Ethical Dilemma Paper

Topic:
Identify one or more forms of countertransference that you might struggle with and address how you would deal with this in an ethical and effective manner.

Countertransference is defined by Merriam-Webster as a psychological transference especially by a psychotherapist during the course of treatment, the psychotherapist's reactions to the patient's transference, and the complex of feelings of a psychotherapist toward the patient. (Merriam-Webster, 2012) The APA defines countertransference as the conscious or unconscious emotional reaction of the therapist to the patient which may interfere with treatment. (APA, 2012) These definitions provide black and white textbook offerings to the meaning of countertransference, but to experience countertransference firsthand brings the concept to light in an irradiating spectrum of colors and intensity. The APA’s definition captures an event of countertransference as being at both conscious and unconscious levels. I believe it’s imperative to acknowledge that during countertransference, the counselor can be both aware and unaware of their reaction(s) to a client’s appearance, tonality, mannerisms, religion, nationality, etc... In the struggle to maintain objectivity, the counselor is obligated to practice self-awareness and recognize (a) when they may be experiencing countertransference and (b) how they reacted to the countertransference.
How can you recognize when you have reacted to countertransference? My thought here is if objectivity was lost with the client, then a reaction contrary to benefiting the client took place. In an article by Stephen Reidborg, he states that “Freud realized that transference is universal, and therefore could occur in the analyst as well.” (Reidborg, 2010) If countertransference is an expected byproduct of the therapeutic process, then a counselor can prepare to overcome it by expecting that this process will be ever present. Conceding one can experience countertransference at any time fosters self-awareness which may facilitate the necessary task to mitigate one’s reaction(s) to the client. There’s an appropriate adage a counselor should keep in mind: Hope for the best but prepare for the worst. By “prepare”, I am suggesting being self-aware. Why is this so important? Well, I have read from numerous sources that an individual can have upwards of 70,000 thoughts in a single day. If only 1% of those thoughts are related to countertransference, we are still saddled by 700 reactions which require understanding and restraint.
It’s obviously not fair to burden a client with a counselor’s unfinished business. By practicing self-awareness and incorporating the process into each client session, a counselor has a better opportunity to function in an objective manner with the welfare of the client as priority number 1. While countertransference is easily understood in the context by which a therapist reacts to a client, it’s important for the counselor to uncover the genesis of their reaction and recognize the onus is solely on the counselor to manage their emotions and reactions.
It’s also important to note that countertransference is a therapist’s reaction to the client which can be elicited not just from being in the presence of the client, but also from outside sources. Imagine having been immersed in bumper to bumper traffic for the past 90 minutes, being late for your appointment, soaked from walking in the rain because you could only find a parking space two blocks from the office, and stressed because you need to leave early today to have a root canal. That’s a lot of baggage to bring into a counseling session. The client whom you are late for tends to speak slowly and repeats himself. Today, because you are late, the client has further anxiety and is repeating himself more than usual. How well would you be able to tend to monitor your emotions and reactions as your mind is contending with the last 90 minutes of stress? How can one further address the issue of countertransference? Perhaps it’s best to practice dealing with countertransference not only in your professional life, but also in your personal relationships.
Personally, I can see what challenges I may have with countertransference as a result of my life experiences. As an individual who experienced a difficult marriage and an emotionally vexing divorce from an individual who is bipolar, dealing with bipolar clients may present a challenge for me. For example, when I meet someone who displays similar behavior as my former spouse, I feel myself instantly withdrawing from them. I have limited interest in interacting with them and look to physically removing myself from their presence. The associated discomforts I sense from being in the company of someone whose actions remind me of troubling times in my own life beg me to take immediate action. Being over sensitized by my experiences, the flight or fight instincts take hold and my first reaction is to run. Obviously, this reaction is not conducive to the best interests of a client in my care who displays bipolar characteristics.
