathy, positive regard, congruence, and countertransference management), the type of psychological work depicted in the ECE construct is involved (Barreto & Matos, 2018). ...
... Trying to add to the understanding of these processes, we recently used the term elaboration of countertransference experience (ECE; Barreto & Matos, 2018) to designate the implicit/spontaneous and explicit/reflective psychological processes through which therapists make sense of their experiences with clients, in and between sessions. 1 ECE can be viewed as a particular type of mentalization (Fonagy, Bateman, & Luyten, 2012), more directed toward self (therapists/countertransference experience) than others (clients). It has been our claim that, to the extent that most of the studied common factors explicitly involve therapists handling emotional states and relational processes in session (e.g., alliance development and rupture repairing, empathy, positive regard, congruence, and countertransference management), the type of psychological work depicted in the ECE construct is involved (Barreto & Matos, 2018). ...
... Our model echoes a "totalistic" position on countertransference experience in the sense that it involves therapist's experiences as a whole. However, it discriminates four experiential components, derived from previous literature, to which different therapists may assign distinct clinical value: subjective countertransference, objective countertransference, therapeutic attitude, and emerging experience (Barreto & Matos, 2018). 2 In combination, the primary dimensions also allow a distinction between diversely mentalized countertransference positions that are intended to represent a therapist's predominant attitude towards his/her current experience of a given session (for a detailed presentation of the model and its foundations in psychotherapy literature of diverse backgrounds, the reader is referred to Barreto & Matos, 2018). ...
Alliance may impact psychotherapy outcomes both as a precondition that enables therapeutic work and an evolving process that is therapeutic in itself. This study examined the participation of the elaboration of countertransference experience (ECE) in alliance variation between therapist–client dyads early in therapy and within dyads over time. A total of 44 session assessments nested within 12 dyads were modeled through longitudinal multilevel analyses and utilized to examine the associations between the ECE dimensions of Immersion and Reflection and alliance components across 4 time points within the first 10 sessions of psychotherapy. Results supported the importance of initial ECE to explain differences in alliance between dyads, the particular relevance of ECE with clients presenting lower levels of personality organization, and the effect of personality difficulties on alliance change. Unexpected results were found concerning the correlations between ECE and alliance and their covariation over time. In conclusion, ECE dimensions appear to be involved in alliance formation, both in initial differences between dyads and in changes over time within the same case. ECE seems particularly important with more personality-disturbed clients. Future research should disentangle therapist and client contributions and examine the participation of ECE in the resolution of alliance ruptures. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
... Jak mówią autorzy terapii opartej na mentalizacji (Mentalization-Based Treatment, MBT) mentalizowanie od zawsze było nieodłącznym elementem psychoterapii w każdym paradygmacie. W odniesieniu do psychoterapii psychodynamicznej Barreto i Matos [4] wskazują na dwa główne ośrodki badawcze zajmujące się mentalizacją: z jednej strony na kanadyjskich autorów skupionych wokół Marca-André Boucharda, związanych z freudowską psychoanalizą, bazujących na koncepcji Biona [5]; z drugiej na brytyjski zespół Petera Fonagy'ego, odwołujący się do ujęcia rozwojowego, neuropsychologii i teorii poznania społecznego [3]. I chociaż to tej drugiej grupie można przypisać obserwowany od dwudziestu lat rozkwit koncepcji mentalizacji na całym świecie, to trudno oprzeć się wrażeniu, że łatwiej znaleźć odniesienia do założeń współczesnej i klasycznej psychoanalizy w pracach zespołu Boucharda. ...
... Terapeuta jest zarówno zaangażowanym uczestnikiem, jak i trafnym obserwatorem relacji terapeutycznej, zdolnym do kontenerowania i opracowywania trudnego doświadczenia pacjenta. Podstawową aktywnością terapeuty jest doświadczanie, reflektowanie, przekształcanie i nadawanie znaczenia wewnętrznemu doświadczeniu [4] 2 . Co ciekawe, badania wykazują, że to mniej doświadczeni terapeuci częściej stosują styl refleksyjny w porównaniu z bardziej doświadczonymi terapeutami [21]. ...
... Klasyfikacja dokonana przez zespół Boucharda znalazła potwierdzenie w badaniach Rizq i Target [22]. Inną, ciekawą klasyfikację poziomów mentalizowania terapeutów opracowali także Barreto i Matos [4], którzy opisali pięć sposobów rozumienia procesu psychoterapeutycznego przejawiających się w sposobie opowiadania terapeuty o sesji po jej zakończeniu. ...
Celem artykułu jest próba zintegrowania obszarów: pracy klinicznej, wiedzy teoretycznej i badań naukowych w kontekście najnowszych ujęć mentalizacji. Teoretyczną i praktyczną bazą dla rozwa-żań nad mentalizacją jest koncepcja organizacji osobowości Otto Kernberga i opisany przez niego system psychoterapii dla pacjentów z patologią osobowości-psychoterapii opartej na przenie-sieniu, Transference Focused Psychotherapy (TFP). W artykule podejmuję problematykę diagnozy poziomu mentalizacji pacjentów wraz z uwzględnieniem poziomu organizacji osobowości, a także opisuję możliwe zaburzenia mentalizacji pojawiające się w relacji pacjenta i terapeuty (pseudomen-talizację, konkretną mentalizację i brak mentalizacji). Przedstawiam także najnowsze badania nad mentalizowaniem w kontekście psychoterapii psychodynamicznej, dotyczące dwóch jego aspektów: jako funkcji terapeuty i pacjenta. Ostatnia część artykułu odnosi się do znaczenia mentalizacji jako czynnika leczącego w terapii TFP. Wnioski: Mentalizowanie można traktować jako pewną niezależną postawę, metazałożenie terapii, w dalszej kolejności stosując techniki wynikające z konkretnego paradygmatu. Psychoterapia psychodynamiczna w swoich założeniach ma zapewnić maksymalny komfort mentalizowania zarówno dla pacjenta, jak i terapeuty.
Summary: The aim of the article is to try to integrate the clinical work, theoretical knowledge, and scientific research in the context of the latest mentalization theories. The theoretical and practical basis for considerations on mentalization is Otto Kernberg's concept of personality organization and the psychotherapy system for patients with personality pathology-Transference Focused Psychotherapy (TFP). In the article, the issue of diagnosis of patients' mentalization along with the level of personality organization is discussed. Possible mentalization disorders appearing in the patient-therapist relation (pseudomentalization, concrete mentalization and lack of mentalization) are also described. Moreover, the latest research on mentalization in the context of psychodynamic psychotherapy is presented, concerning two aspects of mentalization: as the function of the therapist and the patient. The last part of the article refers to the importance of mentalization as a therapeutic factor in TFP. Conclusions: Mentalizing can be seen as a certain independent attitude, a specific meta-theoretical basis of the therapy, followed by techniques resulting from a specific paradigm. Psychodynamic psychotherapy is intended to provide maximum comfort of mentalizing for both the patient and the therapist.
... While these findings are unexpected, several explanations may account for this observation. As described in some occupational psychology literature, which posits that facing challenges at work can enhance engagement (Tadić Vujčić et al., 2017), therapists handling more severe cases may experience deeper immersion and concentration, known as flow, which enhances their responsiveness (Barreto & Matos, 2018). This engagement is thought to support key therapeutic factors such as the therapeutic alliance and countertransference management (Barreto & Matos, 2018). ...
... As described in some occupational psychology literature, which posits that facing challenges at work can enhance engagement (Tadić Vujčić et al., 2017), therapists handling more severe cases may experience deeper immersion and concentration, known as flow, which enhances their responsiveness (Barreto & Matos, 2018). This engagement is thought to support key therapeutic factors such as the therapeutic alliance and countertransference management (Barreto & Matos, 2018). Additionally, therapists' ability to reflect on their own mental states aids in managing countertransference reactions, highlighting the role of introspection in challenging therapeutic encounters (Bhola & Mehrotra, 2021). ...
