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TherapistTherapistMagazine of the California Association of Marriage and Family Therapists

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COUNTERTRANSFERENCEListening to Ourselves in Order to Hear Others Using Countertransference in Our Work with Clients (page 7)

Does Our Codependency Help or Harm Our Clients? (page 13)

The Threat of Therapy Countertransference and Resistance (page 19)

TherapistTherapistthe

Volume 25, Issue 1 | January/February 2013

in this issue...

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07Listening to Ourselves in Order to Hear Others:Using Countertransference in Our Work with Clients

Countertransferenceoriginallyreferredtothepsychoanalyst’stransferencetoapatient,andwasthoughttoimpairthetherapist'sabilities.However,thethinkingaboutcountertransferencephenomenahasdevelopedtremendouslyoverthepast100yearstomeansomethingradicallydifferent,andfarmoreclinicallyusefulthantheoriginalconcept.

13Does Our Codependency Help or Harm Our Clients?

GiventheprevalenceofcodependencyinAmerica,it’sadisorderthatshouldn’tbeoverlookedinclients,irrespectiveoftheirdiagnosisorpresentingproblem.Whetheratherapist'scodependencyhelpsorharmsthetherapydependsonself-awareness.Thisarticlehighlightshowcodependencyaffectstreatment.

19The Threat of Therapy: Countertransference and Resistance

Countertransference,themannerinwhichthetherapist’sownunconsciousentersintothetherapeuticrelationship,entailsthetherapist’sresistanceeithertochangeinthepatient,ormoreparticularly,resistancetochangethatdoesnotoccuronthetherapist’sownterms.Itprovidesacomfortingmirrorinwhichtherapistsseetheirownimagereflectedbackinthepatient,ratherthanbeingawindowthroughwhichtheycanviewthepatientasauniqueandseparateindividual.

35Personal and Professional Alchemy: Creating Your Own Clinical Style

MarkyourcalendarstoattendCAMFT’s49thAnnualConferenceattheSheratonGrandSacramento,May16-19,2013.Keynotespeakers:BuckRunyan,JohnJolliffe,BruceEcker,EstherPerel,andTerryReal.EarlydiscountofferedthroughMarch31,2013.

65The Living History of the MFT License

AntoniaBouyer,JillEpstein,andEileenSchusterhadthegreatpleasuretochatwiththreeCAMFTmemberswhoareamongstthefirstpeopletohavereceivedtheMFCClicense:Dr.IsabelleFox,#596(licensedApril10,1964),Dr.MyronHowland,#226(licensedFebruary21,1964)andMarciaLasswell,#210(licensedFebruary21,1964).

71The BBS’ “Garden of Forking Paths”

With“TheGardenofForkingPaths,”JorgeLuisBorgespennedoneofthegreatestshort-storiesinallofworldliterature,and,althoughhecertainlywasnotintendingtodoso,hisconceptionoftimeandhisemphasisontheconsequencesofthechoiceswemakegivesusaframeworkfortheoutcomesofpossibleinteractionswiththeBoardofBehavioralSciences,withthreepossibilitiesbeingparticularlyimportantandfairlyrecurrent.

77Reasonable Accommodations and Emotional Support Animals

Lettersfromhealthcareandmentalhealthprovidersaregenerallyrequestedtoshowthatananimalprovidesadisability-relatedbenefittoanindividual.Therefore,itisbecomingmorecommonforclientstoasktheirtherapiststoprovidesuchdocumentation.Thisarticlewillprovideabriefsummaryoftherelevantlawsanddiscussionofsomelegalandethicalissuesfortherapiststoconsiderwhenrespondingtothistypeofrequest.

02 President’s Message

04 CAMFT Calendar

07 Professional Exchange

25 Supervisors’ Corner

29 Self-Study CE Questions

31 The Business of Practice

34 What’s New at CAMFT.org?

54 BBS Board Update

60 Legislative Update

62 Law and Ethics Self-Study

69 Members in the Media

83 Book Reviews

85 In Memory

87 Cracking Up!

88 Chapter Directory

91 Disciplinary Actions

(888) 89-CAMFT | January/February 2013 | The Therapist 7

Professional Exchanae

Profe

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Like the topic and want CEs? Read "What

Shall We Do With the Wounded Healer? The Supervisor's Dilemna"

by Sue Wheeler, Psychodynamic Practice,

August 2007, Volume 13, Issue 3, pages 245-256, through CAMFT’s

self-study program with EBSCO. Log on to

www.camft.org/EBSCO to get started!

