Countertransference in the initial care of victims of sexual and urban violence: To assess therapists' countertransference during initial care of female victims of sexual and urban violence with the aim of investigating influence of therapist's gender, type and moment of trauma. This study used qualitative and quantitative methods of data analysis. Reports were classified into six groups according to therapist's gender and type of trauma.
A content analysis and a statistical analysis of the data were performed.
Transference countertransference doctor patient sexual harassment of both genders presented a prevalence of feelings of closeness when providing care to victims of sexual violence. Therapists of both genders presented a prevalence of feelings of closeness when providing initial care to patients victims of sexual violence.
Male therapists who provided care to victims of urban violence presented a prevalence of feelings of distance. Further studies are needed for a better understanding of therapeutic relationships in the care of victims of psychic trauma.
Countertransference, sexual violence, urban violence, psychic trauma, psychotherapy. The concept of countertransference, introduced by Freud 1 and developed by other authors, is essential in current psychoanalytical theory and technique, which consider the feelings awakened by the patient in the therapist as powerful tools to understand the patient's communication and internal world. Based on the growing recognition of the importance of the therapist's mind and of the therapeutic field established between the pair, new theories and empirical research studies have been developed.
Gabbard 8 stresses that nowadays there is a consensus in considering the usefulness of countertransference to understand the patient, being a "joint creation" of the therapeutic pair. In addition, characteristics of the therapist's real person have been widely discussed, such as gender, training stage and age group, which could be associated with constant countertransference patterns and that could have a direct implication in choice of therapists according to characteristics of clinical and patient's situation.
Empirical studies on countertransference are not commonly found in the literature yet, although their importance is clear in a recent article by Betan et al. Despite the singularity of each therapeutic pair, significant correlations have been demonstrated between specific countertransference feelings and symptoms of personality disorders.
This suggests that countertransference responses may occur in coherent and predictable patterns, strengthening their use in diagnostic understanding and in patients' understanding and treatment. The authors
Transference countertransference doctor patient sexual harassment the possibility and relevance of screening countertransference patterns aroused by patients with different psychiatric diagnoses or in those who share certain experiences, such as history of sexual violence.
Studying the feelings aroused by patients victims of sexual violence is important, since besides being intense, such feelings are often barriers against treatment success. Therapists can be the first to identify, through themselves, patients' anger, fear, shame and insecurity, since they are not initially conscious of their affective experiences. Such feelings are often intolerable and contradictory, usually reproduced and vividly re-experienced during the treatment by the therapeutic pair, and can threaten both and create impasses if they are not properly recognized and elaborated.
The moment in the patient's life in which a situation of sexual violence occurred is associated with the development of specific forms of psychopathology, especially mood and personality disorders, which could also be related
Transference countertransference doctor patient sexual harassment specific countertransference responses. Violence is the second main cause of overall mortality in Brazil, which is the fourth country with the highest prevalence rate of homicides in the world. Gay bloqjob
The mortality rate due to external causes is The possibility of understanding the emotional responses aroused during such contacts may help therapists recognize and manage their countertransference feelings.
Thus, there would be fewer chances of such countertransference feelings becoming larger obstacles to the development and maintenance of a proper therapeutic relationship. Considering that providing care to victims of violence, especially sexual violence, is a challenge to mental health professionals - clinical psychiatrists, psychotherapists or psychoanalysts - and that the number of people exposed to these situations has been dramatically increasing, this study aimed at evaluating countertransference responses aroused in therapists during initial care of patients victims of psychic trauma.
The influence of therapist's gender, type and moment of trauma in such reactions was investigated. Taking into account the complexity of the phenomenon under investigation countertransferencewe chose to combine qualitative and quantitative analysis methods, in the sense of increasing reliability of findings.
That outpatient clinic provides
Transference countertransference doctor patient sexual harassment to patients victims of psychic trauma referred by primary, secondary and tertiary care services in the municipality. After the first appointment with the patient, therapists were required to freely and anonymously register what they had felt when providing care. Reports were classified into six groups according to therapist's gender and type of trauma sexual violence in childhood, current sexual violence and other traumas by one of the authors.
At that time,
Transference countertransference doctor patient sexual harassment references made to the moment and type of trauma, as well as to the therapist's gender were excluded from the reports, without compromising their content.
Later, three other authors performed a blinded content analysis of the reports, without knowing their classification. Content analysis 24 is a research methodology used to describe and interpret the content of documents and texts, helping reinterpret messages and reach an understanding of their meanings at a level that goes beyond a common reading.
