Countertransference Issues in Psychiatric Treatment

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Glen O. Gabbard
American Psychiatric Pub, 1999 - Medical - 127 pages
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In psychiatry, clinicians recognize the influence of their own personal characteristics on the assessment and treatment of their patients. No interactions in psychiatry are entirely free of countertransference dynamics. Most major theories point to countertransference as a jointly created phenomenon involving feelings induced by the patient combined with the conflicts and preexisting self and object representations that the clinician brings to the encounter.

Countertransference Issues in Psychiatric Treatment provides an overview of theory and technique that gives the reader a detailed account of how countertransference is used in contemporary practice. This timely reference • Illustrates the usefulness of examining countertransference issues in a wide range of psychiatric settings, including pharmacotherapy, consultation-liaison settings, and forensic facilities• Explores the specific countertransference dynamics evoked when clinicians treat suicidal borderline patients and the common countertransference problems confronted when treating antisocial and violent patients• Describes the difficulties encountered in general medical settings when physician-assisted suicide is considered as an acceptable clinical intervention• Breaks new ground in considering psychiatrist's emotional reactions to the patient as an integral part of psychiatric practice and discusses some of the current controversies about countertransference• Reviews cutting-edge psychoanalytic theory involving subjectivity, projective identification, role responsiveness and countertransference enactments

Whereas most literature on countertransference is geared toward psychoanalysis and dynamic psychotherapy, this volume illustrates how countertransference issues must be considered in every clinical setting in which a psychiatrist works. It is an excellent introduction to the topic for psychiatric residents and medical students.

  

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Contents

An Overview of Countertransference Theory and Technique
1
Key Concepts in Countertransference
3
RoleResponsiveness
8
Countertransference Enactment
9
RelationalConstructivist Theories
10
Consensus and Controversy
12
Role of Countertransference Enactments
13
Therapist SelfDisclosure
14
When the Psychiatrist Is Ill
67
Conclusion
68
References
69
Countertransference in the Treatment of the Antisocial Patient
73
Mistrust and Skepticism
75
Reactions to Accounts of Violence
76
The Background of the Clinician
77
The Resident as the Victim of Violence
78

Containment of Countertransference Feelings
17
Conclusion
21
Countertransference in the Treatment of the Suicidal Borderline Patient
27
Suicidal Borderline Patients
29
Psychological Circumstances Favoring Projective Identification
31
Coercive Bondage
33
Reactions to Debasing Hostile Projections
34
Enlistment of the Therapist in Suicide
38
Conclusion
40
References
41
Countertransference in General Psychiatry
45
Medication Compliance
47
The Triangular Relationship
51
MultipleTreater Settings
53
Violent and Assaultive Patients
57
Consultation and Liaison
62
Forensic Psychiatry
65
Reimbursement
66
Narcissism
79
Drug Abuse and Countertransference
80
Antisocial Women
81
The Alien Nature of Crime
82
Case Example
83
References
84
Countertransference and Assisted Suicide
85
Suicide and Rational Suicide in the Terminally Ill
87
The Interpersonal Context in the Desire for Death
92
Doctors and Death
95
Assessment of Competence and the Therapeutic Frame
100
The Intersubjectivity of the Request for PhysicianAssisted Suicide
104
Conclusion
111
References
112
Afterword
117
Index
119
Copyright

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Page 112 - Brody, H: Assisted Death - A compassionate response to a medical failure. N Engl J Med 327:1384-1388, 1992 Brown JH.
Page 112 - Cassel EJ: The nature of suffering and the goals of medicine. N Engl J Med 1982;306:639. Council on Scientific Affairs, American Medical Association: Good care of the dying patient. JAMA 1996; 275:474. Covinsky KE et al: The impact of serious illness on patients
Page 115 - Quill TE, Cassel CK, Meier DE: Care of the hopelessly ill: proposed clinical criteria for physician-assisted suicide. N Engl J Med 327:1280-1384.

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About the author (1999)

Glen O. Gabbard, M.D., is Professor and Director of the Baylor Psychiatry Clinic at the Baylor College of Medicine and Training and Supervising Analyst at the Houston-Galveston Psychoanalytic Institute in Houston, Texas. He was previously Director of the Menninger Hospital in Topeka, Kansas. Dr. Gabbard is the author or editor of sixteen books and currently is joint Editor-in-Chief and Editor for North America of the International Journal of Psychoanalysis. His numerous awards include the 2000 Mary Sigourney Award for outstanding contributions to psychoanalysis.

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