The articles printed under the heading “Professional Exchange” represent the

views and opinions of the writers and do not necessarily

reflect the attitudes or opinions of the California

Association of Marriage and Family Therapists.

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Listening to Ourselves in Order to Hear OthersUsing Countertransference in Our Work with ClientsBob Gallo, LCSW, BCD

IntroductionCountertransferenceoriginallyreferredtothepsychoanalyst’stransferencetoapatient,andwasthoughttoimpairthetherapist'sabilities.However,thethinkingaboutcountertransferencephenomenahasdevelopedtremendouslyoverthepast100yearstomeansomethingradicallydifferent,andfarmoreclinicallyusefulthantheoriginalconcept.

Althoughmanystillconsidercountertransferencetorefertoatherapist’s“personal”reactions,manyothersthinkofcountertransferenceasaspectsofthetherapist’ssubjectiveexperiencewhichprovidesimportantinformationabouttheclient.Countertransferencedynamicsarepresentinallpsychotherapeuticworkregardlessofthesetting,clientpopulation,treatmentmodality,ortherapeuticapproach.Attendingtothemcanbeofgreatbenefittotheclientandthetherapeuticprocess.

The analyst’s psyche is similar to a musical instrument, upon which the patient plays. (Dieckmann, 1974, p.171)

…A good half of every treatment that probes at all deeply consists in the doctor’s examining himself. (C.G. Jung as quoted in Stevens, 1994, p.110)

In order to find the patient, we must look for him within ourselves. (Bollas, 1987, p.202)

8 The Therapist | January/February 2013 | www.camft.org

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My InterestIbecameinterestedincountertransferencephenomenaandcountertransferencetheoryaboutsixteenyearsagoduetothefollowingexperience:

Asocialworkerbroughtanadolescenttoseemebecausehemadeacommentaboutwishinghewasdead.WefirstmetlateintheafternoononaFriday.Hewasangryaboutneedingtomeetwithme,anddidnotwanttotalk.AsIkepttrying(unsuccessfully)toengagehiminconversation,Ibecameawareoffeelingfrustratedwithhim.Soonafterwards,Istartedhavingafantasyofsaying,“Youdon’twanttotalkwithme?That’sfine,seewhatyouthinkofthis!”,thenhittinghimwithabelt,lockinghiminmyoffice,turningoffthelights,andleavingfortheweekend.Iwassurprisedandverydisturbedbymyreaction.Ihadneverhadsuchsadisticthoughtsbefore,anddidn’tunderstandwheretheywerecomingfrom.

OnMondaymorning,thesocialworkercalledtoseehowtheappointmentwent.Duringourconversation,shegavemesomebackgroundinformationabouttheclient,whichincludedahorrifichistoryofbeingbeatenregularlybyvariousmeninthefamilyhomewhooftenlockedhiminadarklaundryroomfordaysatatime.

AlthoughIwasstillupsetaboutmyexperience,Iwasalsointriguedbythestrikingsimilaritiesbetweenmyfantasyandwhathappenedinhislife.So,Icontactedasocialworker/Jungiananalystwhoseprimaryareaofclinicalinterestwascountertransference,andbeganconsultingwithher.

Countertransference PerspectivesIwillhighlighttwoperspectivesoncountertransferenceandmentionanintermediatestagebetweentheminordertoprovidesomecontextforconsideringhowoursubjectiveexperiencescanbeusefulinourtherapeuticworkwithclients.

