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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Inspiration of psychotherapists by patients.

BRIEF COMMUNICATIONS phenomenon in that termediate “not me” link between therapist. the unpaid money the becomes “me” patient an inand CO...
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