A Counselling Psychology Perspective on the Challenges Inherent in the Treatment of Perversions
The field of perversions or paraphilias has been traditionally the “privilege” of psychoanalysts and psychiatrists, resulting in theoretical understandings that emerged either through case studies or quantitative research involving the pharmacological and behavioural treatment of these conditions. Moreover, although the importance of countertransference experiences when working with perverse clients is emphasised in the literature, no systematic effort has so far been undertaken to explore their nature in more detail. The present study represents the first effort to address the lack of qualitative research in the field, by exploring psychodynamic therapists’ countertransference experiences when working with this client group. Employing Interpretative Phenomenological Analysis, ten semi structured interviews were conducted with both male and female British and Greek therapists. The analysis yielded five main themes: (1) Therapists’ Understanding of Perversions (2) Development of Countertransference, (3) Ways of Coping with Countertransference, (4) Making Sense of and Using Countertransference, (5) Parallel Process. The findings of the study confirm previous clinical observations in that countertransference and in particular annihilation anxiety is the most challenging aspect of therapy, but it extends previously literature by highlighting the threat to the therapists’ identity as well as the risk of traumatisation. In addition, as a result of the present research, a Preliminary Countertransference Model of Perversions is developed and a countertransference based therapeutic approach is proposed for the treatment of these conditions. Furthermore, the implications of these findings in terms of the therapeutic work with sex offenders and counselling psychologists’ practice are discussed. Finally the limitations of the study are presented along with suggestions for further research.
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