Classical Perspective:TheClassicalperspectivedevelopeddirectlyfromFreudiantheory.Inthisparadigm,theanalystattemptedtobeaperfectlydetached,objective,scientificobserverandinterpreterofthepatient’sintra-psychicdynamics. Iftheanalysthademotionalreactions,theywerethoughttoresultfromunresolvedchildhoodconflictswhichweredisplacedontothepatient.Theseemotionalreactionswerethoughtofasimpedimentstotherapythatneededtobeeliminatedbecausetheypreventedtheanalystfrombeinga“scientist-observer”andledtodistortionsinunderstanding,anderrorsintherapeuticintervention.

Intermediate Stage:Thisstagecameaboutasclinicians(manyofwhomwereworkingwithchildrenandpsychoticadults)begantospeakopenlyabouthavingthoughtsandfeelingsintheirsessionsthattheybelievedweresomehowrelatedtotheclient’sexperience.Theircuriosityledthemtobegindevelopingtheoriesaboutcountertransferencephenomenawhichrevolvedaroundtheconceptofprojectiveidentification.

Totalist Perspective:ClinicianswhoholdaTotalisticperspectiveaboutcountertransferencecomefromavarietyoftheoreticalorientationsincluding:Object-relations,Relational,Attachment,Intersubjective,andJungian.Thisperspectiveemphasizesthatourexperienceswhiledoingtherapyareoftenrelatedtotheclient’sexperience.Italsoprovidesguidanceabouthowtomaketherapeuticuseofcountertransference.

• Ratherthanstrivingtobedetachedandobjective,Totalistsconsiderthemselvestobeparticipant/observersinthetherapeuticprocess,believingthattheclientandtherapistconstantlyaffecteachother’sstateofbeing.

• Totalistsbelievethatclientsuseunconsciousprocessestoevokecertainfeelingsintheirtherapists,and/orinfluencetheirtherapiststoco-createspecific(usuallyunpleasant)relationaleventswiththeminhopesthattheoutcomewillbemorepositivethanithadbeeninthepast.

• Fromthisperspective,atherapist’sexperienceswhileworkingwithaclientarethoughttoresultfromacombinationofpersonhoodand theeffectofbeingreached/impactedbytheclient.

• TheTotalistsconsidercountertransferencetobeallofoursubjectiveexperiencesin relationtoaparticularclient.Thisincludeswhathappensinourmind,ourself-states,emotionalstate,andphysicalexperience.(Iwillelaboratemoreaboutthisinalatersection.)

• Totalistsareattentivetotheirsubjectiveexperiencesandattempttomaketherapeuticuseofthem.

“

“

Although many still consider countertransference to refer to a therapist’s “personal” reactions, many others think of countertransference as aspects of the therapist’s subjective experience which provides important information about the client. Countertransference dynamics are present in all psychotherapeutic work regardless of the setting, client population, treatment modality, or therapeutic approach. Attending to them can be of great benefit to the client and the therapeutic process.

     

Presents    

DONNELL  STERN,  Ph.D.    

UNFORMULATED  EXPERIENCE,  DISSOCIATION  AND  ENACTMENT  

 In  a  rare  West  Coast  Appearance  

   Saturday,  March  16,  2013                                                            

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 Can  experience  be  formulated  outside  verbal-­‐reflective  thought?  Rooted  in  the  heart  of  Relational  and  Interpersonal  psychoanalysis  and  based  on  his  soon-­‐to-­‐be  released  book  Relational  Freedom  and  Therapeutic  Action,  Dr.  Stern  will  present  his  newest  thoughts,  a  revision  

and  expansion  of  his  theory  of  unformulated  experience.  

   

For  further  information  go  to:  www.npi.edu      or  

call  (714)  505-­‐9080  or  e-­‐mail    admin@npi.edu  

     

 

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(888) 89-CAMFT | January/February 2013 | The Therapist 9

professional exchange

Why Work With Countertransference?• Attendingtoourcountertransference

experiencescanhelpus“hear”andunderstandourclients’unconsciouscommunications.ThepsychoanalystTheodorReikreferredtothisas“listeningwiththethirdear.”Ifwedon’tdothis,weneglectavitalsourceofinformation;alotlikeworkingwithoutoneofoursenses.

• Cultivatinganongoingpracticeofinquiryandreflectionaboutourcountertransferencecanenhanceanddeepentheworkwedo,andprotectthetherapeuticprocessbyreducingouractingoutoffeelings.

