Countertransference and The Skill Set of the Therapist

Therapists frequently have to listen to their clients espouse points of view with which they disagree. Sometimes these points of view are very powerfully stated and held by the client. Often they are not logical, they are primitive, gut level “knowings” that the client feels. The challenge for the therapist is to hear the message of the client and understand it. When I say hear it, I don’t just mean be able to recite the words that were stated. “Hearing” in therapy involves empathically resonating with the feelings and intuitive meanings of the client. This is important, especially when (as there often are) levels of meaning of which the client is unaware. Part of the challenge for the therapist is to “sense” the conflict surrounding these statements and develop a strategy that will help the client become aware of the conflict and of the feelings which are generated in response to the conflict.

It is not the job or the right of the therapist to solve the problem and resolve the conflict. If the therapist attempts to do this, there is countertransference going on. The therapist is responding to their own set of values and conflict -based issues around whatever the topic is. They are projecting the solution that they feel would be the correct one and the one most likely to ease their own anxiety around the topic. That is not the job of the therapist. If the therapist is experiencing resistance, resentment or volatile reactions to the pronouncements of the client, they need to work through those feelings in their own therapy. They must not try to do that with the client. It is unethical.

A therapist needs to be able to compartmentalize their feelings and reactions (to which they are fully entitled) so that they can focus on the “message” of the client. Then the therapist can respond in such a way that they help the client conceptualize and become aware of the conflict with which they are struggling. Often the conflict is not the one that would be most obvious. The temptation is to take the challenging statement and dissect or confront the elements in the statement. Reacting to the overt message most often creates a conflict or a challenge for the client. Then this leads them to utilize their defenses to protect against the anxiety being provoked by the therapist as the therapist directly challenges the “facts” of the statement or the correctness of the statement. Young therapists often make this mistake. It is never about whether or not you agree with the statement or find it offensive, or even reprehensible. It is never about your ability to “prove” the inaccuracies or over generalizations of the statement. As a therapist, you are not there to debate, challenge or master the conversation. You are there to help the client.

In order to help the client, what must you do? First you must hear. Hear at an intuitive, emotional level that displays for you what the pain and conflict to which the client is reacting. If you learn to understand that, you can begin the task of reframing the awareness to examine the underlying issues that cause the conflict and the emotional instability for the client.

Let’s examine some possibilities. A client comes in and says “gays are an abomination before the Lord, and I hate them”. It is not your job, nor your right to challenge their thinking and to disagree with them politically or from your religious convictions. It is your responsibility to attend to them enough to try and understand what about this issue is causing them pain, anger, grief or conflict. When you think you understand the background behind this distress, then you can begin to probe and focus the conversation between you on the background. What is the history around this conflict? Where did they internalize this script? What is going on in their lives now that causes this conflict? How do they think they “should” respond to this conflict? What will happen in their lives if they do respond in the way they think they “should” versus the way they might respond if they did not have the “should”? What is the cost/benefit ratio of the choices they make?

There is some wound here that must be identified and gently treated. The idea is to heal the wound, not change the verbiage. If the wound is healed then the verbiage will automatically change. You as the therapist cannot necessarily predict what the new script will be, but you can be assured that there will be one.

The reason I am writing about this is that in my experience many therapists, particularly new therapists, get knocked out of balance about these kinds of issues when they happen. I have heard therapists say, “I need to refer this client because I just cannot work with someone with this belief system.” I have heard new therapists agonize over their gut feeling of dislike or distaste about a client. Sometimes this is about the things the client says, sometimes it is about their look or presentation, sometimes about their life style.

Therapists have their own prejudices and ignorance to content with. Their relationships are often in flux and sometimes are damaged in ways they have not yet been able to resolve. Often when this causes the therapist to say, my God, if I am getting a divorce, how can I market myself as a marriage counselor? If I can’t save my own relationship, how can I save the relationships of my clients? They may think, “I have to go and get a real job, I just can’t do this.” What would my clients say if they knew I was getting a divorce? These are legitimate questions to ask, and the answer might surprise you.

The skill of being a good therapist requires that the therapist learn to compartmentalize themselves. The job is to be able to put your stuff aside and focus on the client. You have to ask: What is the message? What do I need to learn from this client to understand how they feel and get a glimpse of the conflict that is churning within them? In order to do that, I have to focus so intently that I can shove my own reactions way back in the distance. I need to not shut them off entirely because they are also a sense of information from the client. There is something called a projective identification that allows the client to give you an experiential message about what it feels like to be them. You will feel rage, hurt, fear, anger, lust etc. and the questions you have to ask yourself are: Is this my stuff? Do I have these feelings, are they reflective of me in my own experience? If the honest answer is no, or at best I don’t know, then you as the therapist have to consider, not assume, that this is some kind of message from the client about what it feels like inside them. This is a useful skill and a necessary one, but it is one that is hard to develop. You need good supervision as a therapist. It helps immensely to have a therapist supervisor who understands this and can help you pull it into consciousness and focus on it in a way that allows you to “know” when it is your stuff and when it is the client’s. It takes practice, consciousness application of the right questions, asking the client for feedback about how it feels to be them, and being strong enough to be honest with yourself about whether or not it is countertransference issues of your own or some particular message from your client.

The next challenge then becomes how to use the information in a helpful way to reflect back to the client so that they have that “ahah” experience of feeling truly seen and accepted. It is not necessary that you agree or approve, but you do have to “accept” the genuine presentation of the self of the client. You do have to believe that the client is deserving of care and support, even when you disagree with them and even when your own personal prejudices are inflamed by the presence of this client. If you can train yourself to get to this place, you will discover that your prejudice does not manifest in the presence of this client and that eventually because of what you are learning about yourself, your prejudice dissipates. Prejudice is based on ignorance. Information and honesty eliminate the ignorance. This is a hard challenge for the client because they have to step outside of their environment to find a place to stand that is anchored and stable so that they do not get swept away by their anxiety, or destroyed by the conflict that the anxiety produces. Therapy is the place where this platform is offered, but only if the therapist is skilled and well trained.

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7 Responses to Countertransference and The Skill Set of the Therapist

  1. I came across your blog when googling for cool biotechnology articles – didn’t expect to find this, but enjoyed some of your posts. Keep it up.

  2. Camille says:

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    • Brett Newcomb says:

      Thank you for your comment. I am always pleased when someone responds to something I have written. I would like to stimulate more dialogue about these topics. I am glad you found them to be helpful.

      • Brett Newcomb says:

        Thank you for your response. It is always helpful to get feedback.My newest post also offers insight on this concept. It is important to work on the ability to see the glass as half full instead of half empty. We make very few always and forever decisions in our lives. Most of what we decide is of the “for now” variety. Change happens and only if we adapt to change can we survive.

  3. chezie says:

    reading this gave me the first moments of calm i have had all day. i am a retired msw working with a young clinician. i asked him if i were mother…and about countertransference. no, he said. he lectured one time as if he were the principal and i were the wayward student. he convinced me to take a trip…yet, the real issues draining me of life were left untouched. we had a break in contact due to weather friday which gave me time to ponder all this and to plan to stay away. it feels like betrayal.

    • Brett Newcomb says:

      I am sorry that you are struggling. I hope you continue your journey and find a balance point in your life where you are in less distress. Thank you for writing.

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