Link [[Books Index]] # Book Notes The wounded healer. Countertransference from a Jungian Perspective by David Sedgwick. ## CONCLUSIONS ### A Countertransference Model (Page 120) #### (1) Preliminary - It has to do with therapist's self-knowledge, personal development and basic attitudes... Training analysis, training in general, clinical experience, supervision and previous experience with countertransference. - "The doctor knows -- or at least he should know -- that he did not choose his career by change; and the psychotherapist in particular should clearly understand that psychic infections, however superfluous they seem to him, are in fact the predestined concomitants of his work, and thus fully in accord with the instinctive disposition of his life. (Jung, 1946, p. 177)" - page 121 - "he.. must be "ready" to roll. The first contacts with patients strongly color countertransference...The analyst...wants to...be in his analytic mode or analytic identity from the outset" (page 121) #### (2) Clearing the field - **This remind me of being totally presence, and attune to patient** - The point is to create a state of openness both to the patient's unconscious and to one's own unconscious in relation to that particular patient...involve concentrating one's consciousness (and unconscious) on the patient, perhaps a sort of centering or meditative-reflective state....without "memory" of past sessions and without "desires for results, 'cure' or even understanding" (Quoted in Langs, 1990, p 244)... - **Self to relations to client** - Practical to review notes on the previous session before the new one begins... help re-orient the therapist toward what is happening with the patient... In addition, it may be useful to reflect on the patient in no specific way, to see what one feels about him, what is coming up in the countertransference. - **Good tip** - Both to provide emotion closure at the end of the session and to clear the field for the next client, brief countertransference notes can be written immediately after the hour. - These between-session activities can have more than just preparatory value as well. (page 122) - **Self Reflexivity, to understand counter-transference** - The more difficult the situation, the more work involved. In this kind of counterfransference work the therapist often carries his patients around with him, consciously or unconsciously. - **It is inevitable that we think of patients even after work, part of the job hazard** - Much of this non-session activity and, when "hooked", much of it is unavoidable. (p 123) #### (3) Reception - **After attuning to the patient, see what come out from within, what impression, feelings and thoughts do I have** - Reception of the patient by the analyst...consisting of multiple attention processes, in which the analyst's attention is directed both outwards, empathically, toward the client and inwards toward himself. Throughout the entire analysis the analyst will be alternately imagining, "seeing" or feeling from the patient's perspective (empathy) and then from his own (countertransference). P 123 - **Anything that may give me an impression, opinion and thoughts, feelings while i talk to the client.** - The analyst "takes in" the client and then may react in ways he begins to notice...Litterally anything can come up; it may be desirable to associate more or less within the context of the patient's statements or material. p 123 - There is a vast range of stimuli the analyst can react to, the primary one being the patient's content and style of presentation... there are the analyst's own reactions, which in turn may spin further fantasies... facial resemblances...clothes, or word use may remind the analyst, vaguely and halfconsciously, or someone he knows.. p123 - **Any biases, prejudices, past experiences, that might color my perception, and attention to the client?** - Resemblance permits the therapist to notice how the feeling tone of the therapeutic relationship has been colored... as the therapist reflects on the possible relevance to the patient of this connection (or the relevance of his patient's resembling a friend, let's say) p 124 #### (4) Selection - **The selection of the problems, or what to focus on is co-selected by both. Analyst responses must be "gentle", let the patient guide and lead the way. (because our questions can influence the direction)** - Selection... it is the patient who unconsciously selects the material to be focuses on... it would seem important simply to let the patient's unconscious unfold and lead the way... - The analyst must listen carefully to the next responses to any intervention. p124 #### (5) Containment - **As the therapy progresses, and selection process will land on topic areas.. and these will trigger more anxiety, or tension reaction in the therapist.** - As the patient focuses... there is a narrowing or deepening which seems to naturally evolve. Deeper emotional areas yield deeper contertransference responses, as do direct patient statements, fantasies or dreams about the analyst. - Typically, there is some recognizable experience of greater anxiety in the analyst, emanating from any of the above sources. - This state does not of course have to occur "later" in the work. There are patients who by attack or other means push into the therapist immediately.. (page 125) - **Need to "hold space" and not "act out" - Purpose of acting out is to release tension. ** - Regardless of source or timing, the main feature of this deepening, experiential phase is the analyst's containment of the unconscious. Here is where he has to "hold", under pressure, and not result to various acting out to relieve the tension. page 125 #### (6) Working Through - **The therapist spend most time asking "how am I reacting to this?".** - When the anxiety flags go up, the analyst's focus turns ever more inward to contain and struggle with it.... all in service of the question: How am I reacting to this?