DEFINITIONS AND TERMS
As we continue to study the feelings and dynamics that are woven into our work, we offer you some definitions of treatment dynamics brought to us by Dr. Patricia Bratt, from The Academy of Clinical and Applied Psychoanalysis in Livingston, NJ.
TRANSFERENCE:
attributing to a person in the present the feelings and attitudes one experienced with a significant person in an earlier relationship, e.g. feeling toward the analyst as one did about a parent and expecting the same responses and attitudes one found in the parent.
anaclitic transference:
a type of transference that can occur after a patient has been in treatment for a significant period of time and is capable of emotional regression and a degree of openness that permits the analyst to experience the patient as the patient might have been had they had the appropriate maturational experiences at earlier developmental phases. The analyst, through emotional induction, experiences the patient and becomes aware of the crucial feelings that were missing or stunted in earlier stages. This is a form of narcissistic transference where the patient has reached a level of safety in the relationship and defenses are minimized allowing for the surfacing of preconscious drives and feelings. The analyst uses this opportunity to assess the missing feelings necessary to help the patient move through maturational blocks and reflects the feelings in the context of the transference.
narcissistic transference:
a type of transference in which the patient experiences the analyst, and everything connected to the analyst, as an extension of herself. The analyst?s being is completely syntonic with the patient?s level of ego functioning and the analyst is not experienced as an intrusion on the ego nor as a threat.
negative narcissistic transference:
a type of transference in which the patient externalizes or projects onto the analyst all of the bottled up negative feelings he has about himself. In this transference the analyst is seen as a narcissistic extension and all of the negative statements that are verbalized may be attributed to both the therapist and the patient, e.g. they are both losers, both underpaid, both cold. The patient may or may not recognize that he is referring to both the analyst and himself. He might simply complain about the analyst or rage at the analyst without conscious awareness that the complaints reflect feelings about himself.
negative transference:
a type of transference in which the patient attributes to the analyst all of the negative feelings and attitudes experienced with significant emotional figures from the past.
object transference:
a type of transference that occurs when the patient has progressed emotionally beyond the preoedipal stage and is capable of experiencing the analyst as an object separate from herself. At this level the patient attributes to the analyst feelings and responses experienced with significant emotional figures from the past.
positive narcissistic transference:
a type of transference that is characterized by a syncronicity between the patient and the analyst where the patient experiences the analyst as a positive, unconditionally accepting extension of himself.
positive transference:
A type of object transference in which the patient attributes to the analyst the positive feelings and attitudes experienced or wished for with significant emotional figures from the past.
III. COUNTERTRANSFERENCE
anaclitic countertransference
countertransference resistance
emotional contagion
emotional induction
objective countertransference
positive-negative countertransference
subjective countertransference
IV. DEFENSESacting out/in
insulation
denial
narcissistic defense
repression
suppression
V. INTERVENTIONS
clarification
contact function
ego reinforcement
ego support
ego syntonic/dystonic communications
ego-oriented question
emotional communication
immunization
interpretation
joining techniques: joining, mirroring, reflecting
maturational interpretation
modeling
object-oriented question
VI. MATURATION
MODERN PSYCHOANALYTIC CONCEPTS
II. RESISTANCE:
is the unconscious drive to defend against, or avoid, certain feelings that are experienced as threatening the homeostasis of the ego-id-superego. The threat of these feelings is the possibility of a reaction that will interfere with one's ability to repeat early emotionally conflicted events.
countertransference resistance:
a type of resistance that occurs when the feelings induced by the patient present a threat to unresolved, generally unconscious, emotional conflicts within the therapist's own personality and history. The analyst develops defenses or resistances to understanding the patient or to helping the patient further verbalize feelings in order to avoid her own reactions.
group resistance:
A form of resistance in which a group responds as a unit demonstrating the unconscious drive to resist emotional maturation and perpetuate the repetitive patterns of the past, e.g. in group therapy one person is allowed to monopolize the group despite complaints of other group members. The group enables this individual to be the spokesperson for the group resistance to cooperative functioning.
internal/external resistances:
Internal resistances are those that arise from within intrapsychic defense patterns while external resistances are those that occur either independently or through collusion from sources outside of the person, e.g. traffic jams prevent the patient from getting to the session.
negative transference resistance:
A resistance pattern that represents the patient's drive to avoid the negative feelings that are being triggered in the transference relationship, e.g. the patient comments, "It's not that I don't want to be here." or "I'm the one to blame, not you."
positive transference resistance:
A resistance pattern that represents the patient's desire to avoid the positive feelings triggered in the transference relationship.
resistance to progress:
Represents a stage in treatment where the patient has reached a level of stability, where early presenting problems have been resolved, where early maladaptive patterns are shifting, the next steps will involve resolution of underlying conflicts and this becomes a threat to homeostasis triggering a resistance to change.