Despite the common assumption that increased therapist experience correlates with improved client outcomes, studies reveal inconsistent relationships between therapist experience and therapy effectiveness. Some studies have demonstrated a slight worsening of client outcomes as therapists gain more experience. Yet, there are few studies that have examined how therapists change in their client outcomes over time, especially across different outcomes (e.g., depression, life functioning, anxiety). The present study used the Behavioral Health Measure-17 to investigate therapist effectiveness over time on multiple treatment outcomes (e.g., general distress, life functioning, anxiety, alcohol/drug use) using a large naturalistic sample of 613 professional therapists and 42,690 clients over approximately 12 years of psychotherapy data. Our results show a significant decrease in client outcomes over time in three domains: general distress, life functioning, and anxiety, albeit small-sized effects. Our findings also indicate that therapist caseload and baseline severity were not associated with predicting client outcomes and that, unexpectedly, the severity of therapist caseloads decreased over time. These findings underscore the importance of a nuanced understanding of therapist effectiveness, challenging the assumption of universal improvement with experience. Furthermore, we believe that these findings may offer preliminary support for matching therapists with clients based on domain-specific strengths.
... Instead, it is for the therapist to notice and to realize other potentials in the therapeutic experience. The third, as an intersubjective space, requires an attitude of doubt and openness regarding the therapist's countertransference (Barreto & Matos, 2018;Tishby & Wiseman, 2022), a mindfulness in action (Eubanks-Carter et al., 2015;Safran & Muran, 2000). ...
... These kind of utterances of mindfulness in action exemplify many of the principles of metacommunication necessary to the resolution of therapeutic impasses, while simultaneously supporting the patient's needs for autonomy, relatedness and competence (Vansteenkiste et al., 2020): they exemplify exploration with tentativeness, establish a sense of 'we-ness' by commenting on what may be a shared experience, emphasize own subjectivity by accepting responsibility for one's own contribution, promote the practice of reflecting on one's mind trough modelling it, focus on the here-and-now of the relationship, as well invite the patient to explore the therapist's contribution. All these foster the capacity of mentalization (Barreto & Matos, 2018;Fonagy et al., 2019), the willingness to reflect on one's own experience and that of others, allowing us to detach from any interpretation of our own and remain open to whatever we encounter (Aron, 2019;Stern, 2019). ...
Psychotherapy research identifies alliance ruptures and their resolutions as significant events in psychotherapy, influencing outcome. However, we know little about the process how such events influence outcomes, only assuming if clients stay in therapy that the rupture was resolved, and the outcome will be positive. The purpose of this paper is to problematize this assumption against the backdrop of self-determination theory, introducing motivation and relational positioning as relevant theoretical concepts for understanding rupture resolution and the effect on outcome. A therapeutic transcript demonstrating best practice for alliance rupture resolution in a brief integrative therapy is critically examined, calling the attention of both clinicians and researchers to the risk of prescribing and blindly following techniques during therapeutic impasses. Our analysis of metacommunication demonstrates how the therapist’s use of a certain technique for resolving threats to the therapeutic alliance can lead to the client’s external motivation and compliance, negatively influencing therapeutic outcome. Focusing on the therapist’s relational positioning we present two alternative courses of therapeutic action, ‘mindfulness in action’ and ‘embracing the patient’s ambivalence’, for supporting the client’s autonomous motivation for the therapy process.
... La mentalisation, permettant une posture dite réflexive à l'égard des vécus affectifs ressentis par l'intervenant, favoriserait quant à elle non seulement une meilleure régulation émotionnelle, mais aussi l'élaboration d'un sens et d'une pertinence clinique du ressenti, permettant ainsi d'ajuster le comportement et les interventions aux besoins de la personne accompagnée, tout en préservant l'intégrité psychique du professionnel (Barreto et Matos, 2018 ;Hoffman, 2015 ;Schore, 2001). En effet, au sein de la rencontre intersubjective se déploient des signaux à la fois verbaux, non verbaux et infra-verbaux qui contribuent à la communication de ressentis conscients et inconscients s'inscrivant de façon unique dans la dyade intervenant-personne accompagnée (Georgieff, 2014 ;Georgieff et Speranza, 2013 ;Stern, 2005b). ...
... Un intervenant pourrait donc se permettre, au sein de ces espaces réflexifs entre professionnels, d'exprimer une envie de se mettre en colère contre une personne accompagnée, et ce, sans que sa compétence professionnelle, son envie réelle de venir en aide, sa motivation ou sa posture thérapeutique soient remises en doute. Notons d'ailleurs qu'une mentalisation efficiente de ces émotions ou vécus internes atténue les risques d'agirs contre-transférentiels, les charges affectives n'oeuvrant plus hors de la conscience des professionnels (Barreto et Matos, 2018). Lorsque non mentalisés, les contenus émotifs risquent plutôt de s'accumuler à l'intérieur de l'intervenant. ...
... La mentalisation, permettant une posture dite réflexive à l'égard des vécus affectifs ressentis par l'intervenant, favoriserait quant à elle non seulement une meilleure régulation émotionnelle, mais aussi l'élaboration d'un sens et d'une pertinence clinique du ressenti, permettant ainsi d'ajuster le comportement et les interventions aux besoins de la personne accompagnée, tout en préservant l'intégrité psychique du professionnel (Barreto et Matos, 2018 ;Hoffman, 2015 ;Schore, 2001). En effet, au sein de la rencontre intersubjective se déploient des signaux à la fois verbaux, non verbaux et infra-verbaux qui contribuent à la communication de ressentis conscients et inconscients s'inscrivant de façon unique dans la dyade intervenant-personne accompagnée (Georgieff, 2014 ;Georgieff et Speranza, 2013 ;Stern, 2005b). ...
... Un intervenant pourrait donc se permettre, au sein de ces espaces réflexifs entre professionnels, d'exprimer une envie de se mettre en colère contre une personne accompagnée, et ce, sans que sa compétence professionnelle, son envie réelle de venir en aide, sa motivation ou sa posture thérapeutique soient remises en doute. Notons d'ailleurs qu'une mentalisation efficiente de ces émotions ou vécus internes atténue les risques d'agirs contre-transférentiels, les charges affectives n'oeuvrant plus hors de la conscience des professionnels (Barreto et Matos, 2018). Lorsque non mentalisés, les contenus émotifs risquent plutôt de s'accumuler à l'intérieur de l'intervenant. ...
Cet article documente le vécu de 120 intervenants québécois oeuvrant auprès des personnes ayant une déficience intellectuelle et pouvant présenter des comportements difficiles (CD). Une analyse descriptive illustre le niveau d’exposition et les catégories de CD rapportées par les intervenants, ainsi que les impacts perçus par ces derniers. Les données soutiennent que ces intervenants effectuent un travail psychologiquement exigeant et suscitant de vives réactions. Leur niveau de régulation émotionnelle (RE), habileté permettant de mieux gérer les émotions induites par un événement stressant, a été mesuré à l’aide du questionnaire DERS. Une analyse de régression a montré qu’une meilleure RE est associée à moins de détresse psychologique. Aucun lien n’a été trouvé entre le niveau d’exposition et la détresse psychologique.
... The therapist is both a committed participant in the therapeutic relationship and its careful observer, capable of containing and processing the patient's difficult experience. The therapist's basic activity is experiencing, reflecting on, transforming, and giving meaning to inner experience [4] 2 . Interestingly, research shows that it is the less experienced therapists who use the reflective style more often compared to more experienced ones [21]. ...
... The classification proposed by Bouchard's team was confirmed in the research conducted by Rizq and Target [22]. Another interesting classification of therapists' mentalization levels was developed by Barreto and Matos [4], who described five ways of understanding the psychotherapeutic process, manifesting themselves in the therapists' ways of speaking about the session when it is over. ...
