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Storm, J.E. (1987). British Journal of Medical Psychology. LVIII, 1985: Staff Countertransference in the Therapeutic Milieu: Creating an Average Expectable Environment. Nathan Szajnberg. Pp. 331-336.. Psychoanal Q., 56:740-741.
Psychoanalytic Electronic Publishing: British Journal of Medical Psychology. LVIII, 1985: Staff Countertransference in the Therapeutic Milieu: Creating an Average Expectable Environment. Nathan Szajnberg. Pp. 331-336.

(1987). Psychoanalytic Quarterly, 56:740-741

British Journal of Medical Psychology. LVIII, 1985: Staff Countertransference in the Therapeutic Milieu: Creating an Average Expectable Environment. Nathan Szajnberg. Pp. 331-336.

James E. Storm

Szajnberg believes that a milieu setting magnifies those facets of the countertransference related to (1) "evoked feelings" and (2) the interaction of the mutual needs of patient and therapist. Reasons for this magnification include the use of action as a communication by regressed patients and the continuous interaction of patients and therapist in a therapeutic milieu. In Szajnberg's clinical example, the mutual needs of patient and therapist interacted and allowed the patient to progress. A therapist spent long hours sitting with a regressed incontinent patient. The therapist felt concern for the patient's comfort. This was formulated as a feeling of caring evoked in the therapist, who then changed the sheets in a non-demanding way. The patient improved and said that she could feel the caring which she sought. The therapist's feelings as perceived by the patient met her needs, whereas during previous changes of sheets the patient had perceived a demanding, critical staff

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reaction of disgust, to which she had reacted by withdrawing further. The predictability of the milieu setting is said to foster this process. Szajnberg uses the term "moment of illusion" to describe the patient's feeling that she had created this situation, although "illusion" thus seems to be used inconsistently. A second vignette is provided in which a therapist's countertransference feelings were acted out in the milieu. When a colleague interpreted and the therapist examined the countertransference feelings openly in the milieu, the patient's observation of this led to insight and improvement. The therapeutic milieu is said to facilitate this process. Exploration of the patient's psychological processes could not be made, however, so any conclusions are speculative. In a final vignette, therapist and staff's multiple observations of each others' countertransference reactions to patients provided a more thorough understanding of these reactions than would be possible outside of the "milieu" setting.

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Article Citation

Storm, J.E. (1987). British Journal of Medical Psychology. LVIII, 1985. Psychoanal. Q., 56:740-741

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