To give an update, since my last post, I’ve started conducting one or two intake interviews per week as part of my regular clinical work. An intake interview essentially involves asking a prospective client various questions to find out who referred the client (self, inpatient psychiatry unit, emergency psychiatry unit), what is the client’s main concern, a drug and alcohol screening, as well as various background questions to see whether this client sounds like he or she is an appropriate patient for our unit.
We typically refer out to other facilities patients who are mentally retarded, heavy substance abusers or those who require more intensive therapeutic treatment than the type that we provide so that they will be receiving the appropriate level of care. That said, we admit patients who are relatively light substance abusers if they are willing to commit to participating in a substance recovery program while they are in attendance at our clinic.
Now, moving back to counter-transference, one of the topics I had raised in my last internship post Integrating Theory with Practice. By counter-transference, I’m referring to those unconscious feelings, behaviors, thoughts and reactions that get triggered in the clinician in therapy and/or towards the client. These feelings continue to be challenging for me to detect.
To illustrate, I have one client (let’s call him S) who was sharing with me a situation in which he had lost his temper with someone who had bumped into him and this accidental bump soon escalated into a fight that only ceased once my client was physically pulled away from the other person. S happens to be someone who struggles with holding his temper and fists.
As I was listening to S, I was wondering what his automatic distorted thought was, what questions do I need to ask to arrive at that thought and how would I go about changing it once I know it. I had succeeded in getting out of S the thought “I’m going to destroy him,” but I didn’t manage to derive the distorted automatic thought that preceded thought, a necessary requirement if I was going to try to apply a cognitive behavioral technique.
In any case, I wrote up a process recording of this particular session and as my supervisor was reviewing it with me, she noted that I had not picked up the fact that S had felt guilty about his actions, something that my supervisor could sense by the language that he was using to describe the event.
As my supervisor and I continued talking about that session, I all of a sudden realized that I had felt quite ambivalent towards S. I had felt a bit unsure/uneasy at showing full empathy with S in case it would get misinterpreted that I was endorsing the way S had responded to getting bumped.
Another example of some counter-transference on my part took place with a female client (let’s call her E). E came and essentially displayed resistance throughout the two entire sessions one week after the other by speaking so quietly that I had to ask E every time she said something to repeat herself.
In addition, I had to continually ask E questions in order for us to have a conversation and nothing I said or did seemed to be able to make a difference in her rather resigned downtrodden mood. I was essentially feeling totally useless and/or helpless. At one point, I asked E what was going on, was she feeling some anger towards me, that I felt that to get her to talk was like pulling teeth (or something to that effect).
In reviewing the process recording of this session with my supervisor, I learned that I had actually felt anger at E for putting me through the ringer, so to speak but instead of recognizing that anger, I had projected it on my client i.e., assumed that she was mad at me.
In an ideal world, I would have recognized my ambivalent and angry/frustrated feelings on the spot during both sessions. However, learning to recognize one’s counter-transference clearly takes both time and practice.
Is this something that has also taken you time to get the hang of? Are there any things that one can do to help in mastering this skill?
Please share your thoughts and comments. I really appreciate them 🙂
Photo Credit: qthomasbower
To be honest, I think you just have to be patient with some of the learning in practice and it sounds like you are doing exactly the right things regarding reflecting on the processes at work and the process recording, discussing with supervisor. Even in practice, while I don’t do the process recording, reflecting constantly is the best way of learning for the next time. No-one picks up everything immediately, regardless of what it may seem like coming in initially. Sometimes our own experiences also colour the way we perceive actions and reactions and the sensitivity that we might have to certain comments and what we may link to them. The best way to learn to is think and reflect and its blatantly clear that that is exactly what you are doing 🙂
Thanks so much for your experienced feedback on this process of interpreting counter-transference.
It is a relief to hear that no one picks up everything immediately and that I am on the right track to getting there by thinking and reflecting.
With much appreciation for all your input and support 🙂
I agree with cb. I think you’re doing great. This takes lots of reflection and practice. You are right on track, be patient with your process….remember, this is only 7 weeks into the internship. By mid-way through the spring semester you’ll be at a very different point.
Thanks so much for all your kind assurance and support, Nancy
I need to work on being more patient with this process – not an easy thing to do but I will work at it.
Also, thanks again for having recommended Jon Kabat-Zinn’s mindfulness. I’ve started listening to his meditation CDs. This should ultimately not only help be more focused during my sessions with clients but also more patient, less judgmental, more appreciative of the journey etc.
Recordings and video taping sessions is a fantastic way to learn– I am so impressed with your clinical skills and openness to learn more! 7-weeks at your internship? Really? By the way, I think patience is one of the hardest things to practice in therapy.
Thanks so much for your very kind and encouraging feedback, Laurel 🙂
Yes, time is flying…
I can see how patience is one of the hardest things to practice/develop in therapy because one’s inclination is to want to help as soon as one possibly can.
However, one has to meet the client where he/she is and typically a client will need time before he/she is ready to confront/discuss a difficult topic but that is OK because it would take time to bring the client to that right place (not to mention for me to learn what I need to know).
Thanks again!
Hi Dorlee, I admire the way you are taking your learning process so seriously and also your open-mindedness about being aware of your own counter-transference. In reality, I think many of us experience these things in every day life…we project our perceived inadaquecies (sp?) and emotions onto others. How wonderful to be developing a heightened awareness of these possibilities. I agree with others above in suggesting that you be patient and compassionate with yourself…even therapists with many years of experience are not perfect…they are still human. Best wishes always. Terry
Hi Terry,
You are so kind. Thanks so much for your feedback 🙂 I really appreciate your support and encouragement.
Warmly,
Dorlee
Dear Dorlee,
I love that you’re open to sharing your learning experiences. It’s not always easy for us to see our counter transference.
And it takes courage to put it out there as you are. Others can learn from you. Thank you!
I love the photo and would really enjoy seeing it at the top of your post and larger!
Hugs,
Lauren
Dear Lauren,
Thanks so much for visiting and sharing your kind thoughts and comments 🙂
Hugs,
Dorlee
This post was so helpful in helping me decided to finally choose Social work.
Hi Candida,
I am very touched that my post/blog played a role in helping you decide to go for a career in social work.
Thanks so much for visiting and sharing this exciting news!
Wishing you the best of luck as you embark on this new endeavor,
Dorlee
I want to thank you for your wonderful website. I have absorbed so much information in just one day on this site. I do have a question concerning past substance abusers who have turned their life around and are looking to help others via social work? Do they have a hard time getting licensed because of their past criminal and drug history? And if so, what can they do about it if they are adamant about getting an education and becoming a social worker?
Hi Jose,
Thanks so much for your kind feedback.
Hmm… I’ve been thinking about your questions. I think that for you to get the most accurate answer, you should reach out to either the National Association of Social Workers (NASW) or to the Dean of a School of Social Work that you are thinking of attending and ask these questions.
As I recall, the professor who taught me about substance abuse happened to share an example of someone who had a history of substance abuse and that she and our school went to bat on behalf of that student in order for that student to be eligible to get licensed but because the student had been such an excellent student, he/she was able to get past his/her past.
That said, I do not know all the details… But I would think that someone in the NASW office or at the admissions office of a School for Social Work should be able to provide you with the direction you need.
Wishing you the best of luck!