Countertransference: see munchousensbyproxy, did, stockholm syndrome

Often, countertransference is unconscious, and both the clinician nor the client realizes it is happening.

Countertransference is an important reminder that therapists are human beings too and that they have their own biases, history, and emotions which can influence their thoughts and reactions to clients.

In a therapy session, a client might remind the therapist of someone or something from their present or their past. As a result, the clinician might unconsciously treat the client in an emotionally-charged or biased way.

Because of this, clinicians must be aware of countertransference at all times and actively work to acknowledge and overcome it in their practice (Overstreet, 2021).

Countertransference therapy

Countertransference in therapy refers to the emotional reactions, biases, or perceptions that a therapist may have towards a client, influenced by the therapist’s own personal experiences, unconscious feelings, or issues. It can affect the therapeutic relationship and the treatment process.

Take-Home Messages

Countertransference is a therapist’s reaction and feelings toward a client in therapy. It is the opposite of transference or a client’s emotional reaction to their therapist.

Countertransference is a common, unconscious phenomenon that can negatively impact the therapeutic relationship if not properly addressed.

Freud first identified countertransference as a detriment to an analyst’s understanding of their patient. Present-day, countertransference is viewed with a mix of both negative and positive associations in psychology.

What Does Countertransference Look Like?

Countertransference occurs whenever a therapist brings in their own experiences to the extent that they lose perspective of the client’s own and stop being objective (Jacobson, 2022).

Examples of countertransference include when the therapist:

Over-identifies with the client’s stories and shares too many about themselves

Offers a lot of advice instead of listening to the client’s experience

Pushed the client to take action the client doesn’t feel ready for

Wants to relate outside of the therapy room

Inappropriately disclosed personal information

Develops romantic feelings for the client

Does not have adequate boundaries with the client

Is overly critical or supportive of the client

Transference vs. Countertransference

If countertransference is the emotional reaction a therapist might have towards their client, it follows that transference is the opposite: a client’s emotional reaction to their therapist.

Transference is a psychological phenomenon that occurs when a client redirects their feelings for someone from their past or present onto the clinician. This can include their feelings towards a family member, friend, or significant other.

Like countertransference, this phenomenon is mostly unconscious, and the client is likely unaware that they are being influenced by it. Unlike countertransference, transference in therapy is accepted. The therapist can even use transference as a tool to better understand their client’s personal relationships and emotionality.

Countertransference can be thought of as the clinician’s response to a client’s transference (Overstreet, 2021).

However, whereas transference is a normal and accepted part of the therapeutic process, clinicians are responsible for monitoring their countertransference so they remain objective in their therapy and do not harm the client.

Types

There are four types of countertransference, three of which have the potential to harm the therapeutic relationship (Fritscher, 2021).

Subjective

In subjective countertransference, the therapist’s own unresolved issues are the cause. In other words, experience from the therapist’s own history is re-experienced in response to their client.

An example of this includes a therapist who fears anger due to a family history of aggression, so they discourage any expression of anger from their client. This subjective form of countertransference can be harmful if not detected.

Objective

In objective countertransference, the therapist’s reaction to their client’s maladaptive behaviors is the cause. Maladaptive behaviors are behaviors that inhibit one’s ability to healthy cope or adjust to certain situations. Most people would have the same reaction to this person; thus, the therapist’s reaction is “objective.”

Unlike subjective countertransference, objective countertransference can actually benefit the therapeutic process. For instance, if the therapist can accept and study this objective reaction they have to their client, they can use this countertransference as an analytical tool.

Positive

Positive countertransference is present when a therapist is over-supportive of their client. Signs of over-support can include when a therapist is trying too hard to befriend their client, disclosing too much from their personal life, or over-identifying with their client’s experiences.

This can harm the therapeutic relationship as it diminishes professional boundaries and keeps a therapist from working and treating their client with objectivity.

Importantly, some psychologists believe that this positive form of countertransference can actually have beneficial outcomes by improving the therapist-client relationship.

Negative

Negative countertransference occurs when a therapist acts out against uncomfortable feelings in a negative way. This includes being overly critical of the client, punishing them, rejecting them, or disapproving of the client.

Negative countertransference is also evident when the therapist feels bored, irked, paralyzed, or contemptuous in their therapy with a particular client.

Countertransference is especially problematic when it is negative, as it can further harm a client’s psyche and lead to therapy doing more harm than good.

I was with Prichards for 26 years, on and off. How are you not seeing patterns yet? I'm trying to help multiple people here. Lost in the system.

See also: Stockholm Syndrome, DID

Munchausen syndrome and Munchausen syndrome by proxy: a narrative review

ABSTRACT

The Munchausen syndrome and Munchausen syndrome by proxy are factitious disorders characterized by fabrication or induction of signs or symptoms of a disease, as well as alteration of laboratory tests. People with this syndrome pretend that they are sick and tend to seek treatment, without secondary gains, at different care facilities. Both syndromes are well-recognized conditions described in the literature since 1951. They are frequently observed by health teams in clinics, hospital wards and emergency rooms. We performed a narrative, nonsystematic review of the literature, including case reports, case series, and review articles indexed in MEDLINE/PubMed from 1951 to 2015. Each study was reviewed by two psychiatry specialists, who selected, by consensus, the studies to be included in the review. Although Munchausen syndrome was first described more than 60 years ago, most of studies in the literature about it are case reports and literature reviews. Literature lacks more consistent studies about this syndrome epidemiology, therapeutic management and prognosis. Undoubtedly, these conditions generate high costs and unnecessary procedures in health care facilities, and their underdiagnose might be for lack of health professional's knowledge about them, and to the high incidence of countertransference to these patients and to others, who are exposed to high morbidity and mortality, is due to symptoms imposed on self or on others.

Keywords: Munchausen syndrome, Munchausen syndrome by proxy, Child abuse, Factitious disorders

INTRODUCTION

The term “Munchausen syndrome” was first described in 1951 by Asher( 1 ) to characterize individuals who intentionally produce signs and symptoms of a disease and who tend to seek medical or hospital care. Later, in 1977, Meadow used the term “Munchausen syndrome by proxy” to describe children whose mothers produce histories of illness to their children and who support such histories by fabricated physical signs and symptoms, or even by alter laboratory tests.( 2 )

The term “Munchausen” is associated with Baron Münchhausen (Karl Friedrich Hieronymus Freiherr von Münchhausen, 1720-1797), to whom fantastic and unreal stories about his life and experiences were attributed.( 2 )

Our study reviews the literature about Munchausen syndrome and Munchausen syndrome by proxy. This is a narrative, non-systematic review including case reports, series of case reports, and reviews indexed in PubMed from the first paper published on this subject in 1951 to November 2015. We used the following keywords “Munchausen syndrome”, “Munchausen syndrome by proxy” and “factitious disorders”.

Each study was reviewed by two psychiatric specialists who later, in consensus, selected relevant studies to be included in the review, considering clinical, epidemiogical and treatment-related aspects of these syndromes. In addition, other relevant studies based on judges’ experience by the specialists were included in our review, i.e., state of the art papers about those conditions.

This review seeks to provide basic information on both syndromes for students and health professionals (mainly non-specialists) interested in a general panel of these conditions generally unknown or misdiagnosed, however, seen in emergency rooms, clinical or surgical units or other health care settings. Munchausen syndrome and its variant forms are challenges faced in clinical and surgical practice. For this reason, to briefly review these conditions is important and justified in order to further understand these frequently unrecognized affections.

CLASSIFICATION AND CLINICAL PRESENTATION

Currently, despite the disseminated use of the term “Munchausen syndrome,” no nosological entity for these two syndromes is described in the International Classification of Diseases. Munchausen syndrome was included in the tenth edition of the International Classification of Diseases( 3 ) and classified as intentional production or feigning of symptoms or disabilities either physical or psychological (factitious disorder). Munchausen syndrome by proxy is classified in the category T74.8, i.e., abuse of children, although this term is also used to refer to elderly or disabled person and/or dependent adults who signs or physical symptoms are created by a caregiver and whose laboratory tests were altered.( 4 )

Munchausen syndrome has also been called “hospital addiction”, “polysurgical addiction,” and “professional patient syndrome"

The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), defines factitious disorders as those imposed on self and on other (previously called “factitious disorders by proxy”).( 5 )

If you're not seeing patterns, I can't help you. Somethings are real. by proxy. Substance abuse is not my problem. The problem lies closer to home(s). Are we catching up yet? Trying to help you, here. I'm not the only one. There are definitely others. They may not be aware. The hospital system is wasting money on diagnostic bullshit when it could solve problems. Just ask IMA. Ask City Center. Clozaril is not my medicine. Prichards is not a magic maker, and this shit ain't kosher. WASTE OF PUBLIC FUNDING. Overmedicalization. DSM vagueness. Perfectionism in medicine. I bet SB sees patterns.

Health

Dear Members of the Community,

Please stop analyzing my health and personal habits. It's wearing me out. It's counterproductive. If you ever want me to stop living in hospitals and doctors' offices, you'll stop asking. Driving me to drink with this shit. Seriously, I'm not a science experiment. I swear to God on one side I've got the medicalization crowd that wants to hyper analyze every perceived fault and on the other the bullshit crowd that knows it's all a load of internalized crap dressed up as DX's. It makes no sense.

Thank you,

Ashes

Plan

I've been asked what the plan is a lot. You may not be familiar with how serious "medically complex" or DID are. It's not exactly hospice, but prognosis isn't great. Permanent disability. Not a normal life. Maybe I'll have a relationship, maybe not. We all gotta die someday. Maybe it will get better. But as the book title says, the body keeps the score. Pretty clear I lost. So, I have to conserve my energy. I may look ok. I promise you; I am not. One too many falls, and all the king's horses and all the king's men... I was trying to work. I'm told that's not realistic. So, I'll try to write. Maybe something will change. Maybe not. I'll let the kids have their turn. Broken mind. Not evil, just broken. Yeah, it's dark. It is what it is. Too tired to fight. You know, I think I'll have one of those parties' people sometimes have when they become terminal. I'd like the process to be happy... ish. Too much medical manipulation. I need to take time to understand this better. It's not that I'm dying anytime soon... but it's coming. Somethings only God can control. It's easier to tell everyone at once, rather than one at a time.

OK, maybe it's not quite that bad. But some people don't know how to mind their own business. They're too busy shaming and manipulating lesser mortals. One of these days I'll rediscover the meaning of "right to privacy". I don't understand why MIP engages with categorizing and demonizing people to such an extreme. Medicalized perfectionism.