Prasko Jan, Diveky Tomas, Grambal Ales, Kamaradova Dana, Mozny Petr, Sigmundova Zuzana, Slepecky Milos, Vyskocilova Jana
Department of Psychiatry, University Hospital Olomouc, Czech Republic.
Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2010 Sep;154(3):189-97. doi: 10.5507/bp.2010.029.
Both patients and psychotherapists can experience strong emotional reactions towards each other in what are termed transference and countertransference within therapy. In the first part of this review, we discuss transference issues. Although not usually part of the obvious language of cognitive behavioral therapy (CBT), examination of the cognitions related to the therapist, is an integral part of CBT, especially in working with difficult patients. In the second part, we cover counter-transference issues. We describe schematic issues that give rise to therapist counter-transference and explain how this interacts in different types of patient therapist encounter. We also examine ways in which the therapist can use CT to help him/her modify the countertransference and, in the process, assist the patient.
PUBMED data base was searched for articles using the key words "therapeutic relations", "transference", "countertransference", "cognitive behavioral therapy", "cognitive therapy", "schema therapy", "dialectical behavioral therapy". The search was repeated by changing the key word. No language or time constraints were applied. The lists of references of articles detected by this computer data base search were examined manually to find additional articles. We also used the original texts of A. T. Beck, J. Beck, M. Linehan, R. Leahy, J. Young and others. Basically this is a review with conclusions about how therapists can manage transference issues.
Transference. The therapist should pay attention to negative or positive reactions towards him/ her but should not deliberately provoke or ignore them. He/she should be vigilant for signs of strong negative emotions, such as a disappointment, anger, and frustration experienced in the therapeutic relationship by the patient. Similarly he/ she should be alert to exaggerated positive emotions such as love, excessive idealization, praise or attempts to divert the attention of therapy onto the therapist. These reactions open space for understanding the patient's past and actual relations outside the therapy. Countertransference. The therapist should be aware of countertransference schemas as they apply to him/her. He/she should monitor his/her own feelings that indicate countertransference. Further, the assistance of and discussion with supervisors and colleagues is useful in regard to countertransference even in experienced therapists. Countertransference can be used as an open window into the interpersonal relations of the patient.
Both the literature and our experience underscore the importance of careful and open examination of both transference and counter-transference issues in CBT and their necessary incorporation in the complete management of all patients undergoing CBT.
在治疗过程中，患者和心理治疗师都可能对彼此产生强烈的情感反应，这被称为移情和反移情。在本综述的第一部分，我们讨论移情问题。尽管认知行为疗法（CBT）通常不会明显提及，但审视与治疗师相关的认知是CBT不可或缺的一部分，尤其是在治疗难缠的患者时。在第二部分，我们将探讨反移情问题。我们描述了引发治疗师反移情的图式问题，并解释了在不同类型的患者与治疗师接触中，这种反移情是如何相互作用的。我们还研究了治疗师如何利用反移情来帮助自己调整反移情，并在此过程中帮助患者。
在PUBMED数据库中搜索使用关键词“治疗关系”、“移情”、“反移情”、“认知行为疗法”、“认知疗法”、“图式疗法”、“辩证行为疗法”的文章。通过更换关键词重复搜索。未设置语言或时间限制。人工检查通过该计算机数据库搜索检测到的文章的参考文献列表，以查找其他文章。我们还使用了A.T.贝克、J.贝克、M.莱因汉、R.利亚伊、J.扬等人的原著。基本上，这是一篇关于治疗师如何处理移情问题的综述及结论。
移情。治疗师应关注患者对其的消极或积极反应，但不应故意引发或忽视这些反应。他/她应警惕强烈消极情绪的迹象，例如患者在治疗关系中所经历的失望、愤怒和沮丧。同样，他/她也应留意过度的积极情绪，如爱慕、过度理想化、赞扬或试图将治疗的注意力转移到治疗师身上。这些反应为理解患者治疗之外的过去和实际关系提供了空间。反移情。治疗师应意识到适用于自己的反移情图式。他/她应监测自身表明反移情的感受。此外，即使是经验丰富的治疗师，与督导和同事进行协助和讨论对于处理反移情也很有帮助。反移情可作为洞察患者人际关系的一扇窗口。
文献和我们的经验都强调了在CBT中仔细且开放地审视移情和反移情问题的重要性，以及将它们纳入所有接受CBT治疗患者的全面管理中的必要性。
