Psychoanalytic considerations on psychopathology and conceptual research
Löffler-Stastka, H., Szerencsics, M., & Blüml, V. (2009). Dissociation, trauma, affect regulation and personality in patients with a borderline personality organization. Bulletin of the Menninger Clinic, 73(2), 81-98. DOI: 10.1521/bumc.2009.73.2.81
Parth, K., Hrusto-Lemes, A., Löffler-Stastka, H. (2014). Clinical reasoning processes and authentic clinical care for traumatised patients. Journal of Traumatic Stress Disorders & Treatment, 3(4), DOI: 10.13140/2.1.4065.3441
While the association between dissociation and trauma has been the subject of intensive research, the relationship between dissociation, childhood trauma, and personality characteristics has not yet been explored in detail. Patients suffering from a personality disorder completed the Dissociative Experiences Scale, the Childhood Trauma Questionnaire, and the personality and affect regulation measurement instruments SWAP and AREQ. Results are critically discussed within a psychoanalytic framework, which should also help clarify the rather vague concept of dissociation. In this diagnostic context the concept of countertransference is a central foundation pillar of psychoanalytic theory and practice. It has become increasingly influential in other forms of therapy and in neuroscience research into resting-states. It is, like many other concepts in psychoanalysis, characterized by its elasticity and covers a wide range of phenomena inside and outside the clinical sector. Attempts to measure countertransference phenomena empirically, on a quantitative or qualitative level have been avoided for a long time due to ist complexity. Recently however, various methodologies and approaches to conduct empirical research in this field have become more and more successful in documenting the importance of countertransference for treatment of patients in the medical context and as well as for diagnostic purposes. We report here the findings of an exemplary study that surveyed and analysed the role of countertransference in regards to clinical care for traumatised patients. Making use of the Childhood Trauma Questionnaire and the Harvard Trauma Questionnaire, the study compared two groups of patients. One was comprised by patients who could and the other comprised by patients who could not remember having been traumatised, yet suffered from Borderline Personality Disorder and displayed symptoms characteristic for traumatisation. The Countertransference Questionnaire measured the relationship between therapist and patient. The results indicate that the measurement of countertransference feelings in the clinician can be utilized as a crucial tool for understanding unconscious dynamics in traumatised patients. The results suggest that only making use of the concept of countertransference enables accessing those traumatic fears, phantasies and memories that cannot be communicated verbally but only in the relationship to the therapist. Furthermore, the paper discusses these results, their clinical implications and contextualizes them with theoretical concepts and a case study.
Henriette Löffler-Stastka, Assoc.Prof.in Priv.-Doz.in Dr.in
Medizinische Universität Wien, Universitätsklinik für Psychoanalyse und Psychotherapie, Währinger Gürtel 18-20, 1090 Wien