Introduction
(Fiction) This paper is about a family that lost a child after a shooting at Tangle Wood School in Greenville. The news took the family by surprise, and everyone began to experience severe suffering. As a result, sleep, eating, and communication with other people worsened. Such factors lead to various mental and physical ailments, significantly affecting health. To work with these cases, the practice of psychoanalytic therapy is required, which is taken as the leading theory for working with this family. The main features of this case are symptoms of depression, and the goal of potential interventions is to identify triggers and develop mechanisms to deal with them. For this, two interventions from the proposed theory are proposed.
Intervention Description
Psychoanalytic techniques include many methods for identifying and dealing with ailments such as anxiety and depression: dream analysis, free association, and Rorschach stains to interpretation, transference, and countertransference. The first group of listed methods has a significantly long time to achieve the set goals and requires a profound analysis (Oliver, 2018). They are not suitable for this case of family therapy since the consequences of depression already significantly affect a person’s behavior: reduced socialization and constant alcohol consumption. The destructive symptoms of the underlying ailment must be addressed as quickly as possible while trying to get to the triggers that lead to such behavior.
Interpretive interventions are primarily in the nature of identifying conscious non-verbal aspects of behavior, including manifestations of depression. Analysis of defense process motivation can uncover the mechanisms and triggers that consistently lead to a patient’s destructive and antisocial behavior (Keogh & Palacios, 2019). Aspects of understanding and accepting the tragedy are constantly repeated with fresh wounds from the past, which in this approach is an argument for using this intervention. On the other hand, there is the practice of transference, which focuses on shifting the focus away from pathogenic internal conflicts from the past (Kernberg, 2019). Here, more targeted work is taking place, which is initially based on the analysis of verbal and non-verbal signs and a gradual change in the direction of their functioning. As a rule, in this situation, a protective mechanism arises, dictated by the characteristics of the character. The features that appear are much easier to interpret, and their diversity falls into certain patterns, with which there are specific mechanisms for working.
Consequently, the first intervention of the psychoanalytic theory therapist will be transference since this method can highlight the specific features of the patient that influence the triggers and their support by destructive behavior. In addition, the event from the past that caused such health effects is already known, and it is not the therapist’s task to dig into certain aspects of triggering such deviations. In this case, transference is a preferred intervention over interpretation, as it is more effective when the causes and preconditions of depression are initially known (Souza & Paula, 2021). In addition, the patient has a significant transition to antisocial activities, which leads to the absence of a person or group of people with whom he could share his energy and sadness. The family is equally devastated and offers no refuge in the irreversible event that has taken place. The opportunity to release emotions with the help of a psychoanalyst-therapist is an essential step toward returning to everyday life.
If the client is possessed by solid unconscious impulses, after some time, they begin to be directed to the psychotherapist; as a result, a transfer occurs. Concerning the psychotherapist, the client begins to experience emotions determined not by the actual situation of their interaction but by patterns of emotional response from the past. Considering that the current tragic event does not belong to days long past, it will be easier to restore the thread of experiences and find specific triggers that lead to such behavior. Such parameters of the psychotherapeutic situation as the analyst’s passive demeanor, his encouragement of the expression of feelings, the inequality of the positions of the participants in psychotherapy, sensory deprivation, the removal of resistances and defenses, and clearing the way for unconscious feelings to come out, allow us to consider it as emotionally difficult (Kernberg, 2019). Thus, the therapist will become a reflection of the projected image by the patient and will take on the energy that has not been released for a long time.
The second intervention can be countertransference, which is often used as the next step in therapy after transference. The therapist first plays the role of a blank slate that does not give a total reaction to the patient’s actions, using them to identify triggers and hooks for therapy. Countertransference becomes a more complex approach as the psychoanalyst now begins to express his own emotions, which must be directed against the patient’s feelings, forming transference dispositions that lead to the necessary changes (Tishby, 2022). In this situation, it is necessary to act extremely delicately since any negligence can lead to even more profound consequences of depression.
To a certain extent, countertransference activities are often determined by the vicissitudes discovered during the first intervention. The emotional reactions of the expert do not have clearly defined boundaries and methods that are most likely to lead to the best results of therapy. A rational approach is fundamental here since each psychoanalyst is a person in whom various problems can be embedded, through the prism of which countertransference actions will be performed. The hindrance to analysis is not the emotions themselves but the unawareness of the reaction. In the course of therapy, unconscious feelings become more intense, interfere with adequate perception of the client, and harm the analysis. If the therapist seeks to become aware of his feelings, then countertransference contributes to the progress of therapy (Kraemer, 2018). Therefore, in this situation, a serious and responsible approach is required, which can lead to relatively quick results and help fight against symptoms.
