Anders Zachrisson
September, 2008
Therapeutic setting and therapeutic attitude
Introduction
Intensive psychotherapy refers to a tradition of psychoanalytic and psychodynamic
psychotherapies. They aim towards a thorough understanding and working-through of
unconscious conflicts and character traits. Central therapeutic concepts are free association,
resistance and transference/countertransference. The medium for the therapeutic process is the
relationship between patient and therapist, and for this process to enfold, it has to be placed in
a setting. This goes for child and adolescent as well as for adult psychotherapy.
In this lecture I will discuss the treatment situation, often referred to as therapeutic
setting and the mental and intellectual attitud of the therapist, the therapeutic attitude of the
therapist. I will shortly comment on three aspects of the therapeutic setting, and hope that they
will form a supplement to Lydia’s presentation:
1.
The surrounding frame. The concrete outer facilities, the room, the therapist’s
appearance and behaviour, and the concrete rituals which frame the interaction
between the patient and the therapist.
2.
The rules of the game. The fixed, fundamental rules, which regulate the interaction and
the situation, e.g. the rules of abstinence and of confidentiality and the basic rule of
free association.
3.
The therapist’s attitude. The intellectual and emotional attitude, which characterizes
the therapist’s work. It comprises professionalism, neutrality, matter-of-factness,
empathic attunement, dependability, the containment of unbearable feelings; in
addition the analytic attitude includes listening with an evenly suspended attention.
Therapeutic setting
Psychotherapy takes place in the relationship between the therapist and the patient. The
central material for the treatment process consists of the way the patient experiences and
relates to the therapist. The core of this way of thinking is that the patient unconsciously
repeats characteristic traits from his original and important relationships in his way of
experiencing the therapist. This is the phenomenon of transference. This is not, however, an
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one-way traffic. How the therapist experiences and behaves towards the patient is also an
important part of the treatment situation. The concept of countertransference refers to this: to
the therapist’s unconscious response to the patient’s transference of emotions and fantasies.
Countertransference is a disturbance of the therapist’s ordinary manner of working and
behaving. Something irrational is activated in the therapist’s experience of the patient.
Because of this, he is brought out of his normal therapeutic position. Originally,
countertransference was considered to be something unwanted, almost shameful. It was
regarded as a sign of unanalyzed conflicts in the therapist, indeed a defect in the therapist’s
education or personality. From about 1950, the phenomenon has been recognized to be
something inevitable, and a sign of important things happening in the process; something
which brings about strong transferences from the patient and which, at the same time touches
and affects the therapist. By being attentive to his own reactions and trying to make them
conscious, the therapist can actually use the countertransference in order better to understand
what is happening in the relationship, and what kind of transferences from the patient he is
subjected to.
Countertransference brings the therapist out of his therapeutic position. The
formulation presupposes that the therapist normally is “in position”, and then experiences a
disturbance of this position. This can also be said in this way: The therapeutic setting has been
disturbed and must be restored.
The restoration of the disturbed position is based upon the therapist’s attitude. With
the help of an internalised attitude, the therapist tries to observe when he is out of position and
so to restore his therapeutic position. This way of understanding gives the concept of attitude
a special position in the therapeutic setting. The therapeutic attitude helps us to monitor and
maintain the setting. We can in fact say that the setting both is created and maintained by the
therapist’s attitude.
It is the therapist who can fall out of position, not the patient. Also, the therapist is the
one who can break the therapeutic frames, not the patient. If a patient hits the therapist, there
is no point in saying that the patient has broken the rules of the game. The patient has acted
upon an impulse, either because of the strength of the emotions, or because of a regressive
weakening of control. The therapist’s interventions must, as always, be directed towards an
understanding of these forces. There is no point in reproaching the patient for breaking the
rules. On the other hand, the therapist must protect his life and health. As Winnicott says: The
therapist’s first duty is to survive the treatment.
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A vignette
I am going to give a vignette in order to strike a note for this way of thinking.
