Countertransference phenomena in the therapist are as meaningful
and potent in therapy as transference phenomena in the child. The physical
setting in which the therapist sees a child should be comfortable for both the
child and therapist. If control of sound and noise is inadequate, conversations
of others are overheard and privacy is lacking for child and therapist. Both will
be uncomfortable. A therapist might think that the child "does not mind,"
or might disregard the child's need for privacy since the therapist is the adult
in control. If the therapist has many objects that he treasures in his office,
he can be concerned about the child's movements. If the therapist is too concerned
about being liked, he might provide many toys, candy and cookies, frequently give
"presents," and permit or ask the child to address him by his first
name to demonstrate that they are friends and equals. This serves to confuse the
child since they are not equal, though at different times from the child's point
of view they may or may not be friendly to each other.
Over-identification
with the child will lead the therapist to be excessively giving and permissive.
When the therapist has difficulty with aggressive impulses, he will allow the
child to become aggressive and vicariously enjoy the child's behavior as some
parents do. Or, again, the therapist will inhibit an expression of aggression
because he is uncomfortable when it happens. In attempting to hide his discomfort,
he might say that he is not angry, or imply that his anger will lead to a dangerous
situation. He may even resort to making the session as bland as possible as a
means of diverting or minimizing the child's anger.
When
a child senses that a therapist has particular needs, he may do the following: concentrate on them to please the therapist, play games or make models which the
therapist likes, or bring in frequent evidence of "good" performance
and behavior, if the therapist asks too often about the child's progress at home,
at school, or with peers. A child will be aware of the therapist's needs if they
become manifest as countertransference. The therapist's ego interests will be
evident to the child, but these are not countertransference phenomena and need
not intrude in the therapy hours. However, when the child makes observations and
comments, he should be answered unambiguously.
The
therapist's countertransference behavior may manifest itself in various ways toward
the child's parents. A therapist who imagines all parents are "bad"
might be very critical, aloof, or exceedingly friendly toward the parents. If
he overindentifies with the child, wishes to rescue him, and sees the child's
environment as harsher than it is, he will be excessively critical of the parents
and undermine their positive attributes. His approach to them could become overly
moral and judgmental. The need to rescue can lead the therapist to recommend placement
of the child out of the home when it is not indicated. If he feels as a child
in relationship to the parents, he may need to please them excessively and in
so doing avoid critical areas of discussion. His need for the parents' approval
makes this kind of behavior necessary. He might attempt to cajole, seduce, or
coerce the child into "good" behavior to get the parents' approval;
he might be too accommodating when it comes to changing appointments, canceling
appointments, and in other ways seeking the parents' approval. A therapist who
needs to please the parents will allow them to believe they are not involved in
the child's difficulty, even in situations where they are, and permit them to
be the sole reporters of the child's behavior, or be the recipients of advice
on management from the therapist.
The therapist who
has unresolved conflicts over aggressive or sadistic impulses and controls
them by reaction formation will be too permissive with a child in therapy. He
will avoid discussing and limiting behavior when it is necessary. When he needs
affirmation of his competence to bolster his self-esteem and avoid narcissistic
injury, he will often strive for rapid symptomatic "cures," and in so
doing can gain his own approval as well as the approval of others. The therapist
who cannot feel comfortable with ambiguity, or adopt a formulation which has some
unexplained facets, will strive for closure and not be receptive to alternative
explanations when they patently are more suitable. If the therapist believes he
must always be available, does not take vacations, spends little time with his
family, or is too "dedicated," he may be acting out of his fears of
abandonment or the role of the idealized "good" parent. He might not
enjoy pleasure because of superego prohibitions. Though the therapist engages
in various maneuvers as part of the therapeutic process, he is very much a "real"
person. The healthy part of the child cannot fail to observe this person and it
serves a useful purpose.
- Committee on Child Psychiatry, The Process of Child
Therapy, Brunner/Mazel Publishers: New York, 1982.
Self-Injurious Behavior: Characteristics and Innovative Treatment Strategies
- Dykes, Michelle, Specian, Victoria, Nelson, Meredith, Gray, Neil Self-Injurious Behavior: Characteristics and Innovative Treatment Strategies.
================================= Personal
Reflection Exercise #9
The preceding section contained information
about countertransference with children. Write three case study examples regarding
how you might use the content of this section in your practice.
QUESTION
23 The therapist who has unresolved conflicts over aggressive or sadistic
impulses and controls them by reaction formation will be to what? Record the letter
of the correct answer the Test.
