The committee noted that therapists do not have well developed and agreed upon ideas of when self-disclosure hinders and when it facilitates analysis. Therapists should have a context for discussing self-disclosure that recognizes disparities in analytical models -- for example those stressing the reparative needs of certain patients for 'new objects' as opposed to those focusing solidly on exploration of the patient's internal existence. The group finally attacked the discussion of evidence against and for self-disclosure. "Group members were in agreement that evidence for the usefulness of self-disclosing techniques based on the patient's sense of well being and exhilaration for a session or so after the revelation did not constitute convincing evidence of the benefit of such techniques." (Lansky, 7)
The gender influence of transference is also an area rife with examples and explanations. As Kalb has noted, "Psychoanalytical endeavor reflects some degree of culturally exaggerated normative roles, including tendencies for women to be more nurturing and containing and for men to be more authoritative and interpretive. Gender is merely one element washing into the undulating currents of the highly complex transferential space. At times gender plays a central role and at other times recedes into the background, at times echoing sociocultural prototypes and at other times becoming more fluid. (Kalb, 2002).
In essence, gender roles play a not insignificant role especially in transference and countertransference: Obviously, a patient is less likely to fall in love with a therapist (and vice-versa) if the genders are not such as they are accustomed to. But as Kalb mentions, gender roles are often not central to transference as well.
As mentioned earlier, countertransference is when the therapist, during the sessions of therapy, begins to develop positive or negative feelings toward the patient. This is actually quite normal during therapy. However, therapists must not and cannot act on such feelings. (Kardas, 1) To act on them is absolutely unethical. Sections 4.05 and 4.07 of APA's Ethical Principles of Psychologists and Code of Conduct state:
4.05 Sexual Intimacies With Current Patients or Clients.
Psychologists do not engage in sexual intimacies with current patients or clients.
4.07 Sexual Intimacies With Former Therapy Patients.
A a) Psychologists do not engage in sexual intimacies with a former therapy patient or client for at least two years after cessation or termination of professional services.
Both of the principles above are, of course, designed with countertransference in mind.
Turning to actual countertransference, one may think of it as an arcane topic; it is certainly an unwieldy word, one which invokes the most abstract of latter-day metapsychological conceptualizations. Indeed, it arose very early and was very immediate: That is precisely why Freud's first collaborator, Joseph Breuer, gave up. He ran away from Anna O. because she aroused him. If transference is in fact projection, countertransference is projective identification -- something elicited by the patient in the therapist: this is called evocative knowledge. For example, here, Anna O. elicited in Breuer a sexual excitement which he found unacceptable and was unbearable to himself and his wife, so he abandoned the work (Gay, 1988, pp. 63-9).
For Freud the transference went from being an annoying interference to an instrument of great value to the main battlefield of the analysis. An analogous story can be told about the countertransference, but it is a story with profound implications. Now, to define countertransference. Freud rarely discussed the topic; he saw countertransference as the patient's influence on the analyst's unconscious. He said that no analyst could go farther than he or she had progressed in his or her own analysis, so the analyst's analysis was all-important. He first mentions the concept in 1910: 'We have become aware of the "countertransference," which arises in [the analyst] as a result of the patient's influence on his unconscious feelings, and we are almost inclined to insist that he shall recognize this countertransference in himself and overcome it. Now that a considerable number of people are practicing psychoanalysis and exchanging their observations with one another, we have noticed that no psychoanalyst goes further than his own complexes and internal resistances permit; and we consequently require that he shall begin his activity with a self-analysis and continually carry it deeper while he is making his own observations on his patients. Anyone who fails to produce results in a self-analysis of this kind may at once give up any idea of being able to treat patients by analysis'" (Young, 8, quoting Freud, 1910, pp. 144-5).
It is often surmised that Freud held a very limited view of countertransference, and he certainly had precious little to say on the topic. However, with respect to the subsequent history of ideas about countertransference, Laplanche and Pontalis trace three successive positions on the subject: (1) Get rid of it by means of one's own analysis, and concentrate on the patient's transference. (2) Exploit it in a controlled way, using the therapist's unconscious as an instrument for fathoming the patient's unconscious. (3) Go with it, treating the resonances from unconscious to unconscious as the only authentically psychoanalytic form of communication. (Laplanche and Pontalis, 1983, pp. 92-3).
There is a difference between exploitative disclosure on the therapist's part and beneficial disclosure, however. Here is one popular line of reasoning:
Psychologists must differentiate between boundary crossings, which are not harmful and which may not only be appropriate at times, but even necessary for providing effective and caring treatment; and boundary violations, which are harmful and should be avoided. The distinction may at times be a difficult one to make, but it is the patient's perception, not ours, that dictates this. Also, as Zur (2000) points out, professional isolation is our enemy. When unsure on these matters, consultation with colleagues is of great importance. There also may be a great difference between various therapist actions and behaviors along the dimensions of intent, impact on the patient, relevance to the patient's treatment needs and treatment plan, outcome for the patient, and the view of others such as colleagues, ethics committees, licensure boards, and the courts." (Barnett, 2)
And that is why the argument develops that it is impossible for a therapist to remain anonymous in a two-person session. Countertransference's powers are simply too great here.
The most important revelation of the APA Code of Ethics in relation to countertransference is that a therapist has to recognize his or her own personal problems or conflicts that may interfere with the patient's treatment. In these cases, the therapist is forced to recognize when countertransference is actually taking place; when it is relevant to the treatment of his or her patients.
Without such admissions, the patient's treatment will be entirely compromised. The advice and interpretations that the therapist is contributing may or may not be beneficial to the patient, and there are no grounds to determine which outcome is likely. This relates entirely to the concept of exploitative and beneficial disclosures. Admitting that countertransference is occurring is undoubtedly a beneficial disclosure, and one that is absolutely mandated by the APA's Code of Ethics.
Transference and especially countertransference are extremely complicated areas of treatment and have the power and ability to entirely torpedo a patient's path to recovery. The ethics of the therapist's profession are, therefore, integral especially in these cases to a productive therapist/patient relationship.
APA: (2002) Ethical principals of psychologists and code of conduct. http://www.apa.org/ethics/code2002.html#intro
Barnett, Jeffrey. (2001). Must some boundaries be crossed? Division 42: