BRIEF
COMMUNICATIONS
phenomenon
in that
termediate “not me”
link between therapist.
the unpaid
money
the
becomes
“me”
patient
an inand
CONCLUSIONS
the rid
Finally, a common syndrome exists in which patients use residents’ countertnansfenence rescue fantasies on guilt about money for the purpose of blackmailing them to remain silent about financial issues. The important and central theoretical and clinical points here are that regardless of meaning, when a
patient
directly
ate
and
fee
or indirectly
the
therapist
refuses ignores
tually denying a significant apy is sabotaged.
the
two
ofneality
Issues related to the technical management cial aspects of the resident-patient relationship certainly be the subject of discussion during
sony
sessions.
residents
(The
and
here.)
question
its effect
Nevertheless,
therapist penvision
the
BY
practice
mutual
that there is such and thereby the
Inspiration
of personal
on their
mu-
of finanshould supervi-
therapy is also
denial
an issue patient’s
are
and the then-
for
relevant
by patient
undermines treatment.
and the
su-
EDWARD
MESSNER,
dressing
by
therapists
may
adopt can
Medical Hospital,
Zero 1462
them
as
is Assistant
School, Boston,
Emerson Am
these
models
in the
Mass.
Clinical Address
Boston,
J Psychiatry
area.
I . Eissler KR: On some theoretical and technical problems regarding the payment of fees for psychoanalytic treatment. International Review of Psychoanalysis I :73-101 . 1974 2. Pasternack 5, Treiger P: Psychotherapy fees and residency training. Am J Psychiatry 133: 1064-1066, 1976 3. Freud 5: On beginning the treatment (further recommendations on the technique ofpsycho-analysis. I)(19l3), in Complete Psychological Works, standard ed, vol 12. Translated and edited by Strachey J. London, Hogarth Press, 1958, pp 121-144 4. Freud 5: Some character-types met with in psycho-analytic work.I.The’exceptions’(l9l6). Ibid,vol 14, l963,pp3ll-3l5
5. Gedo
J: A note on the non-payment 44:368-371
,
of psychiatric
fees.
Int J
1963
Patients
and respect leading patient’s virtues.
Examples overcoming tion, and calization
for
their a degree
Professor
Psychiatrist,
/33:12,
own
clinician
Although
psycho-
traits
desire
are loyalty;
to acquire
the
perseverance
in
personal handicaps: energy, determinaeffort in pursuing a goal ; verbalization and voof intense emotion while forbearing from
could
probably
compile
impulses; and digEvery experienced a similar
list.
PHENOMENA
to Dr.
behavior.
1976
Harvard
General Messner
countertnansfenence,
identification
,
and
learning may occur along with inspiration, they are diffenent processes. Countertransfenence is a therapist’s emotional response on reaction to a patient that is not entirely conscious and includes some elements in-
of admiration
Massachusetts
December
of such
enactment of their corresponding nity in meeting enormous stress.
features
of Psychiatry,
reprint requests Mass. 02114.
to a conscious
of character
The
exemplary
therapist
and Associate Place,
traits
of personality.
encounter
evoke
Messner
splendid
qualities
who
They
Dr.
possess
PATIENTS
exceptional
a significant role in clinic finances and by more actively ad-
REFERENCES
RELATED MANY
to this
that psychiataspects of psy-
M.D.
Many patients possess such exemplary traits and virtues that their psychotherapists are inspired to emulate them. This process can benefit the clinician and reinforce the therapeutic alliance, rapport, and the spirit ofreciprocity; however, it can also arouse responses by the clinician that are therapeutically detrimental. Awareness ofthis hazard can enable the clinician to avert it and enhance the benefits provided by the patient’s outstanding strengths.
and
themselves
Psychoanal
of Psychotherapists
the impression the monetary
chotherapy. Educators can play both the improvement of training the broadening of resident growth
to pay an appropnithis
piece
This survey confirmed residents tend to avoid
at
appropriate to their current relationship (I , 2). Identification is a form ofautomatic modeling on imitation, the most significant elements of which are not available to consciousness (2). Learning is a process of acquisition
BRIEF
of knowledge, skills, or concepts. Inspiration, in contrast, is a process that is largely available to consciousness and includes strong elements of motivation, energy, and desire. The phenomenon of inspination of the therapist may be classified as part of the nontnansference aspect of the relationship with the patient (3). It is also one of the psychotherapist’s sources of personal enrichment and development (4). I reviewed the literature on countertnansfenence and
other
subjective
experiences
of psychotherapists,
coy-
ering approximately 70 publications from 1924 and found no reference to the phenomenon spiration of the therapist by the patient.
