A Pilot Study of a Method for Teaching Clinical Psychology Trainees to Conceptualise and Manage Countertransference

There is evidence that therapists' countertransference responses can affect the therapeutic relationship. There is also evidence that trainee therapists can experience difficulty understanding and managing countertransference. This evidence suggests the need for greater focus on countertransference in the training of professionals, such as psychologists, for whom therapy is a core activity. However, little is currently known about the best way of providing such training or the impact of such training on recipients. This pilot study examined clinical psychology trainees' responses to a teaching and learning method for conceptualising and managing countertransference. The method was designed to be accessible to a range of psychology trainees including those in cognitive behavioural therapy programmes. This article outlines the method and its pilot evaluation. An anonymous online questionnaire was completed by 55 trainees pre‐intervention and 40 post‐intervention. Qualitative methods were used to examine changes in trainees' analyses of countertransference pre‐ and post‐intervention, and their reports of understanding and managing countertransference. Trainees also rated the intervention. The majority of participants who completed the post‐intervention questionnaire reported that training increased awareness of or the ability to conceptualise countertransference. They reported strategies for managing countertransference, although they were less confident in this area.     

Erotic Countertransference and Clinical Social Work Practice: A National Survey of Psychotherapists' Sexual Feelings,Attitudes, and Responses

Male and female social work psychotherapists were surveyed on sexual feelings toward clients, sexual behavior with clients, and utilization of erotic countertransference. Relationships between these variables and therapists' self-reports of training in erotic counter-transference, utilization of supervisory consultation, length of clinical experience, and theoretical orientation were also examined. Male therapists were significantly more likely than females to report sexual attraction toward clients, and to report using erotic countertransference to further treatment goals. The frequency of therapists' discussion of sexual feelings toward clients in supervision was related to the reported frequency of utilization of sexual feelings in treatment. The majority of therapists reported that their social work training did not prepare them adequately to work with erotic countertransference.     

Graduate training and the treatment of suicidal clients: the students' perspective

Existing literature suggests that graduate programs may not provide adequate training in working with suicidal clients. Therefore, we surveyed 238 predoctoral psychology interns and assessed the prevalence of clients engaging in suicidal behaviors and the amount of formal training in managing suicidal clients received. Results showed approximately 5% of participants indicated a client suicide and 99% indicated they had treated at least one suicidal client during their graduate training. In contrast, results demonstrated only 50% of the participants reported attending programs where formal training was offered. These findings suggest a continued need for increased formal training in managing suicidal clients in graduate psychology programs.     

A change in frame and countertransference experiences: Transitioning from face-to-face to telepsychotherapy

Unprecedented changes in traditional psychotherapeutic practice arose from the lockdown restrictions associated with the COVID-19 pandemic. These changes to practice included the imposed change to the therapeutic frame when transitioning clients from face-to-face meetings to delivery of psychotherapy sessions via videoconferencing (defined here as telepsychotherapy). The current study conducted qualitative interviews with 16 Australian psychologists who transitioned their existing adult psychotherapy clients from face-to-face therapy to telepsychotherapy and explored their novel experiences associated with countertransference reactions during this period. Thematic analysis of the interviews revealed several unique findings. The type of countertransference reactions towards existing clients was consistent across both face-to-face and online meetings; however, the felt intensity of countertransference reactions was reduced. Psychologists reported an increased hesitance to work with intense emotions during telepsychotherapy sessions and felt increased pressure to work harder during online sessions when compared to face-to-face meetings. Exposure to their clients' personal and home environments during telepsychotherapy sessions elicited several novel reactions towards their clients. These findings on countertransference and telepsychotherapy are informative for future practice and training. Awareness of these unique countertransference experiences is recommended prior to engaging in telepsychotherapy or when transitioning clients to this modality.     

When Personal and Professional Values Conflict: Trainee Perspectives on Tensions Between Religious Beliefs and Affirming Treatment of LGBT Clients

At times the personal beliefs or values of graduate students in training programs for professional psychology can create complications in their providing therapy for certain patient populations. This issue has been brought to national attention recently through several prominent legal cases in which students have contested their expulsion from graduate programs due to their assertions that they were unable to treat clients in same-sex relationships because of their own religious beliefs. The goals of the current article are to (a) review the literature on values conflicts, (b) provide an analysis of how portions of our professional Ethics Code directly relate to this issue, (c) describe a developmentally sensitive theoretical framework that is designed to foster the growth of ethical reasoning over time, and (d) provide a forum for trainee perspectives on this issue based on trainees’ responses to an ethical vignette describing an intern struggling with a values conflict. The trainee quotations are used to structure a discussion of practical recommendations for how to handle values conflicts within the context of training and clinical supervision in professional psychology.     