The aim of the article is to try to integrate the clinical work, theoretical knowledge, and scientific research in the context of the latest mentalization theories. The theoretical and practical basis for considerations on mentalization is Otto Kernberg's concept of personality organization and the psychotherapy system for patients with personality pathology - Transference Focused Psychotherapy (TFP). In the article, the issue of diagnosis of patients' mentalization along with the level of personality organization is discussed. Possible mentalization disorders appearing in the patient-therapist relation (pseudomentalization, concrete mentalization and lack of mentalization) are also described. Moreover, the latest research on mentalization in the context of psychodynamic psychotherapy is presented, concerning two aspects of mentalization: as the function of the therapist and the patient. The last part of the article refers to the importance of mentalization as a therapeutic factor in TFP. Conclusions: Mentalizing can be seen as a certain independent attitude, a specific meta-theoretical basis of the therapy, followed by techniques resulting from a specific paradigm. Psychodynamic psychotherapy is intended to provide maximum comfort of mentalizing for both the patient and the therapist. © 2018 Komitet Redakcyjno Wydawniczy Polskiego Towarzystwa Psychiatrycznego. All rights reserved.
... The therapist is both a committed participant in the therapeutic relationship and its careful observer, capable of containing and processing the patient's difficult experience. The therapist's basic activity is experiencing, reflecting on, transforming, and giving meaning to inner experience [4] 2 . Interestingly, research shows that it is the less experienced therapists who use the reflective style more often compared to more experienced ones [21]. ...
... The classification proposed by Bouchard's team was confirmed in the research conducted by Rizq and Target [22]. Another interesting classification of therapists' mentalization levels was developed by Barreto and Matos [4], who described five ways of understanding the psychotherapeutic process, manifesting themselves in the therapists' ways of speaking about the session when it is over. ...
The aim of the article is to try to integrate the clinical work, theoretical knowledge, and scientific research in the context of the latest mentalization theories. The theoretical and practical basis for considerations on mentalization is Otto Kernberg's concept of personality organization and the psychotherapy system for patients with personality pathology − Transference Focused Psychotherapy (TFP). In the article, the issue of diagnosis of patients' mentalization along with the level of personality organization is discussed. Possible mentalization disorders appearing in the patient-therapist relation (pseudomentalization, concrete mentalization and lack of mentalization) are also described. Moreover, the latest research on mentalization in the context of psychodynamic psychotherapy is presented, concerning two aspects of mentalization: as the function of the therapist and the patient. The last part of the article refers to the importance of mentalization as a therapeutic factor in TFP. Conclusions: Mentalizing can be seen as a certain independent attitude, a specific meta-theoretical basis of the therapy, followed by techniques resulting from a specific paradigm. Psychodynamic psychotherapy is intended to provide maximum comfort of mentalizing for both the patient and the therapist.
... There is accumulating evidence that working with transference and countertransference in psychotherapy is beneficial (Norcross, 2011). Barreto and Matos (2018) offer an interesting perspective on how therapists by mentalizing the countertransference can stimulate mentalizing in the therapist-patient relationship. Offline mentalizing can be done both within a therapeutic relationship and on one's own, whereas online mentalizing is more intertwined with the current interpersonal context and depends upon the mentalizing capacity of the other party (Luyten & Fonagy, 2015). ...
... Contrary to our expectations, the clinician's emotional responses do not seem to influence the patient's mentalization over time. If we consider therapists' CT as an indirect indicator of therapist's mentalization (Barreto & Matos, 2018), perhaps its influence on the patient's mentalization is more immediate and evident at session level than across phases of treatment, occurring within individual sessions rather than having a slow-release effect over time. In other words, we do not believe that our results confute the idea that patient and therapist mentalization mutually influence each other, but rather that the timing of this influence may differ depending on the direction of the influence. ...
Mentalization, that is the capacity to understand our and others’ behaviors in terms of intentional mental states, represents one of the core features of personality disorders (PDs) and can be related to therapists’ countertransference (CT) and interventions. Aims: The aim of the present work was to study the relationship between therapists’ technique, therapists’ CT, and patients’ mentalization, in a sample of patients with PDs undergoing a 40-session program of sequential brief-adlerian psychodynamic psychotherapy, a psychodynamic therapeutic model specifically developed for the treatment of PDs in public mental health services. Method: Eighty-seven patients with PD and their therapists completed ratings of mentalization (mentalization imbalances scale and reflective functioning questionnaire), CT (therapist response questionnaire), and therapists’ intervention (comparative psychotherapy process scale) at five different time points (Sessions 5, 10, 20, 30, and 40). Results: Results showed that patients’ mentalizing problematics decreased over time. Moreover, we found a reduction of therapists’ disengaged CT, and an increase in positive CT over time. Regarding therapists’ techniques, psychodynamic-interpersonal interventions were on average higher than cognitive–behavioral, but both techniques were used increasingly over time. Our results also showed significant and clinically coherent interactions between therapist’s CT and techniques and between patient’s mentalization imbalance and therapist’s response. Our results highlighted the importance of early stages in therapy, since the most significant relationships between the various process variables (patient’s mentalizing imbalances, therapist’s techniques, and emotional responses) are observed between t1 and t2, corresponding to the initial phases of the treatments. Clinical implications will be discussed.
... RF has been explored in parenting child research as intrinsically associated with parental attachment. Although the complex, non-overlapping, and relation-specific nature of these constructs, insecure attachment, involving internalized negative representations of self and others (Bartholomew & Horowitz, 1991;Brennan, Clark, & Shaver, 1998), has been associated with impoverished and minimal RF skills (Barreto & Matos, 2018;Fonagy & Target, 1997;Slade, Grienenberger, Bernbach, Levy, & Locker, 2005). ...
... First, by preserving the countertransference referent, we wish to situate the subject within a technical realm that implies therapists' need to work with these phenomena. Second, the type of work required from therapists, which we have called the elaboration of countertransference experience (ECE) elsewhere (Barreto & Matos, 2018), involves making sense of the whole experiential field before hypothetical distinctions between different components (SCT, OCT, etc.) and considerations about their momentary or enduring balance can emerge. Therefore, what some authors prefer to leave outside the realm of 'proper' countertransference must be dealt with just in the same way as other aspects of therapists' experiences and can actually share common underlying psychological processes (Levine, 1997). ...
The attempt to identify and classify distinct experiences falling under the common designation of countertransference has been labelled the specifist tradition. In this paper, a model describing two dimensions differentiating four components of countertransference experience is proposed. For each experiential component (subjective countertransference, objective countertransference, therapeutic attitude and emerging experience), a brief description based on previous literature from diverse theoretical fields is offered, along with clinical implications and illustrations and an account of empirical literature explicitly or implicitly addressing the specific component. In conclusion, the model is presented as a heuristic guide that can serve different purposes across different therapeutic orientations, with valuable implications for practice, training and supervision.
... 83). A concept strictly related seems to be the one of elaboration of countertransference experience, i.e., the implicit and explicit psychological work to which therapists' experiences are submitted (Barreto & Matos, 2018, 2020. The elaborative work between sessions by itself does not, of course, guarantee the necessary analytic space to foster awareness, since it could be, in its turn, influenced by CT. ...
Objective: Countertransference (CT) research has demonstrated the importance of CT management for successful therapy outcomes. Over time, CT research began to take this aspect more and more seriously and expanded the concept of CT management to include aspects, such as stable characteristics of the therapist and his or her theoretical model, that do not necessarily pertain the single session (e.g., therapist’s self-integration, theoretical framework). In this study we further expand the boundaries of CT management by investigating the relationship between CT experienced within sessions and the elaborative activity taking place between sessions. Method : Twenty-three in-training psychotherapists were asked to rate their emotional reactions through the Therapist Response Questionnaire at the end of 69 counselling sessions and to fill the Post Session Therapist Questionnaire, an instrument assessing three relevant reflexivity activities in the post-session time. The 69 sessions were also recorded, transcribed and evaluated by three external raters, who applied the Countertransference Behavior Measure. Results: Results showed significant correlations between some dimensions of CT experienced in the session and some dimensions of the therapist’ post-session working through. Conclusion: Results highlighted the centrality of the reflexivity processes that therapists put in place between sessions and not only within the session to increase awareness of their countertransference, a prerequisite for its handling during the session for therapeutic purposes.
