Coping with Countertransference

Countertransference is defined as therapist emotional and behavioral reactions to clients. As an example, imagine an interviewer who lost his mother to cancer when he was a child. His father's grief was very severe. As a consequence, little emotional support was available when the interviewer was a child. The situation eventually improved, his father recovered, and the interviewer's conscious memory consists of a general sense that losing his mother was very difficult. Now, years later, he's a graduate student, conducting his first interviews. Things are fine until a very depressed middle-aged man comes in because he recently lost his wife. What reactions might you expect from the interviewer? What reactions might catch him by surprise?

Countertransference reactions may be more or less conscious, more or less out of the therapist's awareness. These reactions, if unmanaged, can have a negative effect on therapy. The following guidelines are provided to assist you in coping with countertransference reactions:

• Recognize that countertransference reactions are normal and inevitable. If you experience strong emotional reactions, persistent thoughts, and behavioral impulses toward a client, it does not mean you are a "sick" person or a "bad" interviewer.

• If you have strong reactions to a client, consult a colleague or supervisor.

• Do some additional reading about countertransference. It is especially useful to obtain reading materials pertaining to the particular type of client you're working with (e.g., eating disorder clients, depressed clients, antisocial clients).

• If your feelings, thoughts, and impulses remain despite efforts to deal with them, two options may be appropriate: Refer your client to another therapist, or obtain personal psychotherapy to work through the issues that have been aroused in you.

tion to client transference. This is certainly the case sometimes. On occasion, clients treat their interviewers with such open hostility or admiration that interviewers find themselves caught up in the transference and behave in ways that are very unusual for them. For example, at a psychiatric hospital, a patient once unleashed an unforgettable accusation against her therapist:

"You are the coldest, most computer-like person I've ever met. You're like a robot! I talk and you just sit there, nodding your head like some machine. I bet if I cut open your arms, I'd find wires, not veins!"

Certainly, this accusation might be considered pure transference. Perhaps the client was responding to her therapist in this manner because, in the past, she experienced males as emotionally unavailable. On the other hand, as the saying goes, it takes two to tango. As interviewers, we need to look at our own contributions to the therapist-client dance.

Taking a hard look at his reactions to this particular patient, the therapist consulted with colleagues and a supervisor, engaged in self-reflection, and came to several conclusions about his behavior with her. First, he admitted to behaving cooler and less emotionally than he generally did with clients. Second, he was frightened of her demands for emotional intimacy. Consequently, he responded by protecting himself by becoming more inhibited and robotic. Third, his supervisor reassured him that coun-tertransference reactions to severely disturbed patients are not unusual. The therapist took solace in the fact that he was not the first clinician to experience countertransfer-ence; he also worked to respond to the client more therapeutically, rather than reacting with his own fears of intimacy.

Interviewers respond to transference reactions in unique ways that elicit, in turn, unique responses from each client. In the preceding example, important men in her past had been emotionally unavailable to the client. Her outrage toward emotionally unavailable men often drew emotional (and sometimes physical) counterattacks from men with whom she had relationships. Her therapist's continued withdrawal into emotional neutrality was unusual for her (and him), and so she kept up a raging attack, possibly in an effort to obtain some type of reaction from him. In turn, he kept constricting his reactions to her, out of fears of intimacy and losing control.

Many theorists go beyond Freud's definition of countertransference and define it more broadly as "any unconscious attitude or behavior on the part of the therapist which is prompted by the needs of the therapist rather than by the needs of the client" (Pipes & Davenport, 1999, p. 161). In other words, countertransference may begin with the interviewer's (rather than the client's) unconscious agenda.

Freud originally considered transference an impediment to psychotherapy, but later modified his position, suggesting that the analysis of transference, conducted properly, is a crucial therapeutic tool. In contrast, Freud always considered countertransference to be an impediment to psychotherapy. That is, he thought good psychoanalysts should deal with their own inner conflicts through analysis; their high levels of self-awareness would then reduce the likelihood of their experiencing countertransference reactions. "Recognize this counter-transference . . . and overcome it" because "no psychoanalyst goes further than his own complexes and internal resistances permit" (S. Freud, 1910/1957, p. 145). In fact, research has shown that therapists reputed as excellent are also rated as having better self-awareness and less countertransference potential than therapists considered average (Van Wagoner, Gelso, Hayes, & Diemer, 1991).

Many contemporary psychoanalysts and object relations theorists have broken with Freud's negative view of countertransference and believe there is much to be gained from an interviewer's countertransference reactions (Beitman, 1983; Weiner, 1998). For example, if a client provokes strong and unusual feelings of fear, disappointment, or sexual attraction, it may be worthwhile to scrutinize yourself to determine if your emotional response is from your own personal issues. Only after scrutinizing yourself can you assume that your client's behavior is an indicator of the client's usual effect on people outside psychotherapy.

Countertransference reactions can teach us about ourselves and our underlying conflicts. They are a source of information about ourselves and our clients. Although it may be a hindrance and make it difficult to distinguish our own issues from those of clients', countertransference can facilitate the therapeutic process.

Clinicians from various theoretical orientations acknowledge the reality of counter-transference. Goldfried and Davison ( 1976), the authors of Clinical Behavior Therapy, offer the following advice: "The therapist should continually observe his own behavior and emotional reactions, and question what the client may have done to bring about such reactions" (p. 58). Similarly, Beitman (1983) suggests that technique-oriented counselors may fall prey to countertransference. He believes that "any technique may be used in the service of avoidance of countertransference awareness" (p. 83). In other words, clinicians may repetitively apply a particular therapeutic technique to their clients (e.g., progressive muscle relaxation, mental imagery, or thought stopping) without realizing they are applying the techniques to address their own needs, rather than the needs of their clients (see Putting It in Practice 5.2 and Individual and Cultural Highlight 5.1).

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