How Countertransference Can Help Us in Our Work

1. How Countertransference Can Help Us in Our Work

2. Quotes “Patients fill our offices with their feelings. They touch us, inspire us, frustrate us, demoralize us, enrage us, bore us, entertain us, delight us, and surprise us. They weep and laugh and rage and tremble with anxiety. We learn from them about feelings we never knew we had” (From “Psychoanalytic Case Formulation”, by Nancy McWilliams) “We find with countertransference that once we analyze it, what seemed a wall is in fact a window” (From “Countertrasnference” by Edmund Slakter)

3. Definition of “Countertransference” Narrow definitions: • Confusing the client with people from the therapist’s past (transference of the therapist) • Very strong reactions to the client • Reactions that don’t “objectively” make sense • Therapist’s blind spots (reactions that are out of his awareness) Broad Definition: “All those reactions of the analyst to the patient that can help or hinder treatment” (From “Countertransference” by Edmund Slakter)

4. Object Relations Perspective: Transference/Countertransference responses are based on schemas of self/other interactions that are automatically reenacted as relationship scripts Self (subject) Other (object) Feelings/ Wishes/ Actions (Verb) The Self-Other Dyad

5. 2 Types of Countertransference Objective Countertransference: The therapist’s love and hate in response to the actual personality and behavior of the patient (Ferenczi, 1919) (Acting out the Client’s Script) Subjective Countertransference: The therapist’s reactions to the client based on his own past experiences or unresolved issues (Acting out the Therapist’s Script)

6. 2 Types of Countertransference Responses Evoked by Clients • Concordant: I am feeling what the client felt or feels (Identify with the “Self” role in the script) • Complementary: I am feeling what others have felt or feel towards the client (identify with the “Other” role in the script) We are likely to go back and forth between roles as the client shifts position

7. Object Relations Perspective: Transference/Countertransference responses are based on schemas of self/other interactions that are automatically reenacted as relationship scripts Self (subject) Other (object) Feelings/ Wishes/ Actions (Verb) The Self-Other Dyad

8. Common Complementary Roles • Victim and Bully (submission/intimidation) • Victim and Rescuer (idealization/disappointment/pressure to “fix”) • Pursuer and Distancer (intrusiveness/abandonment) • Good Cop/Bad Cop (making excuses/passing judgment) • Friend and Enemy (trust/paranoia) • Alcoholic and Enabler (controlling/controlled) • Performer and Audience (boredom/fascination) • Rational and Emotional (withdrawal/hysteria)

9. Common Countertransference Responses • Dislike for the client • Difficulty empathizing with client • Overemotional reaction to client’s hostility • Excessive Liking for Client • Discomfort with client; dread of sessions with him • Preoccupation with client • Difficulty paying attention to client, mind wandering • Beginning late or running overtime • Getting involved in arguments with the client • Defensiveness to client’s criticism • Repeated misunderstandings with client • Sympathy with client about how others are treating him • Feeling you have to “do” something in action for client, feeling pressured to act • Avoiding certain topics or not having certain feelings that come up with other clients (Adapted from Cohen, MB 1952)

10. Common Countertransference Responses by Diagnosis • Dissociation: Absorption/Fascination; Confusion; Sleepiness; Perceptual Distortions • Trauma/Borderline PD: Wish to rescue/engage in boundary crossings; Feeling abused or taken advantage of/manipulated by the client; feeling angry/sadistic/withholding • Psychopath: Feeling duped; Gut level fear; Feeling charmed • Narcissist: Feeling devalued or idealized- but either way, not seen as who you really are by the patient; Boredom; Annoyance • Depression: Hopelessness about the treatment; Anger • Self-Defeating: Feeling defeated yourself by the client, sadism (wanting to tell the person to get over his self-pity/blaming the victim) • Perverse Mode of Relating/Mind Games: Excitement, arousal, confusion, suspense- feeling like you don’t know if you are going crazy

11. What are the roles and who are the actors in the client’s theatre? “The therapist needs to be familiar with the internal world of a client. Are its inhabitants generous or stingy, controlling or permissive, impinging or distancing, validating or undermining, exploitive or supportive, autocratic or consensual, merciful or punitive, critical or accepting, warm or cold, active or passive, inhibited or expressive, passionate or indifferent, involved or negligent, predictable or chaotic, stoic or self indulgent?” (“Psychoanalytic Case Formulation” by Nancy McWilliams, page 141)