• Wecanusecountertransferenceexperiencesinwaysthatarebeneficialtoourclients.

Another Countertransference ExampleIworkedwithamanwhonearlyalwayslookedoutthewindowwhenhespoke.Inourthirdsession,Ibecameawareoffeelingboredanddisengaged,andwonderedifIwouldbeabletoclosemyeyes,andperhapsevensleepforawhile,withouthimnoticing.Ialsohadamentalimageoflongtuftsofgreyhairgrowingoutofmyears.Irespondedtoallofthisbysimplyaskingabouthisrelationships.Hetoldmehehadbeenavoidingcontactwithpeoplebecausehefeltsobadlyabouthimself,hefeltdifferentfromeveryoneelse,andhadbeenunspeakablypreoccupiedwithgettingold.Ithinkthatmyboredom,disengagement,andfantasyaboutgoingtosleepweresimilartohisavoidanceandsenseofalienation.TheimageIhadofhairgrowingoutofmyearswasconsistentwithhispreoccupationaboutaging.

Projective Identification & EnactmentsProjectiveidentificationandenactmentsarethetwomostimportantconceptsinTotalisticthinkingaboutcountertransference.Projectiveidentificationmeansdifferentthingsdependinguponone’sspecifictheoreticalorientation.Forourpurposes,Iwillrefertoitasanunconsciousaffectiveprocessthathelpstheclientevokespecificfeelingsinthetherapistinorderto:1)communicateaboutapainful,traumatic,orpre-verbalexperiences,or2)communicateaboutaninternalobjectworld(mentalmodelsaboutpeoplebasedonone’spastexperience).

Withenactments,aclientunconsciouslydoesthingsandactsinwaysthatareaimedat:1)evokingparticularfeelingsinthetherapist,2)communicatingissuesaboutaninternalobjectworld,or3)gettingthetherapisttorelatetotheclientinspecificallydetermined(usuallyunpleasant)waysinhopesthattheoutcomewillbemorepositivethanithadbeeninthepast.

Eventhoughitcanbedifficulttoclearlyseparatethesetwodynamicsduringthecourseofourwork,itismostusefultothinkofthemasaclient’sattemptstobeunderstood,heal,andgrow.Theeffectsofprojectiveidentificationandenactmentscanrangefromsubtleandfleeting,tointense,distressing,anddisorienting.Itishelpfultoconsiderourfullrangeofthoughts,feelings,physicalexperiences,andactionsaspotentiallyimportantsourcesofinformationabouttheclient,eveniftheyseemirrelevant,unprofessional,orunacceptable.Wecanthinkaboutourreactions/experiencesaspossiblymeaningthatwehave“heard,”orbeenimpactedby,theclient’sunconsciouscommunication.

Types of Evoked CountertransferencesThecountertransferenceexperiencesthatareevokedthroughprojectiveidentificationandenactmentstendtofallintoafewmaincategoriesor“positions.”I’llhighlightthreeofthem,andmentionanotheronethatisnotrelatedtotheseunconsciousmechanisms.Thepositionsweexperiencewithaclientmayberelativelyconsistent,ortheycanchangerapidly.

1.Sometimesweareattunedtotheclient’sfeltexperience.Thishappenswhenwefeelaccurateempathyfortheclient,orhaveanexperienceintheroomthatmatchesorparallelstheclient’sexperience.Forexample,wemightbecomeawareoffeelinganxiousandoverwhelmed,anddoubtourabilitieswhenlisteningtoaclienttalkaboutthesituation.Thismaybethesamethingtheclientfeelsandcommunicatesthroughprojectiveidentificationand/orenactment.ThevignetteinwhichIdescribedfeelingdisengagedandenvisionedhairgrowingoutofmyearsisanotherexampleofthiskindofcountertransference.

2.Sometimesweareattunedtotheclient’sdenied,repressed,ordisavowedexperience.Thiskindofcountertransferencecancreatea

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professional exchange

senseofdisparitybetweenusandtheclient.Anexamplemayincludefeelingangrywhilelisteningtoaclienttalkinacasual,matter-of-factwayabouthavingbeenabused.

