What follows is an overview of the clinical experiences regarding countertransference that we have gathered over 25 years in the treatment of severe personality disorders at the Personality Disorders Institute of the Weill Cornell Medical College and the Westchester Division of the New York Hospital. Earlier experiences of the author in his work with the psychotherapy research project of the Menninger Foundation provided the conceptual and clinical background that influenced the development of new technical approaches and the reshaping of the relevant concepts.

The contemporary concept of countertransference

At this time, the “totalistic” or “global” concept of countertransference clearly has replaced the classical concept as originally defined by Freud (1910). The classical concept defined countertransference as the analyst's transferences toward the patient, or the analyst's unconscious reactions to the patient's transference; the accent was on the unconscious aspect of the analyst's reaction, with the implication that only further analytic work by the analyst on himself would help him to “overcome” the countertransference, as Freud recommended. The contemporary “totalistic” or “global” concept, in contrast, defines countertransference as the therapist's total emotional reaction to the patient at any particular point in time (Kernberg, 1975). The implication of this modern, contemporary concept is that the therapist needs to monitor his/her countertransference consistently to deepen the understanding of the patient by relating it to the developments in the transference.