to 1976, of in-
In
other
ways
the
COMMUNICATIONS
inspirational
experience
may
prove detrimental to the patient. It can provoke a sequence of gratitude, obligation, and resentment in the therapist. In some clinicians, it can stimulate rivalry with the patient. It can also arouse feelings of admiration in the therapist that may lead to unfounded expectations of strengths in other areas of the patient’s personality. In addition, inappropriate application of these standards of conduct and character to other patients may have an adverse impact. The inspinational virtues may also arouse envy and defensive comparisons in the clinician. This might lead him to emphasize, inappropriately, his own superiority in oth-
en areas. CLINICAL
CONSIDERATIONS
One ofmy patients, a man crippling physical handicap enormous effort to become
petent.
Eventually
he not
who developed in childhood, autonomous
only
became
a severely exerted and com-
the
source
of
This article was reviewed in preparation by Dr. Aanon Lazane, an Associate Professor of Psychiatry at Harvard Medical School and a skilled and experienced psychotherapist. Since the inspirational phenomenon is a part of many therapists’ clinical experience, Dr. Lazare wondered why it has not been described previously. He conjectured,
financialsupport for his impoverished family but also provided encouragement and love. I had not previously encountered, directly, anyone who had accomplished so much after starting with so little. His determination was immense. I discovered that I wanted to
build
my capacity
to his
for steadfastness
and
for
including
him while
this
patient
nonverbally.
he was
profound
showed
Initially,
depressed.
respect
Following effects ofmy plicitly. This
al
by
a
helpful
it became
patient
enrichment to
cure
to
served
to complicate
ahead
even
greater
more.
He developed
as to give. from close
acceptance
the therapy.
of the countertherapeutic we were able to discuss it exto progress subsided, and he He was personal
the ability
eventually relationships
of himself.
able
Favorable
to to and
effects
of therapy were evidenced by the patient’s own obsenvations, several events and relationships in his life, my opinion (obviously vulnerable to bias), and the views
important
relative
ly occasionally
who
because
loved
him but saw him on-
of geographical
in
ways
that
that
can
and
development
his
neurosis
to our
ways
for
prove
be help
other
In
role
cannot
or
to
to ac-
explained
than
by
see
the
too
it. We
detrimental
to
our
being
counter-
patient’s
direct, may, the
by person-
our
perhaps
simple,
or influ-
us with
understand
sum, us
unwilling
by a patient
a patient
on us is too
might
we are
be inspired
How
impact
threatening in
of therapists
difficulty?
spirational
a threat.
role
we can
processes.
able
in several
it was
Later
my recognition admiration, impediment
receive as well gain satisfaction
ofan
that
neurotic
perseverance
Admiration was associated with warmth, warmth with closeness, and closeness evoked the spectre of loss. Loss and bereavement were crucial to the problems that had brought him to therapy. Consequently, my
moved
in our
transference
admiration
ways,
from
enced
level.
My
.
Perhaps
knowledge
in-
and then,
too react
patient.
(5)
CONCLUSIONS
Psychotherapists of inspiration just
nomena
such
as
need to be alerted as they must with
to the appearance other clinical phe-
countertnansfenence,
transference,
and identification. Particularly at times of difficulty in therapy-e.g. , periods of turmoil on of stagnation-the clinician might do well to include inspiration in his mental checklist of possible causative factors. The clinician’s awareness of hazards offers the possibility
that
they
come. virtues panded,
will
be
anticipated,
neutralized,
Similarly, the beneficial effects can be shared, reflected to and enhanced.
or
oven-
of the inspiring the source, ex-
separation. REFERENCES
COMMENT
The
inspirational
the therapy strengthen
force
the
gethenness
on the
experience
may
as well as to the therapist. the therapeutic alliance.
emotional (4).
patient.
atmosphere
In these
ways
be beneficial
It can serve to It can also rein-
of reciprocity it may
to
reflect
and favorably
to-
I . Reich A: On countertransference. Int J Psychoanal 1951 2. Moore BE, Fine BD (eds): A Glossary of Psychoanalytic and Concepts, 2nd ed. New York, the American
analytic
Association,
32:25-3
1,
Terms Psycho-
1971
3.
Greenson RR, Wexler M: The nontransference relationship in the psychoanalytic situation. Int J Psychoanal 50:27-39, 1969 4. Hora T: Beyond countertransference. Am J Psychother 10:1823, 1956 5. Lazare A: Personal communication, Feb 25, 1976
Am
J Psychiatry
133:12,
December
1976
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