Incest: transference and countertransference implications

It has not been the attempt of this paper to discuss the overall treatment of adults with a history of incest, but rather to elucidate and identify the various transference and countertransference implications that are emergent in psychoanalytic therapy. Despite this, some statements can be made regarding the analysis of these themes and the overall effectiveness of treatment with these patients. Analytically oriented treatment with adults with a history of incest concerns itself with three intertwined aspects. They are the reconstruction, integration, and validation of a past history of trauma (Alpert, 1991; van der Kolk, 1987), the analysis of its impact on self-identity and its effect on the person's object relations. This last component is deeply connected with the analytic relationship. This relationship is initially consciously and/or unconsciously consciously constructed by the patient as one that can typify his or her past and will be characterized by fears of abuse, neglect, and exploitation, as well as wishes and fantasies of merger, idealization, and reparation. "In the patient's psychic reality, the experience of the analytic situation then becomes the trauma, be it seduction or failure to protect" (Levine, 1990). The concept of projective identification explains how the patient may attempt to reenact his or her history and how this may be used as a vehicle for empathy and change. Throughout treatment, the analyst attempts to contain, understand, and make timely interpretations regarding herself, reactions to the patient, and their mutual interactive processes. Even when acting out inevitably occurs, it is hoped that it will be reflected on and eventually understood. At times, this process is shared with the patient and becomes a mutual endeavor. Individuals with a history of incest have been abused and exploited by those on whom they were dependent. The development of a realistic intimacy with the analyst that takes into account and respects each other's boundaries is a therapeutic goal in the treatment of adults who have been sexually abused. This can occur through the successful identification and analysis of transference/countertransference themes and the various projective identifications. Through this, the patient who has been a victim of incest is able to develop a new object relationship that is not characterized by deliberate abuse. As Horner (1987) states, the analyst and patient create a new history together, a new object relationship.(ABSTRACT TRUNCATED AT 400 WORDS)