Controversies on Countertransference (Book Review)

Author:  Strean, Herbert S.
Publisher:  Northvale, NJ: Jason Aronson, 2001
Reviewed By:  Edward B. Jenny, Spring 2005, pp. 49-50

In Controversies on Countertransference, Herbert Strean reprints six of his papers on countertransference. After each paper, two invited discussants offer their views in order to amplify the topic and explore the development of a modern conception of countertransference. As Strean states in his introduction, his goal was to replicate the debate originally stimulated by his papers. The original articles were published between 1984 and 2000. Strean’s respondents were chosen as individuals who were experts in their field. Many had conversed with Strean regarding the issue of countertransference, and many were students or colleagues. Strean begins each chapter with a review of the literature followed by several clinical vignettes illustrating the concepts discussed.

The first paper examines the role of countertransference in analytic candidates’ selection of interventions and application of theory to justify these choices. This interesting paper suggests that clinicians often utilize theory as a means of supporting or justifying interventions after the fact. Often the intervention is chosen in reaction to conflicts stimulated by patients. Our character structure, shaped by life events and personal dynamics, affect what we attend to in sessions as well as how we formulate interventions. Strean points out that since enactment precedes recognition, we generally choose an intervention and then use theory to justify that choice. In this way, discussion of theory can be understood as a countertransference enactment. Strean presents case examples in which psychoanalytic candidates presented resistance to the supervision they were receiving. Often, supervisors discovered that they had been colluding with the candidates in focusing on theoretical conceptualizations while avoiding transference-countertransference issues. The resistance-collusion pattern served to avoid confrontation of salient interpersonal dynamics operating below the surface that interfered with the progress of treatment. As Strean points out, attention to theory in the supervision hour may well serve to avoid examination of transference-countertransference interactions in the therapy. The supervisor, in his desire to see the supervisee grow and develop, may unconsciously feel the need to gratify this behavior, thereby colluding with the supervisee and seeing only his or her mastery of theory.

The second paper amplifies many of these themes in looking at the image of the supervisor co-created by the supervisor and the supervisee. In this instance, both the supervisor and supervisee may share an illusion of the supervisor as a conflict free influence whose vast experience guides the supervisee. In this configuration, the image of the supervisor as omnipotent and omniscient may prevent the recognition and analysis of resistance in the supervisor-supervisee relationship. Strean points out that while there is a literature devoted to the study of parallel process in supervision wherein the dynamics between patient and supervisee are reenacted in the supervisory relationship, there is little in the literature examining the ways in which actions of the supervisor may reinforce the parallel process and hence contribute to the impasse. In the clinical vignettes, Strean demonstrates how collusion with the supervisee can lead to therapeutic impasses with patients and how progress in the therapy depends upon resolution of the parallel process resistance.

In an interesting paper on the use of countertransference disclosures, Strean advocates the use of well-timed disclosures of therapist countertransference as an aid to the resolution of treatment impasses. This has been a controversial issue in the literature with some advocating regular and open use of therapist reactions in an attempt to present genuineness, and others viewing this as an egregious example of therapist acting-out. Strean advocates using countertransference disclosure as means of increasing the reality of object relations and increasing the level of interpersonal relating. He points out that very little has been written about when or how to disclose countertransference reactions. Strean suggests that countertransference disclosure is indicated when the patient resists confrontation of material felt to be critical to the treatment, when the patient resists transference interpretation, when the patient resists confronting feelings about the therapist, when the therapist feels blocked and rejected by the patient, and when disclosure would help to bolster reality testing. Often these situations create a feeling of competition with the patient that prevents the therapy from progressing.

This same theme is continued in the next paper on the use of supervisor disclosure of countertransference to supervisees as a means of resolving treatment impasses. Again, the main point is that progress in therapy can be enhanced by exploration of resistance in the supervisory relationship. Similar to therapy, the supervisory relationship is colored by transference and alliance dynamics that either inhibit or contribute to progress. Strean makes the point that for supervision to be effective, the supervisor must be willing to encourage the exploration of the supervisory relationship as an analog to the therapeutic relationship. Far from an anonymous figure providing expert advice to the supervisee, the supervisor is a powerful influence on the direction of the therapy he or she supervises. Supervisee reactions to the supervisor, influenced by the supervisee’s prior experiences and expectations, lead to different choices of intervention with patients under supervision. Landany, et al., (1996) report that psychotherapy trainees often knowingly omit significant details from presentations to supervisors. These omissions may be motivated by a desire to please the supervisor or by fears of being seen as incompetent. Just as patients rarely “say everything” in analysis, supervisees withhold information thought to be too shameful or painful from the supervisor.

