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Question 1. Client characteristics
Previous mental health major with anxiety/ relationship issues and childhood parental loss. A few months into treatment, client’s sibling died in an accident.
Question 2. Countertransference reactions from this therapist
I had extremely high empathy when the client. My body was very tense and I was very still, leaning forward and listening intently for the whole session. I felt slightly nauseous, even after the session.
She was usually self-directed in control of the session; however, this session she wanted direction on how to create a self-care plan for the next 24 hours as she went to see family. When we created this plan together, during a small section; I did a self-disclosure in increasing her awareness of an additional self-care coping skill specific to the situation.
Question 3. Facilitative or harmful?
I believed my reaction to the client was facilitative. In the next session, we briefly processed the creation of her self-care plan including my disclosure – and she said that it was extremely helpful because she had needed direction and would not have considered that skill on her own.
Question 4 – my experience
My countertransference was intensified because of my own similar experience. As an adult, my parent was killed suddenly in a car accident. Both my siblings chose to use some different self-care coping skills to quickly move through the burial process and subsequently had extremely long, intensive repercussions of this act. Through many discussions and reading more about this type of loss afterward, I became aware that this skill can be helpful for closure.
Other countertransference which was lesser was her similar field of study and that we had both had a parent die, although very different situations.
Question 5: Strategy
My strategy at the time was to respond to my client’s request for assistance at a time when she was not cognitively strong. My strategy after that time was to briefly process the disclosure in a following session to make sure A) no harm was done to the client B) to address any clarity issues regarding the disclosure and C) to be transparent about the rareness of this type of disclosure and why I chose to offer it to the client.
I do think my understanding of this type of out of control loss added to my understanding of the client’s position.
I think the way disclosure of the countertransference response would be harmful to the therapeutic relationship would be if we did not process the disclosure, if we did not set it apart as a different, rare action on the therapists’ part. I am also aware that I was working with a client who was thinking about being in the mental health field. Being transparent about my process in this disclosure may also be important in her own journey of becoming a helper.
Question 6: Self-care for the therapist
When I do or want to do a different intervention in session, I know that I need to process my feelings and choices with my supervisor. If a single session does not release my need to talk about this disclosure, I would go to a therapist to begin processing this issue. For lack of a clinical term, if the feelings continue to “stick” with me, I know I need take care of myself outside of my profession.
Question 7: Supervisor addresses the issue
I would be transparent about discussing the process of self-care for the therapist. Therapy is just one option for self-care when a clinician is dealing with a trigger from session.
Sometimes I say during that procesing “Hey, I go to a therapist when I need to….. helps me be a better clinician.” It conveys being genuine, normalizing the self-care process and helping the therapist learn their own self-care options.
I would also check in with the supervised about how they are doing with self-care in a later session.