The transformative therapeutic relationship is a unique interpersonal and intrapsychic phenomenon between analyst and patient. It occurs within the therapeutic framework, and is characterized by specific boundaries of time, place, and verbal and behavioral interactions. Collectively, these interactions may facilitate mutual trust, caring, respect, and affection between analyst and patient. The shared experience of the transformative therapeutic relationship can result in significant intrapsychic and interpersonal changes for both patient and analyst. Clinical case presentations are provided.

This Analyst at Work section examines the work of an older psychoanalyst as he ages yet continues to work as a psychoanalyst. Eike Hinze describes his work with a disturbed young man. Decisions about starting an analysis and the struggles involved in \'reaching\' this patient form part of the question of whether this is a \'quest\', or another analysis, near the end of an analytic career.Of particular note is Dr. Hinze\'s explicit use of his own \'reverie\'/ countertransference/ unconscious states to form interventions. The two discussants express their own understanding of how they might approach the problems posed. They both speak to the forms of intervening that differ from their own, and their clinical understanding of revealing one\'s own associations in the clinical hour. They also speak to how the process of aging might have influenced the clinical work itself.The possible shift in technique over the course of Dr. Hinze\'s clinical career is more difficult to assess: does it come from age, maturity, shifts in theory and technique, or an intense desire to make emotional contact within this particular patient and clinical setting? These are the \"question marks\" conveyed in their discussions, like the one in the title itself.

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UNASSIGNED: Psychotherapeutic failures involve situational, relational, and personal factors. Dropout refers to a patient\'s unilateral termination of treatment without the therapist\'s knowledge or approval. Premature termination occurs when therapy is discontinued before achieving a sufficient reduction in initial problems.
UNASSIGNED: This study explores the role of therapist\'s emotional response (countertransference), gender, psychotherapeutic orientation, and patient diagnosis in the context of psychotherapeutic failures.
UNASSIGNED: A mixed-method approach was used. Fifty-nine Italian psychotherapists, practicing mostly privately with at least 5 years of experience, were recruited through Italian professional internet websites. The Therapist Response Questionnaire and the Impasse Interview were administered to each psychotherapist. Each therapist was asked to reflect on their last dropout patient. Quantitative (MANOVA) and qualitative analyses (textual content analysis) were conducted with SPSS and T-LAB, respectively.
UNASSIGNED: The quantitative analyses revealed that the most frequent countertransference response was Helpless/Inadequate, with female therapists experiencing this more frequently than male therapists. The qualitative analyses identified two main factors explaining most of the variance in countertransference responses: Parental/Protective versus Hostile/Angry, and Positive/Satisfying versus Helpless/Inadequate, with Helpless/Inadequate central. Additionally, the qualitative analysis of treatment interruption methods revealed two factors explaining over 50% of the variance. Lack of communication was linked to negative themes, while mediated and direct communication were associated with positive terms. Direct communication was characterized as useful, while mediated communication was linked to dropout and attachment figures.
UNASSIGNED: Under pressure, psychotherapists\' anxiety levels increase, often managed ambivalently or avoidantly. These results suggest that awareness of psychotherapist emotional responses is important to limit psychotherapeutic failures. These findings offer valuable insights for clinical practice.

The Impact Message Inventory-Circumplex (IMI-C) is a two-dimensional measure of patient-induced countertransference. Surprisingly, in a replication study of its circumplex structure, Hafkenscheid and Timmerman could retrieve a third dimension, in addition to the basic dimensions of Affiliation and Control. They tentatively interpreted this preliminary third dimension as representing \'reactance\' (oppositional and uncooperative patient behaviours), with \'active\' and \'passive\' as polarities. This provisional interpretation was no more than plausible and was partly speculative. Therefore, a more systematic empirical approach to the meaning embedded in the third dimension is required. The present empirical study tests the hypothesis that the preliminary third dimension might represent aversiveness rather than reactance. A panel of IMI-C users (N = 100) independently judged all 56 items of the instrument in terms of the general (i.e., without taking a specific patient in mind) emotional undertone enclosed in the item formulations using a forced choice three point scale format: \'positive emotional undertone\' (+), \'neutral\' (o) and negative (aversive) undertone (-). Overall, IMI-C users appeared to evaluate the formulations of items constituting the preliminary third dimension as intrinsically more aversive (negative emotional connotation), compared to the group of IMI-C items not included in this preliminary third dimension. However, the original octants of the IMI-C could be discriminated in terms of aversiveness as well. Anyhow, clinical interpretations of IMI-C profiles may benefit from an examination of the aversiveness component, enclosed within the items and octants themselves, irrespective of the specific patients judged with the instrument.

