Monday, May 16, 2016

Countertransference in the Psychiatrist-Patient Relationship

As a faculty member of Temple University School of Medicine's psychiatry department, Dr. Gregg Gorton builds on 30 years as a clinical educator. Dr. Gregg Gorton has presented courses and lectures on a variety of topics, including professional conduct and ethics as well as boundary setting in the therapeutic relationship.

Countertransference exists as a pervasive phenomenon in psychiatry. It occurs when the psychiatrist experiences an unconscious reaction to a patient, which then affects future interactions within the dyad. The concept stems from the psychodynamic principle of transference, in which a client translates feelings from outside relationships onto his or her interactions with the psychiatrist. Countertransference is the same phenomenon but sourced from the experience of the psychiatrist, who must be aware of and in control of the process to avoid harm to the therapeutic relationship.

To understand their countertransference, psychiatrists must assess whether the countertransference stems from the patient's behavior or from their own experiences. Countertransference feelings and behaviors that arise from unrelated prior experience are typically not helpful in understanding a patient. Nevertheless these same countertransference feelings may be useful to the psychiatrist in his or her professional development, which requires the skill to set aside personal difficulties and focus on the client.

Countertransference may be immediately helpful, however, when it reveals a patient's particular behavioral process. For example, feelings of resistance or repulsion in the psychiatrist may stem from the patient's tendency to alienate others, which the psychiatrist can then identify and address. It is only by assessing countertransference experiences and identifying their sources that the psychiatrist can learn to use those experiences therapeutically.