Chapter 12 Acute and Chronic Countertransference Reactions

The early concept of countertransference defined it as the analyst’s unconscious reaction to the patient or to the transference derived from the analyst’s own transference potential. Such countertransference was to be overcome by the analyst’s self-analysis so that the analyst could return to a position of technical neutrality (Little 1951; Reich 1951). This concept of countertransference and our view of its importance in the psychoanalytic situation have since undergone significant changes. Under the influence of psychoanalytic contributions in the 1950s, particularly those of Paula Heimann (1950) and Heinrich Racker (1957), a global or totalistic view of countertransference, defined as the analyst’s total emotional reaction to the patient, emerged and gradually prevailed. Now the task became the analysis of the various components included in the analyst’s global countertransference, including

• unresolved or reactivated unconscious conflicts,

• the analyst’s external reality and reactions towards third parties,

• the contributions of the patient’s transference, and

• the reality of the patient’s life.

(Kernberg 1965)

Particularly under the influence of Racker’s concepts of concordant and complementary identification in the countertransference (emphasizing the contribution of the transference), the analyst’s exploration of countertransference now permitted a sharper diagnosis of the patient’s activated internalized object relations. Countertransference analysis became an important tool in the analysis of the transference.

More recently, in technical contributions of the 1980s and early 1990s (Alexandris and Vaslamatzis 1993; Carpy 1989; Grinberg 1993; Hamilton 1990; Kernberg et al. 1989; Loewald 1986; McDougall 1993; Ogden 1993; Pick 1985; Segal 1981; Spillius 1988; Volkan 1993), countertransference analysis has emerged as a crucial aspect of

psychoanalytic technique, because it provides fundamental information about the nature of