Developing countertransference awareness as a therapist in training: The role of containing contexts

The psychodynamic literature suggests that countertransference is an inevitable part of therapy and a significant feature of the client-therapist relationship. However, countertransference is also considered to be a ‘double-edged sword’: when it is reflected on by the therapist, it can offer valuable insights into the therapeutic relationship, but when it remains outside of awareness and therefore unmanaged it can result in the therapist unwittingly acting out in the therapeutic relationship and responding in counter-therapeutic ways. The purpose of this research was to explore the factors involved in the development of countertransference awareness in therapists and to construct a grounded theory of the process. Fifteen qualified therapists were recruited and interviewed, either face to face or via Skype, using a semi-structured interview schedule. The grounded theory constructed from the data suggests that during training participants initially experienced countertransference as threatening and overwhelming. When this experience was contained in supervision and therapy, the organisational context and by participants’ theoretical framework, they could reflect on their countertransferential responses and make sense of their experience, which then developed their self-awareness and other insights to the benefit of the therapeutic relationship. Conversely, a lack of containment in these domains resulted in participants acting out their countertransference and becoming either over or under available in the therapeutic relationship. The findings offer a useful process model on the role containing contexts play in the development of countertransference awareness for therapists in training.     

Therapists' Use of Religious and Spiritual Interventions in Christian Counseling: A Preliminary Report

This study explored the use of religious and spiritual interventions in counseling by Christian therapists (N = 100). Use of religious and spiritual interventions correlated with personal religiousness and clinical training involving religious clients and religious and spiritual interventions. Course work involving either psychology or theology did not correlate with use of or self‐reported competency in using religious and spiritual interventions. Self‐reported competency was associated with personal religiousness; professional beliefs, attitudes, and values; personal experiences with counseling; and clinical training involving religious clients and religious and spiritual interventions. It is suggested that training programs incorporate clinical rotations, workshops, and supervision involving religious clients and religious and spiritual interventions to teach therapists to use religious and spiritual interventions in counseling.     

The challenge of prejudice: counsellors’ talk about challenging clients’ prejudices

This paper considers the implications for training and practice of counsellors’ responses to the notion of challenging clients’ prejudices. It explores tensions in counselling discourse between social responsibility, responsibility to the client and responsibility for one's self as counsellor. Three focus groups of counsellors were asked whether a counsellor should challenge clients’ prejudices. Responses were categorised as challenge, not-challenge or exit responses. Discursive themes identified in the responses are: managing congruence and being non-judgemental; self-care and self-respect; and social responsibility. Strategies for managing the discursive conflicts identified in responding to counsellor-identified client prejudices are summarised.     

Aging and Family Therapy: Exploring The Training and Knowledge of Family Therapists

The present study examined therapists' training in aging issues, and their knowledge and attitudes about aging. One hundred and ninety-one clinicians completed a web-based questionnaire. The majority of respondents reported to have some training in aging issues, although they did not believe it prepared them well to work with older clients. Clinicians reported feeling comfortable working with older adults, yet they also agreed that special training could benefit their work. Knowledge scores were significantly correlated with interest in aging issues, perceived importance of training, perceived competence, and perceived effectiveness in treating older adults. Research and clinical implications are discussed.     

Metaphorical interpretations: A critical examination

Abstract

This paper seeks to place the technique of metaphorical interpretations (called amplification in analytical psychology) under scrutiny due to theoretical uncertainty surrounding the therapeutic value of the practice. The historical roots in Freud and Jung are briefly presented, as well as the contributions of subsequent psychoanalytic theory. The theoretical and technical implications of the practice of metaphorical interpretations have relevance for practitioners who are working psychotherapeutically with clients, as well as those who are case managing patients (under CPA), particularly patients with severe disturbances. Case material is presented and advanced theoretically from which it is suggested that potential problems with metaphorical interpretations result primarily from an incorrect assessment of the patient's symbolic capacity and/or the inappropriate presentation of the interpretation. Aspects relating to countertransference and unamplifying (internal amplifications) are also explored. Finally, the positive aspects of metaphorical interpretations are noted.     

