Countertransference in Groups – definition


*Definition of Countertransference
Countertransference concerns the therapists relation to the patient. The term is often loosely used to describe the whole of the therapist’s feelings and attitude towards her patient. Such a usage is very different from what was originally intended, and as a consequence confusion has arisen about the precise meaning of the term.
Freud (1910) originally saw counter-transference as a sort of ‘resistance’ in the analyst towards her patient, a resistance due to arousal of unconscious conflicts by what the patient says, does or represents to the analyst. (Therapists blind spots – impose limitations on the work that the therapist does) e.g. if an analyst is threatened by her own unconscious homosexual feelings, she may be unable to detect any homosexual implications in the patient’s material, or she may react with undue irritation to homosexual thoughts or wishes in the patient, may sidetrack the patient, etc.
In 1950 Analysts started to focus on the positive value on counter-transference. Here the analysts emotional responses to the understanding of the patient are seen as a key to the understanding of the patient (yet the analyst does not necessarily discuss this with the patient).
Countertransference, the therapists’ psychopathology, is always present in group psychotherapy.
Because of the transference (and countertransference) the perception or conception of another individual is distorted.

How does the group process work?


 The Process:

A newcomer to the group is greeted by many transference reactions. Early relatedness in the group are those of maximal distortions; later, just before termination, these patterns are based on more real foundations, the departing members tending to see themselves as they actually are
During the early sessions patients are increasingly made aware of their relationships with family members and other influential figures. It is pointed out to the members how frequently they respond to another group member or the leader as though s/he were a significant person in either the present or past. There is a tendency for each patient to see the group in terms of his/her own family and others with authority.
Initially obvious attempts are made to turn the group into a classroom, this should be resisted by the therapist. Toward the end of therapy, as the person is about to leave, there is generally a much more real (actual) meeting.
The Use of the Interaction
The therapist initiates a search of the past reasons to be found for the present behaviour: an attempt to remember rather than repeat. This is the reflective stance, which the therapist does first alone, and later with the others when they develop co-therapeutic ability.
If the group is organised according to the homogenous nature of the members’ complaints, the members will meet only to discuss an impairment, hoping to get some relief from it, while at the same time getting the attention of the group and the therapist. When the group stresses the status of the therapist, making her their leader, they become her followers and avoid analysis of transference.
Worse still, if the therapist sees herself as leader, and the group members merely as her followers, analysis of transference-countertransference is avoided. Some special purpose groups, not therapy groups are run along these lines – I would call them educational groups. Here the therapist remains the leader throughout, constantly being directive. The group never becomes “member centered”, always remaining “leader-led”.
The therapist, through insistence on group therapy, indicates that she alone cannot help the patient and that they need the group to assist them. The group therapist, unlike the individual therapist, goes against her fantasy that she is the sole healer, and recognises the capacity of all people to help one another. Group members are accepted as “co-therapists” which enhances each member’s worth.
The group-analytic group can be described as a series of emotional states, thus the conductor can at all times ask: “What is the group really doing at this moment? Is it attempting to avoid, or to get to a problem?”
Provide the group with little structure or direction and the initial reactions of patients is anger or confusion – this is used as material for exploration. The emphasis is on the interpretation of group behaviour rather than on individual behavior.
Group psychotherapy experience represents a microcosm of the world, the loneliness and isolation that patients experience is part of the total anxiety the world experiences.
Some people advocate that patients undergoing long-term drug therapy should be seen in groups.

Child Sexual Abuse:


The long term consequences for children who experience systematic or sustained sexual abuse are well known: issues with differentiation (development of identity and sexual identity), problems in attachment (in ongoing and future relationships), and development of mental health issues and substance use problems (Watkins & Bentovim, 1992). Perpetrators of child sexual abuse exploit and corrupt the normal attachment and differentiation processes (Isely, et al, 2008) and in doing so create significant challenges in the development of sexuality, sexual identity and future intimate relationships for the developing individual.
Men who have been sexually abused as children have not usually been well supported by the caring professions. Men who were sexually abused as children are less likely to seek treatment, and if seeking treatment, are less likely to disclose their abuse history, than women in the same situation (Gold, et al, 1999). The shame which is commonly felt by survivors of sexual abuse is often further compounded for men due to the differential impact of same-sex abuse (Nathanson, 1989). Often the revelation of abuse leads to fractures in the internal and external world of the adult survivor, worsening the challenges faced in recovery.