A woman had been in psychotherapy some years because of a paralysing anxiety. She
had developed a strong dependency of her therapist, whom she idealized and tried to protect
from her rage. The episode I will tell about took place when her father unexpectedly died. It
happened on a Saturday. Her sessions were on Tuesdays and Fridays. She did not try to get in
touch with her therapist. Perhaps the possibility didn’t even occur to her. Instead she did
something else. She walked down to the bus-stop and rode with the bus like she usually does
on her way to sessions. She walked up to the house where her therapist had his office and
stopped in front of the entrance door. After a short while, she turned and walked back to the
bus-stop and rode back home - as if she just had had a therapy session. She did not ring the
bell, in case the therapist, just by chance, should have been at his office this Saturday
afternoon. Her point was obviously not to talk to her therapist, but to restore, or strengthen,
her relationship to him in her inner world. A less deeply injured patient would have been able
to bring forth the image of and relationship to her therapist in her mind; in order to find
support in a crisis. This patient lacked the necessary stability in her relations to primary
objects. She lacked the necessary object constancy to be able to manage this mentally, i.e. in
her mind. She needed a more concrete kind of help. By carrying through the journey to the
office, she was able to consolidate her inner relationship to her therapist. Perhaps we can say
that she, by her journey, recreated the therapeutic setting in her mind. Probably, this “therapy
session”, which she gave herself, also helped her to keep her therapist alive in her inner world
when her father died.
The surrounding frame
The room is a central concept in psychotherapy. This goes for both the very concrete meaning
(the room where the sessions take place), and as a metaphor for the psychic, emotional room
where the therapeutic interplay unfolds. The metaphor has been given a further depth of
meaning by Bion’s concept containment (of projective identifications). This means to contain,
to give mental room for whatever is present in patient’s mind, a room for what is unbearable
for the patient.
The therapy situation can in a way be compared to the vulnerability of the suckling
situation of mother and baby. So, we try to protect the situation. We pull out the telephone
jack. We let in fresh air between sessions and we turn on a red light outside the door. The
point is, that we, as therapists, try to offer a quiet room and a safe place; a room in which it is
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possible to think and feel; a room where attention can be directed towards the main theme of
the therapy: the inner world of the patient. A room, where the emotional, psychic reality can
stand out and find its shape.
The comparison to the mother-infant relationship makes a point, even though it only
partly is relevant. It emphasizes that the therapeutic relationship often unfolds on a track
which is infantile, emotional, vulnerable, and which goes parallel to a track that is more adult,
rational and reasonable. Simultaneously, under the surface, we find the wordless undercurrent
where perhaps the very aspects of the original mother-child relationship are re-activated. This
is often experienced by the patients with the same overwhelming, vulnerable dependency, the
same excoriation and helplessness as they felt as infants.
Children often think that the therapist lives in the consulting room, i e always is there.
And it is not unusual that adult patients, in the termination phase of the therapy, express their
worries that the therapist will not remain in the consulting room in the years to come. A child
in psychotherapy illustrated this connection between the therapist as a person (his inner room)
and the consulting room. The therapy started in the big play therapy room in the clinic, used
by many therapists, but was later moved to the therapists office, which of course was much
smaller. Nevertheless, when entering the room, the child exclaims: such a big room. We can
understand this as an expression of the feeling to move from a room that certainly was big,
but not really the therapist’s own; and into the therapist’s own room, getting more space in his
mind.
I will try to summarize these points:
It is important that the frame, and the room, we offer is relatively sheltered, safe and
predictable. We try to communicate a matter-of-fact note and an atmosphere of seriousness:
“This is a place for labour. This kind of work has been done before”. The therapeutic sessions
are often rather unpleasant and uncomfortable for the patient, occasionally also for the
therapist. There is no reason for wrapping it up in a light note. If that is done, tha patient will
feel that the therapist is not quite able to bear the seriousness of the ongoing process.
It is of importance that the frame communicates a personal expression and a sense of
self-respect on the part of the therapist. The communication of a personal expression may, at a
first sight, be in conflict with the demand of neutrality. It is, however, not possible for the
therapist to avoid a personal expression. Consequently, I think, it is better to take hold of the
personal expression and let it be exactly what it is, in a reflected manner. However, the
therapist must be attentive to, and careful about, exaggerated (narcissistic or exhibitionistic)
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exposure of himself. It might happen that his needs to appear prominent or “special”,
characterizes his manner of presenting himself. Or, he might signal that he identifies himself
with some kind of subculture. This might make it difficult for some patients simply to relate
to him without prejudice from the start. Or even make it difficult for them to develop a
confidence. In a sense, the therapist’s personality must be subordinated to the therapeutic task.
Therapeutic rules of the game
I have decided to group the following items under the heading of “rules of the game”:
The analytic basic rule
The rule of confidentiality
The principle of abstinence (avoiding gratification
Protection of the therapeutic relationship, (avoiding privatization of the relationship).
