Counter-Transference in Graduate Counseling Programs: A Phenominological Study

Introduction

    This article will present a target population, an overview, and results of a needs assessment process on the topic of counter-transference. Empirical literature concerning counter-transference will be reviewed, and an intervention will be proposed. The correlation between the necessity for training in counter-transference and graduate counseling curriculums will be drawn. Lastly, research questions will be proposed which could be useful in conducting a research study on this topic.

Population of Interest

    

  The target population for my research on the prevalence of graduate counseling programs in

the United States which include curriculum or courses on the topic of counter-transference are all graduate mental health community counseling programs with a CACREP accreditation. Of the nearly 600 graduate counselor training programs with the CACREP accreditation, 5% of these will be selected at random for a survey which will include both quantitative and qualitative research questions exploring this issue. The age range of the participants who will be verbally screened by telephone will include adults who are in administration of, or instructors of the CACREP counseling programs, and will be both male and female, of various random ethnicities. A review of research showed that overwhelmingly, literature on the subject of counter-transference is written about, and for psychotherapists. While the majority of peer-reviewed articles are written by psychoanalysts or psycho-dynamic psychotherapists, the subject of counter-transference is common to all psychotherapists, regardless of theoretic orientation. "It is the awareness of the counter-transference, then, that is the essential need. The necessity for awareness is denied by no analyst, and any relaxing in the effort to make the counter-transference conscious is bound to have most damaging results in all forms of analysis and indeed in all therapy and in any psychiatric, psychological, or similar work that is based on human relationship" (Kraemer, 1958).

Needs Assessment

    Although at first glance the topic of counselor counter-transference in psychotherapy might seem minor, having worked in mental healthcare for 11 years, I have found the topic of counter-transference to be critical to the success of the client-counselor relationship, and to outcomes in therapy. Freud (1910/1957, p. 145) explained the need for counselor self-assessment this way: "We have noticed that no psychoanalyst goes further than his own complexes and resistances permit; and we consequently require that he shall begin his activity with a self-analysis and continually carry it deeper while he is making his own observations on his patients. Anyone who fails to produce results in a self-analysis of this kind may at once give up the idea of being able to treat patients by analysis." In current research Waska (2007) states, "It is critical to monitor the therapist's counter-transference as a map towards understanding the patient's phantasies and conflicts that push them to engage in a particular form of projective identification." Given the importance that transference and counter-transference played in the foundational psychoanalytical writings of Freud, and the modern practice of addressing these issues during counselor supervision, the argument could be made that graduate counseling programs should re-consider the importance of transference and resulting counter-transference, and include more curriculum or courses on this topic for the counseling graduate student.

    

    As psychotherapy has evolved, emphasis on the importance of monitoring counter-transference has eroded considerably. Nevertheless, Waska (2007) explains how counter-transference can impact the therapist: "This does not negate the possible counter-transference by the analyst in which he or she may indeed be seduced into becoming a discouraging or encouraging parental figure who actually voices suggestions and judgment." Wasca is encouraging therapists to retain an objective stance lest they find themselves entangled in counter-transference. However, Wasca (2007) claims that counter-transference can be utilized to effect positive change in the client: "Whether immediately obvious or more submerged in the therapeutic relationship, projective identification almost always leads to some degree of acting out on the part of the analyst. Therefore, it is critical to monitor or use the analyst’s counter-transference as a map towards understanding the patient’s phantasies and conflicts that push them to engage in a particular form of projective identification." Walker (2004) believes that counter-transference is unavoidable and inevitable, "But it is a crucial task of the therapist and the supervisor to ensure that these understandable, humane and human responses are used in a therapeutically helpful way and do not ultimately rebound on either the client or the therapist in ways that re-create and replicate the destructiveness of the original abuse." Golberg (1994) describes the mutuality of the transference and counter-transference relationship this way: "The therapist is both observer and participant (Sullivan, 1953), and both the influencer and the influenced. Both participants bring their life experiences, their beliefs about themselves and others, and their unresolved issues into the relationship, and each consciously and unconsciously influences the other, often in ways that are never known to either. The patient reacts to the therapist by interpreting numerous verbal and nonverbal communications in terms of his/her personal view of self and others. The therapist in turn does the same with the patient."

    Shubs (2008) summarizes modern psychology's stance on counter-transference when he says, “The countertransference becomes not so much an impediment or obstacle to accurate and empathic analysis, or a further cue, when analyzed, to the transference pressures, but a major vehicle [a form of unconscious communication] for the understanding of the patients conflicts, affects, and past object relations.” According to these authors the subject of counter-transference is central to understanding and developing a healthy therapeutic relationship with the client.                                     

