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"Communication by impact" and other forms of non-verbal communication: a review of transference, countertransference and projective identification.

This article aims to review the importance, place and especially the emotional impact of non-verbal communication in psychiatry. The paper argues that while biological psychiatry is in the ascendency with increasing discoveries being made about the functioning of the brain and psycho-pharmacology, it is important to try and understand what is happening between psychiatrist and patient. The importance of being aware of the subtleties of this interaction is argued, as are the roles of phenomena such as transference, counter-transference and projective identification. The workings and use of these phenomena are explored as central in the doctor-patient interaction, as well as the consequences of failure to utilize and understand these phenomena. The author reviews - amongst others - the work of the analysts Casement, Gabbard, Goldstein, Ogden and Symington.