Countertransference, Essay Example

Introduction

This paper begins with an introduction of what the term countertransference mean in the practice of psychotherapy. It then elaborates on the implications of countertransference occurrences during psychotherapy practice. The idea is to identify how the phenomena affects or influences treatment process of a patient. Common issues of debate in the theoretical conception of countertransference are discussed and exemplified. In conclusion, the paper also highlights some examples of cases when countertransference has accrued in my practice at the practicum site and how I resolved or was limited by them.

The term countertransference is common in psychotherapy practice. It is used to refer to instances where defined a psychotherapist’s personal feelings are subjectively redirected towards a client in a way that determines the course of treatment. When the therapist experiences emotional entanglement in the treatment process of a client, countertransference accrues (Etchegoyen, 2005).

Sigmund Freud identified and defined this phenomenon in 1910 in his book, The Future Prospects of Psycho-Analytic Therapy. He was actually reacting to his life experiences in practice of psychotherapy. Freud defined countertransference as the result of a patient’s influence affecting the physician’s general but unconscious feelings. Freud did not however elaborate on the phenomenon and it is other psychotherapy experts who developed the body of knowledge we now have on countertransference (Etchegoyen, 2005).

In the early texts after Freud’s conceptualization, countertransference only included the unconscious reactions a therapists has for a patient, reactions primarily determined by the personal life history of the psychoanalyst unconsciously held at his or her mind. This unconscious but very influential mindset came into play during the treatment of the patient, influencing the treatment administration. In later texts however, the concept was expanded in coverage or occurrence to include the unconscious erotic and or hostile feelings that develop in a therapist towards the patient. According to Gabbard (1999) these feelings usually interfere with his or her objectivity, thus limiting his or her effectiveness in the practice.

Implications in Treatment

A simple example of how countertransference becomes an issue in treatment is when a psychotherapist feels a strong desire and wishful expectation for a particular client to pass with all A’s during his or her university education only because that client reminds the therapist of his or her children at a similar stage in life. According to Gabbard (1999), the desire might also be born out memories of anxieties the therapist may have experienced in his life while pursuing university education. In this instance, the occurrence is transference where the therapist reacts to the patient based on his or her personal experiences and anxieties. This is what experts have called the narrow perspective of countertransference. It mostly leads to a subjective treatment of the client (Groves, 2004).  

Modern day experts on the subject have also defined countertransference to encompass the entire range of subjective feelings a therapist may have towards a patient particularly in sharing with the client’s predicament emotionally. In such cases, a therapist will literally take on a client’s suffering and experience the patient’s state instead of treating him or her objectively. Groves (2004) says that when that occurs in extreme cases, a therapist can end up taking on the psychosis or neurosis of the patient with bouts of psychotic intervals paranoia being evident in the therapists. These extreme cases have been illustrated well by Jung, in his studies of schizophrenia treatments.

Contemporary trends are moving to a liberal understanding of how countertransference accrues during practice of psychotherapy. Scholars today regard occurrences of countertransference as jointly created between the therapist and a patient. For instance, the patient may pressurize the therapist into transference by subjecting him or her to play a role that is congruent with that patient’s internal reality (Etchegoyen, 2005).

Nonetheless, the specific role dimensions are only applicable if exacerbated and triggered by therapist’s own personality and experiences. Some experts believe that in some cases, countertransference can be used as a therapeutic tool. This is especially the case when the occurrence is used by the therapist to sort out the patient’s mental attitude and identify exactly what inspires a particular condition in the patient.

Examples of Countertransference Instances

My practicum site has been in a Head Start school. The Head Start program is US national initiative primarily designed to assist American children who are in the ages of between days to five years. To qualify for the programs, the children must come from families averaging an income that is below or even at the US poverty level. The objective of the Head Start initiative was to assist these marginalized children in readiness of kindergarten by providing them with some necessities like the opportunity to learn, health care support and even healthy food provision. The initiative was approved by US president Lyndon Johnson in 1965 only as part of the comprehensive ‘War on Poverty’ program.

The poverty level of the families submitting their children in the school is appalling and sometimes one cannot remain objective while administering to such children. A particular little girl I met at the school in her second year comes to mind. She was already at the age of five at the time of our acquaintance. She was particularly likeable, exemplary beautiful and very well behaved. The problem however was that she had a skewed graph of growth and body development. She showed signs of stagnated growth and delicacy of health. During my stay, I met with her single mother who was in a desperate situation herself. Even as I recognized the need for the child to move on from the Head Start school, I felt overly protective of her.

I unconsciously found myself discussing the girl with other staff members, especially those who had influential decision making responsibility. In almost all instances, I was advocating for the girl to stay in the school a little while longer to ensure that her health and provisions were catered for at least until her growth and body development showed normalcy. I am very sure that if I had been in a decision making position, I would have subjectively preferred and insisted on the continued stay of the girl in the facility based on my personal feelings and in complete disregard of official protocol. My reaction was completely in disregard of consideration of what was good for the girl but based on my feelings, a case of countertransference.

This is in complete contrast to what I felt for another boy child. I was briefed by my supervising officer about the boy’s family the moment I met him. His family was hostile and provided the boy with no attention that a baby should have. Even at that tender age, the boy was showing a tendency to hate attention and care. He was ignorant of what you said to him or tried to do to him. That insensitivity and what seemed to be outright repulsion of my efforts to show him affection slowly got into me. Most importantly, the boy depicted a character borne by my younger brother and with whom I have always had a soar relationship. This made it almost impossible to treat the boy objectively and when I did extend my help, I was in a way forcing myself to. That is another case of countertransference, which however I identified and tried to address immediately after noting it.

References

Etchegoyen, H. (2005). The Fundamentals of Psychoanalytic Technique. New York: Karnac Books.

Gabbard, G. (1999). Countertransference Issues in Psychiatric Treatment. New York: American Psychiatric Press.

Groves, J. (2004). Taking Care of the Hateful Patient. New England Journal of Medicine. Vol. 298 (16) pp. 15-17.