Through the prism of this theory, the family system will change. The inability to transfer one’s own experiences is almost certainly not only a problem for the patient but for each member of his family with a difference in manifestation. As soon as the client can overcome negative emotions and as soon as it becomes possible to direct this energy in a specific direction, the process of gradual dissipation of the problematic state of the entire cell of society will start. Since certain events will reappear that will shift the focus from the past to the need to act in the present, difficult conversations and interactions will collide with other emotions that no longer drag the general condition of family members to the bottom. Similar studies on the release of suffering and depressive preconditions have positive results, with specific differences only in the time of action (Alexandris & Vaslamatzis, 2018). In psychoanalytic theory, constant observation by experts is highly desirable because of the development of potential relapses in psychological health.
Intervention Application
Consequently, the therapist must engage in a dialogue with the family and the patient first, looking for opportunities to implement the tactics of transferring problems to himself and then evaluating all possible ways of countertransference by demonstrating his own emotions. A potential transcript is proposed for this solution, reflecting the main possible ways of developing a dialogue during psychoanalytic therapy. The therapist is invited to start the dialogue by returning to the moment of the tragic events to gradually unwind the thread and identify the triggers stuck in the unconscious.
“How did you feel at the moment when you learned this news and what was your further reaction within a few days?”. In the case of a sincere answer, it is necessary, with notes, to further track the reactions in the period that followed the one under consideration. In the absence of a clear answer or detection of a reaction, including silence, dictated either by fear or embarrassment, it is necessary to choose the tactics of indirect questions that try to get close to the patient’s feelings in other ways. For example, “How is your workday and day off now?”. Given the tendency to depression and alcohol consumption, it is possible to carefully and delicately approach any trigger through these destructive habits.
In case of closing the feelings of the patient and family, the analyst may encounter resistance to the transference process. Here the therapist should ask family members: “How did your behavior and the behavior of your family members change after that event?”. An outside view of this situation will be more valuable than their own assessment; however, it can reveal specific complexes or triggers that support a general depressive mood in the family system. With such questions, the therapist will have to identify these triggers and then move on to countertransference. For example, a trigger can be a feeling of guilt, feelings not expressed in time, or feelings of guilt towards those responsible for this incident. Once the therapist has identified the levers of depression, the therapist turns to countertransference and begins to express the feelings in response, provoking patients and families to release their emotions. In the case of experiencing feelings of guilt, the dialogue should lead to apologies, and in the case of unexpressed feelings, the opportunity to identify with them and express them. The therapist, in this case, should not create countertransference in turn if a vital defense mechanism against the trigger is achieved.
Transference phenomena are essentially resistance to remembering. Resistance analysis is a daily work in analytical practice; more time is spent on analyzing transfer resistance than on any other aspect of the work. Therefore, through countertransference, the therapist must demonstrate such behavior, which should become a defense mechanism against returning to this state of the family system and, in particular, the patient. In this situation, it can be a special ritual of apology or the release of devastating aggression that previously had no way out. The full dialog with the father, that can occur, is presented in Appendix A.
Discussion of Impact and Change
The transfer will affect the family system by bringing up a complex topic of conversation differently and confronting a family member with an unexpected reaction. Since the family did not enter into activities related to the funeral, the situation became much more challenging to let go since there was not even a formal ritual. Collisions within the system do not lead to any result; as a result, each member of the family is increasingly immersed in depression at a different pace. The therapist gives a different reaction and the opportunity to take the conversation in a different direction, which was closed or banned within the family for various reasons. Therefore, the first intervention should change the behavior and, at a minimum, the rhetoric in the family’s conversations. In other words, patients will now be able to consider activities that previously prevented them from changing their depressive behavior.
Countertransference will be a logical extension of the first intervention. Due to the thoughtful reaction of the psychoanalyst, family members will not only independently overcome the obstacles of thoughts in a direction different from the tragic one but will adapt their behavior accordingly. The therapist will push the system back to normal functioning within real life, which continues and needs to be turned on despite severe suffering that should not last forever. Through such adaptation, a particular protective mechanism must be developed for each family member, which the therapist will first support, and then other family members. With the proper work of a specialist, not only an individual implementation of techniques is created, but a stable improvement in the mental state and consistency of the entire family system.