... Pandangan klasik mendefinisikan kontratransferensi sebagai reaksi bawah sadar klinisi terhadap transferensi klien dan mengonsepkannya sebagai hambatan proses psikoterapi yang harus diatasi. Namun, dari perspektif totalistik, kontertransferensi adalah reaksi konselor (sadar dan tidak sadar, emosional dan kognitif) mencerminkan, sebagian, interpersonal klien berfungsi (Barreto & Matos, 2018;Colli, A., & Ferri, 2015). Frued pertama memandang kontratransferensi mengacu pada titik buta analisis yang menghadirkan hambatan untuk analis (Joseph Sandler, 1976). ...
... Osobnym nurtem badań nad mentalizacją są badania nad mentalizowaniem terapeutów w kontekście różnych zmiennych związanych z psychoterapią, np. siły przymierza terapeutycznego i efektywności terapeutów(Cologon i in., 2017; Reading i in., 2019), reakcji przeciwprzeniesieniowej(Barreto & Matos, 2018; Bhola & Mehrotra, 2021). Używa się do tego różnych narzędzi (przegląd w: Shaw i in., 2019), np. ...
**** To jest robocza, polska wersja ebooka ****
Jańczak, M. O. (2021). What’s on your mind? A Guide for Mentalization Assessment in Adults. Wydawnictwo Rys. http://doi.org/10.48226/978-83-66666-85-6
... Measures of mentalization in therapists. A separate stream of research on mentalization involves research on mentalizing therapists in the context of various psychotherapy-related variables, such as the strength of the therapeutic alliance and the effectiveness of therapists (Cologon et al., 2017;Reading et al., 2019), or countertransference (Barreto & Matos, 2018;Bhola & Mehrotra, 2021). For this purpose, various measures are utilized (reviewed by Shaw et al., 2019), including The Therapist Mental Activity Scale TMAS (Normandin et al., 2012), the Mentalization-Based Treatment Adherence and Competence Scale, and the MBT-ACS (Karterud et al., 2013). ...
The theory of mentalization, put forward by P. Fonagy over twenty years ago, indubitably remains one of the most dynamic concepts to have developed in clinical psychology in recent years. In this book, I explore the theoretical and empirical aspects relevant to the assessment of mentalizing. In the first part, the issues and challenges that researchers face when planning to measure mentalization are discussed. The second part presents an overview of the most prevalent research tools, describing how they are administered, how the results are calculated and interpreted, their psychometric properties, and their research applications. It is my earnest hope that this book may serve as a practical guide for students and researchers interested in measuring mentalizing.
... Αντίθετα, η γόνιμη διαχείριση της αντιμεταβίβασης (countertransference management) βρέθηκε να συσχετίζεται με το θεραπευτικό αποτέλεσμα με υψηλό βαθμό συσχέτισης, καταδεικνύοντας έτσι ότι αυτό που έχει μεγαλύτερη σημασία είναι η αξιοποίηση της αντιμεταβίβασης προς όφελος της θεραπείας. Μάλιστα, τα τελευταία χρόνια προτείνεται μια μεταστροφή του ερευνητικού και κλινικού ενδιαφέροντος περισσότερο στους τρόπους επεξεργασίας της αντιμεταβίβασης παρά της ευρύτερης διαχείρισής της, καθώς η αντιμεταβίβαση φαίνεται να συνιστά μια ειδική μορφή εν-νόησης (mentalization) (Barreto & Matos, 2018;Fonagy et al., 2012). Σε κάθε περίπτωση, επιμέρους μελέτες επιβεβαιώνουν ότι η επιτυχημένη αντιμετώπιση της αντιμεταβίβασης από τον θεραπευτή αποτελεί έναν ιδιαίτερα υποσχόμενο θεραπευτικό παράγοντα στην επιστημονικά τεκμηριωμένη θεραπεία, ο οποίος χρήζει περαιτέρω εμπειρικής διερεύνησης . ...
In the psychodynamic approach, the therapeutic relationship stands at the core of the therapeutic process and constitutes a key factor of the effectiveness of treatment. As such, highlighting the psychodynamic components associated with the therapeutic relationship can help reinforce the role of counseling and clinical psychologists, by offering a broader understanding of the various dynamic interactions in clinical work. Specifically, the present paper delineates particular aspects of the therapeutic relationship (e.g. therapeutic alliance, transference, countertransference, real relationship) that should be taken into account in counseling and psychotherapy as essential components of the therapeutic relationship. Current empirical data are presented to demonstrate the importance of these parameters for the therapeutic process and outcome. Emphasis is also placed on the conditions that need to be fulfilled in order to ensure a relationship of therapeutic value, such as the importance of the therapeutic framework and the role of the psychologists / psychotherapists in dealing with enactments. Finally, the benefits of using the potential of the therapeutic relationship in clinical practice are highlighted, for improving both someone’s relationship with oneself and with others.
... which has also indicated that more seasoned therapists had less intense and fewer negative emotional reactions to borderline patients.However, the findings from these three studies were limited by the use of written or audiotaped case vignettes to evoke responses from participant therapists. The links between therapist experience levels and the occurrence of difficult countertransference reactions may not be restricted to BPD and similar findings have been reported with narcissistic personality disorder,43 another Cluster B disorder.Therapeutic work is a meaning making process, one in which both the patient and the therapist need to represent their inner worlds in mental state terms.44 In this process, the therapist needs to look both inward and outward, at their own experiences and at what the patient might be doing or feeling.5 ...
Objective: This exploratory study locates countertransference as a pan-theoretical concept, comprising of thoughts, feelings, and behaviours expressed or experienced by therapists toward their patients. It aimed to understand the patterns of countertransference experienced in working with borderline personality disorder. The associations between countertransference reactions and therapist related variables of experience and mentalization ability were also examined.
Method: Psychotherapists (N=117) completed the Therapist Response Questionnaire to assess patterns of countertransference experienced with a representative patient diagnosed with borderline personality disorder. They also completed a measure of mentalization ability that examined self-related mentalization, other-related mentalization and motivation to mentalize.
Results: The profile of responses across eight countertransference dimensions is discussed, with the most strongly endorsed reactions being positive/satisfying, parental/protective and helpless/inadequate. More experienced therapists reported less negative countertransference reactions on select dimensions. Therapists’ self-reported ability to reflect on and understand their own mental states was negatively correlated with a range of difficult countertransference experiences. There were few associations between their ability to make sense of others’ mental states, the motivation to mentalize, and the strength of their countertransference reactions.
Conclusion: The implications for countertransference management as well as therapist training and development are highlighted.
... However, research related to countertransference in clinical assessment contexts have shown acceptable intraclass correlation coefficients (Laverdière, Beaulieu-Tremblay, Descôteaux, & Simard, 2018), substantiating that countertransference reactions might consist of both subjective and objective parts (Kiesler, 2001). Interrater reliability, though, might differ for various counter-transference reactions (Hafkenscheid, 2012), and the therapists' experience of counter-transference can occur at very different levels of reflectivity and mentalizing (Barreto & Matos, 2018). ...
Primary aim of this study was to determine the extent and type of self‐reported interpersonal problems in patients with non‐affective psychoses and their impact on psychosocial functioning. Furthermore, we aimed to explore potential links with the psychodynamic construct of Stavros Mentzos' “psychotic dilemma”, which describes an insufferable inner tension caused by an individual's struggle of being torn between “self‐oriented” and “object‐oriented” tendencies.
In a cross‐sectional study among 129 patients with non‐affective psychoses, measures of cognition, symptom load and social functioning as well as a tentative, psychodynamic assessment of Mentzos' “dilemma” were obtained during a clinical research visit. Self‐report data on interpersonal problems were gathered using the Inventory of Interpersonal Problems (IIP‐64D) and compared with a German representative standard sample. Second, IIP‐64D scores were compared between groups with or without Mentzos' “dilemma”. Hierarchical regression analyses were performed to test for the impact of interpersonal problems on psychosocial functioning, while controlling for cognitive deficits and psychopathology.
