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PTSD & other Traumas: Ethical Issues in Using Recall
3 CEUs PTSD & other Traumas: Ethical Issues in Using Recall

Section 1
Track #1 - Tools for when Your Empathy Leads to Countertransference

Question 1 | Answer Booklet | Table of Contents | Introduction | PTSD CEU Courses
Social Worker CEU, Psychologist CE, Counselor CEU, & MFT CEU

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On this track, we will examine the ethical risks of countertransference and an efficient way to avoid it through supervision.

Share on Facebook #1 Countertransference and Therapists
Therapists that specialize in trauma clients tend to be exposed to some of the most emotionally exhausting sessions. Many times, these therapists are people who have experienced a type of trauma themselves. While this can give a therapist insight into a client's mindset, it can also lead to serious consequences. Countertransference has been described as an emotional reaction to a client by a therapist. Also, it could be thought of as a distortion of judgment on the part of the therapist due to the therapist's life experience or the process of seeing oneself in the client, of over-identifying with the client or meeting needs through the client.

Not only does countertransference refer to the therapist's reactions, but also how the client's stress is more apt to cause a therapist to countertransfer. This more contemporary view of countertransference includes all of the emotional reactions of the therapists toward the client, irrespective of the source. Also affecting a tendency to countertransfer is the therapist's absorption of the trauma expressed by the client.

Share on Facebook #2 Emphatic Reactions
If a trauma therapist, who has had their own trauma experience, has worked extensively for years with trauma victims, eventually, the therapist will encounter a client whose situation closely resembles their own. Do you agree? When this encountering of the closely resembling situation occurs, there is an ethical dilemma of over-generalizing the trauma worker's, or therapist's, experiences and methods of coping to the client and over-promoting these methods.

Here are three examples related to
#1. unconscious assumptions,
#2. prescribing methods, and
#3. APA code of ethics.

1. A crime-related traumatization may be very different from the experiences of the trauma worker, yet the therapist could unconciously assume they are significantly similar and not listen carefully.

2. Also, there is a risk of prescribing methods that may have worked for the trauma worker, but may not produce the same effects for the client.

3. Also, in addition to unconscious assumptions and inappropriate prescribing methods, the APA code of ethics states that psychologists "refrain from undertaking an activity when they know or should know that their personal problems are likely to lead to harm…They have an obligation to be alert to signs of, and to obtain assistance for, their personal problems at an early stage, in order to prevent significantly impaired performance." If you believe that a client's trauma is too similar to your own experience, and that this might impair your judgment, what should you do? Go to another colleague? Refuse to treat the client? Recommend the client to another therapist?

Share on Facebook #3 Avoiding Countertransference
A recent study suggests that there are five qualities in a therapist that best manage the risk of countertransference: anxiety management; conceptualizing skills; empathic ability; self-insight; and self-integration. Of these five, expert therapists rate self-insight and self-integration the most profitable in resisting the risk of countertransference. Think about these qualities for a few minutes. Are there any specific areas that you know you need to improve?

Share on Facebook #4 Supervision
One way to avoid countertransference is through supervision by another colleague. Supervision can ease the effects of countertransference by assisting the supervised therapist in identifying painful countertransference dynamics and recognizing traumatic reenactments. Supervision, which respects both the self of the therapist and the therapist's need to identify and express the powerful emotions extracted by this work can help to create an environment in which the therapist can feel safe with the strong affects he or she is asked to hold in his or her clinical work.

The basic components of social support, a main factor of supervision, include
(1) emotional support;
(2) information;
(3) social companionship; and
(4) instrumental support.

The peer group of a therapist provides all these components, particularly during periods in which a stressful client is involved. Casual contacts may supply some support, but a professional group with some form of formal organization (such as a consultation group, treatment team or case conference) can be more helpful.

Share on Facebook 5 Ways Professional Peer Can Benefit the Therapist

Let's look at some of the ways professional peers benefit the single therapist.

1. Professional peers can be supportive by providing resources. Resources refer to tangible aid in the form of helping with paperwork, making phone calls, and providing backup during non-work hours.

2. Professional peers can help the (secondarily) traumatized therapist clarify her insights by listening carefully and non-judgmentally, by getting the facts straight, and by accepting all the feelings which the traumatized therapist is experiencing.

3.
Professional peers provide support by listening to the therapist who has been traumatized or is going through countertransference and by correcting distortions in the therapist's assessment of his or her behavior and responsibility in regard to the disturbing cases. This is particularly relevant when the therapist feels guilty. Informed listeners can help him or her assign blame and credit more objectively. Since other therapists have an intimate understanding of a therapist's role in dealing with traumatized clients, they can offer an invaluable perspective on the realities of the therapist's responsibilities and limitations.

4.
The perspective that other therapists can offer will often constitute a reframing of the trauma. They can offer and support more generous or accurate perspectives on the impairing stress reactions. This can lead the traumatized therapist to develop a different cognitive appraisal of his or her role in dealing with the original trauma survivor.

5.
Professional peers provide support by being emphatically attuned to the traumatized therapist. They do this by recognizing and responding to the emotional experience of the therapist, and by maintaining the emphatic link even when the affected therapist is experiencing strongly melancholic emotions. A state of emphatic attunement underlies the listening skills and creates the opportunity to offer a different perspective.

I am sure by hearing these five methods that professional peers can provide support you are not hearing anything new. But, do you need to replay track 1 to review these and actually take action on an idea found in this track related to countertransference and your trauma client?

On this track... we discussed the ethical risks of countertransference and an efficient way to avoid it through supervision related to #1. unconscious assumptions, #2. inappropriate prescribing methods, and #3. APA code of ethics.

On the next track, we will discuss four ethically questionable possible results of hypnosis. 1. clients create memories; 2. distort existing memories; 3. incorporate cues from leading therapist questions; and 4. incorporate therapist beliefs. We will also examine the path the client might take to resolve their supposed sexual abuse.

QUESTION 1
According to a recent study, what are the five qualities in a therapist that best serve to manage the risk of countertransference? To select and enter your answer go to Answer Booklet.

 
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