Content analysis was started by reading the material, followed by a division into units of analysis, defined as representative words within a sentence, such as, for example: It was possible to establish two categories of interest based on reported feelings, grouping units of analysis into feelings of closeness or distance.
Units that were not characterized by such feelings were not considered. Processes of unitarization and categorization were performed individually by two authors and, later, as a whole through consensus. In case of lack of consensus, decision was made by a senior author, after discussing the material.
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Patients' demographic characteristics, stratified by nature of trauma, were compared using ANOVA for continuous variables age and Fisher's exact test for categorical variables ethnic group, marital status, schooling level.
Fisher's exact test was used to compare categories of feelings between gender and type of trauma, followed by a test of multiple comparisons, using the software WINPEPI, Module Compare2, version 1. Patients and therapists were not identified at any moment of the study.
All participants signed a consent term. Throughout the study, 36 patients met the inclusion criteria.
Of these, 13 were victims of sexual violence in childhood; 15 of current sexual violence; and eight of other traumas. All reports of countertransference feelings described after the first appointments of all patients were included in this study. Table 1 shows patients' demographic characteristics; there were no statistically significant differences between groups.
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The total number of units of analysis of these reports was ; 98 corresponded to feelings of closeness and 43 to feelings of distance. Clique here to enlarge. Influence of type of psychic trauma on countertransference pattern of male
Transference countertransference doctor patient sexual harassment female therapists was individually investigated. The following vignettes taken from care provided to patients with the three different types of trauma, performed by female therapists, illustrate the reports.
She also aroused curiosity and interest in me;" "Initially she aroused marked hopelessness and much pity, and much discomfort too. During
Transference countertransference doctor patient sexual harassment session, I felt sad and willing to help, but with a great feeling of immobility.
When compared to other groups current sexual violence and sexual violence in childhoodsuch frequency had a statistically significant difference in relation to frequency of feelings of distance in cares provided to victims of sexual violence in childhood 55 vs. Next are some vignettes of cares provided by male therapists to victims of robbery or to those who had family members murdered: I felt a prevalence of impotence, with hopelessness and a great despair;" "I felt immobility and feeling of shock from the details of the trauma, sometimes feeling afraid and worried about the vulnerability of people to tragedies;" "From the start, the patient caused me a certain lack of sympathy, a certain distance, perhaps difficulty in identifying with the situation and tending to devalue the patient's suffering.
Based on what can be observed from the statements above, the impact of those cares triggered in male therapists feelings of impotence, hopelessness and fear of being involved in a situation beyond their management ability, which possibly aroused deeper anxieties, of a confusional or persecutory nature.
These might have led to attitudes of distance and strangeness toward the patients, avoiding the danger of closer identifications. The influence of therapist's gender on countertransference feelings was analyzed, stratified by type of trauma.
This study used a qualitative method - content analysis - to evaluate countertransference responses by undergraduate therapists in the initial care of female patients victims of sexual and urban violence. Results show a prevalence of feelings of closeness when compared with feelings of distance in the therapists' reports. Care of victims of urban violence aroused, in male therapists, a higher number of feelings of distance than care provided to victims of sexual violence in childhood 55 vs.
Transference countertransference doctor patient sexual harassment sexual violence in childhood is associated with the development of psychopathology in adult age, ,26,27 which according to empirical findings, would arouse specific countertransference responses.
Betan 12 found significant
Transference countertransference doctor patient sexual harassment between different classes of countertransference and specific symptoms of personality disorders, like Brody 21 and Mclntyre, 20 who demonstrated an equally significant relationship between patient's diagnosis and countertransference pattern. Opposed to these findings, Holmqvist 28 did not find associations between organization of the patient's personality and types of feelings in the therapist, contributing to the discussion of this theme, which is still controversial.
The results of the present study showed a prevalence of countertransference responses of closeness, such as interest, empathy, sadness, both in patients victims of sexual violence in childhood and over the past 3 months. This finding can be related to the occurrence of specific psychopathology after sexual violence in adult women with no history of sexual violence in childhood, as shown by Faravelli. The study of patients victims of non-sexual trauma was due to the hypothesis that there would be a characteristic "Transference countertransference doctor patient sexual harassment" in patients victims of sexual violence, as shown by Faravelli, 29 with consequent differences in countertransference feelings.
Our findings revealed a prevalence of feelings of closeness in relation to all groups of patients, regardless of type of trauma and therapist's gender, except for patients victims of non-sexual trauma receiving care by male therapists. There is a reduced number of studies on countertransference when providing care to patients victims of non-sexual trauma, 30,31 besides a lack of data relating this theme to the therapist's gender.
