 | The examples and perspective in this article may not represent a worldwide view of the subject.(June 2011) |
Body-centred countertransference involves a psychotherapist's experiencing the physical state of the patient in a clinical context. [1] Also known as somatic countertransference, it can incorporate the therapist's gut feelings, as well as changes to breathing, to heart rate and to tension in muscles. [2]
Dance therapy has understandably given much weight to the concept of somatic countertransference. [3] Jungian James Hillman also emphasised the importance of the therapist using the body as a sounding-board in the clinical context. [4]
Post-Reichian therapies like bioenergetic analysis have also stressed the role of the body-centered countertransference. [5]
There is some evidence that narcissistic patients and those suffering from borderline personality disorder create more intense embodied countertransferences in their therapists, [6] their personalities favouring such non-verbal communication by impact [7] over more verbalised, less somatic interactions.
Susie Orbach has written emotively of what she described as "wildcat sensations in my own body...a wildcat countertransference" [8] in the context of body countertransference. She details her role responsiveness to one patient who evoked in her what she called "an unfamiliar body experience...this purring, reliable and solid body" [9] to counterbalance the fragmented body image of the patient herself.
Irish psychologists at NUI Galway and University College Dublin [10] [11] have begun to measure body-centred countertransference in female trauma therapists using their 'Egan and Carr Body-Centred Countertransference Scale' (2005), a sixteen symptom measure. [12]
Their research was influenced by developments in the psychotherapy world which was beginning to see a therapist's role in a therapeutic dyad as reflexive; that a therapist uses their bodies and 'self' as a tuning fork to understand their client's internal experience and to use this attunement as another way of being empathic with a client's internal world. [13] [14] Pearlman and Saakvitne's seminal book on vicarious traumatization and the effect of trauma work on therapists has also been an important directional model for all researchers studying the physical effects of trauma work on a therapist. [15]
High levels of body-centred countertransference have since been found in both Irish female trauma therapists and clinical psychologists. [16] This phenomenon is also known as 'somatic countertransference' or 'embodied countertransference' and it links to how mirror neurons might lead to 'unconscious automatic somatic countertransference' as a result of postural mirroring by the therapist. [17] [18]
Hamilton et al (2020) revisited BCT in a larger sample of 175 therapists (122 females). A similar pattern of body-centred countertransference was reported, as in the previous two studies. The most common being: (a) Muscle Tension- 81%, (b) Tearfulness- 78%, (c) Sleepiness- 72%, (d) Yawning- 69%, (e) Throat constriction- 46%, (f) Headache- 43%, (g) Stomach disturbance- 43%, (h) Unexpectedly shifting in body 29%, (i) sexual arousal- 29%, (j) raised voice- 28%, (k) aches in joints- 26%, (l) nausea- 24%, (m) Dizziness- 20%, and (n) Genital pain-7.5%. The authors reported how previous researchers did not find BCT, because surveys have previously failed to ask specifically about it, and have focused on emotional and cognitive and relational CT. The authors called for larger longitudinal studies and larger sample sizes, to allow a comparison of gender and orientation effects, as well as whether higher levels affect levels of burnout and therapeutic engagement and treatment outcomes. [19]
Loughran (2002) found that 38 therapists out of 40 who had responded to a questionnaire (which was distributed to a sample of 124 therapists) on a therapist's use of body as a medium for transference and countertransference communication reported that they had experienced bodily sensations (nausea or churning stomach, sleepiness, shakiness, heart palpitations, sexual excitement, etc.) while in session with patients. [20]
A list of the frequency of occurrence of body-centred countertransference symptoms reported by trauma therapists (Sample A: 35 Female Irish Trauma therapists [21] ) and Irish clinical psychologists (Sample B: 87 Irish Clinical Psychologists [22] ) in the previous six months 'when in-session with a client' is given below in order of frequency:
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A small but significant relationship was found between female trauma therapists' level of body-centred countertransference and number of sick leave days taken, suggesting a possible relationship between uncensored body-centred countertransference and somatization. This relationship was not however found in clinical psychologists who were working mainly with a non-trauma population. Therapists have noted the connection between a tendency for some clients to express emotional discomfort by focusing on bodily symptoms rather than being able to put their emotional distress into words. [23] It is thought that such processes are more common in people who have experienced childhood abuse and trauma. [24]
Recent research which measured female genital arousal in response to rape cues found that women when listening to rape, consensual sexual activity or violence developed genital arousal more frequently than men. It also might explain the relatively frequent reported experience of sexual arousal amongst Irish female trauma therapists. [25] Further validation of body-centred countertransference in psychologists and therapists is on-going in both NUI Galway and Trinity College Dublin.
