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Binder, J.L. Strupp, H.H. Schacht, T.E. (1983). Countertransference in Time-Limited Dynamic Psychotherapy—Further Extending the Range of Treatable Patients. Contemp. Psychoanal., 19:605-622.
  

(1983). Contemporary Psychoanalysis, 19:605-622

Countertransference in Time-Limited Dynamic Psychotherapy—Further Extending the Range of Treatable Patients

Jeffrey L. Binder, Ph.D., Hans H. Strupp, Ph.D. and Thomas E. Schacht

SUMMARY

Time-limited dynamic therapy is organized around a "focus"—an affectively charged maladaptive interpersonal pattern that pervades a broad range of the patient's interpersonal relationships, including the therapeutic encounter. Identification and systematic examination of this interpersonal focus as enacted within the therapeutic relationship constitutes the primary work of the treatment. As this vignette illustrates, countertransference reactions can provide invaluable clues for identifying the nature of the therapeutic focus. The therapist's countertransference responses reflect his limited participation in the maladaptive focal pattern; the countertransference appears as a reciprocal response, "evoked" by the patient's transference enactments. In the case presented, the therapist felt intensely scrutinized by the patient, as though he was being tested, and he felt a reciprocal urge to be very careful in what he said and how he acted. These personal reactions prompted his initial hypothesis that the patient expected to be coerced and criticized, and therefore needed to remain vigilantly stand-offish while giving only the appearance of cooperation.

Subsequent to this initial formulation, the focus provided a conceptual framework within which the therapist systematically organized his impressions—including countertransference reactions—along a track that kept the therapeutic work circumscribed. Thus, in the latter part of the vignette case, the therapist's realization that he had devalued the patient's expression of affectionate interest alerted him to the continued operation of the initial focal pattern regarding the patient's chronic expectation that her feelings would be discounted and criticized.

In sum, we suggest that the effectiveness of time-limited dynamic therapy may be enhanced when specific attention is directed to discovering and working with the reciprocal relationship between the therapeutic focus and the therapist's countertransference reactions. Each may serve to clarify the other, thereby helping the

therapist to rivet his attention to the limited therapeutic radius required of short-term therapies. Furthermore, attention to countertransference aspects of the brief-therapy situation is essential to establishing and maintaining a productive alliance with those especially "difficult" patients whose predominant relationship patterns would otherwise strain the therapist's skill. By viewing countertransference as a welcome treatment ally, the therapist may devote himself more fully to changing the patient, rather than attempting to also change himself by pursuing an impossible ideal of neutrality.

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