On this track, we will
examine the ethical risks of countertransference and an efficient way to avoid
it through supervision.
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.
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.
three examples related to
#1. unconscious assumptions,
#2. prescribing methods,
#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?
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?
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;
(3) social companionship; and
(4) instrumental support.
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.
5 Ways Professional Peer Can Benefit the Therapist
Let's look at some
of the ways professional peers benefit the single therapist.
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.
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 .