Literature Review

    

    Hoffer (2000) & Maroda (2004) define the psycho-therapeutic phenomenon of transference and counter-transference in the following way: "Transference and countertransference are the total reactions of patient and therapist to each other." Upchurch (1985) warns that counseling supervisors should be alert for negative transference and counter-transference in the supervisory relationship with counselors-in-training. If this phenomenon is common within the supervisory relationship, it can be deduced that counselors will experience the same with clients. In a study to measure imagined conversations which the therapist had about clients between sessions (a factor correlated with counter-transference), Arnd-Caddigan (2013) coded counselor reactions into two categories: counter-transference and negative counter-transference. Negative counter-transference included: anger, frustration, helplessness, helplessness, ineffectiveness, etc. This study suggests that there is both normative and negative counter-transference. Karlsson (2004) states, "Long-term resistance to change can sometimes be understood as an interaction between the patient and the therapist, where the transference and counter-transference interact into a mutual lock of the psychotherapeutic progress. Such mutually constructed resistances, conceptualized here as collusions, occur in the therapy situation as though there were a tacit agreement that particular aspects of the patient’s problems will be avoided. However, I argue that parallel to this kind of static resistance, a process of change can still develop that involves both the transference of the patient and the counter-transference of the psychotherapist." Karlsson (2004) views collusion as an opportunity to introduce dynamic change instead of avoid subjects that the counselor or client may feel uncomfortable with.

    

    Bienen (1990), a therapist writing about counter-transference during pregnancy reminds clinicians that while overall she supports exploring transference and counter-transference with clients, certain clients will react poorly at attempts to explore the subject: "My understanding of counter-transference issues and related sense of greater freedom in the therapy were not matched by a significant reduction in the rigidity of my patient's defenses." It has been my experience that while most adult clients are good candidates for discussion of these topics, clients with personality disorders such Paranoid Personality Disorder (PPD) may personalize the feedback and abreact. It has also been my experience that teenagers may not respond well to these discussions due to a developmentally-induced egocentric focus. Further, Beinen (1990) states that, "Under ordinary circumstances, therapists have difficulty talking openly with colleagues about counter-transference limitations and their impact on clinical work...While readily understandable, this reluctance is unfortunate, since awareness of countertransference reactions (during pregnancy) can illuminate significant dynamics within the treatment and can help the therapist make fuller use of her experiences for the benefit of the patient."

    
    Encapsulating countertransference theory, Thomas Ogden's (1986) seminal work on inter-subjectivity characterizes transference as, "the externalization of an internal object relation via projective identification" (Morton, 2003), and asserts that client projection is a conscious decision on the part of the client. However, Ogden (1989) emphasized the unconscious nature of the inter-subjective process, as did Bollas (1999, 2001). There seems to be disagreement on whether transference and counter-transference are conscious or unconscious defense mechanisms. If they are unconscious defense mechanisms as Freud (1953) originally suggested they were, counselors can more easily de-personalize the projections of the client, since they are largely unconscious in nature. It is interesting to consider that if these defense mechanisms are unconscious in nature, the counselor’s counter-transference reactions are also unconscious, and the counselor may not be aware of the impact her reactions are having upon the client and the therapeutic relationship. Because of this factor, the majority of counseling interns can expect to explore counter-transference during the supervisory relationship.

                                                           

 Clinical Intervention

    Because counter-transference remains an under-explored topic in the majority of graduate counseling programs, intern counselors may spend a good amount of time examining their feelings, history, biases, and avoidance (collusion) in order to comprehend how they are influencing the counseling process and the client: "Thus, throughout the supervisory process, the intra-personal and interpersonal variables in the triadic supervision transaction may activate ethical dilemmas, both subtle and overt, within the relationship. Those ethical dilemmas of greatest concern are (a) transference, counter-transference, power, and dependency; (b) dual relationships; (c) gender-role and other stereotyping; and (d) imposition of the supervisor's personal belief system on the supervisee" (Kurpius et al., 1991). Research leads me to the conclusion that these topics have been relegated to the counseling supervisor: "The Association for Counselor Education and Supervision Standards for Counseling Supervisors states that supervisors should interact with the counselor in a manner that assists their self-exploration (5.9). Both of these standards emphasize the supervisor's responsibility for encouraging self-awareness as part of the trainee's professional development" (Kurpius et al., 1991).