Thesefirsttwopositions,inwhichweareattunedtotheclient’sexperience,arereferredtoas“concordant”countertransferences.Thefollowingoneisreferredtoasa

“complementary”countertransference.

3.Wemayhaveexperiencesthataresimilarto,orparallelwith,someonewhohascausedtheclientharm.ThefirstvignetteIgaveillustratesthistypeofcountertransference.

4.Theclientinfluencesustoeither:1) feelandresponddifferentlyfrompeoplethathavecausedtheclientharm,2)provideneededempathicresponsesthattheclienthasneverreceived,or3)provideresponsesthatcorrespondstopositiveearlyexperiences.Irefertothisasthe“NeededObject”position.

Capacities That Help One “Look” For Evoked CountertransferenceBeforebeginningtolookforevokedcountertransferenceexperiences,onemustfirstbeverypresentforthetaskathand.Anypreoccupationsorupsetfromourpersonallives,professionallives,orpreviousappointmentswilloccludeourabilitytonoticethecountertransference,orcauseustoincorrectlyattributeourownexperiencestosomethinghappeningbetweenusandtheclient.

Helpful Capacities: Workingwithevokedcountertransferencereactionscanbeverychallenging.Itrequirescenteredness,self-awareness,curiosity,andreflectivecapabilities.Onemuststrivetoacceptalloftheexperiences/reactions,whilecontainingthefeelings,affects,andimpulses.ItisalsonecessarytohavewhatWilfredBionreferredtoas“negativecapability,”anabilitytotolerateuncertaintyandnotknowing.

Here are some ways to “look” for evoked countertransference reactions:

• Beawareofwhatyoufeelwhilemeetingwiththeclient.Forexample,doyoufeelbored,aloof,unmoved,impatient,overwhelmed,sad,angry,orashamed?

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• Noticeanyattitudes,“positive”or“negative,”thatyouexperience.Forexample,doyoufeeljudgmental,condescending,dismissing,orthinkoftheclientasavictim?

• Noticeanyphysicalsensationsyouexperience.

• Beawareofwhatgoesoninyourmind.Forexample,doyouhaveanyday-dreams,fantasies,orrepetitivethoughts?

• Noticehowyoufeelaboutyourselfwhenyouarewiththeclient.Forexample,doyoufeelself-critical,inadequate,orconfident?

• Noticewhatyoudo,andhowyouareinteracting.Forexample,didyourunover-time,wereyou“chatty,”wasitdifficultforyoutounderstandorempathize,didyouself-disclose,giveadvice,orlookattheclock?

• Recognizeanyimpulsesordesiresthatarisewithinyou.Forexample,doyouwanttoendthemeetingearly,wanttoblurtsomethingout,orwanttogotosleep?

Irefertotheinformationgatheredfromthesepracticesassourcesof“un-mined”treasure,whichshouldbeexaminedtoidentifyanyunderlyingcountertransferencedynamics.Asstatedpreviously,itisusefultoconsiderthatsomeofourexperiencesariseasaresultofhaving“heard,”orbeenimpactedby,theclient’sunconsciouscommunication.Itcanalsobehelpfultowonderifwemightbeexperiencingaconcordantorcomplementarycountertransference.Reactions/behaviorsthatareatypicalforyou,ordonotseemtohaveanidentifiableorigin,areoftenrichsourcesofevokedcountertransference.Ifweexperiencethingsthatareintense,distressing,ordisorienting,wemaybeinclinedtodisengage,becomeself-involved,self-recriminating,oract-out.However,itisvitaltobeawareofourexperiences,containthem,andremainengagedinthetherapeutictask.

What Can Be “Done” With Evoked Countertransference? Thereareseveralthingstherapists“do”withevokedcountertransference.Iwillmentionthreethatanytherapistcanimmediatelyputintopractice.Duetothebrevityofthisarticle,Iwillnotillustratetheinterpretiveor

disclosingtypesofinterventions.Furthermore,onemustbewell-informedaboutthesubjectandreceiveguidancefromanexperiencedsupervisor/colleaguebeforeattemptingtomakemoreexplicituseofevokedcountertransference.