Financial and practical implications of counselling psychology training: A student survey

It is common knowledge that students make considerable sacrifices in order to pursue a course of study, and there is no reason to belive that counselling psychology trainees are any differnt in this regrd. The results are presented of a survey of 56 postgraduate students in the greater London area which addressed some of the practical and financial implications of counselling psychology training. While none of the respondents was registered on a BPS recognised course, the majority intended to become Chartered Counselling Psychologists. Many t rainees had considerable debts as a consequence of having to pay tution fees, for personal psychological counselling and in some cases to for the supervision of their practical work with clients. Most trainees found that they had to set up their own practice placements, which were unpaid, and had difficulty doing so. The majority of respondents devoted, on average, 30 hours per week to their studies while nearly 60% had a paid job (not related to counselling) to help them cover their expenses. Inplications are discussed for conunselling psychology training in the 1990's and beyond.     

Supervision zwischen Differenz und Triangulierung

The author outlines some aspects helpful for a better understanding of supervision processes, which focus on difference, e.g. between perspectives of the analyst and the supervisor and take place in a triadic setting. Based on his experience he assumes that this triangulation allows for a differentiation high enough to effectively work on the treatment deliverer’s countertransference. In order to shed some light on this assumption the term “difference” as well as the history of the terms “difference” and “differentiation” are discussed. Furthermore, the concept of early triangulation as understood in developmental psychology is introduced and applied to the process of supervision. An exemplary report of a supervision session with a psychoanalyst in training follows which is intended to underline how supervisory work on countertransference processes within the framework of difference and triangulation can benefit the patient.     

Transference with the borderline client

This paper addresses the question of what is involved in psychodynamic counselling with borderline clients. The concept of borderline functioning or structure is explained and the technical difficulties of working in this area noted, especially in the establishment of a working alliance. The types of transference manifestations with borderline clients are then described, looking in particular at the emergence of a psychotic transference. Two case examples are given of working with borderline clients, where the transference was dominated by primitive elements, provoking powerful countertransference reactions in the counsellor. How both the client and the counsellor can be contained in the therapeutic work is then addressed. Finally, some implications of this discussion are drawn out for the training of psychodynamic counsellors, in order to equip them best for working with borderline clients. Three features of what a training should offer are identified: it should provide students with the opportunity for the exploration of the psychotic parts of their own personality; it should allow for and encourage the internalization of psychoanalysis itself as a sustaining internal object; and it should provide students with the experience of working with clients over sufficient time and at sufficient depth so they can learn about the timing and effectiveness of interventions in work with borderline clients.     

Barriers and challenges in the practice of multicultural counselling in Malaysia: A qualitative interview study

Counsellors face a lot of problems and stressors in their daily lives. As a person, counsellors may face challenges to deal with their personal expectations and responsibilities in life, work, family and community. As a professional, counsellors may face difficulties in dealing with professional issues and ethical dilemmas in their professional practice such as countertransference and value conflicts. These raise issues concerning their perceived multicultural competence and the adequacy of their training. Informed by a multicultural counselling perspective and drawing on semi-structured interviews with 12 professional counsellors in Malaysia, this study discusses the types of barriers and challenges faced by Malaysian counsellors and how these challenges were manifested and addressed in the cross-cultural counselling sessions. Results revealed five emerging themes based on participant counsellors’ responses on the barriers and challenges encountered in their practice of multicultural counselling in Malaysia. These were challenges related to counsellors’, clients’, presenting issues’, third-party and specific contexts’ characteristics. Research implications for the education and training of counsellors in the specific Malaysian socio-political context are also discussed.     

Supervision, transference and countertransference

The author discusses supervision, transference and countertransference as seen in the context of the clinical case of a patient who had been first seen as a training analysis case and who later, in a fortuitous way, was treated by the supervisor of the training analysis. The supervisor, who in the first instance did not recognize the patient, discusses the reasons for this unusual experience in terms of the presence and absence of transference during the analysis of this patient as a training case and the problems inherent in the task of supervising. The patient's feelings towards the first and the second analyst and the vicissitudes of transference and countertransference during the supervision of the training analysis and its influence on the presentation of the analytical sessions by the student are also detailed and discussed. The question of recorded supervision presentations and their possible influence on the dynamics of supervision is raised.     

