The Therapist as a Bad Object: the Use of Countertransference Enactment to Facilitate Communication in Therapy

Psychoanalysis as it exists today is not constituted by a single theoretical framework describing pathology and indicating a specific set of interventions. Since Freud originally conceptualised psychoanalytic understanding of pathology and psychoanalysis as a mode of intervention, there have been many revisions and reformulations of his theory. This thesis has attempted to integrate some psychoanalytic ideas regarding personality formation, psychopathology and psychotherapeutic intervention (Fairbairn, 1952; Ogden, 1992, 1994), with interpersonal (strategic / structural) ideas regarding intervention (Minuchin, 1974; Sullivan, 1940, 1953, 1964). In order to do so, the thesis used the relational psychoanalytic perspective, as depicted by Aron (1996) and Mitchell and Aron (1999), as an overarching conceptual framework. The focus from these points of view is the patient’s internalized relationship patterns and the therapist’s participation in their repetition. It is held that internalized relationship patterns are not only based on, but can be changed by, lived experience. From this perspective, the goal of therapy is to enhance the patient’s capacity to reflect and think about experience, and therefore, to communicate about it. This means a change in the patient’s predominant mode of communication. Ogden’s (1994) modes of communication were described. The thesis suggested that Ogden’s modes of communication can be stretched or translated into the types of communication outlined by Langs (1978). This thesis aimed to explore the deliberate use of countertransference responses to facilitate communication in the beginning stages of therapy with patients functioning predominantly in the paranoid-schizoid mode (Ogden, 1992). Patients who operate in this mode are often unable to tolerate interpretation and therefore traditional approaches to intervention are not effective. A “strategic / structural relational psychoanalytic” approach to treatment was proposed. It was suggested that therapists utilize joining and accommodation techniques as described by Minuchin (1974) and alter their style of interaction to match that of the various object relational constellations that they have managed to identify within the patient via their countertransference responses. It was hypothesized that patients need their therapists to be similar to their original objects in order to feel safe in the therapeutic environment and that this may facilitate communication in the beginning stages of therapy. The research utilized a qualitative research approach. Qualitative research methods attempt to use data gathered phenomenologically, always acknowledging the researcher’s biases when gathering the data. The data gathered is then interpreted according to various theories or hermeneutic lenses. The hypothesis mentioned above has been investigated by analyzing three cases in terms of the research questions based on Langs’ (1978) classification of communication. The thesis described the difficulties inherent in collecting clinical data from psychologists working from within a psychoanalytic framework. Eventually three sets of therapy details and verbatim therapy transcripts were obtained, provided in the thesis and analyzed in terms of the research questions. However evidence for the success of the hypothesized alternate approach was not found in this research study. It was suggested that other possible methods might be useful to investigate the hypothesized approach further.