The analytic basic rule
This concerns the instruction for free association. The patient is encouraged to let the thoughts
go, and as honestly as possible to tell whatever appears in his mind. It is recognized as a
difficult task.And it contains a paradox: I want you to be spontaneous! One way to surpass the
paradox could be to say to the patients: “Take the time you need in order to say what is on
your mind and in your heart”. This formulation is fairly close to Freud’s instruction. And it
underlines the importance of honesty and sincerity.
Timelessness reigns in the unconscious. To take the time we need is probably the best
method we can use in order to be able to say what must be said.
/You probably know the Buddhist story about the very ambitious young man asking a
Zen master how long time it would take to become master of the art of sword. The master
says, “well, perhaps three years”. The young man was impatient. “Three years, that is a long
time. What if I really work hard and do all I can to progress?” The master answers, “if you try
so hard, well, then you will need 5-6 years, I suppose.”/
To adolescents, we can give a similar instruction, I think. To children whose free
association is less verbal, and more in action, through playing, we give another instruction.
For instance, we can say: the toys in this box are for your use, and you can play with all of
them. We are careful not to invite the child to do what it wants to do, because there are actions
we do not permit.
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The rule of confidentiality
This is the rule of professional secrecy. It safeguards the feeling of security when sharing with
someone else the thoughts which are the most secret, the most shameful, the most painful.
The patient has to trust discretion and confidentiality on the part of the therapist.
Working with children, we have a more complex situation and quite specific
considerations to make. What kind of information from the sessions shall we tell the parents
and how do we do it? How can we discuss this in advance with the child, and cooperate with
the child to prepare our meeting with the parents? One point I think we can introduce with
quite small children is, that we inform the parents about the therapeutic process in general
terms, but we do not go into details about what is going on in the sessions. The older the child
is, the more control of, and insight into, the exchange between parents and therapists, should
the child be granted. From about the age of 10 we can consider to let the child join these
meetings.
The rule of abstinence
This can also be called the rule of non-gratification. It was in 1915, in his observations on
transference love, that Freud formulated the principle behind the rule of abstinence. He
encouraged the analyst to let the patient’s needs and longings remain unsatisfied, and realize
that they are forces driving man to work and change. They should not be silenced by
surrogates. So, the starting point is Freud’s idea that frustration (abstaining from need
satisfaction) might promote insight in the drive origin of the symptom. It was also supposed to
incite the patient’s needs directed towards the therapist (transference feelings), a supposition
for the working through of the neurotic conflicts and patterns. The third point is the basic
view of psychoanalysis that to be satisfied can’t cure a patient with infantile needs and
longings rooted in unconscious conflicts. It is the infantile roots that have to be analysed,
opening the way for more mature forms of satisfactions.
The rule of abstinence is today referring to the rule of non-gratification. It says that the
therapist must abstain from gratifying the patient’s needs. Here, we have to make a distinction
between affirmation, understood as a confirmation of the validity of an experience (I can
understand your emotional reaction) and gratification, understood as a direct gratification of
infantile needs (to inflate the patient’s self image. To say to a child: Oh how clever you are!
Or: what a nice picture you have made!). This latter type of gratification has no place in
psychotherapy based on psychoanalysis. The question of gratification is, however, really not
that simple. The experience of being understood in a deep, existential manner is, of course,
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intensely gratifying. This goes, whether this understanding is expressed by an affirmation, or
by an elucidating interpretation. In both cases, the patient gets a strong satisfaction; an
experience promoting the therapy process. The decisive point here is what is gratified, and in
which manner. Which needs are gratified? We have to note the difference between drive
needs, especially infantile drive needs on the one hand, and relational needs, e g. need for
security, on the other.
Protection of the therapeutic relationship
What is the therapist’s private sphere has to be kept outside the therapeutic situation. The
important boundary between professional and private is already anchored in the concept of
professionalism. It is valid for all psychological and psychiatric activity, not only
psychotherapy. By this boundary, a frame is established. If we discover that we have stepped
into our private sphere, we have to adjust the course. It concerns the protection of the
relationship. Ethical missconduct in psychotherapy probably always starts as small, almost
unnoticeable deviations from a professional attitude, in the form of private elements being
introduced into the relationship. Keeping the boundaries against the private sphere is a
protection both of the patient (against incestuous or other kinds of exploitation), and
of the therapist (by reduction of the strain on the therapist’s private sphere of life concerning
emotional and other effects from exposure and engagement in his work). We need ways of
thinking and theories and concepts which give us the possibility to regain ourselves and
recover from the strains of work. Perhaps we also need ways of thinking, which makes it
possible for us to dare to engage emotionally, because we know that we have the necessary
tools to recover and not drown in our engagement.
