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"It's Not You, It's Me" : Counter-Transference and It's Impact on The Therapeutic Relationship

Presentation given to The State University of New York at Albany School of Social Welfare Continuing Education program. May 20, 2016

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"It's Not You, It's Me" : Counter-Transference and It's Impact on The Therapeutic Relationship

  1. 1. “It’s Not You, It’s Me”: Counter- Transference and It’s Impact on the Therapeutic Relationship Presented by Sean Erreger, LCSW (@StuckOnSW) For SUNY Albany CEU Program May 20, 2016
  2. 2. Goals  Understand Definitions (Transference, Countertransference, and Therapeutic Relationship)  How Do These Concepts Effect Practice  Some Tools to Identify Problems / Strengths within these concepts.  How does some of these tools adopts to types of practice. Including family, groups, and even in macro practice. -
  3. 3. “I invented it’s not you… it’s me!”
  4. 4. Transference  …the clients resistance, the transference-feelings wishes, fears, and defenses that influence the clients perceptions of the therapist” (Strean, 1996).  “the clients’ experience of the therapist that is shaped by his or her own psychological structures and past, and involves displacement onto the therapist, of feelings, attitudes and behaviors belonging rightfully to in earlier significant relationship.” (Gelso and Hayes, 1998)
  5. 5. Transference  Can be positive Office smells like a child memory  Can be negative Office same color as the room as where the client was assaulted  How has transference effected your practice?
  6. 6. Counter-Transference
  7. 7. Counter-Transference  “We have begun to consider the ‘counter transference’ which arises in the physician as a result of the patient’s influence on his unconscious feelings, and have nearly come to the point of requiring the physician to recognize and overcome this counter transference in himself… We have noticed that every analyst’s achievement is limited by what his own complexes and resistances permit.” (Freud ,1910/1959)
  8. 8. Counter Transference  “Counter transference is the same dynamic phenomenon as transference except it refers to those unconscious wishes and defenses, which are always part of the perception and treatment of the client” (Strean, 1996).  Hayes (2004) argues that the notion of the unconscious slowly evolved to include any emotional reaction by the therapist to a client’s words or actions
  9. 9. The “Wounded Healer”  “…For only what he can put right in himself can he hope to put right in the patient. This, and nothing else, is the meaning of the Greek myth of the wounded physician” (Jung, 1959)  What is “right” and “wrong” ?
  10. 10. How Do You Manage Counter- Transference  Countertransference Factors Inventory (CFI-R) | (Latts, MG, 1997)  Observational Tool for Supervisors/Clinicians
  11. 11. CFI-R (continued)
  12. 12. CFR-I (continued)
  13. 13. Let’s Try It  14 year old Client you are treating for ADHD but the parent starts to discuss some “some problems about sex”
  14. 14. Therapeutic Alliance
  15. 15. Therapeutic Alliance  Robert Hatcher (2010) defines Therapeutic Alliance as “a way of talking about the quality of collaborative work between the patient and therapist. Asking the critical question of a patient feeling like that they are working together toward goals of therapy in a single session, a month, or throughout therapy thus far“.  How Do You Measure This?
  16. 16. The Scales  The Helping Alliance Questionnaire (Haq-II 1996, therapist and client version),  System for Observing Family Therapy Alliances (SOFTA-S 2006, both therapist and client version)  Adolescent Therapeutic Alliance Scale (ATAS 1998)
  17. 17. Categories  1) Shared Goals  2) Subjective feelings  3) The process of therapy  4) being mindful of the potential for a rupture/impasse in the relationship.
  18. 18. Shared Goals  Haq-II is asked “I believe that we have similar ideas about the nature of the problem”  The SOFTA-S challenges the therapist to think if they are indeed “working as a team”  ATAS asks the observer if there was a clear stated understanding
  19. 19. Subjective Feelings  In the Haq-II asks the following of therapist..  1. The patient feels he/she can depend on me  2. He/she feels I understand  3. The patient feels I want him/her to achieve the goals.  9. The patient likes me as a person  15. The patient and I have meaningful exchanges
  20. 20. The Process of Therapy  The HAQ-II asks the following of the therapist  8. The patient believes the procedures used in his or her therapy are not well suited to her needs.  4. At times the patient distrusts my judgment.  The SOFTA-S asks therapist  3. The therapy sessions are helping the client open up (share new feelings and try new things)  4. It is hard for me and the client to discuss together what we should work on in therapy  11. There are some topics the client just won’t discuss in therapy.  14. I lack the knowledge and skills to help this client. 
