Transference, countertransference, and abuse in psychotherapy

The complex factors that can lead to either creative or destructive experiences in psychotherapy for both patients and therapists are explored with reference to the treatment of patients with a history of abuse. Particular emphasis is placed upon the formation of an intermediate space, in which a safe therapeutic environment is established, allowing for the creative interplay of past and present. The concepts of the transitional object, transitional phenomena, and projective identification are defined and amplified in explaining how they help to determine whether a safe therapeutic space is achieved, or whether destructive, abusive experiences are re-created, for both patient and therapist. In addition, the importance of the therapist's capacity to tolerate the ambiguity and uncertainty of psychotherapy is elaborated. The relationship between these formulations and the therapist's countertransference is emphasized. Also described is the importance of supervision in helping therapists--during training and throughout professional life--to discuss shame-arousing experiences with their patients.