Conclusion
Consequently, as the head of the family, the father experiencing an irreparable loss will become an example for other family members to restore mental and physical health. Other family members who were previously unable to resist the development of depressive mood in the system will be able to develop unique defense mechanisms identified at the countertransference stage. To a greater extent, work will be carried out with the father, in whom responsibility for his family should be revived, fueled exclusively positively by the complex events of the past. Each member of the family, seeing a way out of this situation on the example of the father, will have to maintain this state and prevent the identified triggers to the best of their ability. Establishing social interaction within the family system and shifting the focus can serve as a starting point to restore social interaction functions outside the family that have suffered in the past.
Telemedicine, in this situation, can provide all the tools for such interaction between the therapist and the family. In fact, for the implementation of transference and countertransference, in the case of proper immersion in the process on the part of patients, all the necessary technologies will require only video communication for fixing non-verbal signs by an expert. Another question is how to achieve such immersion, especially against mental problems. Many studies are struggling with this problem, trying to find mechanisms for overcoming this situation (Grady et al., 2021). Nevertheless, the results of psychoanalytic interaction using telemedicine tools show positive dynamics (Schön et al., 2018). Consequently, this branch of medical development can have a significant beneficial effect due to simplified access to many patients who did not previously have the opportunity to visit therapists in person. Such interventions include many more approaches that can be implemented in absentia, which only emphasizes the prospects of telemedicine in the future.
References
Alexandris, A., & Vaslamatzis, G. (Eds.). (2018). Countertransference: Theory, technique, teaching. Routledge.
Grady, C. B., Claus, E. B., Bunn, D. A., Pagliaro, J. A., Lichtman, J. H., & Bhatt, A. B. (2021). Disparities in patient engagement with video telemedicine among high-video-use providers during the COVID-19 pandemic. European Heart Journal-Digital Health, 2(4), 691-694. Web.
Keogh, T., & Palacios, E. (Eds.). (2019). Interpretation in couple and family psychoanalysis: Cross-cultural perspectives. Routledge.
Kernberg, O. F. (2019). Therapeutic implications of transference structures in various personality pathologies. Journal of the American Psychoanalytic Association, 67(6), 951-986. Web.
Kraemer, S. (2018). Is there another word for it? Countertransference in family therapy. In Systems and Psychoanalysis (pp. 39-55). Routledge.
Oliver, K. (2018). Family values: Subjects between nature and culture. Routledge.
Schön, J., Kadish, Y., Green, J., Hanson, S., & Kuhn, J. (2018). Psychotherapy in the age of technology: the ethical challenges of online treatments for South African clinicians. Psycho-analytic Psychotherapy in South Africa, 26(1), 30-53. Web.
Souza, M. M. P. D., & Paula, A. P. P. D. (2021). Transference and Subjective Implication: Psychoanalytic Reflections on an Action Research. Organizações & Sociedade, 28, 944-968. Web.
Tishby, O. (2022). Countertransference—Introduction to a special section. Psychotherapy Research, 32(1), 1-2. Web.
Appendix A
Therapist: “How did you feel at the moment when you learned this news and what was your further reaction within a few days?”
Father: “I was devastated and could not find a place for myself, since then it seems to me that I did not keep track of my child”.
Therapist: “What would you do if you had the opportunity to change your behavior with your son?”
Father: “I would have shown more attention, concern for his interests, maybe I should have given him more freedom, since now he will not be able to see life.”
Therapist: “Try to transfer this concern to loved ones. You are surrounded by a wonderful family, can it be worth directing that unspent care to them?”
Father: “How can I do anything else if I couldn’t even keep an eye on my own son?”
Therapist: “How can you allow other members of your family to be treated like this? You have a chance to give them more attention, especially in this difficult moment when they need you.”
Father: “Do you think I’m worthy of influencing my family again in any way? Everyone around is as devastated as I am.”
Therapist: “That is why you still do not allow the thought of how to live on. Everyone is waiting for your example. If you think that you are to blame for your son, try to apologize to him, maybe he will hear you. Express your apologies and do not keep them to yourself, as they are what prevent you from taking any step forward.”