The therapeutic profession is often challenged by patients who try to turn the therapist into
another, more private or familiar position. It is decisive that our private life is kept apart from
our professional self and kept outside the therapeutic relationship. If the relationship is
privatized, both the therapy process (the transference analysis) and the therapeutic
relationship will break down.
We have a third concept that functions as mediator of the dicotomy between the
professional and the private. That is the personal. The private has nothing to do in the
therapeutic relationship. Yet, of course we perform as persons in the relationship. And we
have our personal style in the way we think and talk to the patient. In these manners, we
expose ourselves as persons. What is personal is actually important in psychotherapy. The
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therapist’s personality and temperament play an inevitable part also of professional
relationships.
In this connection we have a related concept, namely authenticity. To be authentic
means to be oneself without pretending. This ties up to a very important assumption: honesty,
sincerety. The demand of honesty in psychotherapy is invariable and complicated. This goes
both for patient and therapist!
Therapeutic attitude.
Schafer states that analytic attitude is one of the most important inventions Freud made. Much
simplified, his opinion may be concentrated in the span between two much quoted statements.
In the one, he recommends the analyst to use the surgeon as a model. He sets his own
emotions aside and concentrates his skill and his strength in performing the operation. In the
second, he recommends the analyst to listen with his own unconscious to the patient’s
unconscious. Today, these two formulations are reflected in the two positions of experience:
the oscillation between an observing, reflecting attitude on the one hand, and an attuning,
understanding attitude one on the other.
Attunement and reflection
Just because the emotional exchange between the patient and therapist is of such decisive
importance for the process, a pure intellectual and “technically correct” effort on the part of
the therapist will always be insufficient. The therapist “lets himself go” emotionally, permits
himself to be moved by the patient’s suffering, experiencing it “as his own”. Simultaneously,
he must preserve his ability to reflect about the patient, about himself, and about what
happens in the relationship. This ability of oscillating between attunement (feeling with the
patient) and reflection (thinking about the patient) is a central factor in therapeutic work, and
an important part of the concept of attitude.
In this oscillation lies a risk. The therapist lets himself be brought out of balance
emotionally, by identifying with the inner condition of the patient, which so often is
characterized by pain and anxiety beyond what is tolerable. He does this in the confidence in
his ability to – in the next moment – to restore his capacity to reflect, and thus not just being
as overwhelmed and helpless as the patient.
The required openness and vulnerability implies that therapeutic attitude can not be of
a static nature. If it turns static, it has turned into a defensive clinging. Whoever lets himself
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move, takes the risk of getting out of position. Whoever opens up empathically for the patient
runs the risk of over identification. Whoever aspires to neutrality, risks becoming impersonal.
Evenly spread attention (to listen without memory and desire)
The analyst’s fundamental rule (the evenly spread attention) concerns letting everything that
happens, everything which is said, initially be given equal importance. This builds upon the
idea that the Unconscious does not work according to ordinary logic nor ordinary rules of
disposition. We cannot expect that what is important comes first and is centrally placed, nor
that the succession is chronological, nor that cause comes before effect. Consequenly, the
orderliness of time, space and causality is disregarded in the unconsciousness. And, because
the patient himself is unaware of how things connect (this concerns unconscious connections
indeed), it is impossible to approach the material by logic and semantic work. By
unconditional, evenly distributed (and patient) listening we try to let the picture become
visible, to discern the figure–ground relations in the patient’s inner world. The point is that a
pure intellectual endeavour is insufficient. /Free association – free listening (reverie); listen
both with head and stomach and with the third ear/
In this connection, I will add a word about patience. Benedetti said that the therapist
must be an artist in waiting. Not a champion, who is able to wait eternally, but an artist who
perceives when it is necessary to give more time, and when the time has come for
intervention.
Neutrality
To think that we can avoid a personal expression is an illusion. Hereby, the concept of
neutrality is actualised. What is the relation between neutrality and therapeutic attitude, and
how can we understand neutrality?