The author presents a long analysis of a patient, Giulia, whose obstinate will to achieve evokes the workings of alchemical sulphur at its fieriest and a dread of its coniunctio with alchemical salt. Jung\'s description of these symbols in Mysterium Coniunctionis offers a useful imaginal perspective to clinical work in the area of compulsion and its possible transformations. Right from the start, the analytic relationship appeared to be mirrored and affected by this alchemical perspective. However, it was only after much time, uncertainty and emotional endurance that a fuller psychological experience of sulphur and salt could be accessed, allowing the analysis to take a more imaginative and mercurial turn. In the course of his work with Giulia the author has witnessed and experienced a range of intense affects-the many colours that the combustion of sulphur can generate-whether on the verge of unstoppable creation or ruthless destruction, often of archetypal intensity. This experience has been lived through and has undergone a transformative relation with salt, which until then had lived a dissociated existence in the fixed trauma of the compulsion and in a nocturnal underworld of tears.
L\'auteur présente la longue analyse d\'une patiente, Giulia, dont la volonté obstinée de réussir fait penser à l\'activité du soufre alchimique à son point le plus ardent et à la crainte terrible de son coniunctio avec le sel alchimique. La description que fait Jung de ces symboles dans Mysterium Coniunctionis fournit une perspective imaginale qui est utile pour le travail clinique dans le domaine de la compulsion et de ses transformations possibles. Dès le début, la relation analytique semblait être reflétée et affectée par cette perspective alchimique. Cependant, ce fut seulement après beaucoup de temps, d\'incertitude et d\'endurance émotionnelle qu\'une expérience psychologique plus complète du soufre et du sel a pu être atteinte, ce qui a permis à l\'analyse de prendre une tournure plus imaginative et plus mercurienne. Durant son travail avec Giulia l\'auteur a été témoin et a éprouvé un éventail d\'affects intenses – les multiples couleurs que la combustion du souffre peut générer – que ce soit au bord d\'une création irrésistible ou d\'une destruction impitoyable, souvent d\'une intensité archétypale. Cette expérience a été traversée et a subi une relation transformative avec le sel, qui jusqu\'alors avait vécu une existence dissociée dans le traumatisme figé de la compulsion et dans les enfers nocturnes des larmes.
Der Autor präsentiert eine lange Analyse einer Patientin, Giulia, deren hartnäckiger Leistungswille die Wirkung von alchemistischem Schwefel in seiner feurigsten Form und eine Angst vor seiner coniunctio mit alchemistischem Salz hervorruft. Jungs Beschreibung dieser Symbole in Mysterium Coniunctionis bietet eine nützliche denkbare Perspektive für die klinische Arbeit im Bereich des Zwanges und seiner möglichen Veränderungen. Von Anfang an schien die analytische Beziehung von dieser alchemistischen Perspektive gespiegelt und beeinflußt zu sein. Doch erst nach viel Zeit, Ungewißheit und emotionaler Ausdauer gelang es, eine umfassendere psychologische Erfahrung von Schwefel und Salz zu erlangen, was der Analyse eine fantasievollere und lebhaftere Wendung ermöglichte. Im Laufe seiner Arbeit mit Giulia hat der Autor eine Reihe intensiver Affekte gesehen und erlebt – die vielen Farben, die die Verbrennung von Schwefel erzeugen kann – ob am Rande einer unaufhaltsamen Schöpfung oder einer rücksichtslosen Zerstörung, oft von archetypischer Intensität. Diese Erfahrung wurde durchlebt und erfuhr eine transformative Beziehung mit Salz, das bis dahin ein dissoziiertes Dasein im fixierten Trauma des Zwanges und in einer nächtlichen Unterwelt der Tränen geführt hatte.
