Review of the book entitled Contratransferência: teoria e prática clínica

BOOK REVIEW

Review of the book entitled Contratransferência: teoria e prática clínica

Gustavo Bolognesi

Pschiatrist

^{Correspondence}

Jacó Zaslavsky and Manuel J. P. dos Santos (orgs.)

Porto Alegre, Artmed, 2006

Jacó Zaslavsky and Manuel J. P. dos Santos, who are the organizers of this book, aim at gathering theoretical, clinical and technical aspects about countertransference. The book can be used as a study instrument by experienced psychoanalysts, as well as by undergraduate students. It has the participation of many thought tendencies and different psychoanalytic schools, which enriches reading and provides knowledge of several approaches in conceptual terms and ways of use in clinical practice.

It was organized and divided into four parts. In the first part, called "At the age of countertransference," a comprehensive review about the theme is performed. Chapter 1, written by Beatriz de Leon Bernardi, makes a historic retrospective of the countertransference concept, including Freud, Paula Heimann, Hacker and the Barangers. She also discusses its relation with intersubjectivity, analytic relationship and therapeutic change.

Chapter 2, entitled "Current tendencies in countertransference," brings a detailed and didactic systematization of current schools.

The four following chapters of the first part bring the ideas of thinkers and mandatory references for any in-depth study on this theme. Elias Mellet da Rocha Barros writes about countertransference and interpretation of object relations; Antonino Ferro discusses countertransference and characters in the consulting room; Thomas Ogden deals with "Working with countertransference: remembering the body;" and Theodore J. Jacobs writes about "Reflections on the role of unconscious communication and countertransference enactment in analytic situation." These are consistent texts, with interesting clinical examples that stimulate thinking about those themes.

Part II, "Countertransference in clinical practice," starts with the chapter written in partnership by Humberto Persano and Adrián Ventura, dealing with borderline and narcissistic personality disorders. First, they introduce the concept of borderline personality disorder, and then analyze the particularities of countertransference in these patients.

The following chapter, written by Richard Lucas, despite the author's unarguable quality, in my opinion, is the only chapter that does not satisfactorily meet our expectations and only refers to a very restricted type of severe depressed patient.

Ivan and Heloísa Fetter, along with Hamilton Fontoura, start their chapter on countertransference in homosexuality and perverse situations with a brief psychoanalytic view on homosexuality, and then discuss the varied aspects of countertransference in the treatment of these patients, in an interesting and didactic chapter organization.

Chapter 10, also written by Humberto Lorenzo Persano, approaches patients with eating disorders, firstly commenting on the clinical dimensions in patients with such disorders. Next are some metapsychological considerations for its understanding, and finally aspects directly related to countertransference. He discusses projective identification and the risks of acting and details the many types of countertransference experience, from autistic to fear of death.

The following chapters are about psychiatry in childhood and adolescence, approaching countertransference in children, adolescents and parents in separate chapters. They warn to the therapist's additional cares, especially involving his own fantasies of salvation and competition with parents. These chapters have a number of clinical vignettes that are a good illustration of presented concepts. The authors are, respectively, Maria Lucrecia M. Zavaschi and Ana Margareth Bassols (countertransference in care of children), Margareth Silveira Campos and Mazlôwa Maris Heck (countertransference in care of adolescents) and Marlene S. Araújo and Maria Helena M. Ferreira (care of parents, couples and families).

This second part ends with a chapter on the elderly patient. Written by Antônio Carlos S. Marques da Roa and Júlio J. Chachamovich, it makes reference not only to technical issues, but also to vicissitudes and gratifications of this treatment modality. It is worth stressing the analysis of countertransference involving the therapist's relationship with his parents and the possible consequences of the treatment of elderly patients in these relationships.

Part III deals with countertransference and special situations.

Chapter 15 is about the relationship between countertransference and character. Written by the organizers, along with Carlos Gari Faria, it initially discusses about the dynamic understanding of character. Next, nonverbal manifestations of character in the analytic field and clinical vignettes deserve special attention by the reader.

Chapter 16, by Manuel Pires dos Santos, Luís Albano Mirândola and by me, is a review on the concepts of erotic and eroticized transference. Next, it deals with the technical aspects of erotic countertransference and ends with two illustrative clinical vignettes.

Chapter 17, concisely and didactically analyzes countertransference enactments and border violations. Its author is Glen Gabbard, who tries to draw attention to nonsexual violations. He suggests that we should be careful and alert to small transgressions, not to go "down the road," inferring that severe violations represent continuity of a process and not of something that occurs independently. He also brings interesting clinical examples.

In his chapter on countertransference in extreme situations, Mauro Manica highlights the action difficulties and countertransference dangers in such cases. Concrete reality acting so directly and need of symbolization and understanding the internal world faced with this external reality become additional difficulties. He also stresses the role of therapist's tenderness (factor T) as a major condition to provide good care and support in these situations.

Chapter 19 deals with a little studied theme: countertransference at treatment discharge. The authors associate the types of discharge with countertransference, cite use of countertransference as a sign of discharge and the therapist's and patient's changes in relation to countertransference. They also make a connection between discharge and mourning. The clinical case illustrating this chapter facilitates assimilation of exposed ideas. It is written by the organizers, along with Antônio C. Scherer Marques da Rosa and Fernando Grillo Gomes.

The last chapter of the third part studies the factors of the therapist's personal life in relation to countertransference. Aspects of the therapist's real life, physical disease, pregnancy, divorce or separation and moment of therapist's life cycle are approached in detail. In the conlcusion, Anete Blaya Luz, Carmem E. Keidann and Jussara S. Dal Zot, authors of this chapter, stress the inevitability of the therapist's influence as a participating observer and the need of constant analysis of such aspect; on the contrary, such participation can be denied and the therapist can be blind to important treatment facts.

Part IV is entitled "Countertransference in teaching and learning." It is divided into four chapters and starts with a discussion on the approach of countertransference in psychoanalytic and psychotherapeutic supervision. It is a chapter with a very high level of detail, including research data on reference and use of such phenomenon in psychoanalytic supervisions. It is written by Manuel Pires dos Santos and Jacó Zaslavski.

The other three chapters are in the same level of the previous chapter and are about the therapist and his formation and relation with the institution (Davi E. Zimmerman and Flávio Rotta Correa), teaching of countertransference in the formation of psychiatrists (Alfredo Cataldo Neto, Carlos Augusto Krieger, César Luis de S. Brito, Edgar Chagas Diefenthaeler and Nina Rosa Furtado) and countertransference experience in students (Juliana Yurgel Valente, Marília Rodrigues dos Santos and Thais Galvani).

I believe this book, besides being an excellent study instrument, as mentioned above, is of great usefulness as a consultation guide for daily practice. Its presentation and formatting are of excellent quality, in a praiseworthy work of edition.

Publication Dates

• Publication in this collection
  31 Mar 2008
• Date of issue
  Dec 2007