  21. 21. Ruptures or Impasse  The Haq-II begins ask the therapist..  10. In most sessions we find a way to work on his/her problems .  11. The patient believes I relate to him/her in ways that slow up the progress,  16. The patient and I sometimes have unprofitable exchanges  Observes using the ATAS are asked rate the overall level of respect between client and therapist. They are also asked to rate the level of anxiety or discomfort with each other
  22. 22. Reasons For Ending Treatment Scale (RETQ) – Garcia
  23. 23. Entries, Exits, and No Exits (Imber-Black, 1988)  Entries – When families enter “the system” we often take for granted their strengths and focus on deficits… The more deficits we focus on the more specialists needed  Exits – When do services end? How does this effect the relationship? What impact to a transfer to another therapist have?  No Exits- Family’s and providers engage in a “seemingly never-ending interaction.” The family and providers agree on a series of “unsolvable problems” or continues to find new ones
  24. 24. Family Therapy  “Not only was there a main effect of adolescent alliance on treatment outcome, but this association was, in part, moderated by the quality of the parent alliance. More specifically, the strength of the adolescent alliance predicted adolescent’s abuse and dependency symptoms only when the parent alliance was of moderate or high strength.” (Shelef et. Al. 2005)  “Notably, when adolescents saw the alliance as strong, the parents reported the session to be relatively less valuable. The latter finding suggests that, in judging the worth of a session, parents were closely observing their adolescent’s reaction to what was taking place. Apparently, very strong adolescent alliances were seen as relatively less productive by the parents” Friedlander, Kivlighan, & Shaffer (2012).
  25. 25. Professional Quality of Life Scale (ProQOL)  The ProQOL is free  A 30 item self report measure of the positive and negative aspects of caring  The ProQOL measures Compassion Satisfaction and Compassion Fatigue  Compassion Fatigue has two subscales  Burnout  Secondary Trauma Available at http://www.proqol.org/ProQol_Test.html
  26. 26. Professional Quality of Life Compassion Fatigue Compassion Satisfaction (ProQOL CS) Work Environment Client Environment Personal Environment Traumatized by work Secondary Exposure (ProQOL STS) Primary Exposure Frustration Anger Exhaustion Depressed by Work Environment (ProQOL Burnout)
  27. 27. Contact Info  Sean Erreger, LCSW  Email: stuckonsw@gmail.com  Blog: www.StuckonSocialWork.wordpress.com  Twitter: @stuckonsw  Facebook: Stuck On Social Work
  28. 28. References: Adolescent Therapeutic Alliance Scale (ATAS 1998) Retrieved on April, 12 2014, from http://www.excellenceforchildandyouth.ca/sites/default/files/meas_attach/Adolescent_Therapeutic_Al liance_Scale_(ATAS).pdf Imber-Black, Evan (1988) Familes and Larger Systems: A Family Therapist’s Guide Through The Labyrinth New York, NY The Guilford Press Friedlander, M. L., Kivlighan Jr, D. M., & Shaffer, K. S. (2012). Exploring actor–partner interdependence in family therapy: Whose view (parent or adolescent) best predicts treatment progress?. Journal of counseling psychology, 59(1), 168. Freud, S. (1910) Future Prospects of Psychoanalytic Psychotherapy. In J. Stratchey (Ed. And Trans). The standard of the complete psychological works of Sigmund Freud Volume 11 pp. 139-151. London Hogarth press. Originally published in 1910.
  29. 29. References (cont) Hayes, Jeffrey A., Charles J. Gelso, and Ann M. Hummel. "Managing countertransference." Psychotherapy 48.1 (2011): 88. Garcia, J. A., & Weisz, J. R. (2002). When youth mental health care stops: therapeutic relationship problems and other reasons for ending youth outpatient treatment. Journal of Consulting and Clinical Psychology, 70(2), 439. Gelso, C.J, and Hayes, J.A. (1998) The psychotherapy relationship, New York, NY: Wiley Jung, C. G. (1959). Collected Works Vol 9.
  30. 30. References  Helping Alliance Questionnaire (Haq-II, 1996) retrieved on April 2, 2014 from, http://www.med.upenn.edu/cpr/documents/HAQ2QUES.pdf  Latts, M. G. (1997). A revision and validation of the Countertransference Factors Inventory (Doctoral dissertation, ProQuest Information & Learning).  Strean H.S. (1996) Psychoanalytic Therapy and social work treatment. In F.J Turner. Social Work Treatment : Interlocking approaches.(4th Edition, pages 523-554) Free Press: New York  Shelef, K., Diamond, G. M., Diamond, G. S., & Liddle, H. A. (2005). Adolescent and parent alliance and treatment outcome in multidimensional family therapy. Journal of Consulting and Clinical Psychology, 73(4), 689.  System for Observing Family Therapy Alliances (SOFTA-s, 2006) Retrieved on October,13, 2014 from http://www.softa-soatif.com/?page_id=2961

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