Countertransference Hate in the Treatment of Suicidal Patients

Abstract

The countertransference hatred (feelings of malice and aversion) that suicidal patients arouse in the psychotherapist is a major obstacle in treatment; its management through full awareness and selfrestraint is essential for successful results. The therapist's repression, turning against himself, reaction formation, projection, distortion, and denial of countertransference hatred increase the danger of suicide. Such antitherapeutic stances, their recognition, and the related potential for constructive or destructive action are the subject of this paper. Components of Countertransference HateCountertransference hate, like all hate, is a mixture of aversion and malice. The aversive component is the one fundamentally most dangerous to the patient and is often not clearly distinguished from the sadistic (malicious) as¬ pects of countertransference hate. Sometimes the aver¬ sion is experienced more consciously while the malice is muted; this will give rise to a sense of inner fear and fore-

Adolescent Avoidance and Risk Behavior

“…Maltsberger and Buie [22] identified five different defensive moves to which therapists may resort when they feel negative countertransference feelings. The first is the repulsion of hatred that can manifest itself as a feeling of boredom or fatigue.…”

“…Also, Winnicott [20,21] claimed that suicide involved a fantasy of destroying bad aspects of the self with the remainder of the self surviving, or as a destruction the entire self when the true self is threatened with exploitation or annihilation. Suicidal individuals often evidence few positive soothing introjects and poorly integrated hostile introjects, and they enact interpersonally and project these pathological internal object relations [22,23]. A common type of object relationship with these patients, projective identification, can be conceptualized as a process involving three phases: first, the fantasy of ridding oneself of an unwanted part of the self and of putting that part into another person in a controlling way; then there is a pressure exerted by means of interpersonal interaction such that the recipient of the projection experiences pressure to think, feel, and behave in a manner congruent with the projection; finally, the projected feelings are reinternalized by the projector, after being psychologically processed by the recipient [24].…”

Attitudes and emotions of trainees in learning disability psychiatry

“…Maltsberger & Buie (1974) also talked about the narcissistic snares related to caregiving: 'to know all, to heal all, to love all'.…”

“…Perhaps as a trainee there is even more expectation that a new face may bring with it new ideas and magical cures. In many areas of psychiatry such hopes are likely to be unfulfilled, disappointing the patient, the carer and the professional involved, thus facilitating negative countertransference towards the patient (Maltsberger & Buie, 1974;Watts & Morgan, 1994).…”

Kronisk suicidalitet ved ustabil personlighetsforstyrrelse: Hvorfor det er behov for særskilte tilnærminger i behandlingen

“…Maltsberger og Buie (1974) har beskrevet hvilken belastning dette kan vaere for klinikere. Behandlere kan bli utslitte av pasientenes kroniske trusler om selvmord.…”