Counter-transference, a very fancy word

The first time I heard about counter-transference was in college, in my social work practice class. I was immediately intrigued and also nervous; could this happen to me? It seemed like a clearly negative experience at the time. However, many years after my first understanding of counter-transference, I’m beginning to see the importance of it as a clinical tool.

First, a quick definition of the two-dollar word I’m using. Essentially, counter-transference refers to how clinicians react to what patients project on to them during the therapeutic process. It refers to how a clinician’s personal goals and desires can shape her feelings towards a patient (and change the course of the therapeutic intervention). It can also be about what populations a clinician is drawn to or conversely wants to avoid. Fairly straight forward, right?

A word I associate with counter-transference is boundaries. It’s become a weirdly trendy buzz word over the past few years but it’s a real thing! In my job, where I’m generally walking into people’s homes, boundaries can be tough to define. Being in the home setting is less sterile than the office setting and definitely less structured. When I’m sitting at someone’s kitchen table or in their bedroom, a certain intimacy grows. It can be harder to maintain firm boundaries in these situations. Patients and families want to offer me coffee or food; they want to know about me since I’m with them at such an intimate time in their lives.

And part of what I want to do in this role is form intimate connections with people at their bedside so that the conversation can open up beyond the superficial and into difficult discussions about goals of care and illness and death. As a result, I sometimes become aware of this experience of counter-transference: strong emotions elicited during a visit that can be a detriment to my practice. However, those feelings can also elicit some good work for me as well as within the bounds of the therapeutic relationship. Further, it’s always wonderful when clinicians are able to acknowledge their limitations as well as their strengths in practice. I think recognizing the counter-transference we experience in our practice, or the blurring of boundaries, or just the discomfort sometimes of being with someone who is dying, can aid us in enhancing our clinical skills.

What I’m getting at here is that we can use counter-transference in our practice. We are, after all, only human. There have been times when I have been in a visit and felt a rush of anger so hot and charged that I’ve had to take a deep breath and clench my toes to keep from screaming. That’s a scary feeling for a social worker. But instead of pushing it down and forgetting it, I try to examine it. If I’m feeling so angry, what is the patient feeling? The family? Likewise, I’ve found myself feeling so friendly with a patient (someone near my age, to be fair) that I kind of forget my clinical role. That needs to be examined closely too. it’s dangerous when the boundaries blur too much.

 Photo by  Cristian Newman  on  Unsplash

This is where good supervision is necessary. The supervision relationship helps us to look at our practice with a clinical eye. Sometimes we may not realize how counter-transference is affecting us. It takes a supervisor to reflect back what we’re saying and feeling. To do that effectively though, the supervision relationship needs to have the same kind of vulnerability as the clinical relationship.

I have a lot more to say on this subject but I’ll leave it here for now. Visit me in the next few weeks for some more posts about counter-transference with young patients, enhancing clinical skills, and growing the supervision relationship. As always, thank you for reading. Please leave some feedback! I’d love to write about something of interest or importance to you.