Working to Understand Our Role in the Patient's Mind: Countertransference and the Problems of Immersion

To be fully helpful, in a way that respects both the internal and external needs and conflicts of our patients in analytic treatment, we must become immersed in their emotional perspective and have a feel for how they view and value themselves and their objects. Allowing ourselves to be carried into their inner phantasies and to be in touch with their strivings towards and away from love, hate, and knowledge is important in the analytic process. Countertransference is unavoidable but, if properly monitored and contained, it can provide a beneficial therapeutic device. However, when treating disturbed patients who draw us into more paranoid transference states or primitive depressive position conflicts, we are often involved in various degrees of enactment. Even then, the countertransference, if carefully studied, can help us rebalance ourselves therapeutically and start to better understand how the patient is using us in their internal world and why they need to or desire to organize their object relational world in such terms. We cannot help but be immersed within the patient's unconscious belief system but, by being aware of our thoughts and feelings and reactions, we can keep our head above the choppy countertransference waters enough to act out less and offer constant interpretations that are more informed and focused on the patient's unique and personal object relational conflicts and internal belief system. From an object relational, post‐Kleinian tradition, the author examines one case in depth. The patient consulted the analyst with concerns about her grown children and her perception of how damaged they were emotionally. The subsequent meetings involved intense transference and countertransference experiences that are explored. The author's approach builds on prior clinical understanding based on the Kleinian method (Waska, 2002, 2004, 2012, 2013).