Throughout the book, Strean emphasizes the development of psychoanalytic theory and practice from a one-person psychology to a two-person psychology in which both patient and analyst co-create an interpersonal field. This point is also made by Atwood and Stolorow (1984), who suggest that the therapy dyad is an interpersonal or relational model co-created by both patient and therapist. Strean discusses Freud’s original contention that countertransference represented a barrier beyond which the therapist would be unable to progress. From this perspective, countertransference was seen as an obstacle to be removed through analysis. Recent conceptualizations of the therapeutic process as an interpersonal or intersubjective field make greater use of countertransference and counter resistance as sources of information regarding the process and dynamics of the therapy. Strean points out that Freud was oddly silent on the issue of countertransference. There are only four references to countertransference in the Standard Edition. Modern writers have also maintained a degree of silence on this issue, preferring instead to focus on the transference. One wonders if this represents a kind of historical parallel process in which therapists avoid focusing on their own reactions in favor of studying patient reactions.

Strean’s articles often refer to a consultation group utilized by experienced supervisors to explore issues of parallel process played out in the supervision of students. Strean advocates this method as an effective way to gain insight into treatment impasses that may develop. In the group, supervisors are able to explore their reactions to the supervision of students. Often these discussions allowed for the resolution of impasses with students and their patients through the analysis of supervisor countertransference and parallel process enactments. This model is similar to Spotnitz’s (1976) model in which he advocates the use of “the group setting for the affect training of group therapists working with problem patients” (p. 345.) While Spotnitz’s focus was more on the analysis of resistance and counterresistance, the essential element of bringing the therapist or supervisor’s reactions into the treatment dialogue remains consistent. The goal of Spotnitz’s group was to examine how the resolution of impasses in the group process might affect treatment of the group member’s patients. The point then is that the reactions and behaviors of the therapist (countertransference and counterresistance) can provide valuable insight into dynamics within the patient-analyst dyad. Further, interactions with colleagues around patient material can provide insight when viewed as parallels of the treatment dynamics. The thinking regarding countertransference has thus shifted from one of avoidance to acceptance of the inevitability and centrality of countertransference to treatment. As human beings, we inevitably respond to patients and supervisors in idiosyncratic and over determined ways. By acknowledging our countertransference, we allow valuable data regarding our experiences with patients to enter the treatment.

Overall, Controversies on Countertransference is an excellent resource for students and experienced clinicians. The articles selected provide an overview of the complexities of parallel process dynamics and the use of countertransference material. Beginning clinicians will likely find the material refreshing and instructive while more experienced clinicians will be reminded of the centrality of countertransference reactions to treatment. Because the works reprinted in this volume represent Strean’s thoughts on the same subject over a period of sixteen years, there is some inevitable repetition. This is most evident in the references, which often reappear in the introductory sections of several articles. For instance, the observation that countertransference as a topic has been avoided is made several times across articles. While most of the commentators represented diverse views on the topic of countertransference, there was very little actual controversy evident in their responses to Strean.

Strean’s knowledge of the psychoanalytic literature is extensive and his literature reviews are concise and instructive. I have the impression of Strean as a caring and dedicated clinician whose extensive experience is represented in his book. Controversies on Countertransference represents a valuable contribution to the literature on countertransference and is recommended reading for anyone involved either in treatment of patients or supervision of clinical work.

References

Atwood, G., and Stolorow, R. (1984). Structures of subjectivity: Explorations in psychoanalytic phenomenology. Hillsdale, NJ: Analytic Press.
Landany, N., Hill, C., Corbett, M, & Nutt, E. (1996). Nature, extent and importance of what psychotherapy trainees do not disclose to their supervisors. Journal of Counseling Psychology. 43, 10-24.
Spotnitz, H. (1976). Psychotherapy of preoedipal conditions: Schizophrenia and severe character disorders. New York, NY: Jason Aronson.

Reviewer Note

Edward Jenny is Assistant Professor in the Department of Graduate Psychology at Immaculata University, Pennsylvania.

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