12. Another Quote: “The analyst is the piano. As he listens to the patient, he opens his keyboard and invites the patient to play. Each key that is struck, each string that sounds, is the analyst’s own- but it is the patient who strikes it. In order for the analysis to work, the analyst must have experienced many different feelings. Psychotic feelings and autistic feelings. Borderline rage and narcissistic insult, sadism, masochism, altruism, and cowardice. Grandiosity and despair. Exhilaration and apathy. Nurturing love and blistering contempt. Aggression and sexuality. The feelings of the youngest baby and the most mature adult. The more strings the piano has to offer, the more accurate the patient’s melody will be.” (Paul Geltner, 2006)

13. Potential Benefits of Using Countertransference Constructively • Identify automatic relationship scripts to gain control over them • Find language so that action is no longer the only way to communicate • Help client to feel understood • Help client discriminate between situations where his schemas fit and those where they don’t • Help yourself to tolerate being with the client based on your own understanding of where the client is coming from • Change relationship scripts so that the rigid complementarity is no longer the only option (find a balance) • Compromise versus winners and losers • Assertiveness versus passivity or aggression • Shared responsibility versus extreme dependence or independence • Balance of closeness and distance versus intrusiveness/withdrawal

14. Obstacles to Using the Countertransference • We remain unaware of the countertransference for defensive reasons (it is too painful to admit the response to ourselves) • We don’t have a point of reference for identifying with the role we are cast into, or the client’s experience (can’t relate to the client) • We don’t know a healthy way to cope with our response to the client (leading us to perhaps distance from the emotions, become unempathic to the client, feel flooded by our emotions, behave in exploitive ways, etc.) • Some of the “countertransference” is split off into other treaters (there are other “actors” that we are not communicating with)

15. So, how can we use it? Step 1: • Become aware of the role we are playing in the client’s drama- either in our emotional response or in our behavior Step 2: We can either: • Reflect on what this means and put it into words for ourselves • Find a conscious, healthy way to cope with the role we have been nudged into (or coerced into, in some cases) or a way out that changes the script rather than simply reversing the roles Step 3: We find a way to respond that either: • Models (verbally or non-verbally) a new response to the role or drama that is being played out (change the script) • Finds words for something that was out of awareness for the client or too painful to think about (disrupt automaticity of the script by using language) • Supports the client’s reality testing by affirming their perceptions of us (validate the client’s part in the script)

16. Options for Interventions • Explain versus Express Emotion • Speak from Self or Other perspective • Tolerate and Reflect versus Express in Language • Model something new in action or nonverbally • Focus on your own contribution or on the client’s • Talk with others to gain perspective or to model for you a new way to respond

17. Exercises for Identifying Countertransference(http://home.webuniverse.net/babette/Tansference.html ) Pre-exercise status: • Feel your body. What do you sense -- specifically. Where do you feel warm/cold, tense/relaxed, big/small? Are there places in your body that seem to call to your attention or disappear? How is your breathing. • How are you feeling emotionally? Sad, happy, content, angry, anxious? Countertransference Exercise #1 • Picture the first of your clients who comes to mind. • What do you sense -- specifically -- in your body as you look at him/her? • Where do you tense, relax, become warm, cold, feel bigger, smaller, etc.? • Does your breathing change? How? • What do you feel as you look at him/her? • Does your body want to move as you look at him/her? How? • What happens if you follow the movement? • What fantasies or other pictures come to mind as you look at him/her? • If this person was an animal, what animal would he/she be? • What animal would you be interacting with this person's animal?

18. Countertransference Exercise #2 Using the same client: • What do you like about him/her? • What don't you like? • What does he/she like about you? Not like? • What do you need him/her to do? • How is he/she like you? Different? • Who does he/she remind you most of? How are they alike? Different?

19. Countertransference Exercise #3 • What have you learned about yourself and your reactions to this client? • What personal issues could you work with that would make you a better therapist for this client? (Repeat Countertransference Exercises #1, #2 & #3 with each client you have.)