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J Can Acad Child Adolesc Psychiatry. 2010 November; 19(4): 255.
PMCID: PMC2962537

Response to Commentary

Relationships stir emotions. Dr. Rasic succinctly outlines for us the dangers inherent in psychiatry marginalizing or ignoring its most human dimension and the need to reacquaint ourselves with CT responses and re-emphasize their clinical importance.

Dr. Rasic’s viewpoint is aligned with recent findings in affective neuroscience. Dr. Allan Schore states the use of an attachment relationship to leverage the empathic therapist’s capacity to regulate the patient’s arousal state within the affectively charged non-conscious transference - countertransference relationship is critical to clinical effectiveness and emphasizes the effects of secure attachment relationships on right brain development, affect regulation, and infant mental health. CT thoughts and feelings, and the dangerous enactments they might evoke, if unprocessed threaten that security, weaken the therapeutic alliance and thus undermine treatment attempts. Child psychiatry, with its inherent systemic complexity, is ripe for such occurrences. Unconscious phantasies, and their accompanying tendency to romanticize, infantilize or villainize others, can grossly contaminate treatment if left unexamined. In both training and practice, it is important to normalize, dissect and explore the origins of CTR’s. Emotions contain vital information and remain our most important tool. The ability to tune into ourselves, and attune with others, is the essence of therapeutic relationship. Be they objective or subjective, the duty remains to examine CTR’s in a non-judgmental manner. Ignoring this responsibility leads to grave clinical outcomes, negative iatrogenic effects, and has a profoundly detrimental effect on the physicians and patients, and the systems within we serve.

Strangely enough, by helping us to recognize and understand the importance of relational interactions, countertransference itself may prove to provide the vital point of convergence necessary to begin to allow the seamless integration sought among genetics, neuroscience and molecular biology.

References

  • Schore AN. The effects of a secure attachment relationship on right brain development, affect regulation, and infant mental health. Infant Mental Health Journal. 2001a;22:7–66.
  • Schore AN. Advances in neuropsychoanalysis, attachment theory, and trauma research: Implications for self psychology. Psychoanalytic Inquiry. 2002;22:433–484.

Articles from Journal of the Canadian Academy of Child and Adolescent Psychiatry are provided here courtesy of Canadian Academy of Child and Adolescent Psychiatry