Results showed that IIP‐64D scores differed significantly from healthy controls, except for “self‐centred” and “intrusive” interpersonal styles. Participants with a potential “psychotic dilemma” scored significantly higher on the subscales: “domineering”, “self‐centred”, “cold”, and “socially avoidant” than the group without a “psychotic dilemma”. The total amount of interpersonal problems, and particularly high scores on the IIP‐64D “socially avoidant” subscale, predicted psychosocial dysfunction, whereas a “cold” interpersonal style had an opposite effect.
In conclusion, specific interpersonal problems may predict psychotherapeutic outcome measures like psychosocial functioning and are partly compatible with the psychodynamic construct of Stavros Mentzos' “psychotic dilemma”.
... These aspects might be understood in terms of specific transference-countertransference configurations. Thus, the therapists' capacity to "mentalize" countertransference seems to be decisive (Barreto and Matos, 2018). ...
Despite the general effectiveness of bona fide psychotherapies, the number of patients who deteriorate or fail to improve is still problematic. Furthermore, there is an increased awareness in the field that the therapists’ individual skills make a significant contribution to the variance in outcome. While some therapists are generally more successful than others, most therapists have experienced both therapeutic success and failure in different cases. The aim of this case-series study was to deepen our understanding of what matters for the therapists’ success in some cases, whereas other patients do not improve. How do the patients and their therapists make sense of and reflect on their therapy experiences in most successful and unsuccessful cases? Are there any distinctive features experienced by the participants at the outset of treatment? To explore these issues, we applied a mixed-method design. Trying to keep the therapist factor constant, we selected contrasting cases from the caseloads of three therapists, following the criterion of reliable and clinically significant symptom reduction or non-improvement at termination. Transcripts of 12 patient interviews and 12 therapist interviews (at baseline and at termination) were analyzed, applying inductive thematic analysis and the multiple-case comparison method. The comparisons within the three therapists’ caseloads revealed that in the successful cases the patient and the therapist shared a common understanding of the presenting problems and the goals of therapy and experienced the therapeutic relationship as both supportive and challenging. Furthermore, the therapists adjusted their way of working to their patients’ needs. In non-improved cases, the participants presented diverging views of the therapeutic process and outcome. The therapists described difficulties in the therapeutic collaboration but not how they dealt with obstacles. They tended to disregard their own role in the interactions and to explain difficulties as being caused by the nature of their patients’ problems. This could indicate that the therapists had difficulty in reflecting on their own contributions, accepting feedback from their patients, and adjusting their work accordingly. These within-therapist differences indicate that taking a “third position” is most needed and seems to be most difficult, when early signs of a lack of therapeutic progress appear.
This study investigates and attempts to give an understanding, through an in depth qualitative analysis, concerning the experience of therapists, in dealing with and managing their negative countertransference (CT) reactions (emotionally, cognitively, and behaviorally), in the here and now of the therapeutic relationship (TR).
In this study, six participants from different theoretical orientations (psychodynamic, CBT, Integrative Counseling Psychotherapy) were interviewed, by using semi-structured interviews, where the transcripts of those, they were analysed in accordance with the Interpretative Phenomenological Analysis (IPA) principles.
From this analysis three master themes emerged: (1) focusing on therapeutic relationship and management of countertransference, (2) inner processing of therapists, (3) immediacy in the here and now. The findings of the analysis highlight the different factors that can influence therapy such as, the quality of the therapeutic relationship, the communication and the interaction within the session, the theoretical concepts from different therapeutic approaches, the work that a therapist does with himself considering the awareness of his/her CT reactions and the theoretical conceptualization of what is the CT and how and why is happening (i.e. based on therapist’s past conflicts, or from perhaps a projective identification of the client). All these factors are not separate; to the contrary they are very interrelated and they can have either a positive or a negative impact to the therapeutic process, with the awareness of CT and the theoretical knowledge of it to highlight as very significant factors, where they can be very useful to the therapists to manage their negative CT reactions. CT is something that inevitably can happen to any therapeutic session, within any therapeutic orientation; therefore, it is important the theoretical conceptualization of the CT to be learned throughout the different therapeutic approaches, apart from psychoanalytic and psychodynamic approach.
The two-volume third edition of this book identifies effective elements of therapy relationships (what works in general) as well as effective methods of tailoring or adapting therapy to the individual patient (what works in particular). Each chapter features a specific therapist behavior (e.g., alliance, empathy, support, collecting feedback) that demonstrably improves treatment outcomes or a nondiagnostic patient characteristic (e.g., reactance, preferences, culture, attachment style) by which to effectively tailor psychotherapy. Each chapter presents operational definitions, clinical examples, comprehensive meta-analyses, moderator analyses, and research-supported therapeutic practices. New chapters in this book deal with the alliance with children and adolescents, the alliance in couples and family therapy, and collecting real-time feedback from clients; more ways to tailor treatment; and adapting treatments to patient preferences, culture, attachment style, and religion/spirituality.
After having reviewed the most important conceptualizations on post-formal knowledge and described the characteristics of this level, the author criticizes some of them, analyzes whether it is possible to speak of a fifth stage of development beyond formal operations, and makes some considerations about the models of development underlying studies of adult behavior.
The introduction of the concept of mentalization in psychological science by Fonagy and colleagues has opened up new perspectives for the understanding of psychopathology, psychotherapy, and child development. The present study reviews the theory of mentalization, with a focus on its 4 dimensions (cognitive/affective, implicit/explicit, self/other, and external/internal), and some unclear points and unresolved issues are identified. Mentalization theory is then contrasted with the theory of primary intersubjectivity, which is often seen as an incompatible approach to the development of social understanding. It is argued that this theory, at least in 1 of its interpretations, is not only compatible with mentalization theory, but may also possibly contribute to the resolution of some problems in mentalization theory. More specifically, it is argued that mentalization originally develops in the context of primary intersubjectivity, and that primary intersubjectivity is a basic prerequisite for the development of mentalization; but also that there is a considerable overlap between the concepts of primary intersubjectivity and those of implicit and externally focused mentalization.
Résumé
Cet article met en relief le rôle central des réactions contre-transférentielles dans le traitement de patients limites selon l’approche focalisée sur le transfert de Otto F. Kernberg (TFP : Transference Focused Psychotherapy). Une grille d’analyse du contre-transfert (GAC) est présentée pour décrire la diversité des activités mentales dans lesquelles le thérapeute s’engage pour comprendre et parvenir à utiliser les réactions que déclenchent en lui ces patients. Un exemple clinique est présenté pour démontrer l’utilité de la GAC dans le travail des réactions contre-transférentielles évoquées par une patiente présentant un trouble limite de la personnalité. Certaines données de recherche viennent appuyer l’importance du travail des réactions contre-transférentielles.
Abstract This study examined whether training can increase the reflective function (RF) of novice therapists about patients with Borderline Personality Disorder (BPD). A total of 48 students in clinical psychology were randomly assigned to mentalization training or didactic training. Their RF regarding patients was assessed with the Therapist Mental Activity Scale (TMAS: Normandin, Ensink, & Maheux, 2012). The RF of trainees assigned to the mentalization training improved significantly, while participants who received traditional didactic training actually became significantly less reflective. These findings show that brief mentalization training can help beginner therapists develop their mentalization capacities with challenging patients.
An integrative approach to countertransference (CT) phenomena is proposed by means of a Countertransference Rating System (CRS). Three types of countertransference (CT) activity are studied: Objective-Rational, Reactive (classical CT), and Reflective (a purposeful awareness with an interpretive function). The rating system was applied to spontaneous written reactions of 45 experienced (10 years and more) and 45 inexperienced (1 year) psychologists of three schools (psychodynamically oriented, humanists, and cognitive-behaviorists). Two clinical vignettes, one of an adolescent borderline, the other of an obsessional man, served as stimuli. Results show an adequate level of interjudge reliability as measured by kappa (?= .72) and intraclass coefficients (ICC: p = .78). A highly coherent pattern of intercorrelations gives support to the logical structure of the CRS. Group comparisons showed that humanists and psychodynamicists are comparatively more reflective, while behaviorists adopt a relatively more frequent objective/rational activity. Surprisingly, novices are more reflective in the patient's immediate experience of the situation compared to experts, who show twice as much of an impulsive, unacknowledged reaction (Reactive CT).
