The essay below is one I wrote for NPI (Nashville Psychotherapy Institute) in 2012. The names and details have been obscured for confidentiality purposes and the essay was read and approved for publication by the subject involved.
Recently I found myself feeling impatient with a client. I’ll call her Margo. She had broken up with a married man a few months prior. The man, who at one time had plans to leave his wife to pursue this romance with my client, had changed his mind. Initially devastated by the break up, Margo set an appointment with me. This is what she wanted from therapy: to get over the guy, get on with her life, and resurface her conviction about infidelity. She told me that she’s not the kind of girl that dates married men. We began the work: looking into past relational themes, her family of origin, coping mechanisms and defenses—good ole’ fashioned talk therapy. A few months in, just as we were catching our stride, the guy started coming back around. He claimed he was working on his marriage but it was just so hard, and his wife was suspicious of everything he did. He was having a hard time handling it and Margo was a spring day in February for him (his metaphor, not mine). She tiptoed back up to the unceremonious secret altar and said, “I do,” becoming the mistress once again. During one particular session, I felt really irritated by all of this – why had she let herself be drawn back into the quagmire of emails, cutesy text messaging and flirty check-ins?
Perhaps the reason for my irritation was to be found in my own relationship history. I’d had a pseudo-boyfriend seven years past. He wasn’t married but he also wasn’t that interested in me, beyond flirting, teasing and a flurry of email flatteries. After heartbreak (on my end), I eventually moved on, but the guy still appears in my email in-box every now and again. He lives in another state and is married with a child now, but still shows up in my virtual world, assumedly to see if he’s still “got it.” Luckily for me, he doesn’t. It’s mostly just annoying. The day before my appointment with Margo, he sent me an inappropriate text. Bravely, I wrote back, “As a general rule, I don’t flirt with married men. Please stop sending texts like this!” I felt proud of myself for staying solid with someone that had a history of making me melt.
So there was a lot going on in me, the day Margo confessed her rededication to the affair. Margo told me about her own version of bravery as she shared an email she’d written to her lover, offering up suggestions to help him to leave his distressing situation. He wrote back and said the topic was too heavy and that he just wanted to have fun. I was hopeful that his response would help her climb out of the fantasy. It didn’t. She wrote him back trying to reason with him: If you want to make it work with your wife, why do you keep this going with me? His response: I love you, so there! She felt chosen by the word love; I felt enraged by his cheap flattery. I emphasized the “so there!” bit with my client, suggesting that his juvenile tease with her might be as deep as his intimacy could go. I could tell we were on our way to a face-off (He loves me! He loves you not! He loves me! He loves you not…) It was then that I started to recognize the juvenile in the room: it was me, the therapist. It occurred to me that I’d felt impatient with her situation before she even started the debriefing. She had me at, “Guess who’s come back ‘round.” I was having a hard time regulating my emotions in the presence of my patient’s current life experiences. On that particular day, my story had usurped hers. Fortunately I caught myself before I did too much damage. “I’m sorry but I’m bringing something from my own life into our time together and that may or may not be helpful,” I confessed. Then I very cryptically disclosed the text I’d received the day before, from my ex. As I dismantled my projection, our collective energy shifted and both of our defenses began to settle. Margo was grateful for my self-disclosure as she flopped back on the couch and said, “See, you GET it!” From there I could genuinely speak to the mixed messages in Margo’s situation and truly empathize, without subtly shaming her or manically wanting her to “get it” in ways that I had been unable to myself, when I’d gone through my own version of the experience. (It is also note-worthy that Margo is around the age I was, when entangled in my relationship with Mr. Not Right.)
Counter-transference, the web in which I was snarled, is loosely defined as what gets stimulated in the therapist in response to what the client is experiencing. When ignored, overlooked, or underestimated, the therapy process can be compromised. Counter-transference can result in therapists attempting to meet their own needs rather than addressing their clients’ presenting problems. In my situation with Margo, I didn’t want to be reminded of the denial and magical thinking from my own past. If I hadn’t been attuned to my own transference, I could have therapeutically bullied her, in an unconscious effort to assuage my own shame and anxiety.