resistance to termination:
Represents a type of resistance pattern that occurs during the final stage of treatment when the drives of the immature personality resurface with the threat of separation from the analyst and old maladaptive patterns occur as resistances to the completion of the treatment.
status quo resistance:
Represents a resistance to maturation that occurs when the patient has resolved early presenting problems and conflicts, or simply is comfortable in the analytic relationship and does not want to lose the positive comfort of the moment by introducing conflictual feelings or whishes.
treatment destructive resistance:
A type of resistance that can potentially interrupt or interfere with the work of the therapy and cause premature termination, e.g. the patient takes a new job that prevents him from keeping appointments, the patient complains that the analysis cannot work because the therapist is too inexperienced, etc.
III. COUNTERTRANSFERENCE: The emotional response elicited or induced in the analyst as the patient talks and tells the story of their life.
anaclitic countertransference:
A type of countertransference response in which the analyst may experience the patient as different from what appears on the surface, as different than the patient's self-image. Through observation and study of the patient's communications it is understood that this is an induction of the feelings the patient may have once had about themselves or the way they wished to be experienced before the intrusion of maturational blocks and defense patterns developed. The analyst is experiencing the feelings missing from the patient's current emotional make-up, the feelings that are repressed or denied or too remote to be a part of the current personality. The anaclitic countertransference response can be used therapeutically to re-expose the patient to the missing, early maturational experiences and re-integrate the personality. For example, the analyst may consistently experience a boisterous bully as tender. The feeling may linger after particularly difficult and aggressive sessions or surface later in memories or dreams the analyst has about the patient. As the analyst studies the feelings, they are recognized as a transference communication from the patient telling the therapist about unconscious needs, drives and feelings. The analyst uses these feelings to design interventions, when the timing is appropriate, to provide an emotionally re-educate experience.
countertransference resistance:
a type of resistance that occurs when the feelings induced by the patient present a threat to unresolved, generally unconscious, emotional conflicts within the therapist's own personality and history. The analyst develops defenses or resistances to understanding the patient or to helping the patient further verbalize feelings in order to avoid her own reactions.
emotional contagion:
A situation that occurs when one person experiences the feelings another person is having at that moment. In treatment the analyst recognizes that the feelings are different from the therapist's usual affect or response state under similar circumstances. The phenomenon is facilitated by the lowering of ego boundaries and surfacing of unconscious and pre-conscious material during the analytic treatment process.
emotional induction:
A situation that occurs when one person influences another, through their behavior, verbal communications or unconscious emotional communication, to react or feel a certain way. For example, an analyst may find themselves feeling unusually critical of a patient who is seemingly innocuous, but who reports that their mother was always critical. In this case we understand that the patient has somehow influenced the analyst to respond to her as the mother did in the past.
objective countertransference:
This form of countertransference is identified when the analyst recognizes that certain feelings or response experienced are triggered by the patient's objective presentation. There is something about the patient that induces particular responses that are not elicited by other patients. For example, an analyst may find themselves inexplicably drowsy during a session and alert before and after the session. If it is found that this occurs repeatedly with the same patient it is viewed as objective countertransference connected to emotional communications from the patient.
Positive-negative countertransference:
As with transference, countertransference responses may be either negative or positive.
subjective countertransference:
This form of countertransference occurs when the emotional communications of the patient trigger unconscious, unresolved conflicts arising from within the therapist. For example, a patient complains that the analyst is a useless failure and the analyst has the impulse to be self-attacking rather than to recognize the patient's words as a transference communication. The patient's verbalizations are personalized and resonate with the analyst's self feelings. These responses may span the range from positive to negative feelings.
IV. DEFENSES:
Defenses are patterns of responding to emotionally life threatening situations in an attempt to protect the psyche. Defenses may be adaptive (coping mechanisms) or maladaptive, they may be conscious or unconscious. They can be transitory or characterological. The characterological defense is influential in determining the course of personality development in that it censors or seeks out certain experiences.
acting out/in:
This defense involves behavior engaged in as the result of a psychic threat translated to an impulse and a subsequent action. Acting-in refers to these behaviors within the treatment setting. Acting out to those behaviors engaged in outside of treatment. For example, the patient who is angry with their parents for being controlling and defies them by doing something self-destructive or dangerous is acting out. The patient who is angry that the analyst is in control may refuse to use the couch or sit in an inappropriate seat and this is referred to as acting-in.
denial:
Denial is one of the earliest forms of defense against psychic conflict. It involves the obliteration of awareness in the service of protecting psychic integrity.
