Academic journal article Journal of Cognitive Psychotherapy

Countertransference and the Therapeutic Relationship: A Cognitive Perspective

Academic journal article Journal of Cognitive Psychotherapy

Countertransference and the Therapeutic Relationship: A Cognitive Perspective

Article excerpt

The current article discusses the potentially inappropriate application of psychodynamic constructs regarding the therapeutic relationship (i.e., transference- countertransference) to cognitive therapy, offering a discussion of the fundamental principles of cognitive therapy that are violated. The therapeutic belief system is defined and offered as an alternative conceptual framework for addressing therapeutic relationship variables in cognitive therapy and the ways in which it is more consistent with the fundamental principles of cognitive therapy are identified and discussed. Finally, application of the therapeutic belief system to the treatment of suicidal patients is provided as a clinical example. Potential implications for treatment and research are noted.

Countertransference in psychotherapy has been well defined and extensively discussed (e.g., Kernberg, 1965,1967,1972,1975; Reich, 1951; Winnicott, 1949, 1958,1960), along with its importance in the treatment of suicidal patients well established by Maltsberger & Buie (1974,1989). From a classic analytical perspective, Countertransference has been conceptualized as the therapist's unconscious reactions to the patient's transference and, for the most part, viewed as a hindrance to the treatment process (Kernberg, 1965, 1967, 1972, 1975). More recently, however, Countertransference has been conceptualized more broadly as the therapist's emotional reaction(s) to the patient, a natural component of any psychotherapy, and a potential ally in the treatment process (Eber, 1990; Mendelsohn, 1987). Additionally, Mitchell (1988) has expanded traditional psychoanalytic models, incorporating both interpersonal and intrapsychic variables in the treatment process, but emphasizing the importance of "relational configurations" in understanding core conflicts. Although consistent with traditional drive theory in acknowledging the importance of core psychic structures in understanding and addressing conflicts, relational psychoanalytic models diverge somewhat by emphasizing the critical role of interpersonal relationships in understanding, maintaining, and ultimately modifying psychopathology. Accordingly, transferencecountertransference reactions and processes are considered a function of enduring efforts on the part of the patient to maintain a rigid and inflexible, albeit dysfunctional, manner of relating to others and ultimately the therapist. Mitchell (1988) has characterized this interdependent and fluid process as a "relational configuration," a construct more acceptable to cognitive theorists and therapists alike, and one that diverges noticeably from traditional psychoanalytic models. Regardless of whether a traditional or modified psychoanalytic approach is employed, it is believed that a thorough, accurate exploration and understanding of countertransference reactions will result in its appropriate management, a more refined and accurate conceptualization of the patient's problems, along with more effective and efficient treatment.

Despite the importance of identifying, understanding, monitoring, and responding to countertransference reactions in the therapeutic process, it is an area that has received relatively little attention in the cognitive therapy literature. Actually, in their original text on cognitive therapy for depression, Beck, Rush, Shaw, and Emery (1979) devoted only a few pages to the topic (pp. 58- 60). More recently, however, an effort has been made to address countertransference in cognitive therapy, since specific treatment approaches have been developed for more chronic problems such as personality disorders (e.g., Beck & Freeman, 1990; Layden, Newman, Freeman, & Morse, 1993; Linehan, 1993; Linehan, Armstrong, Suarez, Allman, & Heard, 1991), necessitating a longer period of treatment. Given the longer duration of treatment and, naturally, the increasing importance of the therapeutic relationship itself as a mechanism or vehicle for therapeutic intervention and change, transference-countertransference issues have been discussed in modified cognitive therapy approaches. …

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