Therapist and writer Dr. Judith A. Schaeffer suggests that counter-transference is particularly challenging because, “The conscious mind cannot have direct knowledge of phenomena “residing” in the unconscious mind … the therapists can detect transferred material only in the vague, shadowy signs of its presence.” My impatience with Margo’s choices manifested physically before I was aware of it cognitively. I was antsy in my chair, leaning forward and shifting my hands—a common habit when I feel uneasy. On reflection, I realize that I was trying to suppress feelings of impotence and inferiority. I have my own history of excusing people too easily when they are careless with me, and of being impetuous with sacred things. Had I not been aware of what was coming up in me (by way of my body), I could’ve fallen into a position of denigrating my client’s choices. Neither justification nor condemnation of my client’s affair would work as a useful portal to the deeper issues at hand. My client’s affair triggered memories of a season in my life that – as I look back – I still find embarrassing. In response, I was having a hard time tolerating Margo’s choices, which needed to be understood, not judged, in order to make our collaborative work fruitful.
When Margo talked about her affair, she exhibited a useless brand of shame. She might say something like, “I feel so bad” or “This is awful…” but she had a smirk on her face and a glint in her eye. She was inviting me to get drunk on her fantasy and stay sober in her reality. She was fleeing from a confrontation of her own conscious, and wanting me to act as her conscious, to balance her scales. Had I subtly shamed her, which was my initial instinct (based on my counter-transference; I was ashamed, but in a useful way, of my own former choices and wanted to “save her” the heartache) something in her might have settled. I could have played bad cop to her fantasy and fostered equilibrium in her dance of shame and desire. Had I said, “You are playing second fiddle to this guy. You’re merely his mistress, his fantasy. He’s not going to leave his wife for you. Get real!” my feeling is that Margo would’ve sobered up for a moment, agreed with me, left my office both resolute and disillusioned … and most likely text Mr. Married Man on the way to the car, to escape her painful, conflicted feelings. This response might have satisfied some part in me as well, allowing me to feel as if I’d “righted a wrong” from my own story. In this scenario, Margo and I would’ve created an alliance, in the intimacy and regularity of the therapeutic setting, reenacting our own respective psychologies over and again, without conscious intent from either party.
Being aware of counter-transference involves a great deal of self-monitoring. We must cultivate our own internal supervision, for the sake of checking the quality of our work.
Shaeffer states: “[Self monitoring] involves watching oneself in order to verify thinking, observing in order to control affect, and evaluating in order to determine what behavior to continue or discontinue. … Self-monitoring during therapy begins with therapists noting how well they are observing clients. Our choices for interventions must be made on the basis of how they impact our clients.”
My self-disclosure with Margo was a judgment call I made based on the particular chemistry between Margo and me. Margo appreciated my use of warmth and humor; she told me in one of our first sessions that her last therapist was “too stiff” and she didn’t feel as if she was able to relate to him, on a human level. Had I been sitting with another client, who exhibited a stronger sense of propriety, it is likely that I would have worked out my transference privately.
As therapists we are continually making calculated observations about our interactions with clients, in order to judge whether their sense of self-efficacy is a dynamic created in the office or if it’s based on the client’s own innate capacity. “Can I monitor my own reactions in such a way that enables me to stay in tune with my client and her primary needs?” a therapist might ask herself, followed by: “Is the direction I am going in increasing my client’s insight? Or is she able to continue satisfactorily without my interpretation or disclosure?”
I’ve given an example of my own counter-transference that would’ve had me acting out negatively towards my client. Similarly, had my transference put me in a position of being constantly entertained by my client, perhaps ignoring underlying hostility, or if I’d felt timid in challenging my client based on one of her positive attributes, the therapy would have been equally as compromised.
There are powerful forces at play in a room with a closed door, two people, secrets, and a pre-determined power structure in place. As therapists, it’s important for us to stay in sync with what we’re bringing into the session. We must patiently and painstakingly help our clients to discover, at their own pace and in their own way, what they must do to change. After all, as patients, and in our experiences in life, wouldn’t we want the same consideration and space, to learn the lessons that we need to learn?
For the purposes of confidentiality, indentifying details have been obscured.