The significance of countertransference and related issues in a multiservice court clinic.

Abstract

The types of patients seen in a multiservice criminal court psychiatric clinic and the conditions under which this occurs may pose difficulties for the mental health professional. When such antisocial behavior as manipulative­ ness, aggression, and criminal activity are combined with gross psychiatric disturbance or severe personality disorder, a variety of intense emotional and cognitive responses can be evoked in the clinician. Understanding these countertransferential responses can illuminate unrecognized aspects of the phenomena that engender them. This may aid the forensic practitioner in improving mastery over his or her clinical tasks. This approach is closely allied to the most recent use of the countertransference concept as it has been developed in the contemporary psychoanalytic and psychiatric litera­ ture.' Briefly, this more totalistic view of countertransference includes the full array of subjective responses the patient evokes in the treating therapist. By not confining the countertransference notion to simply neurotic-type responses that somehow have to be expunged, the subjective responses of the clinician become not simply problematic autobiographical data but, if carefully understood, can be used as a helpful in the diagnosis and treatment of the patient. Kernberg~ and others: l .4 have developed this diag­ nostic tool into a refined skill. Recently, other authors have expanded the application of the countertransference concept from that of the psychoanalytic situation to such age groups as children, ~ such settings as a family court clinic,6 and to the short-term transaction of the psychiatric differential diagnostic examination in which the present authors adapted the response set.7 This term referred to a constellation of reactions that are likely to be evoked in the clinician by a particular patient presentation in the forensic context.