How Do Clinical Psychologists Manage Countertransference With Patients?

How Do Clinical Psychologists Manage Countertransference With Patients?

Managing countertransference is a crucial skill for therapists, and to gain deeper insight, we've gathered responses from eight professionals, including Licensed Psychotherapists and Psychologists. From navigating pet loss countertransference to addressing grief-related countertransference, these experts share their personal experiences and strategies for maintaining therapeutic boundaries.

• Navigating Pet Loss Countertransference
• Distinguishing Personal Projections
• Managing Frustration with Teen Clients
• Recognizing Limbic System Responses
• Embracing Transparency in Therapy
• Reflecting to Maintain Professionalism
• Overcoming Personal Resonance with Client
• Addressing Grief-Related Countertransference

Navigating Pet Loss Countertransference

Countertransference management often occurs for me surrounding pet loss. A patient shared with me the unexpected death of her dog and the overwhelming feelings that needed to be unpacked for her to begin the healing process. My own disenfranchised grief, involving extreme emotions over my dog's death, made it challenging for me to sit with her in that space. I began to feel the sadness sensations in my own body and had to remind myself to just breathe to maintain that boundary for her. In that process, it reminded me of what I really needed from others at that time in my own life and the support that I was not always given. It was an opportunity for me to give her the best listening ear with my heart as the therapeutic process between us unfolded. When I see myself in the same space as my patient, it can be dysregulating, but by remaining present for them, I too heal again.

Distinguishing Personal Projections

I had a client who reminded me of my mother. She seemed critical and irritated by everything I said or did. I managed to recognize that it was my inner little girl who was looking at this client and 'seeing' my mother. I was then able to be more present to the client; to 'be' the client and not my inner little girl. I could energetically embody the client and feel what it was like to be her.

Managing Frustration with Teen Clients

For myself, as a former child and adolescent psychiatrist, managing countertransference becomes especially pertinent when working with my teenage clients. These kids often live in relatively hostile environments with little to no support from parents and no adults in their lives to advocate for them. After building an alliance with these patients and truly wanting to see them succeed in their lives, I can become frustrated with my limited resources and circumscribed role, often leaving me feeling as powerless as they do.

Especially when they cry out for me to do something and my instinct is to 'put client care first' in efforts to 'do no harm,' I've learned that such action is not a healthy way to handle this countertransference. Aside from crossing boundaries and being beyond my scope of practice, if I tried to make each kiddo's world ideal, I would become emotionally spent and not have the energy to do my job competently or give myself to my other patients.

In these situations, after taking stock of my strong emotional impulses and observing myself spending excessive time on these cases, I have to take a step back, breathe, and tell myself that I can only play the role of therapist and ally; I cannot take on the role of case manager or parent, and I remind myself that there is still power in what I offer even if I'm not 'saving' a child in totem, were that even possible.

Recognizing Limbic System Responses

As a Brainspotting therapist, I look at limbic countertransference, which refers to the therapist's emotional and neurobiological responses during therapy sessions. This limbic countertransference happens when, as the therapist, I empathetically connect with my clients' experiences, potentially triggering my own limbic system responses. Managing this requires me to be self-aware and trained in recognizing my own emotional responses to maintain therapeutic effectiveness. I have practices I use during sessions to validate my own responses and plan to address them in my own work outside of sessions with my clients.

Embracing Transparency in Therapy

Countertransference is an uncomfortable topic that therapists often avoid discussing with colleagues and supervisors. They fear judgment for their inappropriate thoughts and unresolved conflicts. Supervisors also shy away from this thorny subject. However, countertransference simply reflects a therapist's inner conflicts surfacing during sessions. Rather than fear it, therapists should honestly acknowledge these feelings and build enough trust with supervisors to discuss them openly. This transparency can prevent countertransference from harming the therapeutic relationship.

Reflecting to Maintain Professionalism

I once worked with a client who reminded me of a challenging colleague from my past. Recognizing the potential for countertransference, I proactively engaged in self-reflection to understand and manage my emotional reactions. I focused on maintaining professional boundaries and redirecting my attention to the client's unique situation, ensuring that my past experiences did not impact the quality of our therapeutic relationship. Through continuous self-awareness and supervision, I successfully navigated the countertransference, fostering a positive and productive coaching dynamic.

Overcoming Personal Resonance with Client

I worked with an adolescent client struggling with relationships at school. He was finding it hard to connect with his peers; he felt lonely and as if he didn’t belong. From the initial session, I felt connected to this client. I felt we had an immediate rapport, I empathized with his experience, and really wanted to help him. In our continued work together, I worked hard to resolve his problems—planning before and after the session, beyond what is usually required for a typical client.

I began to realize that I was overly invested when I spent my personal time with the client in mind. Upon reflection, I came to see he reminded me of myself; I struggled with the exact same issues at his age, and that during our sessions, I would be jumping in to resolve his problems. I was trying to rescue him, and this was actually keeping my client stuck and holding him back from making those changes for himself. It was when I realized the countertransference that I began to take the backseat, and that's when he began to make more significant progress as I allowed for him to feel empowered and have agency in the changes he wanted to make.

Addressing Grief-Related Countertransference

In a therapeutic context, countertransference can manifest as a therapist's emotional reaction to a client's experiences. In a specific case, I worked with a client who was grappling with profound grief. As the client shared their emotions and struggles, I noticed a deep sense of sadness and personal loss welling up within me.

Recognizing the potential countertransference related to grief, I took deliberate steps to manage and navigate these emotions. Initially, I acknowledged my emotional response without judgment, understanding that it could be connected to my own experiences with loss.

To gain perspective and insight, I sought supervision and consultation from a colleague. This external guidance helped me separate my personal grief from the client's, ensuring that my reactions did not unduly influence the therapeutic process.

Engaging in self-care became a crucial aspect of managing grief-related countertransference. I prioritized my emotional well-being through personal therapy, mindfulness practices, and activities that promoted a healthy balance in my own life.

Throughout this process, maintaining open communication with the client was essential. While respecting professional boundaries, I transparently acknowledged the emotional impact of their narrative on me. This facilitated a collaborative exploration of their grief while preserving the therapeutic relationship.

Effectively addressing grief-related countertransference not only strengthened the therapeutic alliance but also enabled me to provide empathetic and client-centered support. This experience underscored the importance of ongoing self-awareness, supervision, and self-care in navigating the complexities of grief within the therapeutic setting.