Reply To: Week 4 Homework Assignment (Ethical Issues in Clinical Supervision)

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Esther Cyr

1. Without using any identifying information, briefly describe a few client characteristics.
History of depression, anxiety, multiple deceased family members within family of origin, liver disease, dementia, hopelessness, suicidal ideation.
2. Without disclosing personal information you are not comfortable share, briefly describe your countertransference reactions to this particular client.
I feel frustration over the client avoiding in therapy sessions, the constant derailing to avoid addressing her emotional pain. Client only attends 1 session a month, if scheduled more frequently she says it is too much and will cancel. The passive suicidal ideations scare me and that is at a baseline; the fear comes from questioning whether the client is under reporting. I see borderline characteristics and a sense she could go beyond the ideation to who the family the emotional pain she is experiencing. I dread appointments with this client as I know ahead it will take half the session to get to a point of working on an issue, then time runs out to cover what needs to be covered and I may not see this person for another month.
3. Briefly describe how your reactions facilitate or inhibit your empathy for the client.
My fear facilitates careful review of the reported suicidal ideation without a plan. The multiple loss of family of origin members is part of the hopelessness and I can empathize that she misses them and has no one outside of therapy who listens after years of mourning. The dread of the appointment results in mentally preparing for the pace, content, outcome of the session and reality that client is in the maintenance phase and my wanting the client to achieve more may not be reasonable or even the clients expectation.
4. Briefly describe the extent to which your countertransference reaction my be intensified by your own history.
I have experienced significant loss in my life. The client’s emotional pain reminds me of my own at various times of my life. Looking back I did not want to resolve my losses, but express them. My empathy and ability t stay present with this client and allow her process to be what the client needs and now what I would want for her. My history tells me it is o.k. to process and grieve in one’s own way and at one’s own pace.
5. Devise a strategy for the countertransference issue.
a. My understanding of the response has allowed me to see her need and support her growth in therapy based upon how she responds. I ask the client at the end of each session if therapy made a difference as was it helpful or not. The response she gives becomes my guide on proceeding with treatment.
b. I have disclosed to the client questioning whether therapy was helping and whether this was the right approach. The outcome was helpful and she contributed on what is helpful for her in therapy sessions.
c. Part of the disclosure was helpful, however, not all of the countertransference would be helpful and could possibly harmful. what is important is to address with client countertransference that would increase understanding in and build on the therapeutic relationship.
6. How would you know that your countertransference response needs to be addressed with your own counselor/psychotherapist? What might be some signs to look for?
If I experience problems with sleep, irritability, intense fear, noticing difficulty with working with client on the treatment plan, feeling stuck, physical symptoms such as sore muscles, headache, tightness in chest, starting to lose hope for the client’s treatment outcome.
7. As your own clinical supervisor, how would you suggest to yourself, as a clinician, that you might need to seek counseling/psychotherapy to address your own personal history as it relates to your work with this client (or other client with similar presentations)?
I would say to self, I have dealt with this countertransference in supervision. I am feeling more fear than is natural to have within a therapeutic relationship, when client feels hopeless I am starting to have feelings of helpless in helping the client, however, this may be linked to feeling helpless in areas of my life. The therapeutic relationship is starting to be impacted with my response it is time to seek counseling to address some of these responses and increase my self awareness of what is causing these and gain insight into strengths, limitations, and areas that need healing.