Research Article| Volume 12, ISSUE 5, P273-281, October 1998

An analysis of the concept of countertransference

  • Irene C. Ens
    Address reprint requests to Irene C. Ens B.N., M.N., Baycrest Centre for Geriatric Care, 3560 Bathurst Street, Toronto, Ontario, Canada, M6A 2E1.
    Baycrest Centre for Geriatric Care, Toronto, Ontario, Canada
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      A knowledge of countertransference is a necessary step in using it therapeutically in the nurse-patient relationship. However, this concept, which has its roots in psychoanalytic theory, has been applied to nurses and nursing situations in an unhelpful and ambiguous manner. In fact, the term is often used to denigrate nurses without providing clarity as to what the components of countertransference are and how they might be understood and used therapeutically. As such, it is necessary to delineate the meaning of countertransference in its entirety as a concept suitable for nursing practice. Positive countertransference, negative countertransference, and empathy are the composite parts of the concept of countertransference. Through concept analysis, by using methods outlined by
      • Rodgers B.L.
      Concepts, analysis and the development of nursing knowledge: The evolutionary cycle.
      , Journal of Advanced Nursing, 14, 330–335, it is suggested that countertransference is an inescapable factor in the nurse-patient relationship. Furthermore, a comprehensive analysis of the concept of countertransference will assist nurses in recognizing it when it occurs and may enhance the use of the understanding gained to the benefit of the nurse-patient relationship.
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        • Adler O.
        Hospital treatment of borderline patients.
        American Journal of Psychiatry. 1973; 130: 32-36
        • Ashton E.
        The narcissistic personality disorder: The great cover up—a challenge to the counsellor.
        Canadian Journal of Psychiatric Nursing. 1990; 31: 14-18
        • Bach-Y-Rita G.
        Habitual violence and self-mutilation.
        American Journal of Psychiatry. 1974; 131: 1018-1020
        • Bellis J.M.
        Countertransference: An odyssey.
        in: Fischer C. Etchells A.B. Proceedings of the Pacific Northwest bioenergetic conference, Whistler, British Columbia, Canada1988: 58-79
        • Benner P.
        • Wrubel J.
        The primacy of caring: Stress and coping in health and illness.
        Addison-Wesley Publishing, Thousand Oaks, CA1989
        • Burnham D.
        The special-problem patient: Victim or agent of splitting?.
        Psychiatry. 1966; 29: 105-122
        • Climo L.H.
        Helping some state hospital mental patients make small but necessary changes: Transference openings from countertransference traps.
        Community Mental Health Journal. 1983; 19: 129-136
        • Cohen M.B.
        Countertransference and anxiety.
        Psychiatry. 1952; 15: 231-243
        • Colson D.B.
        • Allen J.G.
        • Coyne L.
        • Deering D.
        • Jehl N.
        • Kearns W.
        • Spohn H.
        Patterns of staff perception of difficult patients in a long-term psychiatric hospital.
        Hospital and Community Psychiatry. 1985; 36: 168-172
        • Dunkel J.
        • Hatfield S.
        Countertransference issues in working with persons with AIDS.
        Social Work. 1986; 31: 114-117
      1. (Unpublished)
        • Ens I.C.
        Countertransference: A human response to caring.
        in: master's thesis. University of Alberta, Menlo Park, CA1993
        • Forrest D.
        The experience of caring.
        Journal of Advanced Nursing. 1989; 14: 815-823
        • Forsyth G.L.
        Analysis of the concept of empathy: Illustration of one approach.
        Advances in Nursing Science. 1980; 2: 33-42
      2. (J. Riviere, Trans.)
        • Freud S.
        Future prospects for psycho-analytic therapy.
        (Original work published 1910)in: Jones E. Collected papers. Vol. 2. Basic Books, Edmonton, Alberta, Canada1959: 289
        • Godschalx S.M.
        Mark: Psychotherapy with a developmentally disabled adult.
        Image: The Journal of Nursing Scholarship. 1983; 15: 12-16
        • Grunebaum H.U.
        • Klerman G.L.
        Wrist slashing.
        American Journal of Psychiatry. 1967; 124: 527-534
        • Hanke N.
        Handbook of emergency psychiatry. Collamore Press, New York1984: 219-228
        • Heimann P.
        On counter-transference.
        International Journal of Psycho-Analysis. 1950; 31: 81-84
        • Holden R.J.
        Empathy: The art of emotional knowing in holistic nursing care.
        Holistic Nursing Practice. 1990; 5: 70-79
        • Irvine A.F.
        in: Fischer C. Etchells A.B. Proceedings of the Pacific Northwest Bioenergetic Conference, Whistler, British Columbia, Canada1988: 1-11
        • Jacques R.
        • White W.
        Projective identification in countertransference: Its energetic origins and therapeutic implications.
        in: Fischer C. Etchells A.B. Proceedings of the Pacific Northwest Bioenergetic Conference, Whistler, British Columbia, Canada1988: 38-46
        • Johnson G.B.
        • Werstlein P.O.