Therapists have been warned against assuming too automatically that their body-feelings always involve somatic resonance to the client, as opposed to being produced from their own feelings/experiences - the same problem appearing with countertransference generally. [26]
Counseling psychology is a psychological specialty that began with a focus on vocational counseling, but later moved its emphasis to adjustment counseling, and then expanded to cover all normal psychology psychotherapy. There are many subcategories for counseling psychology, such as marriage and family counseling, rehabilitation counseling, clinical mental health counseling, educational counseling, etc. In each setting, they are all required to follow the same guidelines.
Person-centered therapy, also known as person-centered psychotherapy, person-centered counseling, client-centered therapy and Rogerian psychotherapy, is a form of psychotherapy developed by psychologist Carl Rogers and colleagues beginning in the 1940s and extending into the 1980s. Person-centered therapy seeks to facilitate a client's actualizing tendency, "an inbuilt proclivity toward growth and fulfillment", via acceptance, therapist congruence (genuineness), and empathic understanding.
Countertransference, in psychotherapy, refers to a therapist's redirection of feelings towards a patient or becoming emotionally entangled with them. This concept is central to the understanding of therapeutic dynamics in psychotherapy.
Transference is a phenomenon within psychotherapy in which repetitions of old feelings, attitudes, desires, or fantasies that someone displaces are subconsciously projected onto a here-and-now person. Traditionally, it had solely concerned feelings from a primary relationship during childhood.
Psychodynamic psychotherapy and psychoanalytic psychotherapy are two categories of psychological therapies. Their main purpose is revealing the unconscious content of a client's psyche in an effort to alleviate psychic tension, which is inner conflict within the mind that was created in a situation of extreme stress or emotional hardship, often in the state of distress. The terms "psychoanalytic psychotherapy" and "psychodynamic psychotherapy" are often used interchangeably, but a distinction can be made in practice: though psychodynamic psychotherapy largely relies on psychoanalytical theory, it employs substantially shorter treatment periods than traditional psychoanalytical therapies. Psychodynamic psychotherapy is evidence-based; the effectiveness of psychoanalysis and its relationship to facts is disputed.
Somatic Experiencing (SE) is a form of alternative therapy aimed at treating trauma and stress-related disorders, such as PTSD. The primary goal of SE is to modify the trauma-related stress response through bottom-up processing. The client's attention is directed toward internal sensations,, rather than to cognitive or emotional experiences. The method was developed by Peter A. Levine.
Projective identification is a term introduced by Melanie Klein and then widely adopted in psychoanalytic psychotherapy. Projective identification may be used as a type of defense, a means of communicating, a primitive form of relationship, or a route to psychological change; used for ridding the self of unwanted parts or for controlling the other's body and mind.
Somatic psychology or, more precisely, "somatic clinical psychotherapy" is a form of psychotherapy that focuses on somatic experience, including therapeutic and holistic approaches to the body. It seeks to explore and heal mental and physical injury and trauma through body awareness and movement. Wilhelm Reich was first to try to develop a clear psychodynamic approach that included the body.
Harold Frederic Searles was one of the pioneers of psychiatric medicine specializing in psychoanalytic treatments of schizophrenia. Searles had the reputation of being a therapeutic virtuoso with difficult and borderline patients; and of being, in the words of Horacio Etchegoyen, president of the International Psychoanalytical Association, "not only a great analyst but also a sagacious observer and a creative and careful theoretician".