Empirical evidence supporting the inclusion of mandatory training therapy for therapists is sparse. We present results from a mixed methods study designed to interrogate how counselling psychologists' attachment status and levels of reflective function (RF) intersect with how they experience, recall and describe using personal therapy in clinical practice. Results suggest that securely-attached, or earned secure participants with ordinary or marked levels of RF used their therapy to manage feelings evoked by difficult or challenging clients. Insecurely-attached participants with lower levels of RF found therapy valuable in terms of behavioural modelling, but not in managing complex process issues. Negative case analysis found that high levels of RF may not be uniformly advantageous for therapists. The study concludes with a brief discussion of issues relating to epistemology, validity and reflexivity.
The concept of countertransference has a long history in psychoanalysis. This paper sketches the phenomenon referred to by countertransference and the development of the concept, from being signs of disturbance in the analyst to an important road to knowledge about the patient's inner life. The complexity of the questions discussed today - how to understand the concepts of neutrality, abstinence, and empathy; the relative subjective mutuality and symmetry of the analytic situation; the analyst's enactments and self-disclosure of feelings - reflects the complexity of the contemporary view of the patient-analyst relationship. In conclusion, the author presents a model illustrating the disturbing and informative aspects of countertransference together with the conceptual relationship between countertransference on the one hand and empathy and projective identification on the other. Finally, by differentiating between intuitive and irrational levels of functioning, an integrated model for countertransference is presented, synthesising the essence of the concept as it is used today.
Application of a computerized text analysis procedure is proposed that has the potential for use by psychoanalytic and psychodynamic clinicians: the systematic examination of linguistic style as reflected by clinicians in their ongoing process and case notes, which are ubiquitous in the mental health field. The studies reported here are, as far as is known, the first attempts to study treatment notes systematically using such procedures. Linguistic measures are used to track the trajectory of the clinical process throughout the treatment in two contrasting cases, one rated successful, the other not. The computerized linguistic analysis used here focuses on two analytically relevant linguistic variables: Mean High Referential Activity (MHW), a measure of the degree to which language is connected to emotional processing, and Reflection (REF), the use of words referring to logical functions. Changes in the relative position of these measures indicate nodal points in the treatment that might be analytically or therapeutically problematic, and that might be overlooked in a solely clinical reading. The analyst's activity as reported in notes during such nodal periods is clinically examined to see how it may have affected the course of the analysis. This method has the potential for use in ongoing treatments, and may help clinicians refine their interventions.
The concepts of multiple code theory and the referential process are examined in relation to levels of awareness and the sense of self as characterized in recent work in neuropsychology by Damasio. The juxtaposition of subsymbolic and symbolic systems in working memory, as this operates in the referential process, is central to both consciousness and the sense of self. The roots of pathology lie in dissociation within emotion schemas; this applies at different levels for all forms of neurosis. The goal of psychoanalytic treatment is integration of dissociated schemas; this requires activation of subsymbolic, including bodily experience, in the session itself, in relation to symbolic representations of present and past experience. Implications concerning repression, resistance, the primary process, the role of language in therapeutic change, and other psychoanalytic concepts are discussed.
Abstract The need for psychotherapy research to understand the therapist effect has been emphasized in several studies. In a large naturalistic study (255 patients, 70 therapists), this topic was addressed using therapists' self-assessed difficulties in practice and interpersonal functioning in therapeutic work as predictors of patient outcome in three conventional outcome measures. Three-level growth curve analyses were employed to assess whether the therapist characteristics, measured by the Development of Psychotherapists Common Core Questionnaire (Orlinsky & Rønnestad, 2005), predicted the level of and change in patient symptom distress (SCL-90R), interpersonal problems (IIP-64), and observer-rated global functioning (GAF). Preliminary estimates of therapist effects in patient change indicated that 4% of change in general symptom distress (GSI), almost 21% of change in IIP global scores, and 28% of growth in GAF could be attributed to therapist differences. The results also demonstrated that certain therapist self-perceptions were clearly related to patient outcome. For example, therapists' scores on a type of difficulty in practice called "Professional self-doubt" (PSD) (denoting doubt about one's professional efficacy) were positively associated with change in IIP global scores. It is suggested that therapists' self-reported functioning can be of value in understanding how individual therapists contribute to therapeutic change although their influence is not necessarily exerted in expected directions.
This article focuses on a particular kind of affect regulation, mentalized affectivity, which entails revaluing, not just modulating, affects. The author argues that affectivity challenges us to comprehend the impact of our representational world on affective experience and that this process plays a crucial role in psychoanalytic psychotherapy. Three elements of affectivity are delineated and divided into basic and complex forms: identifying affects (naming, distinguishing), processing affects (modulating, refining), and expressing affects (outwardly, inwardly/communicating). Case material is introduced to describe how affects manifest themselves clinically: The author distinguishes between what he terms strong and aporetic feelings, and he shows how affectivity works. Next he locates the concept of affectivity historically, emphasizing a debt to thinkers such as Jacobson, Loewald, Sandler, and Kernberg, who have sought to integrate ego psychology and object relations theory. Finally, he raises some general questions about affect regulation based on what he has proposed about affectivity. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This study examined (1) male and female counselors' countertransference (CTF) reactions to lesbian and heterosexual client actresses and (2) the role of counselor homophobia and CTF management ability in CTF reactions. 67 counselors viewed a videotaped client actress in 1 of 2 conditions: lesbian or heterosexual. The client discussed sexual problems within a stable relationship. Counselors responded to the taped client at 8 points. CTF, the dependent variable, was assessed at behavioral, affective, and cognitive levels. Contrary to prediction, counselors did not exhibit more CTF with a lesbian client. As hypothesized, (1) counselor homophobia correlated with counselor avoidance behavior in the lesbian condition and (2) female counselors had greater recall problems than did male counselors with the lesbian client, whereas male and female counselors had equivalent recall with the heterosexual client. CTF management ability was uncorrelated with CTF reactions in all but a few instances. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Models of brief psychodynamic therapy posit the corrective emotional experience as a key factor in therapeutic change. Although widely taught and used, these models do not have strong empirical support. This article proposes the client-counselor match as a facilitating condition for a corrective emotional experience and reviews the relevant evidence from attachment and interpersonal research. Overall, the notion of the corrective emotional experience has received some support from attachment research, which looks at complementarity of styles at the personality level. Interpersonal research, rather, considers complementarity of actual exchanges in therapy and has yielded mixed results. It thus appears that the validity of the corrective experience has yet to be established, notably through the use of a more fine-grained approach. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Self-concept clarity (SCC) references a structural aspect of the self-concept: the extent to which self-beliefs are clearly and confidently defined, internally consistent, and stable. This article reports the SCC Scale and examines (a) its correlations with self-esteem (SE), the Big Five dimensions, and self-focused attention (Study 1); (b) its criterion validity (Study 2); and (c) its cultural boundaries (Study 3). Low SCC was independently associated with high Neuroticism, low SE, low Conscientiousness, low Agreeableness, chronic self-analysis, low internal state awareness, and a ruminative form of self-focused attention. The SCC Scale predicted unique variance in 2 external criteria: the stability and consistency of self-descriptions. Consistent with theory on Eastern and Western self-construals, Japanese participants exhibited lower levels of SCC and lower correlations between SCC and SE than did Canadian participants. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Compared the spontaneous written reactions to 2 clinical vignettes of 20 beginning (less than 1 yr) and 20 experienced (10 yrs or more) psychoanalytically oriented psychologists, using a countertransference rating scale (CRS). The Ss comprised equal numbers of women and men. The CRS distinguishes 3 major mental states: objective/rational countertransference is a detached, nonparticipating, observing position; reactive countertransference is an unconscious defensive reaction, in which the therapist is an unaware participant–subject; reflective countertransference is an aware, preconscious–conscious subjectively transparent participating state. Results indicate that beginning therapists were more reflective and that experienced therapists were more reactive. As for gender differences, female therapists were more reflective, and males were more objective/rational. