Is This Countertransference?
I peeked out of my office into the small waiting room for the third time. Ignoring the anxiety stirring in my stomach, I was conjuring a warm welcome to my client, but the waiting room was still empty. With no one else around, I sighed. It seemed my client was a “no-show.” And it was more than okay with me.
Our intake session occurred a week prior. The 18-year-old recent high school graduate arrived with his mother, whom I had spoken with on the phone several days earlier. “He isn’t himself,” she said with concern. “I think he smokes a lot of marijuana. I just want him to have someone to talk to.” I hear that, I thought. At that time, I was living with daily anxiety due to my teenage son’s drug use and mental health challenges. I immediately connected to the client’s mother’s worry.
I had a drug and alcohol counseling certification, so I knew my background and education would be helpful. And, more importantly, I had once actually enjoyed working with older teens. So, it did not cross my mind to refer this new client elsewhere. I had become so accustomed to, or perhaps desensitized to the discomfort that comes with having a child with mental health and drug issues, that I did not pay attention to the internal sensations of distress brewing in my nervous system, let alone the clear countertransference I experienced in the first session with him.
Deja Vu, All Over Again
When he and I sat down together for the initial intake evaluation, I heard that all-too-familiar familiar apathy behind his polite words. “So, what brings you in today?” I began. “My mom thinks I need counseling.” Well, he’s honest, I thought. His responses were consistently brief and unsurprisingly vague, especially when it came time for the drug and alcohol assessment.
“Do you drink alcohol or use any substances?” I asked.
“Sometimes,” he said noncommittally.
“How often?”
“Once in a while, you know, like at a party,” he offered.
I knew that later I would ask him to complete the standard screenings, which would hopefully provide more specific answers, but just sitting with him was an unsettling experience because I was already forming a story in my mind about his drug use––I know, I know! That’s unprofessional and unfair! I could not articulate it then, but I can sure see it clearly now, he reminded me of my own son, and his mother reminded me of myself.
The countertransference I felt towards him was not clear to me at that moment. During that time in my personal life, I was so engrossed in my panicked efforts to help my son, that I was not very careful about screening potential clients when they called.
By the time we finished the first part of the initial intake session, I had his mother’s concerned face in the periphery of my mind and felt an increasingly urgent need to try to help this young adult––a familiar feeling. When he did not show up for the second session, it was an opportunity to reflect on my own reactions, particularly the relief. We’re not supposed to feel relief when a client fails to show, right?
On Good Enough Parenting
British psychologist D.W. Winnicott is best known for the “Good Enough Mother” theory, but his reflections on countertransference have been equally impactful. He believed that clinicians’ negative feelings towards their clients are inevitable and clinically meaningful. From that wisdom, I thought I could manage my own and to understand, as best I could, how I was feeling pulled in the session between my role as therapist to this teen, and that of mother to my own. I became poignantly aware of feeling annoyance, frustration, and suspicion. What role did I feel pulled into? That quickly became obvious; the mother!
As this realization solidified, my shame and embarrassment about feeling so anxiously connected to the client diminished somewhat. Clarifying to myself that I was relating to him as a mother rather than as a therapist, was clearly not clinically helpful. At that moment of clarity, I realized that he needed counseling far more than more mothering from me.
Looking Back with Gratitude
Looking back, I am grateful that this particular client did not return. That no-show gave me the chance to reflect on my parenting life when I was at a loss to help my son. I had become so overwhelmed with my obsessive search for resources and attempts to protect him, that I could not have effectively separated that struggling parent part of myself from an inadequate therapist part.
After that, I did not accept clients whose presenting issues were like my son’s (and I was fielding a lot of similar referrals). I wish I could say it was an intentional decision, but I think it was more avoidance than anything. I probably did not want to experience the same muddled angst about seeing another teenage boy whose mother was worried about him.
Today, I am far more attuned to my countertransference with clients, thanks to the support of clinical consultation groups. I often think about Winnicott’s countertransference theory, and I am willing to look inward at the negative feelings I experience such as annoyance, boredom, and jealousy. There’s probably a trailing list after being a psychotherapist for 15 years! Seeking to understand what role I am playing in that dynamic has also been helpful because it gives me a place to intentionally step back and recommit to my natural stance as a Rogerian, person-centered therapist, rather than lapsing into an unintentional, counterproductive role.
I also no longer ignore my internal process, such as that very familiar knot in my stomach, a pounding heart, or fuzzy thinking. I give them the attention they deserve. I listen to my body. I ground myself. I breathe. I speak compassionately to myself. Take a minute, I tell myself.
Inhale to the belly for 1, 2, 3, 4. Slowly exhale for 1, 2, 3, 4, 5, 6, 7, 8. Repeat! Slow down,
Be yourself, you’re okay!!!
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