L\'autore presenta una lunga analisi di una paziente, Giulia, il cui desiderio ostinato di raggiungere degli obiettivi evoca il funzionamento dello zolfo alchemico nella sua forma più feroce ed il terrore della sua coniunctio con il sale alchemico. La descrizione di Jung di questi simboli in Mysterium Coniunctionis offre una prospettiva utile al lavoro clinico nell\'area della compulsione e delle sue possibili trasformazioni. Fin dall\'inizio, la relazione analitica sembrava rispecchiata e influenzata da questa prospettiva alchemica. Tuttavia, è stato solo dopo molto tempo, incertezza e persistenza che si è potuto accedere a un\'esperienza psicologica di zolfo e sale più completa, permettendo all\'analisi di prendere una piega più immaginativa e mercuriale. Nel corso del suo lavoro con Giulia, l\'autore ha osservato e sperimentato una serie di affetti intensi – i molti colori che la combustione dello zolfo può generare – sia sull\'orlo di una creazione inarrestabile che di una distruzione spietata, spesso di intensità archetipica. Questa esperienza è stata vissuta a fondo ed ha attraversato una relazione trasformativa con il sale, che fino ad allora aveva vissuto un\'esistenza dissociata nel trauma fissato nella compulsione ed in un mondo notturno di lacrime.
Автор описывает длительный анализ пациентки Джулии, чье упорное стремление к достижениям вызывает ассоциацию с жгучей едкостью алхимической серы и ужасные последствия при ее конъюнкции с алхимической солью. Юнг описал эти символы в книге “Mysterium Coniunctionis“, обогатив содержащей ценные образы моделью клиническую работу с навязчивыми состояниями и их возможной трансформацией. Эта алхимическая метафора, по‐видимому, с самого начла проявлялась в аналитических отношениях и воздействовала на них. Однако потребовалось довольно много времени, эмоциональной выдержки и пребывания в состоянии неопределенности, чтобы появилось более целостное психологическое переживание серы и соли, что позволило сделать анализ более меркурианским и задействующим воображение. В процессе работы с Джулией автор наблюдал и испытывал на себе целый ряд ярких аффектов (цветового многообразия, которым может сопровождаться взрывное горение серы), часто архетипической интенсивности – на грани либо неудержимого созидания, либо безжалостного разрушения. Эти переживания были прожиты и подвергнуты трансформирующему соединению с солью, которая прежде оставалась диссоциированной в застывшей травме навязчивости и ночном подземном мире слез.
El autor presenta un largo análisis de una paciente, Giulia, cuya obstinada voluntad de logro evoca el funcionamiento del azufre alquímico en su forma más ardiente y el temor a su coniunctio con la sal alquímica. La descripción que Jung hace de estos símbolos en Mysterium Coniunctionis ofrece una perspectiva imaginal útil para el trabajo clínico en el ámbito de la compulsión y sus posibles transformaciones. Desde el principio, la relación analítica pareció reflejarse y verse afectada por esta perspectiva alquímica. Sin embargo, fue sólo después de mucho tiempo, incertidumbre y resistencia emocional que pudo accederse a una más plena experiencia psicológica de azufre y sal, lo cual permitió que el análisis tomara un giro más imaginativo y mercurial. En el transcurso de su trabajo con Giulia, el autor ha sido testigo y ha experimentado una gama de intensas emociones ‐los múltiples colores que puede generar la combustión del azufre‐, ya sea al borde de una creación imparable o de una destrucción despiadada, a menudo de intensidad arquetípica. Esta experiencia pudo ser atravesada y ha experimentado una relación transformadora con la sal, la cual hasta entonces había vivido una existencia disociada en la fijeza compulsiva del trauma y en un submundo nocturno de lágrimas.
在对强迫症工作时硫与盐的情绪力量 作者对一位名叫朱利亚的病人进行了长时间的分析, 她顽固的意志让人联想到炼金术中最炽热的硫磺的作用, 以及对硫磺与炼金术中的盐的结合的恐惧。荣格在神秘参与中中对这些象征的描述, 为强迫症及其临床转化的可能性的工作提供了一个有用的带有想象力的视角。 从一开始, 分析关系似乎就受到这种炼金术观点的映射和影响。然而, 只有经过漫长的时间、经过对不确定性和情感的忍耐, 才能获得对硫和盐的更全面的心理体验, 从而使分析变得更具想象力和水银性的转变。 在与朱利亚合作的过程中, 作者目睹并体验了一系列强烈的情感‐‐硫燃烧所能产生的多种色彩‐‐无论是发生在濒临不可阻挡的创造中, 还是面临无情的毁灭中, 这些体验往往都具有原型的强度。这种经历历尽了与盐有关的转化性关系, 而在这之前, 它们隔离地存在于固着的创伤性强迫症中, 存在于冥界的暗夜眼泪里。.