Maintaining objectivity in these cases require that I strive for a greater sense of self-awareness. In these situations, the flood of returning memories needs to be channeled productively to serve in the best interest of the client. Recognizing that the client relationship is not a personal relationship may be a first step in monitoring my emotions and controlling my reactions. Developing a sense of empathy and concern in place of apathy and avoidance would be necessary steps for me to take. The client has no choice to be bipolar, yet it is my choice and responsibility both professionally and ethically to put the client’s welfare first and foremost. Recognizing that the client sought counseling is helpful to me in understanding and managing my reactions. This consideration is indicative that the client is aware and actively seeking change which is dissimilar to my personal experiences. In this light, I can see myself being able to understand what evoked my emotions and differentiate the significant components of the current client experience from my past personal experiences.
I also recognize that continued education in this particular area of study will be helpful. Acquiring further knowledge and consulting with others who are experienced with bipolar patients will afford me greater avenues of reflection when counseling such clients. The more expansive your repertoire of knowledge and experiences are, the less limited your vision and choices for action will be. What better way is there to increase your knowledge and experience in weak areas than by enlisting the aid of those who have more familiarity and practice than you? Consulting with others offers you opportunities to learn, to engage in productive dialogue, to hear different perspectives, to discuss opposing viewpoints, or perhaps receive a vote of confidence that your instincts are right on target. Joining a peer group is also a great approach in seeking consultation in areas where I find myself tested. In an article from APA’s Practice Central, contributing practitioners believe there are multiple benefits to be derived from participating in a peer consultation group (APA P. C., 2005): * "Peer consultation groups keep you from isolation, and help you to stay present with colleagues." * “Participation in peer consultation groups can also help practitioners relieve stress and ward off burnout” * "Peer consultation is important for our own mental health, especially for practitioners who are in full-time practice." * Information exchange is another major benefit of peer consultation, say practitioners. Being part of a group provides a forum for members to share challenges and solutions regarding clinical issues, and often to see cases in a new light. "We all get stuck in therapy, and we all don't see certain things with our clients," says Grossman. "It is very helpful to get someone else's perspective." * Sharing information and experiences can also facilitate professional growth, allowing members of a peer consultation group to develop their clinical skills and improve their decision-making abilities. It can also facilitate professional growth by offering mentoring and networking opportunities. * "Peer consultation is psychoeducational. It's a part of lifelong learning."
While practicing self-awareness, pursuing continual education, and seeking consultation are important components to managing countertransference, I believe the most effective means by which I can be effective in counseling would be to practice self-care and engage myself in personal therapy. I believe if I can identify a weakness in my character and capitalize on learning more about it, I would be better equipped to counsel others and avoid being entrapped in countertransference. Instead of allowing my own personal experiences to hinder the counseling experience, personal therapy can provide me with insight into what steps I need to take within my framework of values to become a more effective counselor. With a goal of being liberated from my emotional triggers, perhaps I can reduce the effect of countertransference and avoid bias when counseling bipolar clients. In closing, I would like to refer to a quote from Dr. Irvin Yalom’s book The Gift of Therapy: “To my mind, personal psychotherapy is, by far, the most important part of psychotherapy training. Question: What is the most valuable instrument? Answer (and no one misses this one): the therapist’s own self.” (Yalom, 2002)

Bibliography

APA. (2012). Retrieved January 15, 2012, from Definitions.net: http://www.definitions.net/definition/countertransference (psychology)
APA, P. C. (2005, November 17). Not Going It Alone: Peer Consultation Groups. Retrieved January 16, 2012, from Practice Central: http://www.apapracticecentral.org/ce/self-care/peer-consult.aspx
Merriam-Webster. (2012). Retrieved January 14, 2012, from www.merriam-webster.com: http://www.merriam-webster.com/medical/countertransference
Reidborg, S. (2010, March 24). Sacromento Street Psychology. Retrieved January 16, 2012, from Psychology Today: http://www.psychologytoday.com/blog/sacramento-street-psychiatry/201003/countertransference-overview
Yalom, I. D. (2002). The Gift of Therapy. New York: HarperCollins Publisher Inc.