insulation:
Emotional insulation is the process of cutting off the experience of intrusive feelings through establishment of a deadening emotional barrier that protects the fragile psyche from over stimulation and disintegration.
narcissistic defense:
This unconscious defense is one of the earliest forms of self-preservation used by the psyche. The primitive ego understands, through experience, that it's feelings and responses may arouse negative responses from those people upon whom it depends for life. In an attempt to protect the object, the important person, from exposure to these feelings, they are re-directed inward and bottled up until another route for discharge can be developed. In this process, the early ego incorporates ideas about the self that are either negative distortions of reality or accurate perceptions of the responses of important object figures.
repression:
Repression is an unconscious defense in which threatening information that is processed either intrapsychically or from the outside world is routed to the unconscious and unavailable for recollection through the ordinary memory channels. A patient may symbolically act out what is repressed but will have no conscious awareness of the conflictual material. Even if the patient is presented with factual information about the conflict, the defense structure will prevent comprehension or recall.
suppression:
Suppression is similar to repression in that it involves the re-routing of conflictual feelings and experiences out of conscious awareness. In suppression the feelings are said to reside in the preconscious and may be available for recognition and understanding as the ego is strengthened.
negative union
V. INTERVENTIONS:
Interventions are the verbal and nonverbal communications a therapist designs to use during treatment to facilitate emotional maturation.
clarification:
Clarification is used to explore a patient's communication when the analyst thinks that a contact would be beneficial, when the patient is not using a narcissistic defense to produce confusion or when the information necessary is immediatelyessential for the patients well-being. Clarification is the asking of a question to explain something the patient has said.
contact function:
Contact function refers to the idea that patients are codirectors in structuring treatment and that the analyst's interventions rely upon communications, contacts, from the patient that solicit interaction from the therapist.
ego reinforcement:
Ego reinforcement is the process of intervening in a way that facilitates a shift in ego strength and awareness.
ego support:
Ego supportive interventions are used to help the patient feel comfortable in a certain position and minimize the need for regression.
ego syntonic/dystonic communications:
Ego syntonic communications are those that the individual experiences as one with his own ideas and feelings. Ego dystonic communications are experienced as alien to feelings about one's self.
ego-oriented question:
Ego-oriented questions are those that explore the basic functioning and status of the self. For example, "Why did you wear that dress?" and "How are you feeling?" are both ego-oriented questions.
emotional communication:
An emotional communication is one that addresses the feeling state of the person and their communications and not just the content of what is said.
immunization:
Immunization is a process of exposing a person to graduated experiences of certain feelings and ideas that will be overwhelming or toxic if experienced all at once, but that are essential for further maturation or stability.
interpretation:
Interpretation is the process of reporting to the patient the understanding of the unconscious drives and motives that are producing maladaptive patterns. Originally, Freud believed that this information, alone, if provided for the neurotic patient, would effect change.
joining techniques:
Joining, mirroring, reflecting are all forms of joining the patient's feeling as a method for helping to insulate the ego and allow further verbalization of thoughts and feelings with the goal of encouraging unconscious feelings to surface unthreatened. Joining involves a communication that is directed to the unconscious content of the patient's words and that indicates an acceptance and awareness and sharing of these feelings by the analyst. Reflection is a method used for encouraging further communications while not soliciting them. It is designed to let the patient know that the analyst understands the feelings. Mirroring is a method use to repeat what the patient has reported in order to communicate that the analyst is with the patient, but making no demand for interaction. Mirroring opens the possibility for the patient to believe that he and the analyst are the same and is used when attempting to foster a narcissistic transference or for emotional inoculation.
maturational interpretation:
A maturational interpretation is one designed to address unconscious drives and motives in an unthreatening manner that facilitates the surfacing and recreation of earlier emotional events that will eventually be integrated with conscious material and signify resolution of unconscious conflict.
modeling:
Modeling is a method of demonstrating emotional and behavioral patterns that will help the patient function in a healthier way to successfully get what they want. For example, the analyst treats the patient in a respectful manner modeling how one behaves in relationships.
object-oriented question:
An object-oriented question is one that addresses objects and situations outside of the patient's ego. For example, "What color is the sky?" and "Am I talking enough?" are both OOQ's. They are used to follow the patient's contact in a way that is not intrusive or ego dystonic and allow for continued verbalization and unthreatened surfacing of unconscious material. They help preserve ego boundaries and prevent undesired regression.
constructive emotional interchange
CEI refers to the interaction between the patient and the therapist that signal a cooperative working relationship in which the patient is able to verbalize and experience a range of feelings without censorship and with the effect of moving toward maturation.
VI. MATURATION:
Maturation is the process of becoming emotionally and intellectually developed in an integrated fashion that allows the personality to assert itself and meet its needs.