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This study examined the relationship among therapist attachment styles, countertransference behaviors, and working alliance. Fifty therapists in training and their supervisors participated in the study. Therapists completed a self-rated measure of attachment style and a measure of working alliance with 1 of their clients. Supervisors completed measures of working alliance and countertransference behaviors about their supervisee's relationship with the same client. Results indicate that therapist attachment style did not correlate with either countertransference behaviors or working alliance. However, negative countertransference was associated with poorer working alliances, and positive countertransference was related to a weak bond within the working alliance. Additional analyses indicate that disagreement among supervisors and therapists about the bond component was predictive of countertransference behaviors. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Examined the impact of therapist gender on countertransference behavior toward rape survivors and tested a 2-step model of countertransference management. The model recommends awareness of countertransference feelings (ACF) followed by employment of theoretical framework to understand these feelings. 47 counseling and clinical psychology graduate students (aged 20–44 yrs) completed measures of ACF and of theoretical framework. 1 wk later, countertransferential "approach" and "avoidance" behaviors were assessed as Ss responded to videotapes of an actress portraying a client survivor of date rape. Based on hierarchical regression analysis, an interaction effect was identified between ACF and theoretical framework. A combination of high ACF and high theoretical framework yielded the least avoidance behavior. As hypothesized, male therapists provided significantly more avoidance responses to the rape survivor than did female therapists. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Relationships between three measures of mentalization (reflective function, mental states, and verbal elaboration of affect), attachment status, and the severity of axis I and axis II pathology were examined. Seventy-three adults, both ex-psychiatric patients and nonclinical volunteers were administered the Adult Attachment Interview (AAI). Comparisons between the three measures indicate that they share some aspect of a core mentalization process and that each illuminates a specific component. Reflective function was the only predictor of attachment status. The number of axis I diagnoses is partly explained by attachment insecurity, but the capacity to generate high-level defensive mental states as well as increments in verbal affect elaboration further contribute to the model. Finally, increments in affect elaboration, as well as augmentations in high-level defensive activity and reflective function are all associated with decreases in the number of axis II diagnoses, over and above the contribution of attachment status and axis I pathology. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Proposes a 4-phase model of the therapist's process of listening and interpreting and replicates previous studies that show (1) that reflective countertransference (CT) is related to adaptive defenses, whereas reactive CT is linked to inadaptive defenses and (2) that experienced therapists are more reactive and less reflective than are novices. Ss were 16 experienced and 16 nonexperienced therapists (aged 22–55 yrs). Instruments used were the Countertransference Rating System, which distinguishes types of CT (reflective, reactive, and objective-rational), and an adaptation of a system developed by R. R. Holt (unpublished manuscript), which provides scores of the degree of regression and of defense effectiveness. Results are consistent with previous findings. Reflective CT is associated with good defenses, and reactive CT is associated with poorer defenses. Experts appear to be more reactive than novices and to express greater regression. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This article presents a model of therapeutic action that takes into account both intrapsychic and intersubjective dimensions of analysis and the necessity of their mutual interaction in the development of self-reflexivity. Reflexive self-awareness is both an intellectual and emotional process; involves conscious and unconscious mentation; draws on symbolic, iconic, and enactive representations; and involves the mediation of the self-as-subject with self-as-object, the "I" and the "me," the verbal and the bodily selves, the other-as-subject, and the other-as-object. Self-reflexivity is not the achievement of an isolated mind in private contemplation, as the traditional concepts of insight and self-analysis may have implied; rather, self-reflexivity always involves an affective engagement, a meeting of minds. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Self-concept clarity (SCC) references a structural aspect oftbe self-concept: the extent to which self- beliefs are clearly and confidently defined, internally consistent, and stable. This article reports the SCC Scale and examines (a) its correlations with self-esteem (SE), the Big Five dimensions, and self-focused attention (Study l ); (b) its criterion validity (Study 2); and (c) its cultural boundaries (Study 3 ). Low SCC was independently associated with high Neuroticism, low SE, low Conscien- tiousness, low Agreeableness, chronic self-analysis, low internal state awareness, and a ruminative form of self-focused attention. The SCC Scale predicted unique variance in 2 external criteria: the stability and consistency of self-descriptions. Consistent with theory on Eastern and Western self- construals, Japanese participants exhibited lower levels of SCC and lower correlations between SCC and SE than did Canadian participants.
Cognitive behavior therapy (CBT) has been traditionally used as a short-term treatment for a wide range of emotional disorders and problems. In the present paper, we review aspects of CBT that allow it to be time efficient. Specifically, CBT maximizes efficiency because it uses manual-based, empirically supported treatment strategies and defines specific, measurable, and achievable target goals. A focused assessment process and a relatively structured session format facilitate the implementation of treatment strategies without delay and allow the therapist to make efficient use of session time. Once treatment is implemented, a periodic review of treatment progress using objective criteria enables the therapist and client to make informed decisions about the direction of treatment. CBT uses strategies to enhance generalization and prevent relapse and empowers patients by providing them with skills they can use outside therapy sessions. Finally, the therapist's active, directive stance plays a critical role in making CBT time-efficient.
Borderline personality disorder (BPD) is a severe personality dysfunction thought to affect some 2% of the population. This title presents a psychoanalytically oriented treatment for BPD known as mentalization treatment. With randomised controlled trials having shown this method to be effective, this book presents the first account of this treatment for BPD.
Bion's central thesis in this volume is that for the study of people, whether individually or in groups, a cardinal requisite is accurate observation, accompanied by accurate appreciation and formulation of the observations so made. The study represents a further development of a theme introduced in the author's earlier works, particularly in Elements of Psychoanalysis (1963) and Transformations (1965). Bion's concern with the subject stems directly from his psycho-analytic experience and reflects his endeavor to overcome, in a scientific frame of reference, the immense difficulty of observing, assessing, and communicating non-sensuous experience. Here, he lays emphasis on he overriding importance of attending to the realities of mental phenomena as they manifest themselves in the individual or group under study. In influences that interpose themselves between the observer and the subject of his scrutiny giving rise to opacity, are examined, together with ways of controlling them.
A measure was developed to assess supervisor-perceived countertransference (CT) behavior during counseling sessions. Eleven experts provided face validity for the items, indicating that each item was at least somewhat an expression of countertransference. Exploratory factor analysis of ratings of 126 supervisors of supervisee counseling sessions revealed, as expected, the existence of two factors. However, rather than reflecting the dimensions of overinvolvement and underinvolvement as hypothesized, the factors were better captured by the terms Negative Countertransference and Positive Countertransference. The total scale and each subscale demonstrated high internal consistency. In addition, both positive and negative CT were found to relate positively with an existing one-item index of countertransference behavior and negatively with an existing measure of countertransference management ability. Research and clinical implications are discussed. © 2000 John Wiley & Sons, Inc., J Clin Psychol 56: 1221–1235, 2000.
This paper expands on three areas of clinical theory that are introduced and discussed in the lead paper and the others in this symposium. The first issue addressed is the concept of the real relationship as used in the moment of meeting model of psychotherapeutic change. Particular focus has been placed on the past, the present, and the hierarchy of goals in the treatment relationship. Second, the paper explores the concept of implicit relational knowledge with attention to the concepts of transference, countertransference, interpretation, and insight in the change process. Finally, the paper attends to the nature of the "now moment" in the moment of meeting model. Specifically explicated are ways this concept relates to changes in brain organization and also ways the moment of meeting model relates to other psychotherapy models, such as the relational schools and self-psychology.