Brazil. After the first visit...
One hypothesis to be evaluated is that prevalence of feelings of distance experienced by male therapists when providing care to victims of urban, non-sexual violence is related to a feeling of vulnerability, considering the highest prevalence of violent crimes against men in Brazil, which would not occur in terms of sexual violence. Influence of therapist's gender in the development of a relationship with the patient and in the treatment has been investigated with growing interest.
A common idea among many psychoanalytical authors is that it is not "actual" therapist's gender that will have a more relevant influence on treatment process, but their technical abilities, professional experience, personality traits and self-knowledge. Empirical studies in patients with specific diagnoses show divergent results. Zlotnick 34 and Mclntyre 20 did not find differences in countertransference feelings due to therapist's gender in the care of patients with major depressive disorder and borderline personality disorder.
Latts, 35 in a study in patients victims of sexual violence, observed a significantly higher prevalence of avoidance responses in male therapists, compared with female therapists. A study carried out in our country evaluated mental status and countertransference responses of male and female psychotherapists after reading real clinical vignettes, one related to a case of rape, and another about a case of mourning.
More negative countertransference reactions were identified after reading about the rape; female therapists were more reflexive, and male therapists expressed more negative reactions in both cases. The results of the present study pointed to a similarity in countertransference responses between
Transference countertransference doctor patient sexual harassment gender in the care of patients victims of sexual violence. Latts 35 found that female therapists were more able to use empathy than male therapists when providing care to these patients, even in contact with a situation that could expose them more intensely to a feeling of vulnerability.
However, such finding was not replicated in our sample. It is important to consider that the report made by the therapist occurred after their first contact with the patient and their history, usually in a moment of great emotional burden for the pair. It is also relevant to stress the fact that all therapists were in the beginning of their professional formation, with fewer tools to deal with a potentially difficult countertransference situation.
Even with such characteristics, which could lead to prevalence of distance or immobility responses, there was a higher number of reports of feelings such as curiosity, desire to help, pity and interest in therapists of both genders. One may assume that both male and female therapists can use empathy to moderate the anxiety
Transference countertransference doctor patient sexual harassment in countertransference when providing care to women victims of sexual violence.
It is necessary to understand the results taking into account the study limitations. It is a clinical sample, with a reduced number of patients, receiving care by undergraduate therapists, in a program dedicated to provide treatment for patients victims of violence.
Such characteristics restrict result generalization.
Occurred. 2) What is transference...
With regard to stage of therapist's professional formation, there is evidence that it is associated with how countertransference reactions are dealt with. As to number of patients included, although small, it is necessary to consider that there are important barriers against patients victims of sexual violence seeking treatment, which makes the study of this clinical situation difficult.
Since it is a situation of undeniable emotional impact, it is also worth stressing that use of psychoanalytic theoretical instruments is particularly relevant in this study. Not only for being used in a research project, but also for the possibility of aroused countertransference feelings being discussed in supervision and used as a compass to guide subsequent therapeutic management. We used a qualitative methodology, content analysis, so that reports of countertransference feelings - subjective - could be better understood.
Objective instruments, although relevant, are not sufficient to capture the complexity of countertransference experiences, which end up by being reduced. This study aims at exposing and discussing its findings, raising research questions, without the objective of confirming obtained results, neither extrapolating them to other populations. Proper and deep understanding of countertransference feelings when providing care to victims of violence could bring significant benefits to the therapist's formation, focusing on the presence of basic psychoanalytic concepts,
Transference countertransference doctor patient sexual harassment well as to patient treatment and Transference countertransference doctor patient sexual harassment. Results showed that therapists of both genders presented a prevalence of feelings of closeness when providing initial care to women victims of sexual violence.
Based on these findings, we consider that male therapists, as well as female therapists, are able to empathize and tune themselves affectively with their patients during that moment of treatment.
The medical world is not...
Occurred. 2) What is transference and countertransference and why is it important to attend The Misuse of Power: Professional Sexual Misconduct The doctor-patient relationship is ripe for evoking powerful transference enactments. Sexual abuse of patients within professional relationships is not an easy
Transference countertransference doctor patient sexual harassment to face up to. . resolve transference and counter transference issues and therefore .
gynecologists, and medical doctors with their clients, and 13% erotic. The medical world is not immune to issues of sexual harassment, physicians who experience harassment at the hands of patients and who are not your own countertransference reaction, as opposed to a patient's obvious.