City Research Online City, University of London Institutional Repository Citation: Peteinaki, Margarita (2014). A Counselling Psychology Perspective on the Challenges Inherent in the Treatment of Perversions. (Unpublished Doctoral thesis, City University London) This is the accepted version of the paper. This version of the publication may differ from the final published version. Permanent repository link: https://openaccess.city.ac.uk/id/eprint/12480/ Link to published version: Copyright: City Research Online aims to make research outputs of City, University of London available to a wider audience. Copyright and Moral Rights remain with the author(s) and/or copyright holders. URLs from City Research Online may be freely distributed and linked to. Reuse: Copies of full items can be used for personal research or study, educational, or not-for-profit purposes without prior permission or charge. Provided that the authors, title and full bibliographic details are credited, a hyperlink and/or URL is given for the original metadata page and the content is not changed in any way. City Research Online: http://openaccess.city.ac.uk/ [email protected] A Counselling Psychology Perspective on the Challenges Inherent in the Treatment of Perversions Margarita Peteinaki City University Department of Psychology Top-Up Doctorate in Counselling Psychology Thesis Supervisor: Dr. D. Rawson December 2014 1 THE FOLLOWING SECTION OF A PREVIOUSLY PUBLISHED PAPER HAS BEEN REDACTED FOR COPYRIGHT REASONS: pp251-253: Hardy, G.E., Aldridge, J., Davidson, C., Rowe, C. & Reilly, S. (2004) Assessing and formulating attachment issues and styles in psychotherapy. British Journal of Psychotherapy. 20(4), 493-512 Contents Page No Declaration ……………………………………………………………………….. 6 Dedication ……………………………………………………………….……….. 7 Acknowledgments …………………………………………………………….….. 8 Preface …………………………………………………………………………… 9 SECTION A: RESEARCH: Therapists’ Countertransference Experiences When Working with Perverse Patients: An Interpretative Phenomenological Analysis ………………………………………………………………….…….…. 15 Abstract ………………………………………………………………….………. 16 Chapter 1: Literature Review ………………………………………….….…. 17 1.1 Countertransference ………………………………………………………..…. 18 1.1.1 “What is Countertransference” or “What is Countertransference for me?” 18 1.1. 2 Sigmund Freud and the Birth of Countertransference ……………….……. 19 1.1.3 Change in Perception of Countertransference1.2.3 Change in Perception of Countertransference …………………………………………………….. 22 1.1.4 Donald Winnicott …………………………………………………………... 23 1.1.5 Paula Heimann …………………………………………………………....... 23 1.1.6 Heinrich Racker …………………………………………………………..... 24 1.1.7 Current Conceptualisations of Countertransference ………………………. 26 1.2. Perversions …………………………………………………………………... 28 1.2.1 Perversions vs. Paraphilias, an On-going terminological debate …………. 28 1.2.2 Psychoanalytic Theories of Perversion; A Modern Babel?............................ 36 1.2.3 Sigmund Freud ……………………………………………………………... 37 1.2.4 Edward Glover …………………………………………………………….. 40 1.2.5 Janine Chasseguet-Smirgel ………………………………………………… 41 1.2.6 Robert Stoller ………………………………………………………………. 42 1.2.7 Mervyn Glasser …………………………………………………………….. 43 1.2.8 Estella Welldon …………………………………………………………….. 44 1.3. Perversion and Countertransference …………………………………………. 46 1.3.1 Countertransference in the Research of Countertransference in the Treatment of Perversions …………………………..……………………… 46 1.3.2 Transference and Countertransference Perversion …………………..…… 50 1.3.3 Feeling like a Thing ………………………………………………………… 53 1.3.4 Feeling like a Part-Object ………………………………………………….. 54 2 1.3.5 Feeling Humiliated and/or Useless ……………………………………….. 54 1.3.6 Feeling Sexually Aroused …………………………………………………... 55 1.3.7 Feeling Charmed and Seduced ……………………………………………... 56 1.4 Rational for the Research …………………………………………………….. 57 Chapter 2: Methodology ……………………………………………………… 59 2.1 Brief Summary of the Ontological and Epistemological Position …………… 59 2.2 Epistemological Position …………………………………………………….. 60 2.3 Method ……………………………………………………………………….. 65 2.3.1 Participants ………………………………………………………………… 68 2.3.2 Data Collection …………………………………………………………….. 69 2.4 Reflexivity and the Interview Process ……………………………………...… 71 Chapter 3: Analysis …………………………………………………………… 73 3.1 Stages of Analysis ……………………………………………………………. 73 3.2 Reflection on Translation, Interpretation and Validity ………………………. 75 Chapter 4: Results …………………………………………………………….. 82 4.1 Therapists’ Understanding of Perversions …………………………………… 82 4.1.1 Definitions of Perversion …………………………………………………… 82 4.1.2 Way of Relating to Self ……………………………………………………... 83 4.1.3 Way of Relating to Others …………………………………………………. 85 4.2 Development of Countertransference ………………………………………… 87 4.2.1 Initial Period Countertransference ………………………………………… 87 4.2.2 Middle Period Countertransference ……………………………………….. 