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Ehrlich, F.M. (2001). Levels of Self-Awareness: Countertransference in Psychoanalysis, Couple, and Family Therapy. Contemp. Psychoanal., 37(2):283-296.

(2001). Contemporary Psychoanalysis, 37(2):283-296

Levels of Self-Awareness: Countertransference in Psychoanalysis, Couple, and Family Therapy

Frederick M. Ehrlich, M.D.

Our Ability to be deeply involved with the private selves of others is an appealing aspect of all forms of psychotherapy. The phenomenon of countertransference relates to this capacity for involvement. I have observed that my own reactions, conscious and unconscious, may be triggered by events that initially seem of little significance. A patient's images, memories, words, gestures, or tones may open regions of feeling and memory in me of which I am, at most, dimly aware when they first occur. In a previous essay (Ehrlich, 2000) I described how the words We shall live for each other, spoken by a couple when they married, connected in my mind to the words “We shall live free as the birds,” which my parents said they had pledged to each other when they married (p. 499). This connection was an important force in my attachment to the couple. Such moments of connection often pass unnoticed, but may hold the key to some of our most intense responses to our patients.

The analyst's participation as a real person in the psychoanalytic transaction is now generally accepted. Testimony to this is found, among others, in discussions of two-person psychology, in the interpersonal and relational schools, and in Kantrowitz's (1996) work on analyst-analysand fit. Mitchell (1993) makes the observation that Freud and others analyzed members of their families, thinking they were using a scientific tool independent of their own persons (pp. 17-18). This now seems absurd. Today we would see such activity as an outrageous lack of insight and an abuse of the patient.

The importance of the therapist's emotional reaction to the patient is now taken as essential to the therapeutic process.

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