It is increasingly apparent that "something more" than interpretation is needed to bring about change in psychoanalytic treatment. Drawing on clinical and developmental observations, we propose that interactional processes from birth onward give rise to a form of procedural knowledge regarding how to do things with intimate others, knowledge we call implicit relational knowing. This knowing is distinct from conscious verbalizable knowledge and from the dynamic unconscious. The implicit relational knowing of patient and therapist intersect to create an intersubjective field that includes reasonably accurate sensings of each person's ways of being with others, sensings we call the "real relationship." This intersubjective field becomes more complex and articulated with repeated patient-therapist encounters, giving rise to emergent new possibilities for more coherent and adaptive forms of interaction. During a transactional event that we term a "moment of meeting," a new dyadic possibility crystallizes when the two persons achieve the dual goals of complementary fitted actions and joint intersubjective recognition in a new form. We argue that such moments of meeting shift the relational anticipations of each partner and allow for new forms of agency and shared experience to be expressed and elaborated.
Pioneering research has been carried out over the last decade on mentalization and the promotion of mentalizing capacity - the ability to interpret the behavior of oneself and others as based on intentional mental states, such as needs, desires, feelings, and beliefs. This book is a consolidation of current knowledge and clinical applications, bringing together a group of international experts who have been on the ground floor of theory and research to clarify the concept, review pertinent neurobiological and psychosocial research, and explore its diverse clinical applications. Four sections will cover Conceptual Foundations, Developmental Psychopathology, Intervention and Prevention. A biopsychosocial approach will be used, integrating new research in neuroimaging with psychodynamic and cognitive perspectives. Clinical issues covered will include parent-child interactions, personality disorders, traumatic brain injury, bullying and at-risk children.
The common factors have a long history in the field of psychotherapy theory, research and practice. To understand the evidence supporting them as important therapeutic elements, the contextual model of psychotherapy is outlined. Then the evidence, primarily from meta-analyses, is presented for particular common factors, including alliance, empathy, expectations, cultural adaptation, and therapist differences. Then the evidence for four factors related to specificity, including treatment differences, specific ingredients, adherence, and competence, is presented. The evidence supports the conclusion that the common factors are important for producing the benefits of psychotherapy.
Computerized linguistic measures of emotional engagement, and reflective and affective language, previously applied to session transcripts, were applied to notes of 14 treatments by candidates under supervision at the New York Psychoanalytic Society and Institute, covering the five decades from the 1950s to the 1990s. The findings indicate a strong relationship between candidates' subjective experience as represented unintentionally in the linguistic style of their case notes and the effectiveness of their clinical work. The treatments were evaluated for effectiveness by experienced clinicians using the Global Assessment of Functioning (GAF) and the Psychodynamic Functioning Scales of Høglend and colleagues; a Composite Clinical Effectiveness (CCE) measure was constructed based on level and change in these measures. The Mean High Weighted Referential Activity Dictionary (MHW), a computerized measure of emotional engagement developed in the framework of Bucci's theory of multiple coding and the referential process, showed a positive correlation of .73 with CCE. The Hostility subcategory of the Negative Affect Dictionary (ANH) showed a negative correlation, -.48, with CCE. In a multiple regression analysis, these two variables accounted for over three-quarters of the variance in the CCE. Implications of the findings for process/outcome research and supervision and evaluation of trainees are discussed.
It is well known that infants as soon as they are born tend to use fist, fingers, thumbs in stimulation of the oral erotogenic zone, in satisfaction of the instincts at that zone, and also in quiet union. It is also well known that after a few months infants of either sex become fond of playing with dolls, and that most mothers allow their infants some special object and expect them to become, as it were, addicted to such objects. There is a relationship between these two sets of phenomena that are separated by a time interval, and a study of the development from the earlier into the later can be profitable, and can make use of important clinical material that has been somewhat neglected. Those who happen to be in close touch with mothers' interests and problems will be already aware of the very rich patterns ordinarily displayed by babies in their use of the first 'not-me' possession. These patterns, being displayed, can be subjected to direct observation. There is a wide variation to be found in a sequence of events that starts with the newborn infant's fist-in-mouth activities, and leads eventually on to an attachment to a teddy, a doll or soft toy, or to a hard toy. It is clear that something is important here other than oral excitement and satisfaction, although this may be the basis of everything else. Many other important things can be studied, and they include: 1. The nature of the object. 2. The infant's capacity to recognize the object as 'not-me'. 3. The place of the object – outside, inside, at the border. 4. The infant's capacity to create, think up, devise, originate, produce an object. 5. The initiation of an affectionate type of object-relationship.
Developed from established psychoanalytic knowledge among different psychoanalytic cultures concerning unconscious interpsychic communication, analysts' use of their receptive mental experience-their analytic mind use, including the somatic, unconscious, and less accessible derivatives-represents a significant investigative road to patients' unconscious mental life, particularly with poorly symbolized mental states. The author expands upon this tradition, exploring what happens when patients unconsciously experience and identify with the analyst's psychic functioning. The technical implications of the analyst's "instrument" are described, including the analyst's ego regression, creation of inner space, taking mind as object, bearing uncertainty and intense affect, and self-analysis. Brief case vignettes illustrate the structure and obstacles to this work.
Objective:
In this article we present preliminary findings from a research program designed to investigate the value of alliance-focused training (AFT), a supervision approach designed to enhance therapists' ability to work constructively with negative therapeutic process.
Method:
In the context of a multiple baseline design, all therapists began treating their patients using cognitive therapy and then joined AFT supervision groups at either session 8 or 16 of a 30 session protocol. Study I investigated the impact of AFT on patient and therapist interpersonal process as assessed through the Structural Analysis of Social Behavior (SASB). Study 2 investigated the impact of AFT on therapists' tendency to reflect on their relationships with their patients in an experientially grounded fashion, as assessed via the Experiencing Scale (EXP). Since one of the goals of AFT is to train therapists to use their own emerging feelings as important clues regarding what may be taking place in the therapeutic relationship, we hypothesized that they would show increased levels of EXP after undergoing AFT.
Results and conclusion:
The results of both studies 1 and 2 were for the most part consistent with hypotheses. Implications and future research directions are discussed.
This methodological study aims at identifying and at validating linguistic indicators of the therapist reflexive consciousness. The indicators were built from the textbooks of existing grid of analysis (Grille d'Analyse du Contre-transfert, Grille d'Élaboration Verbale de l'Affect et Experiencing Scale) and thanks to a linguistic-pragmatic model of the mental states in the speech. An empirical study concerning 1762 propositions quoted the three grids and the linguistic indicators allowed to confirm the validity of these indicators. As waited, the reflexive propositions are characterized by the presence of linguistic indicators. This linguistic method turns out thus decisive. It is presented as an alternative to the usual grids of analysis of contents. It increases the metrological qualities of the instruments based on the language by improving, in particular, the reliability of the quotation.
A half-century of psychotherapy research has shown that the quality of the therapeutic alliance is the most robust predictor of treatment success. This unique book provides a systematic framework for negotiating ruptures and strains in the therapeutic alliance and transforming them into therapeutic breakthroughs. Cutting-edge developments in psychoanalysis and other modalities are synthesized with original research and clinical wisdom gleaned from years of work in the field. The result is a practical and highly sophisticated guide that spells out clear principles of intervention while at the same time inspiring therapists toward greater creativity.
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The authors propose that although the psychoanalytic constructs ‘reflective functioning’ and ‘potential space’ overlap and are sometimes used interchangeably, a knowledge of their distinctions and the ways in which they interface have important clinical implications. These concepts are similar in that both are capacities considered (1) to originate in the caregiver-child relationship, (2) to involve playing with ideas and symbolic thought, (3) to facilitate the therapeutic process and (4) to represent a desirable treatment outcome. The terms diverge in three important ways. First, potential space is a broader concept that can be applied not only to thinking about internal states but to aspects of human experience (e.g. art, religion) involving a sense of aliveness. Reflective functioning is more circumscribed to representations of mental states and their implications for interpersonal functioning. Second, potential space has more of a conscious introspective element, whereas reflective functioning is based in procedural memory. Third, reflective functioning operates intrapsychically, whereas potential space tends to be thought of as occurring in an interpersonal field. The authors hypothesise and illustrate a possible bi-directional, dialectic relationship between the two constructs. It is suggested that this new understanding might, in some cases, facilitate productive reformulations of clinical formulations, such as working with a perceived resistance.