95 4.2.3 Final Period Countertransference …………………………………………. 101 4.2.4 Post-therapy Countertransference …………………………………………. 104 4.3 Ways of Coping with Countertransference ………………………………….. 106 4.3.1 Strength of Countertransference …………………………………………… 107 4.3.2 Acting Out ………………………………………………………………….. 108 4.3.3 Defence Mechanisms ……………………………………………………….. 109 4.3.4 Clinical and Peer Supervision ……………………………………………… 112 4.4 Making sense of and Using Countertransference ……………………………. 114 4.4.1 Understanding of Countertrasnsference …………………………………… 114 4.4.2 Creating Therapeutic Meaning …………………………………………… 116 3 4.5 Parallel Process ……………………………………………………………….. 118 4.5.1 Parallel process between therapist and supervisor ………………………... 119 4.5.2 Parallel process between interviewee and interviewer …………………….. 120 Chapter 5: Discussion ………………………………………………………… 125 5.1 Therapists’ Understanding of Perversions …………………………………… 125 5.1.1 Definitions of Perversion …………………………………………………… 125 5.1.2 Way of Relating to Self ……………………………………………………... 127 5.1.3 Way of Relating to Others ………………………………………………….. 128 5.1.4 Theories of Perversion and Countertransference ………………………….. 129 5.2 Development of Countertransference ………………………………………… 131 5.2.1 The Initial Period Countertransference: Battle for Survival ………………. 131 5.2.2 The Middle Period Countertransference: Sadomasochistic Control vs. Empathic Understanding ………………………………………………….. 136 5.2.3 The Final Period Countertransference: Attachment and Loss …………….. 144 5.2.4 The Post-therapy Countertransference: Traumatisation vs Personal and Professional Growth ………………………………………………………. 146 5.3 Ways of Coping with Countertransference …………………………………... 150 5.3.1 Strength of Countertransference …………………………………………… 150 5.3.2 Acting Out …………………………………………………………………... 151 5.3.3 Defence Mechanisms ……………………………………………………….. 152 5.3.4 Clinical and Peer Supervision ……………………………………………… 155 5.4 Making Sense of and Using Countertransference ……………………………. 158 5.4.1 Understanding of Countertransference ……………………………………. 158 5.4.2 Creating Therapeutic Meaning …………………………………………..... 159 5.5 Parallel Process ………………………………………………………………. 161 5.5.1 Parallel process between therapist and supervisor ………………………... 161 5.5.2 Parallel process between interviewee and interviewer …………………….. 162 5.6 Implications for the Treatment of Perversions ………………………………. 164 5.7 Implications for the Treatment of Sex Offenders ……………………………. 165 5.8 Implications for Counselling Psychologists’ Practice ………………………... 169 5.9 Implications for the Treatment of Other Mental Health Conditions …………. 174 5.10 Reflections on and Critique of Methodology ……………………………….. 175 5.11 Reflections on the Study …………..………………………………………… 159 5.12 Limitations of the Study …………………………………………………… 181 4 5.13 Conclusion and Suggestions for Future Research …………………………... 182 References ………………………………...……………………………………… 184 Tables …………………………………………………………………………….. 202 Table 1. Participants’ Characteristics ……………………………………………. 202 Table 2. Master Themes …………………………………………………………. 203 Table 3. Table of Themes and Participants’ Quotes ……………………………. 204 Index of Appendices …………………………………………………………….. 211 Appendix A: Research Flyer - English Version …………………………….….. 211 Appendix B: Research Flyer - Greek Version ……………………………………. 212 Appendix C: Information Sheet & Consent Form - English Version ……………. 213 Appendix D: Information Sheet & Consent Form - Greek Version ……………… 215 Appendix E: Interview Schedule - English Version ……………………………... 217 Appendix F: Interview Schedule - Greek Version ……………………………….. 219 Appendix G: Debriefing - English Version ………………………………………. 220 Appendix H: Debriefing - Greek Version ………………………………………... 222 Appendix I: Example of Transcript Analysis …………………………………….. 223 Appendix J: Preliminary Countertransference Model of Perversions ……………. 224 SECTION B: PROFESSIONAL PRACTICE: The Therapeutic Journey of William: a casy study on perversions from an Attachment Theory perspective .. 227 SECTION C: CRITICAL REVIEW: “Forty Years of Successful Outcomes or Forty Years of Flawed Research Designs & Potentially Unfounded Hypotheses? A Critical Review on the Pharmacological Treatment of Paraphilias” ……………………………………………………………………… 254 5 Declaration “I grant powers of discretion to the Department of Psychology to allow this dissertation to be copied in whole or in part without any further reference to me. This permission covers only single copies made for study purposes, subject to the normal conditions of acknowledgment” 6 To my father Emilios He lived at the frontiers of an indetermined age And died for distant things He once saw in an uncertain dream Tassos Leivaditis 7 Aknowledgments Every single part of this portfolio would have been impossible