Notice and Contain: Wecansimplybeawareofourcountertransferenceexperiences,andcontainthem.Aseasyasthismaysound,itcanbeverychallenging.Althoughitmaynotsoundhelpful,theimpactcanbeprofound.Oneofmyteachersusedtosay,“Don’tjustdosomething,sitthere!”

Projectiveidentificationandenactmentsallowustoexperiencewhattheclientexperiences(viatheconcordantcountertransference).Whenthishappens,theclientcanfeelknownandunderstood,whichistremendouslyhealing.Whenwetoleratethedifficultemotionsthathavebeenevokedinus,weofferanexampleofstrength,andprovidehope.Bothofthesethingscanbesustainingfortheclient.Bysharingtheexperience,theclient'sburdenislightenedasweworktogethertoholdandmasterit.

Whenthetherapistcontainsacomplementarycountertransferenceacorrectiverelationalexperienceisprovidedfortheclient.Thiscanhelpmodifytheclient’sinternalizedimagesofself,others,andrelationships.

Hereisanexample:Imetwithamanwhoprettymuchtalkednon-stopeachmeeting.HebeganwhenIgreetedhiminthewaitingroom,andcontinueduntilhewashalfwaydownthehallafterleavingmyoffice.EachtimeIinhaledpriortosayingsomething,hestartedspeakinglouderandfaster.Then,Istoppedtakingthein-breathsbecauseIrealizeditcuedhimtothefactthatIwasabouttotalk.However,hestillspokeovermeeachtimeIbegantosayanything.Thiswentonforseveralsessions,andIstartedfeelingveryirritatedbywhathewasdoing.

Oneday,hementionedthatthemeetingswereveryhelpfultohim.ThissurprisedmebecauseIhadn’treallysaid,ordoneanything.HesaiditmeantalotthatIdidn’tyellathimto“shutup,”orbecomeverballyabusive.Ithenlearnedthathewassubjectedsinceearlychildhoodtoongoingsilencingandverbalabusefromhis

father.HewasterrifiedthatIwouldtreathimsimilarly.Thetruthwas,thereweretimesthatIhadtheimpulsetoyellathimto“shutup,”butIdidn’t.Ijustkeptlistening,beingkind,andcontainedmyfeelings.

Inquire: Wecanusecountertransferenceasacuetoinitiateinquiry.Whenrealizingthatwemaybehavinganevokedcountertransferencereaction,wecansimplyaskwhattheclientisexperiencing.Oftentimes,theclientwillrevealaffects,experiences,orconcernsthatarepresent.Forexample,hadIaskedthemanfromthepreviousvignettewhathewasexperiencinginthesessionwithme(withoutdisclosinganythingaboutmyirritation),hemighthavegivenvoicetohisworry,fear,oranxiety.

Wecanalsouseourcountertransferencereactionsasaguideforourinquiry.Forexample,Iaskedtheman(withwhomIwashavingtheearhairfantasy)abouthisrelationshipsbecauseIrelatedtohislackofconnectiontoothers.

Get Comfortable With Your Experience: Manyclinician/theoreticiansbelievethatthetherapistandclient’spsychesbecomedeeplyintertwinedduringthetherapeuticprocess.Theyassertthatprojectiveidentificationallowstheclienttotemporarilygetridofoverwhelmingorpainfulaffects(andtheassociatedselfandobjectrepresentations)byevokingtheminthetherapist.Bycontainingthecountertransference,thetherapist’spsyche“metabolizes”theaffects(andrelatedrepresentations)andgivesthemback(viaprojectiveidentification)totheclientinamoretolerableform.

Sometimes,wemaybecomeunsettledordisturbedbytheexperiencesevokedinuswithaparticularclient.Duringthesetimes,itcanbebeneficialtoattempttoreduceourreactivitytowhathasarisen,allowtheexperiencetobe,andbecomecalmandgroundedagain.Besideshelpingyourself,doingthesethingscanalsoinvite/facilitatechangetohappenintheclient.

