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Without using any identifying information, briefly describe a few client characteristics, e.g. this person has a history of childhood sexual trauma, multiple substance abuse issues, and depression with hopelessness.
This client is a married mother of three young children. Her husband is in the military and is an alcoholic. Her sister passed away at a young age due to alcoholism and her father is a recovering alcoholic. She struggles with anxiety and struggles with balancing parenting and working.
Without disclosing personal information you are not comfortable sharing, briefly describe your countertransference reactions to this particular client, e.g. “I feel sick to my stomach when I know I have an appointment with this client. I feel intense guilt about the fact that the client continues to drink and hopeless about her getting better.”
When she described her physical response when she hears her husband put ice in a glass, because she knows he is going to start drinking hard alcohol, I started to feel my heart race. I want to help her get out of her situation, and I jump to solving her problem and wanting to tell her what to do.
Briefly describe how your reactions facilitate or inhibit your empathy for the client.
My empathy grows for her, however, I notice I become more maternalistic and what to “help her out of her situation.”
I have increased empathy for her because she is a mom and working and I am a working mom as well.
Briefly describe the extent to which your countertransference reaction may be intensified by your own history (e.g. your own or family’s trauma, depression, substance abuse, etc).
My ex-husband struggled with alcohol. I am mindful of this when working with female clients who are in relationships where their partners are using substances. I have to remind myself that everyone journey is different and is different than mine. My job as a therapist is to be neutral and help my clients find the answers/skills they are looking for without judgment.
Devise a strategy for addressing the countertransference issue.
Some questions to explore:
How does your understanding of your response to the client help you hear, see, understand the client more clearly? It increases my empathy towards the client. We have shared experiences in being mothers and working full time while raising children with a distant partner who is using substances. I can feel her challenges because I have walked in her shoes.
Would disclosure of the countertransference response be helpful to the client or the therapeutic relationship? How?
I would not disclose in this situation because of the risk of having the client wanting me to tell her what to do. I would share that I am a mother and working full time, however I would not share how similar our stories are. I would worry that the amount of information would harm the aspects of our clinical relationship that need to be neutral to help her come to her own conclusions without judgment or by me leading her to a conclusion.
Would disclosure of the countertransference response be harmful to the client or the therapeutic relationship? How? I think it could potentially harm the relationship. The risk of the client wanting me to “tell them what do to” is great with the stories as similar as they are.
How would you know that your countertransference response needs to be addressed with your own counselor/psychotherapist? I would look for my own avoidance during sessions. Am I holding back or not asking specific questions. Or the opposite, am I noticing myself leading her to certain conclusions. Is my language changing to be more directive vs more curious and open? What might be some signs to look for? I would also pay attention to if I am thinking about the case at home or after work hours. Or if I am noticing more emotional dysregulation when I interact with my ex-husband.
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 (and other clients with a similar presentation)?
If boundaries seem compromised, or if there appears to be greater emotional distress during supervision related to specific cases. If the clinician appears “stuck” with a specific case that has triggering elements to it. Or if the clinicians’ self-care routines appear to not be working. If a clinician is discussing feeling burned out or traumatized, then I would also explore the need for counseling.