TRANSFERENCE AND COUNTERTRANSFERENCE:

FEELINGS GENERATED IN WORK WITH CHILDREN & PARENTS & TIPS ON WORKING WITH PARENTS DESPITE THESE FEELINGS

CHAPTER 3

Discussion Points

  1. Discuss the main points of Engel’s systems influenced Biopsychosocial Model and its advantages in trying to understand presenting problems brought to Child and Adolescent Psychiatrists.
  1. Link to similar models such as nature-nurture, stress-diathesis, GXE, epigenetics, and Bronfenbrenner’s ecological model.
  2. It allows for complex multi-determined formulations and treatments.

2.Discuss factors that might explain our society’s ambivalence towards children.

  1. Determine if participants agree with the premise in the first place.
  2. If the participants agree, then discuss problems that face children and their caregivers in America. Are there segments of our society that are doing better, and if so, why?
  3. One could compare American standards to those of other countries.
  4. Discuss what legislation might improve the plight of children and their caregivers in America.

3.Have a discussion on how the participants define “unconsciousness.”

  1. Discuss Freud’s theory.
  2. Discuss if there is a difference between events that are “out of awareness” vs. what we choose to focus on vs. things that are unconscious.
  3. Discuss right brain/left brain issues.

4.Discuss the concepts of therapeutic alliance, working alliance, therapeutic relationship and their importance in therapy and patient-physician relationships.

  1. Discuss strategies to enhance such relationships and how to measure the results.
  2. Discuss issues that get in the way of such relationships.
  3. Transference/countertransference
  4. Not enough time
  5. Being under stress
  6. Cultural/diversity/gender issues.
  7. Discuss strategies for determining if the relationship is “good enough” to add to likely success in “your” treatment.

5.Discuss the concepts of transferences and countertransferences and their impact on therapeutic alliances.

  1. Discuss the difference between unconscious transferences and unconscious countertransferences and conscious resistances and reactions to patients and their caregivers.
  2. Discuss clues/warning signs that might let you know that transference/countertransferences are occurring.
  3. Discuss difficult cases of the participants with an eye towards identifying transferences/countertransferences and reactions to patients and their caregivers.

6.Discuss how to engage caregivers in the treatment of their children.

  1. Discuss the complex feelings of guilt and shame in parents.
  2. Discuss how to engage caregivers in treatment.
  3. Discuss what should be the expectations of caregivers.
  4. Discuss common problems that occur with parents that interfere with the initiation and maintenance of therapy.
  5. Discuss Paul Adam’s description of the varying roles of caregivers and therapists and how they might enhance or complicate therapies.

7.Discuss Fraiberg’s concept of “Ghosts in the Nursery” and the impact of past unresolved family conflicts on parenting styles.

  1. Link this to Bowen’s concept of Family of Origin work.

8.Discuss the four major styles of parenting (authoritarian, authoritative, indulgent-permissive, and indifferent-neglectful) and their impact on child development.

A.Ask which type might contribute to which type of the following problems.

  • Aggression
  • Temper tantrums
  • Internalizing disorders
  • Problems with self-esteem

B.Discuss difficult cases with a focus on the contributions of parents.

9.Discuss Daniel Stern and Nadia Bruschweiler Stern’s Model for work with young children as a way of identifying key aspects of work with caregivers and their children.

  1. Discuss whether this model is generalizable to older age children
  2. Discuss how the model addresses behaviors, feelings, cognitions, interactions, relationships, attachments, transferences/ countertransferences, etc.

10.Discuss how different therapies focus on different contributions of behaviors, cognitions, or feelings, and how these focuses lead to differing assessment and treatment strategies.