Returningbacktothefirstvignette,IwasveryupsetbythesadisticfantasyIhadwiththeteenageclient.Iwasfrightenedbytheintensityofmyreaction.IworriedthatIhadjustfoundapreviouslyunknownwell-springof

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crueltywithinmyself.Ijudgedmyselfharshly,andwonderedifIshouldrefertheclienttosomeoneelse.

TheconsultationIreceivedhelpedquietmyreactionstomyexperience,andallowedmetobecomecuriousaboutit.Thisbroughtmeasenseofcalmandspaciousness.Asthisprocesshappenedforme,Inoticedthattheclientbecamelessself-recriminating,lesssuspiciousofothers,morecomfortablewithhisstrongfeelings,andmorepositiveinhisoutlook.

Summary Manycontemporarycountertransferencetheoristsbelievethatclientsuseunconsciousprocessestoevokespecificfeelingsintheirtherapists,and/orinfluencetheirtherapiststoco-createspecificrelationaleventswiththeminordertobeunderstood,heal,andgrow.Thesetheoristsclaimthatmanyofoursubjectiveexperiencesariseasaresultofhaving“heard,”orbeenimpactedbytheclients’communication.Someoftheseexperiencesmaybesubtleandfleeting,whileotherscanbeintense,disorienting,anddistressing.

FromtheTotalisticperspective,countertransferenceisdefinedasallofoursubjectiveexperiencesin relationtoaparticularclient.Becauseofthis,weareencouragedtoconsiderourfullrangeofthoughts,feelings,physicalexperiences,andactionsaspotentiallyimportantsourcesofinformationabouttheclient,eveniftheyseemirrelevant,unprofessional,orunacceptable.However,wemustbeskilledatidentifyingthe

personalandprofessionalpre-occupationsandupsetsthatwebringtoourwork,whicharenotrelatedtotheclient.

Workingwithevokedcountertransferencereactionscanhelpus“hear”andunderstandourclients’unconsciouscommunication,enhanceanddeepentheworkwedo,protectthetherapeuticprocess,andassistinthedevelopmentoftherapeuticinterventions.

Containmentisacrucialcapacityforworkingwithevokedcountertransference.Itpreventsthetherapistfromacting-outfeelingsthatwouldbedetrimentaltotheclient,orthetherapeuticprocess.AlthoughImostlygaveexamplesofwhatareoftenreferredtoas

“negative”countertransferences,containmentisofutmostimportancewith“positive”and

“romantic/erotic”countertransferencesaswell.

Evokedcountertransferencesoccurinallpsychotherapies.Workingpurposefullywithcountertransferenceisachallengingandfascinatingendeavor.Itoffersendlessopportunitiesforlearningandpersonal/professionalgrowth.Italsoprovidesuswiththeprofoundrealizationthatbylisteningtoourselves,wecanoftenhearothers.

Bob Gallo, LCSW, BCD graduated from Smith College School for Social Work in 1993, and completed the Contemplative Clinical Practice program at Smith in 2011.

He works with individuals, couples, and families in English and Spanish at his private practice in Watsonville, California. He also

supervises and consults to therapists, social service providers, and early childhood educators. You can contact Bob for consultations related to countertransference, and clinical practice in general at gallob@msn.com

References

Bollas, C. (1987). The shadow of the object: Psychoanalysis of the Unthought Known. New York: Columbia University Press.

Dieckmann, H. (1974). The Constellation of the Countertransference in Relation to the Presentation of Archetypal Dreams: Research Methods and Results, in Adler, G. (ed.) Success and Failure in Analysis. New York: Putnam.

Grayer, E. & and Saxe, P. (1986). A Model for the Diagnostic and Therapeutic Use of Countertransference. Clinical Social Work Journal. 14 (4), 295-309.

Jung. C.G. as quoted in: Stevens, A. (1994). Jung. Oxford.

Reich, Teodor. (1949). Listening with the Third Ear. New York: Farrar and Strauss.

Symington, J & N (1996). The Clinical Thinking of Wilfred Bion. New York: Routledge.

“ “Evoked countertransferences occur in all psychotherapies. Working purposefully with countertransference is a challenging and fascinating endeavor. It offers endless opportunities for learning and personal/professional growth. It also provides us with the profound realization that by listening to ourselves, we can often hear others.

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