The therapeutic relationship refers to the relationship between a healthcare professional and a client or patient. It is the means by which a therapist and a client hope to engage with each other and effect beneficial change in the client.
Therapy interfering behaviors or "TIBs" are, according to dialectical behavior therapy (DBT), things that get in the way of therapy. These are behaviors of either the patient or the therapist. More obvious examples include being late to sessions, not completing homework, cancelling sessions, and frequently contacting the therapist out-of-session. More subtle examples can include sobbing uncontrollably, venting, criticizing the therapist, threatening to quit therapy, shutting down, yelling, only reporting negative information, saying "I don't know" repeatedly, and pushing the therapist's limits. Behaviors that "burn out the therapist" are included, and thus, vary from therapist to therapist. These behaviors can occur in session, group, between sessions, and on the phone.
Psychoanalytic dream interpretation is a subdivision of dream interpretation as well as a subdivision of psychoanalysis pioneered by Sigmund Freud in the early 20th century. Psychoanalytic dream interpretation is the process of explaining the meaning of the way the unconscious thoughts and emotions are processed in the mind during sleep.
Modern psychoanalysis is the term used by Hyman Spotnitz to describe the techniques he developed for the treatment of narcissistic disorders.
Transference focused psychotherapy (TFP) is a highly structured, twice-weekly modified psychodynamic treatment based on Otto F. Kernberg's object relations model of borderline personality disorder (BPD). It views the individual with borderline personality organization (BPO) as holding unreconciled and contradictory internalized representations of self and significant others that are affectively charged. The defense against these contradictory internalized object relations leads to disturbed relationships with others and with self. The distorted perceptions of self, others, and associated affects are the focus of treatment as they emerge in the relationship with the therapist (transference). The treatment focuses on the integration of split-off parts of self and object representations, and the consistent interpretation of these distorted perceptions is considered the mechanism of change.
Vicarious trauma (VT) is a term invented by Irene Lisa McCann and Laurie Anne Pearlman that is used to describe how work with traumatized clients affects trauma therapists. The phenomenon had been known as secondary traumatic stress, a term coined by Charles Figley. In vicarious trauma, the therapist experiences a profound worldview change and is permanently altered by empathetic bonding with a client. This change is thought to have three requirements: empathic engagement and exposure to graphic, traumatizing material; exposure to human cruelty; and the reenactment of trauma in therapy. This can produce changes in a therapist's spirituality, worldview, and self-identity.
Surrogate partners, formerly referred to as sex surrogates, are practitioners trained in addressing issues of intimacy and sexuality. A surrogate partner works in collaboration with a talk therapist to meet the goals of their client. This triadic model, composed of the client, talk therapist, and surrogate partner therapist is used to dually support the client and the surrogate partner therapist. The client engages with the surrogate partner therapist in experiential exercises and builds a relationship with their surrogate partner therapist while processing and integrating their experiences with their talk therapist or clinician.
"Acting in" is a psychological term which has been given various meanings over the years, but which is most generally used in opposition to acting out to cover conflicts which are brought to life inside therapy, as opposed to outside.
Parallel process is a phenomenon noted in clinical supervision by therapist and supervisor, whereby the therapist recreates, or parallels, the client's problems by way of relating to the supervisor. The client's transference and the therapist's countertransference thus re-appear in the mirror of the therapist/supervisor relationship.
Marion Rosen was a German-American physiotherapist. She developed Rosen Method Bodywork and Rosen Method Movement. Under Rosen's guidance in 1980, the Rosen Institute (RI) was formed as the governing international organization that protects and sustains the quality and standards of Rosen Method. The Rosen Institute has affiliate training centers in 16 countries and has certified 1150 bodywork practitioners and 150 movement teachers.
Ethical guidelines for treating trauma survivors can provide professionals direction to enhance their efforts. Trauma survivors have unique needs and vary in their resilience, post-traumatic growth, and negative and positive outcomes from their experiences. Numerous ethical guidelines can inform a trauma-informed care (TIC) approach.
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