        Reframing: A strategy to improve care of manipulative patients.
        Issues in Mental Health Nursing. 1990; 11: 237-241
        • Kaplan C.A.
        The challenge of working with patients diagnosed as having a borderline personality disorder.
        Nursing Clinics of North America. 1986; 21: 429-438
        • Kernberg O.F.
        Notes on countertransference.
        Journal of the American Psychoanalytic Association. 1965; 13: 38-56
        • Kernberg O.F.
        Borderline conditions and pathological narcissism.
        in: Jason Aronson, Lexington, Mass.1975: 49-67
        • Klein M.
        Notes on some schizoid mechanisms.
        International Journal of Psycho-Analysis. 1946; 27: 99-110
        • Lakovics M.
        Classification of countertransference phenomena and its application to inpatient psychiatry.
        Psychiatric Journal of the University of Ottawa. 1983; 10: 132-138
        • Langs R.
        The technique of psychoanalytic psychotherapy. Volume II. Jason Aronson, New York1974: 292-376
        • Lego S.
        The American handbook of psychiatric nursing. J.B. Lippincott, New York1984
        • Lego S.
        Multiple personality disorder: An interpersonal approach to etiology, treatment, and nursing care.
        Archives of Psychiatric Nursing. 1988; 2: 231-235
        • Lego S.
        The fear of moving beyond one's parents.
        Perspectives in Psychiatric Care. 1990; 26: 28-31
        • Little M.
        Counter-transference and the patient's response to it.
        International Journal of Psycho-Analysis. 1951; 32: 32-40
        • Little M.
        British Journal of Medical Psychology. 1960; 33: 29-31
        • Main T.F.
        The ailment.
        British Journal of Medical Psychology. 1957; 30: 129-145
        • Maltsberger J.T.
        • Buie D.H.
        Countertransference hate in the treatment of suicidal patients.
        Archives of General Psychiatry. 1974; 30: 625-633
        • Marck P.
        Therapeutic reciprocity: A caring phenomena.
        Advances in Nursing Science. 1990; 13: 49-59
        • Mark B.
        Hospital treatment of borderline patients: Toward a better understanding of problematic issues.
        Journal of Psychosocial Nursing and Mental Health Services. 1980; 18: 25-31
        • McMahon A.L.
        Nurse-client relationship.
        in: Haber J. McMahon A.L. Price-Hoskins P. Sideleau B.F. Comprehensive psychiatric nursing. 4th ed. Mosby-Year Book, Philadelphia1992: 159-177
      3. 3rd Edition. Mosby's Medical and Nursing Dictionary. C.V. Mosby, St. Louis1990
        • Paternostro J.M.
        Working in psychiatric research: Answers tomorrow, dilemmas today.
        Perspectives in Psychiatric Care. 1991; 27: 33-36
        • Racker H.
        The meanings and uses of countertransference.
        Psychoanalytic Quarterly. 1957; 26: 303-357
        • Reiser D.E.
        • Levenson H.
        Abuses of the borderline diagnosis: A clinical problem with teaching opportunities.
        American Journal of Psychiatry. 1984; 141: 1528-1532
        • Relling-Garskof K.
        Transferring the past to the present.
        American Journal of Nursing. 1987; 87: 477-478
        • Rodgers B.L.
        Concepts, analysis and the development of nursing knowledge: The evolutionary cycle.
        Journal of Advanced Nursing. 1989; 14: 330-335
        • Sandier J.
        • Holder A.
        • Dare C.
        Basic psychoanalytic concepts: IV. Countertransference.
        British Journal of Psychiatry. 1970; 117: 83-88
        • Savage C.
        Countertransference in the therapy of schizophrenics.
        Psychiatry. 1961; 24: 53-60
        • Schroder P.J.
        Recognizing transference and countertransference.
        Journal of Psychosocial Nursing. 1985; 23: 21-26
        • Sebree R.
        • Popkess-Vawter S.
        Self-injury concept formation: Nursing diagnosis development.
        Perspectives in Psychiatric Care. 1991; 27: 27-34
        • Slakter E.
        Jason Aronson, Inc., St. Louis1987
        • Stamm I.
        Countertransference in hospital treatment: Basic concepts and paradigms.
        Bulletin of the Menninger Clinic. 1985; 49: 432-450
        • Stem A.
        On the counter-transference in psychoanalysis.
        Psychoanalytic Review. 1924; 11: 166-174
        • Taffel R.
        In praise of countertransference.
        Family Therapy Networker. 1993; 17: 52-57
        • Tudor G.E.
        A sociopsychiatric nursing approach to intervention in a problem of mutual withdrawal on a mental hospital ward.
        Psychiatry. 1952; 15: 193-217
        • Venn E.S.
        • Derdeyn A.P.
        Working with a difficult adolescent.
        Journal of Psychosocial Nursing. 1988; 26: 28-31
        • Winnicott D.W.
        Hate in the counter-transference.
        International Journal of Psycho-Analysis. 1949; 30: 69-74
        • Winnicott D.W.
        British Journal of Medical Psychology. 1960; 33: 17-21