Commentary on “Specific Personality Traits Evoke Different Countransference Reactions: An Empirical Study” by Rossberg et al.

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Rossberg and colleagues (2008) present data regarding therapists’ reactions to their patients’ specific personality traits. These patients were not in a psychoanalytic situation or in a long-term one-to-one relationship of the kind which has patients’ fantasies about their therapists determined by their past experience. Instead, they related to several staff members in a daycare center. In addition, group therapy led by 2 therapists, 4 days a week and attended by all 11 staff members provided the formal psychotherapy. Under the circumstances, the authors’ use of the term, “countertransference,” to characterize these staff reactions requires comment.The authors do note Freud's original caution regarding identification of the analyst's transference as, necessarily, a counter response to that of the patient. They also note the view that, within the context of a psychoanalytic relationship, an analyst's responses might reflect his or her patient's particular unconscious conflicts. Recognizing the contribution of one's own history and needs to behavior allows it to be avoided or analyzed. On the other hand, recognizing the reflection of a patient's conflicts in one's own clinical perceptions may become a potential source of therapeutically useful information. It is this difficulty in separating the analyst's transference from his/her response to the transferential reflections of the patient's unconscious conflict which has led to lumping all of the analyst's responses under the heading of countertransference. This combining process led these authors to identify their staff's attitudinal responses to patient behavior as countertransference. The reported setup is measuring the reactions to the behavior of patients in a day treatment program with varying treatment roles among 11 staff members. One can speculate that these staff attitudes would include the various members’ transferences to the individual patients and the clinic's prevailing group attitudes and philosophies about diagnoses, attitudes about antagonism versus compliance on the part of patients, and the hierarchical influence that certain leaders among the staff have on their colleagues. The inclusion of a cognitive behavior component in group therapy could put a premium on conformity and control. At the same time, a concurrent psychodynamic component might evoke affective expression and conflict to be explored.Although a sample of the details of the therapy process or exchange is not provided, one could hardly assume that a staff member's subjective affective responses (elicited for example from a projective identification process) would be employed as “useful countertransference” in making the patient aware of internal conflicts. The day treatment group setting including patients and staff might easily lend itself to replicating the situation of the patient's original family. The patient would recreate the family scenario using various members to reenact the roles from the past. One would expect at times, with patients sick enough to be in day treatment, that splitting processes would be manifested in staff behavior. Were such countertransferences analyzed or were they covered over with a pseudo “we have to present a united front?” Might the emergence of splitting account for the changes from Table 1 to Table 2 (see Rossberg et al. 2008)? If so, instead of treatment ending, it should continue until a more ambivalent capability on part of the patient is achieved.The authors found that therapists’ conscientiousness correlated positively with their feeling confident and negatively with feeling rejected. Patients continued treatment if the therapists felt positively toward them. These findings would seem to value conformity on the part of patient by the staff. However, I shall advocate for the positive value of negativism.

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