How do counsellors make client assessments?

This paper reports on a consultation exercise undertaken with 18 experienced counsellors on how they make client assessments. These practitioners expressed a high degree of consensus on the purposes of assessment making (to reach a shared understanding with the client about their willingness and ability to undertake a shared therapeutic journey) but the way in which they approached the task varied according to the theoretical orientation they acquired during training. Although most had developed their counselling skills and techniques considerably since initial training, not all had integrated the assessment implications of later experience into their formulation making. The implications of combining single model assessment with eclectic practice are discussed, particularly in relation to making a decision to continue working with a client or to refer a client to a colleague. The authors call for further debate on how counsellors find meaning in what their clients say, why they ask the questions they do at the assessment stage, and how they achieve coherence in relation to ideas and skills accrued through ongoing training and practice. The implications of such a debate for training and supervision are discussed.     

Countertransference, supervised analysis, and psychoanalytic training requirements.

Because psychoanalysts have an ever expanding appreciation for the many factors that contribute to the psychoanalytic treatment process, they no longer view themselves simply as the receiver of the patient's transferences. When patient and analyst meet in the consulting room, they bring along with them a blend of intrapsychic and external ingredients--including countertransference--that make up the analytic soup. Candidates in psychoanalytic training must contend with even more sources of indirect countertransference reactions (Racker 1968) than experienced graduate analysts, due to aspects of the training experience itself. The author contends that minimum graduation requirements for supervised analyses are one such source of indirect countertransference. Four clinical examples of control analyses demonstrate this form of indirect countertransference during the assessment, opening, middle, and termination phases. These examples are followed by implications and recommendations for didactic psychoanalytic training curricula, countertransference awareness, supervision of control cases, institute governance policies and procedures, publication of clinical material, and future research.     

Using Student Paraprofessionals in the Treatment of Eating Disorders

A rationale for adjunctive treatment in responding to eating disorder clients at a university counseling center is presented. The program described provides a highly structured internship experience for paraprofessional psychology trainees who serve as therapeutic aides and peer counselors to eating disorder clients. This collaborative Counseling Center and Psychology Department model emphasizes intern training, close supervision, and professional-paraprofessional cotreatment of anorexic and bulimic clients. Program evaluation methods and therapy outcome data are presented. Advantages of this treatment-training program for all participants are discussed.     

Approaching countertransference in psychoanalytical supervision: A qualitative investigation1

A recent examination of the literature concerning countertransference and its developments reveals its clinical usefulness in different psychoanalytical cultures. Nevertheless, a shortage of publications is apparent with respect to its approach in supervision. The authors aim in this study was to examine the concepts of transference and countertransference and how countertransference is approached in supervision, in the training of candidates, at an institute of psychoanalysis belonging to a society affiliated to the International Psychoanalytical Association (IPA). Qualitative research was carried out, interviewing supervisors and supervisees. Through analysis of the material acquired, the authors classifi ed the data into initial, intermediate and fi nal categories. The principal fi ndings were subdivided into three categories: the concepts of transference and countertransference, psychoanalytical listening and the complementarity of the phenomena, and the approach to countertransference. The concepts of transference and countertransference predominantly used by those interviewed are based on the totalistic outlook. Countertransference in supervision has been approached in a more direct and objective way when compared with the previous period, although great care is taken to delimit the boundaries between supervision and personal analysis. The main aim of supervision is to broaden comprehension and to deepen the interpretations directed towards the patient. These fi ndings suggest that the evolution of the concept of countertransference in different psychoanalytical cultures and developments in the analytical fi eld are contributing to this change.     

Interprofessional Education: Psychology Trainee Experiences and Perspectives on Team Skills

Interprofessional education (IPE) is defined as educational activities involving trainees from two or more professions learning about, from, and with each other with the goal of building team-based collaboration skills. The degree to which psychology trainees are involved in IPE is unknown. A national survey was distributed to gather information regarding the nature and prevalence of IPE experiences and psychology trainees’ perceived competence in collaboration skills. Participant responses (n?=?143) are presented overall and by training level. Some respondents reported no IPE activities in their training, especially trainees earlier in their training. Highest rated competencies were in acting with honesty and integrity and developing/maintaining mutual respect and trust of other professions. Lowest rated were in giving feedback to others and managing differences in opinion. More research related to the nature and impact of IPE on psychology trainees is critical.