Wilfred Bion\'s contributions to psychoanalysis are numerous: his early work on the psychology of groups that grew out of his experiences in the first World War; theories and work on the treatment of psychosis with Melanie Klein and later psychoanalysis with her; and the beginning of his own theoretical and clinical ideas, which nurtured analytic thinking and treatment approaches beginning in the mid-1960\'s followed by his relocation to the United States (1967). Bion\'s thinking can be deceptively simple, such as his statement that his third book, Transformations (1965), considered by many as exceptionally dense, is about \"the communication of both patient and analyst about an emotional experience\" (p. 29).

The author explores some ways that we help patients to hold paradoxical realities intrinsic to transference and play in analytic work. He suggests that Winnicott\'s guardianship of the setting for the emergence of playing raises questions about the role of neutrality in an ontological analysis. The author tries to demonstrate some ways that the work of helping patients to hold paradox in play overlaps with a concept that he has earlier referred to as an activity of neutrality. He explores how in the analytic process, understanding and being are two dimensions of the analytic process that work in concert with each other. Often the analyst works quietly in spaces between epistemological and ontological approaches in the holding of paradox.

Given that practicing teleanalytically is relatively new and more widespread than ever, questions about how to practice and teach it effectively have increased and are more pressing than ever. To contribute answers to these questions, this paper addresses long-standing and persisting negative views of teleanalysis as an inherently muted, remote, and pale experience with reduced therapeutic effectiveness. I propose that this view of teleanalysis as inherently inferior to in-office analysis limits or even precludes its therapeutic usefulness because it allows analysts to avoid making analytic use of the disturbing feelings hiding within the experience of practicing teleanalysis. Through case examples, I suggest that when analysts do not take our negative views of teleanalysis at face value but instead consider them as symbolic expressions of our and our patients\' anxieties, we can improve our understanding of our analytic functioning within the tele-setting and enhance our capacity to think and engage analytically effectively in any setting. I maintain that these considerations have important implications, not only for how experienced analysts practice, but also for how we treat and teach future analysts.

Countertransference is a basic tenet of psychodynamic theory. Although it was initially considered an unwelcome phenomenon in psychiatry, attitudes have shifted, and many mental health professionals now consider it to be a useful therapeutic tool. In this article, the author discusses countertransference as defined by the International Psychoanalytical Association\'s Inter-Regional Encyclopedic Dictionary of Psychoanalysis (IRED) and examines its clinical impact by using constructed vignettes of psychodynamic psychotherapies to illustrate theoretical points. As IRED delineates, countertransferences may exist at the conscious or unconscious level. In addition, the author suggests that countertransference may also exist at the preconscious level. Clinicians\' examination of all levels of countertransference has the potential to be revelatory and facilitate therapeutic action, whereas unexamined countertransference can interfere with effective treatment. For this reason, self-reflection on the part of psychiatrists is essential.