Transference and countertransference

Transcription

1 Transference and countertransference From Freud to 2010 Lyons Hardy, MSN, CNS, RN 1

2 Definitions Transference: feelings experienced by the patient about staff and other caregivers Countertransference: feelings experienced by staff about the patient 2

3 Classical view T/C were seen as reactions displaced from one s past relationships Nurse reminds patient of past parental figure, so patient relates to nurse as if nurse were parental figure Countertransference was viewed as therapist s transference to the patient and believed to be an impediment to treatment (Freud) 3

4 Freud Psychoanalyst should be similar to a surgeon, able to separate feelings from technique in treatment Therapists should engage in selfanalysis to remove countertransference feelings Countertransference results from unresolved conflicts in therapist 4

5 Current views: Totalistic view T/C seen as all feelings experienced by patient and professional (Heimann, Kernberg) Countertransference can be influenced by therapist s past relationships and/or patient s real behavior Can be used diagnostically and can be beneficial to treatment if used appropriately 5

6 Current views: Complementary view Patient and therapist are constantly influencing each other and creating reactions in each other Projective identification commonly seen as trigger for complementary countertransference 6

7 Current views: Relational view Two person psychology (contrast with Freud s one person psychology) T/C are co-constructed Pt s dynamics and therapist s unresolved conflicts interact to produce reactions 7

8 Research on countertransference Unresolved conflicts in the therapist can lead to countertrans. It may be triggered by interactions between patient factors and therapist factors It may be expressed as overt behavior or covert reactions 8

9 Neurobiology Transference is related to internal object representations/neural networks being activated by real characteristics (Gabbard, 2005) Orbitofrontal cortex is believed to be the main area for representations of self and others linked by affect states 9

10 Neurobiology Mirror neurons may play a role in countertransference (Gallese et al.) Theoretically, therapist s observation of patient s behavior and expressions activate same neural pathways that are activated in patient This may allow for empathy and therapeutic attunement 10

11 Effective use of countertrans. Diagnostic Empathy and compassion May help nurse draw conclusions about patient s real life experiences 11

12 Projective identification Pt s behavior and actions create reactions in nurse that mimic pt s feelings Case examples 12

13 Working with transference Long-term psychodynamic therapy TFP- shown to be effective for Borderline PD Caution is important when therapeutic relationship is not well-established 13

14 T/C and boundaries Intense T/C feelings may lead to boundary crossings or violations Self-awareness and professional consultation/supervision are key to reducing possibility of boundary issues 14

15 T/C in inpatient settings Short-term acute vs. long-term Nurses may not receive adequate training in recognizing signs of T/C Nurses need to be aware of their own weak areas or soft spots Nurses can use countertrans. to deepen and inform their work 15

16 T/C in outpatient settings Longer term relationships Psychotherapy vs. prescribing Transference interpretation and countertrans. disclosure may be appropriate for therapeutic benefit 16

17 Developing self-awareness Mindfulness Knowledge of own blind spots and triggers Talking and releasing feelings Case conferences Personal therapy Clinical supervision 17

18 For further study Gabbard, G.O. & Wilkinson, S.M. (1994). Management of countertransference with borderline patients. Jason Aronson: New Jersey. Gabbard, G.O. (2005). Psychodynamic psychiatry in clinical practice, 4th ed. American Psychiatric Publishing: Arlington, VA. Gabbard, G.O. (2006). A neuroscience perspective on transference. Psychiatric Annals, 36, Gallese, V., Eagle, M.N., & Migone, P. (2007). Intentional attunement: Mirror neurons and the neural underpinnings of interpersonal relations. Journal of the American Psychoanalytic Association, 55, Wheeler, K. (2008). Psychotherapy for the advanced practice psychiatric nurse. Mosby: St. Louis. 18

19 Contact 19