Modelos de arrancadores estáticos

There are four paradigms of countertransference that are on a spectrum of the Cartesian (Stolorow et al., 2001) to intersubjective positions (Stolorow et al., 1994). These models are:

i) Countertransference as Neurosis

ii) Cartesian Countertransference Paradigm

iii) Combining Countertransference as Neurosis and a Cartesian Approach iv) Intersubjective Countertransference

The paradigms are considered in relation to their usefulness to investigate the type of metaphor being generated and in light of whether they promote a collaborative approach to interpretation.

3.17.1 Paradigm 1: Countertransference as Neurosis

The experience of countertransference was originally postulated by Freud (1937) as being the unresolved neurosis of the analyst activated by the transference of the patient, making it difficult for the analyst to interpret the transference material.

In his writings on technique, Freud stated,

“I cannot advise my colleagues too urgently to model themselves during psycho-analytic treatment on the surgeon, who puts aside all his [her] feelings, even his human sympathy, and concentrates his mental focus on the single aim of performing the operation as skillfully as possible.” (Freud, 1912, p. 115)

Freud suggests that the emphasis of the analytic position is to maintain an objective technique that can be precise and neutral without interference from feelings evoked in relation to the patient’s transference. This idea is about countertransference being obstructive to interpreting the patient experience.35

3.17.2 Paradigm 2: The Cartesian Countertransference Paradigm

A Cartesian paradigm refers to René Descartes mind-body dualism of ‘Archimedean certainty and clear objectivity, in which isolated mind entities are radically estranged from external others.’ (Stolorow et al., 2001) This paradigm is based on a model of projective identification (Klein, 1946), whereby elements of the patient’s estranged experience are projected into the analyst. For example, Kernberg (1985) takes a Cartesian perspective, that all emotions36 experienced by the analyst in

35 _{See also De Rivera (1977) who postulated that negative countertransferential reactions}

should be avoided in order to maintain clarity of perspective.

the clinical relationship constitute the countertransference and can inform how we understand the transference issues of the patient.37

3.17.3 Paradigm 3: Co-Existence of Countertransference as Neurosis and a Cartesian Approach

There is a third paradigm proposed by Kiesler (2001) which accommodates paradigm one and two. He suggests that ‘acting out’ from neuroses, (paradigm one), can be considered a ‘subjective countertransference’, which is largely about the therapist’s prejudices and unresolved conflicts. He states that this always co-exists with an objective countertransference (paradigm two), which is a direct response evoked by the patient during the session. Geltner (2006) also attempts to differentiate the ‘subjective’ by bringing objectivity to the understanding of a multiplicity of countertransferential experiences, likening the analyst to a piano being played as a metaphor for objective countertransference.

3.17.4 Paradigm 4: Intersubjective Countertransference

Intersubjective countertransference is inclusive of the therapist’s own internal world in the construction of the patient’s experience. For example, when working with a patient, Ogden uses his own seemingly arbitrary experiences to make sense of the transference (Ogden, 1992). This method accounts for the countertransference as a co-created event in what Ogden refers to as the ‘third’, which is both something of the

patient and the therapist. This would assume that the therapist uses their personal experience as a foundation for understanding the patient experience. As Overton (1994, p. 219) stated about metaphor formation, ‘Metaphor as process then operates projectively—beginning from the known, giving meaning to the unknown, and recursively resulting in a restructuring of the known.’. In concurrence Stolorow et al. (Stolorow et al., 1994) state that the therapist also co-creates the type of transference as well as perceives it in a particular way depending upon the schemas that reflect their personal experience.

Given the epistemological position of the researcher-clinician, and the complexity of interpreting material with patients who are diagnosed with SMI, paradigm four meets the demands of interpreting the data to inform an understanding of the dynamic nature of the CRM.

3.17.5 Common Factors of Countertransference Processing

The commonality between paradigms about countertransference is based on the method of processing. Wagoner et al ( 1991, p.418) postulate some of the key aspects of clinical competency in relation to using counter-transference,

“...insight into their feelings and the basis for those feelings; as having a greater capacity for empathy in the sense of being able to partake of the client's emotional experience, as well as having an intellectual understanding of client emotions; as being more highly integrated, and therefore, more able to differentiate client needs from their own needs; as possessing less anxiety in

general and with clients in the session; and as being more adept at conceptualizing client dynamics, in both the context of the therapeutic relationship, and the client's past.”

These competencies form the basis of a dynamic art psychotherapy approach (Case and Dalley, 2014) of being available to the patient, empathic, and the ability to tolerate high levels of anxiety to enable thinking about the patient’s current situation in relation to the past. Perhaps this is the most fundamental rule of understanding countertransference phenomena, that it is processed in relation to what happens in the session and is made sense of acknowledging a personal standpoint without being overshadowed by the therapist/ researcher’s personal anxieties. Holmes (2014, p. 11) adds to this that the researcher must have ‘…an ability to examine potential links between observed changes in feeling states and other aspects of the research situation’. Bram and Gabbard (2001, p. 696) also identify the use of the reflective function in countertransference processing as a dialectical, bi-directional therapeutic playfulness. This brings the technique employed in the methodology, to the forefront, the focus of which lies in the capacity to be reflexive about countertransference.