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Clinical Social Work Journal, Vol. 33, No. 4, Winter 2005 ( 2005)
DOI: 10.1007/s10615-005-7037-8THE USE OF SHAME AND DREAD IN THECOUNTERTRANSFERENCEM. Kim Sarasohn, M.S.W.1ABSTRACT: Much has been written about paranoid anxieties as these occur
in the patient. Less, however, has been written about primitive experiences as
these occur in the therapist during the session. This paper recounts a patients
correct articulation of the therapists self-perception, which, because of its
accuracy, initially flooded the therapist with shame and dread. Nonetheless, the
patients perception was able to be used in a way that clarified, in the
countertransferance, a piece of the patients early experience in relation to her
mother and strengthened the therapeutic relationship.KEY WORDS: countertransference; projective identification.Much has been written about paranoid anxieties as these occur in
the patient. Less, however, has been written about primitive experiences as these occur in the therapist during the session. Racker (1968)
discussed the sense of shame evoked by the experience of countertransference, which, he suggested, points toward the therapists own unresolved conflicts and neuroses. He warned that these function as a
trap. Because of the therapists identification with the patients internalized objects, the therapist may be pulled, such that the patients
accusations regarding the therapists badness are believed. According
to Racker, this occurs when the therapists own internal objects match
those that are projected by the patient. Similarly, Searles (1975) argued
that, in addition to distorted perceptions of the therapist, the patient
has access to perceptions that have some basis in reality. Hoffman1Correspondence should be directed to M. Kim Sarasohn, MSW, 41 East 11th Street,
4th Floor, New York, NY 10003, USA; e-mail: [email protected] 2005 Springer Science+Business Media, Inc.446CLINICAL SOCIAL WORK JOURNAL(1983) assumed the patients capacity for accurate apprehension of the
therapist and described these moments as extraordinarily provocative.
He noted the need to disentangle oneself through interpretation so as to
avoid a transferencecountertransference enactment. Meltzer (1968)
perhaps came closest to articulating the actual sensation of being accurately perceived by the patient when he described, a most intimidating
monitoring of the analysts technique and way of life (p. 396).Klein (1946) normalized paranoid and persecutory feelings, weaving these into a developmental schema that is repeatedly re-visited
throughout the course of ones existence. This means that we as therapists are subject...