Challenges presenting in transference and countertransference in the psychodynamic psychotherapy of a military service member.

Complicating the management of the transference-countertransference set for the military psychiatrist is the dilemma of dual agency. This can be a hidden force in the work of most psychiatrists but it is continuous in the field of military health care. The military clinician must candidly engage with this dilemma as it is intrinsic to the mission, "to conserve the fighting strength." In the conduct of a dynamic psychotherapy, the military psychiatrist must craft ways simultaneously to attain both the needs and interests of the individual patient and those of the organization of which he or she is a member. Presented in this article is a case in which the dual agency dilemma manifested itself between the patient and military therapist within the transference-countertransference set. The discussion will center around (a) how this ubiquitous dilemma may present and affect the progress of a psychotherapy, and (b) interventions that will help resolve the conflict. Time honored psychoanalytic principles guiding these interventions include maintenance of therapeutic neutrality, recognition of the therapist's bright and blind spots, and awareness of patterns in the patient's current and past relationships.