Depression and Relationships


Monday, 25 June 2012

Depression and Relationships

Major Depressive Disorder impacts a significant amount of people across the world, with the World Health Organisation (WHO) predicting that by 2030 depression will account for the highest disability in the world (WHO, 2008). When focused on the Individual this is a staggering prospect, but it is even more severe when considered in the context of the individual’s social field. The impact of depression is not only felt by the individual who is diagnosed but also their families and those with whom they have significant relationships.

It is reported that depression and relationship problems commonly occur in a bidirectional fashion where depressed married individuals report poorer marital adjustment, and poor martial adjustment has been seen to predict increases in depressive symptoms (Whisman & Beach, 2012). Some researchers have suggested that the ability of females empathic accuracy (ability to infer and understand their partners’ thoughts and feelings) is reduced when depressed (Gadassi, Mor & Rafaeli, 2011). This finding is not seen directly in males; however partners of depressed females who display the reduced empathic accuracy do tend to show a similar reduction of their partner.  As such, couples therapy, and interventions that focus on the individual’s family system, is a promising therapeutic option for people in distressed relationships (Whisman & Beach, 2012)

My first post


Sunday, 11 March 2012

 

Our practice in Kirrawee is continuing to see clients with a broad range of presentations at flexible and convenient times. The practice is open six days a week, with after-hours appointments also available.
We have a team of 17 therapists at the centre: Clinical Psychologists/Psychologists/Psychologists-in-training/Social Workers & Psychotherapists all with different specializations (see enclosed). I hope that this will be of benefit when you refer patients under the Mental Health Care Plans/Better Access initiatives & ATAPS.
Medicare
Since the budget changes, from 1st November 2011 and more recently the announcement from the Minister of Health and Ageing on 1st February 2012, the standard number of allied mental health services for which an individual can receive a Medicare rebate will be 10 per calendar year. However, for the 2012 calendar year eligible individuals will be able to receive up to an additional six allied mental health services under ‘exceptional circumstances’. This means that eligible individuals can receive up to 16 consultations where ‘exceptional circumstances’ apply.
Medicare Benefits under Enhanced Primary Care (EPC) have been removed and replaced by the Chronic Disease Management (CDM) items (721-731). Therefore the term ‘EPC plan’ is now obsolete.
There are no changes to the eligibility requirements for the CDM items, including the allied health services for people with chronic disease. This is simply a change to terminology to bring it up to date.  This will enable patients to have 5 further sessions per calendar year.
Educational and Memory Assessments
Please note that we can also conduct IQ, Educational and Memory Assessments at this practice.
How to refer?
A client can call us directly to book in, or we can let you know who may be best for your client to see. The main number to call is 9545 4772 for intake.  For ease of referral we have included a referral pad, which can be given to the client to book in with. When they call the intake psychologist would match them to the most appropriate therapist for their problem.
Fees
We have a sliding scale of fees dependent on need.   Each therapist sets their own rate, based on the rebates they receive. We also have limited bulk billing places at the discretion of the therapist.  Our intake psychologists can advise you/the client if there are bulk-billing slots available, however, the client may not get their therapist of choice or after-hours appointments.
Treatment by our Psychologist-in-Training
We also have a Psychologist-in-Training who is seeing patients for up to 10 months of therapy for $20 per session. She is a psychology graduate working with us for a year to gain clinical experience. She will be supervised by a senior clinician and can also provide assessment services at a greatly reduced price.
Please find enclosed a brochure about our centre. Should you have the need to refer clients for the specialty services we provide please feel free to use our new referral pads.
Vera Auerbach

Clinical Psychologist & Principal