    Dr. Freud's view of the importance of these topics were as follows: "Freud (as noted in Greenson, 1965) identified transference as “the experiencing of feelings, drives, attitudes, fantasies, and defenses toward a person in the present which are inappropriate to that person and are a repetition, a displacement of reactions originating in regard to significant persons of early childhood” (p. 156). Gelso & Hayes (2007) summarizes, "From this starting point, he (Freud) referred on several occasions to “counte-rtransference,” or the correlate of transference within the analyst. He understood this phenomenon to be problematic for the treatment process; it must be eradicated through self-analysis." How the client interprets the counselor's response may either be helpful or damaging to the therapeutic relationship, which is why the issue of counter-transference is a crucial subject for graduate students to understand. "A truly integral approach to counseling ethics will consciously engage the subjective self and moral agency of the counselor, who must ultimately decide not only what is the right thing to do when confronted by an ethical dilemma" (Foster & Black, 2007). The next question seems to be: how do counselors "engage the subjective self"? Foster & Black (2007) state, "To do so requires that counselors, on an ongoing basis, mindfully engage those aspects of themselves that are only available to themselves through self-reflective and/or contemplative practices.”  Levi & Scala (2012) state, "Although transference interpretations were related to good outcome, they were occurring at low rates in only a few treatments, a finding that is consistent with the notion that transference interpretations were being de-emphasized during this time. Additionally, given the level of improvement in the context of low rates of transference interpretations, other variables that were not assessed could have been contributing to improved outcome in these treatments." This recent study showed that a majority of psychotherapists do not use a method of therapy which includes interpretation of transference. Yet only in interpreting transference can counter- transference be avoided, and thus one could conclude that counter-transference may be occurring in the majority of therapies.
    

    Certainly, the subject of counter-transference requires self-reflection and is an inter-subjective task which historically has been explored during counselor supervision. Given the importance of counter-transference in the counseling relationship, I am of the opinion that graduate programs should require more training for graduate students while still in graduate school. Once the counselor-in-training's internship program begins, she is acting as a student-counselor and it is my conviction that she should be well-versed, in advance, about the theory of counter-transference and the dangers and benefits of counter-transference within the counseling relationship.

                           

Research Questions-Quantitative Research Question

     

    A quantitative research question that could be asked of counseling programs regarding adding curriculum or courses in counter-transference might be, "What are the advantages or benefits of training graduate students in counter-transference?" According to Kernberg (1989), negative transference should be interpreted as fully as possible early on in treatment" (Levi & Scala, 2012). We can deduce from this that the earlier a counselor-in-training, or even a counseling graduate student learns of counter-transference and its management, the more successful an outcome the psychotherapist will have.

   

    A relevant and worthy quantitative research question might be, “What percentage of graduate counseling programs in the United States include courses or curriculum on counter-transference?” The goal of asking this quantitative research question would to be to accurately reflect the current trend of inclusion or exclusion of counter-transference curriculum in graduate counseling programs in the U.S. My hypothesis (Rosnow & Rosenhal, 2005) is that graduate counseling programs in the United States do not offer in-depth course material or classes on counter-transference any longer.

   

    In conclusion, among CACREP graduate counseling programs in the United States, it is unknown to me if curriculum or courses in the crucial topic of counter-transference are being offered to graduate counseling students before they enter the counselor supervision portion of their program. It seems that studying the philosophy of counter-transference, and applied techniques of counter-transference management within the counseling relationship would properly prepare and benefit the counselor-to-be. Peer-reviewed literature regarding counter-transference places this topic as pivotal to counselor-client relations; from Freud to modern psychotherapeutics, the topic of counter-transference is still being acknowledged as a deciding factor in successful counseling relations. Counter-transference encompasses the counselor's feelings and conclusions about the client, and the resulting impact upon the client. I feel graduate programs may benefit by including a more comprehensive understanding of counter-transference in their counseling curriculums because, of the research literature found, the subject of counter-transference is under-represented in most graduate schools. Yet The American Counseling Association Code of Ethics (2005, A.4.b) suggests that the counselor must be self-aware in these areas: "Personal Values: Counselors are aware of their own values, attitudes, beliefs, and behaviors and avoid imposing values that are inconsistent with counseling goals. Counselors respect the diversity of clients, trainees, and research participants and avoid imposing values that are inconsistent with counseling
goals. Counselors respect the diversity of clients, trainees, and research participants." Exploring counter-transference would allow the graduate student to assess her values and biases before working as a counselor-in-training. It is therefore my opinion that graduate counseling programs should revive the historical roots of teaching and emphasizing counter-transference self-analysis skills during the graduate counseling program.

References:

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