The concept of neutrality directs attention towards areas of conflict. Psychotherapy is
almost always concerned about conflicts. Dynamics and oppositional forces are at stake all
the time. The therapist has a perspective, which takes more than one side into account. He
shows for the patient that there are opposites. This also means that the therapist avoids
thinking in simple solutions of the either-or type. Splitting is an example of either-or thinking
and is a primitive manner of organizing contradictions. Seen from this angle, it is a regression.
To fall down on one-sided solutions is in this connection a weakening of the ability to think.
So, neutrality in psychoanalysis and in intensive psychotherapy does not refer to an
attitude of unemotional, distanced, and unengaged attitude. In psychotherapy neutrality means
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that the therapist positions himself strategically in order to be able to observe the patient’s
conflicts. This means that he does not side with the superego against the needs, nor vice versa.
And we try not to judge. Judgement means usually to side with the superego. In working with
children this can be extended also to the therapist’s relationship to the child and to the parents.
The therapist stays neutral in conflicts and disagreements between child and parents, and does
not side with any part. Anna Freud referred to neutrality as the equidistant position between id
and superego. In the same way we can talk about the equidistant position between child and
parent.
Neutrality as an attitude does not exclude ordinary friendliness, or showing interest or
warmth for the patient. Heimann formulated it this way: It is just a tiny step between the
neutral therapist and a neuter. The goal is not to be impersonal in one’s neutrality. Schafer
says clearly that in the analytic neutrality there must be room for calling a spade a spade, as
well as ordinary warmth and cordiality in the contact.
This concerns, in a sense, the regulation of distance in the relationship and the
temperature in the contact. This means to dose one’s presence of mind and find a balance
between closeness, which must not be allowed to become intimate on the one hand, and the
respectful distance, which must not become so distant that it becomes remote,
unapproachable, perhaps arrogant, on the other hand. It is the therapist’s own style which
must find its manner of expression. This also concerns the temperature in the contact. Not so
cool that it gets cold, not so warm that it becomes heat. The goal is to be oneself, in a
disciplined manner.
Matter-of-factness
A spade is a spade. Matter-of-factness belongs to the therapeutic attitude. If a therapist senses
that a patient is tortured by anxiety for becoming psychotic or falling into pieces, he talks to
him about this anxiety. He does it, however, in a sober manner and is careful not to express
himself in ways that are insincere or veiling.
The therapist is careful about the use of irony or joke. However, it is obvious that
humour may have a beneficial therapeutic effect when patient and therapist get a quick
change of perspective and see what is funny in the situation. This often makes an integrative
experience. But, a joke must be presented with great care, just because the patient and the
therapist have different positions, and the joke easily can be misunderstood.
Irony is almost always wrong. Irony is a kind of double communication and often
contains a touch of contempt and self-contempt. If the therapist is ironic about himself, it is
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himself he is ridiculing. If he is ironic towards the patient, the he is ridiculing him. Irony has
often a poisonous under-tone, which rarely makes it proper in the psychotherapeutic situation.
Empathy
An important part of therapeutic attitude is empathy, that is, an attitude of empathy. Focus is
upon trying to listen and understand the patient’s inner world. The therapist listens carefully
before he speaks. Empathy, especially with the patient’s inner conflicts, implies to open up
for, and live along with, what is filled with conflict and experienced as unbearable in someone
else’s inner life. In both adult and child psychotherapy, empathy with the helpless, hurt and
wrecked part of the patient is necessary. And here, our neutrality is put to the test, namely to
avoid over identify with this part of the child.
Dependability/trust
This kind of work presupposes a basic feeling of safety and trust in the relationship. The
question of trust and lack of trust - whether the patient can trust the psychotherapist – is a
central problem in most psychotherapeutic work. In therapies with serious psychopathology,
this frequently will be the central problem. Simultaneously, trust is a part of the working
alliance, one of the conditions for therapeutic work to take place at all. Here we face a
paradox, namely the patient’s trust in the therapist. The patient has an injury which affects a
central condition for the therapeutic process to take place. For this reason, it will often be
necessary with therapy for a long period of time. It is important that the therapeutic frame and
the therapist’s attitude are predictable, secure, and distinct. In working with the patient’s lack
of trust, trustworthiness and clearness in the way the therapist behaves is necessary; what he
promises or does not promise, what he says and does not say, what agreements he makes or
does not make.
A patient was, through her whole psychotherapy, working with her basic problem of
trusting other people, including the therapist. Towards the end of the treatment she told how
important it had been for her to be allowed to be sceptical and full of distrust and be allowed
to expose her doubt; to experience that there was room for her feeling of distrust towards the
therapist, who behaved dependable all through the therapeutic process, and did not fail her.
