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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.
Client was a mom, highly intelligent, in unhappy marriage, pregnant with second baby, both professionals from parents who were doctors. She was depressed, in conflict with mother-in-law, friends, cried most of the entire sessions, didn’t seem to want to make any changes personally, only expected others around her to change.
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.”
I dreaded every session with her, hoped she’d cancel, felt bored, watched the clock every 5 minutes.
Briefly describe how your reactions facilitate or inhibit your empathy for the client.
It was hard for me to have empathy when she seemed to want help but rejected every intervention. I tried to not show my frustration or boredom, and even at times tried to use that as a way to connect more deeply with her. I tried to remember her pain and desperation and stay with that to support her.
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).
This always intrigued me as we had some family cultural similarities of cultural background and I personally have experienced depression but didn’t think to her extent. I also have a physician father as she and raised with high expectations, so I think that played a role. It was odd that we shared the same birthdate (not year) and I felt so disconnected from her. I also shared a cultural name with her sister (which I did not reveal). There were these oddities that just added to my frustration that I should feel more connected to her and be able to help her more. Also, I didn’t feel that I shared her tendency to push others away and be in conflict with them, and so that was confusing, plus I experienced her doing that with me.
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?
• Would disclosure of the countertransference response be helpful to the client or the therapeutic relationship? How?
• Would disclosure of the countertransference response be harmful to the client or the therapeutic relationship? How?
I tried to look at my response in order to quiet the countertransference and stay more connected with her pain. I tried using more motivational interviewing, both the skills and spirit of MI. Occasionally I used disclosure of frustration and not sure how to help as it seemed she wanted it but didn’t, to try to better understand and move into her pain. I also didn’t disclose often because I felt it mostly would not be helpful and would recreate her cycle of conflict with others, and didn’t sense that she was emotionally resourced enough to address this process therapeutically. I also used the strategy of exploring issues like career around which she could engage in a different way sometimes with more engagement.
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 was not able to remain somewhat empathic or if my reactions got in the way of doing therapy and not being able to hold her in positive regard, then I would seek more supervision. I’m not sure that I needed therapy per se to work with her. I did not seek therapy, however perhaps because of some of the weird connections I felt that frustrated me, it would have been enlightening.
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 my countertransference reactions as a therapist were getting in the way of therapy, of continuing to serve the client well with the highest level of empathy and support and use of skills—if I felt I was giving up and just sitting there, so to speak, and not engaged, then I would recommend therapy of the therapist. If it was also bleeding over into my work with other clients, or subsequent sessions during the day, or holding boundaries or taking it home, that would be another reason to recommend therapy. Also, if I found myself engaging in poorer self-care or unable to do so, that would be a big indicator for need of therapy.