Friday, March 16, 2012

Nuances in Countertransference

In school, we learn a little about countertransference - basically, enough to know that it's normal for therapists to have emotional reactions to clients, which are called countertransference, and that these reactions can provide us with important information about the client's internal experience, and how others may relate to him/her. While that's useful knowledge for beginning therapists, countertransference is actually much more complex.

There are two ways of distinguishing various countertransference reactions that I find helpful. The first is subjective vs. objective. Subjective countertransference comes out of our own issues and histories, rather than the client's. One possible source of subjective countertransference is our past relationships - for example, when a client reminds us of our mother or daughter, a childhood friend or bully, and therefore elicits feelings from these relationships. Another source of subjective countertransference is emotional difficulties, traumas, or other vulnerabilities we've experienced. For example, someone who has had depression may find the experience of treating a client with depression more distressing due to fear of being sucked back into that state, or someone who has experienced rape may have strong reactions to a client describing a rape, let alone a client who has been a perpetrator, or even makes general comments that seem to justify sexual aggression.

While these kinds of subjective countertransference are normal, they do not give us information about the client, and can hinder rather than help therapeutic work. As a result, it's important for us to learn to recognize, manage, and contain our subjective countertransference, to keep it from negatively influencing the work. If we are unable to contain it, the ethical decision would be to transfer the case to someone who might be more objective, and if the reaction is to a certain client population (e.g., perpetrators of sexual abuse) we should seek out a field of practice or practice setting where we won't be working with that population.

Objective countertransference is elicited by the client, out of their own issues and histories. It gives us information about their emotional state, unconscious material, and/or how they may be experienced by others. For example, if we become irritated by a client, they may be experiencing irritation - even if they are not expressing it. If we feel distanced or dismissed by the client, they may also distance or dismiss others, or feel distanced and dismissed by others. Awareness of objective countertransference can be a useful tool in therapy, both by informing our own clinical hypotheses, and through carefully constructed comments sharing our observations, make implicit clinical material explicit.

The other useful distinction between types of countertransference is common vs. idiosyncratic. Common countertransference refers to the reactions that we always or usually have to a particular clinical situation. For example, sitting with someone who is depressed makes me feel like I'm in a black hole, and the feeling is so consistent that I can use it as a diagnostic tool. These reactions can be helpful (e.g., when they are a diagnostic tool), or unhelpful (e.g., if my lethargy when sitting with a depressed client interfered with effective intervention), depending on how we manage and use them.

Idiosyncratic countertransference is the unique reaction we have to a particular client and/or a particular clinical encounter. For example, experiencing a surge of anger toward a client with whom we have not felt angry in the past can point to their own anger, and/or to how they might elicit antagonism from others, while anxiety without a known cause likely reflects the client's level of anxiety. Such idiosyncratic reactions are the most informative kind of countertransference because they provide a window into this client at this moment in time, and may even reveal things that client is not yet consciously aware of. Of course, like all forms of countertransference, the utility of such reactions depends upon our being aware of them and managing them effectively so that we reflect on, rather than enacting, them.

How do you understand, manage, and use countertransference in your work?

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