Containment of intolerable feeling states
A central part of therapeutic attitude is the containment of any feeling that arises in the
situation. That every feeling in the patient is allowed to appear and is neither covered up nor
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run away from. When everything seems hopeless, the therapist avoids colluding with the
patient that there is hope for a brighter future. We might think that there is “light in the end of
the tunnel”. However, a patient might need quite a long time to be able to see any light at all.
In the meantime the patient and therapist must stay in a tunnel with no light. This is part of the
strain in engaging in therapeutic and analytic processes.
So, the therapist does not escape from painful situations. He does not use the
possibility of agreeing with the patient on a supposed happy ending, that everything will be all
right. The therapist stays in the painfull moods and feelings. The very first and very important
clinical action is not to run away, but to stay and share the pain with the patient.
Nævestad, a Norwegian psychoanalyst, has called this “a borrowed hope”. She said to
her patients: “What is intolerable and too much for you to bear alone – perhaps you can bear it
if we are two to share the burden”.
Several concepts of different theoretic standings refer to these processes. Containing
(Bion) and holding (Winnicott) are the most central. The “borrowed hope” means that the
therapist, as long as the therapy lasts, offers to share with the patient the anxiety, the pain, and
the hopelessness. He can, however, only lend the hope, because he does not oblige himself for
a life-long relationship. He does not promise something forever, but gives a promise for the
time the therapy will last.
Final comments
We have viewed the therapeutic setting, or framing, from three angles: the outer frame for the
therapy, the fixed rules for the interaction, and the therapist’s attitude. It is the task of the
therapist to create a setting for the therapy, to maintain it, that is, to restore it when
disturbances occur. And it is by the help of the internalised therapeutic attitude that this can be
done.
By the framework of the process, which the setting offers, the therapy room is turned
into a therapeutic room. If the setting collapses, this therapeutic room is destroyed. The
therapeutic frame is, in fact, a necessary condition for the therapy room to become a place
where emotional development can take place – a therapeutic room.
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A selection of the literature used in the writing of this paper
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Bion, W. R. (1962). Learning from experience. New York: Basic Books.
Freud, A. (1936). Ego and the Mechanisms of Defence,
Freud, S. (1910). The future prospect of psychoanalytic therapy. Standard Edition, 11, 141151. London: Hogarth Press.
Freud, S. (1912). Recommendations to physicians practising psychoanalysis. Standard
Edition, 12, 111-120. London: Hogarth Press.
Freud, S. (1915). Observations on transference-love. Standard Edition, 12, 157-171. London:
Hogarth Press.
Heimann, P. (1950). On counter transference. Int J of Psychoanal, 31, 81-84.
Joseph, B. (1987). Projective identification: some clinical aspects. I E. B. Spillius & M.
Feldman (Eds.). Psychic equilibrium and psychic change. London and New York:
Tavistock/Routledge, 1989, pp. 168-180.
Killingmo, B. (1995). Affirmation in psychoanalysis. Int J of Psychoanal, 76, 503-518.
Killingmo, B. (1997). The so-called rule of abstinence revisited. Scandinavian Psychoanalytic
Review, 20, 144-159.
Klein, M. (1946). Notes on some schizoid mechanism. I The writings of Melanie Klein, vol 3,
1-24. London: Hogarth Press, 1975.
Klein, M. (1952). Some theoretical conclusions regarding the emotional life of the infant. I
The writings of Melanie Klein, vol 3, 61-93. London: Hogarth Press, 1975.
Künstlicher, R. (1996). The function of the frame: to protect the psychoanalytic room.
Scandinavian Psychoanalytic Review, 19, 150-164.
Laplance, J. & Pontalis, J-B. (1973). The language of psychoanalysis. NY: Norton.
Sandler, J. (1976). Countertransference and role responsiveness. International Review of
Psychoanalysis, 3, 43–47.
Schafer, R. (1983). The analytic attitude. New York: Basic Books.
Winnicott, D. W. (1947). Hate in the counter-transference. I: Through paediatrics to
Psychoanalysis. London: Karnac Books, 1975, pp. 194-203.
Zachrisson, A. (2006). Analytic work with adolescents. Reflections on the combination of
strict method and creative intuition in psychoanalysis. Scand. Psychoanal. Rev., 29: 106–
114, 2006.
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