The number of words in this article is 4500+｜It is expected to be 12min
article｜Jin Qinghua (Simple Psychological Certification·Psychological Counselor)
Counselors may encounter negative emotions and thoughts during the consultation process, which inevitably makes the counselors doubt themselves: "I am so bad, I can't help the client." Don’t rush to draw conclusions first, you may be experiencing countertransference at this time.
Countertransference uses the counselor's emotional response as a resource to understand the client's subconsciousness and personality. Especially for , the significance of countertransference is very important for some visitors with personality disorder.
Photo/"Secret Questioning"
So, what is countertransference in ? How to detect countertransference? How to use countertransference to identify personality disorders and better understand visitors?
Many contemporary articles are about how to use transference to understand the client. This is a common view of psychoanalysis , but using the counselor's own countertransference to understand what kind of personality disorder the client has, such articles do not seem to be very common, so I will discuss this topic with you today.
Definition of transference and countertransference
Freud was the first to propose the concept of transference in 1895.
Anna Freud proposed that transference is an impulsive experience experienced by the patient and caused by the relationship between the patient and the therapist. These experiences are not caused by objective analysis of the treatment scenario, but originated from the patient's early object relationships, and are the reappearance of these object relationships under the action of compulsive impulses.
Photo/Anna Freud
Menninger and Holzman made this summary:
Transcendence is the patient's unconscious pointing to a therapist's various non-realistic roles and identities. This situation occurs during the regression of analytical treatment, and the patient's response to those roles and identities usually originates from their early experiences.
So they believe that transference is an inevitable result in treatment and plays a very important role in psychotherapy.
Transference
The client transfers his emotional attitudes and attributes to his parents or an important person in his past life to the counselor and responds to the counselor accordingly.
Countertransference
An unconscious response to patient transference.
In 1910, Freud first discovered countertransference, and he believed that countertransference had adverse effects on treatment.
Therapists should work hard to overcome, but by 1950, Herman defined countertransference as all the emotional responses that an analyst pointed to the patient, including not only the emotional components of the analyst inspired by the patient, but also the emotional projection from himself.
Photo/Freud
There are two attitudes and views about countertransference
First of all, it is the classic Freud Reud's view: believes that countertransference is the part that the therapist needs to overcome and needs to be solved by being analyzed.
The second point is the view of contemporary object relations: believes that the therapist's countertransference is a very important tool to understand the client's inner world.
4 transference and countertransference manifestations of personality disorders
Personality disorder refers to a deformed development of personality, forming a cognitive behavioral pattern that is unique, obviously deviating from the social and cultural background they are in and not recognized by most people.
The deviation of personality traits and poor adaptation to the environment have obviously interfered with the client's social and professional functions, resulting in their inability to maintain harmonious interpersonal relationships and difficulty in adapting to social life.
1. Borderline personality
Borderline personality is manifested as a behavioral pattern of interpersonal relationships, self-image and emotional instability, and obvious impulsiveness. They may:
. Crazy, hard work to avoid being abandoned as real or imagined, sometimes suicide or self-harm behavior, and an unstable and tense interpersonal relationship pattern.. There will be changes between idealization and degradation, disorder of identity, obvious and persistent instability to self-image and self-awareness, and there may be some characteristics of substance abuse, sexual or bulimia, repeated suicide or self-harm, or some thoughts of suicide threats. . Emotional confusion, long-term sense of emptiness, inappropriate, intense, and difficult to control anger, such as constant anger and losing temper to fight. Photo/"Soul Moving Girl"
Some visitors will come to consult in advance. They do not come in a short time in advance, but may have been in advance in . For example, they will arrive at the consultation room 15 minutes or half an hour in advance, and then refuse to leave until the end time, and it does not mean that they delay three or five minutes, but 15 minutes or half an hour or even longer.
In addition, they will uncontrollably believe that the counselor wants to abandon himself and will take various ways to test the counselor, , for example, to commit suicide or threaten the counselor to commit suicide. This treatment relationship of
will become very difficult, and the strong hostility and harshness of the counselor requires more consultation time and attention.
For example, some clients will call the consultant after the consultation and then send a message to ask the consultant to contact the consultant. If the consultant cannot reply to him in time, they will think that the consultant does not care about him and even wants to abandon him.
For a period of time, the client's life is completely centered on the counselor, completely excluding others. Moreover, they generally do not realize their own contempt for the counselor, and they are uncontrollable. When the client works with the borderline personality, the countertransference of the consultant will be very, very strong. Individual counselors may encounter situations:
visitors always refuse to leave when they arrive early or end, and knocks on the door half an hour in advance. If you ask him to wait outside, he is very angry and angry. When you come in, you will keep complaining, saying that the counselor is too cold and ruthless. consultants will feel that the client is breaking the settings. This feeling is very uncomfortable.
Call or send a large number of text messages to the consultant outside the consultation time. The consultant will feel very annoyed and unwilling to pay attention to the visitors.
When faced with some very extreme impulsive behaviors of the client, such as suicide and self-harm, the consultant may feel very worried and unable to sleep or eat, and is worried that the client will do very extreme things.
I met a client who tried to commit suicide. I couldn't sleep at night and was very worried that the client would have life safety, but I couldn't take the initiative to contact him because it involved the setting and boundary issues of consultation.
In addition, visitors will have very strict harsh criticism and belittlement, which the consultant cannot bear. sometimes wants to end it quickly.
Borderline personality is a very difficult personality disorder, and there are also some possible suicide or self-harm behaviors. Therefore, beginners have a higher risk of doing individual cases. We will recommend consulting with supervision, especially individual supervision, which will become safer.
must also establish a good treatment alliance and provide visitors with a safe and trustworthy environment. The most important thing is to face, deal with and understand the projective identification brought by a large number of visitors.
Photo/Gone with the Wind
2. Narcissistic personality
The very important feature of narcissistic personality is that it has a feeling of exaggeration and will exaggerate one's achievements and talents. fantasizes that one is very successful and has great power, talent, beauty or ideal love.
thinks that he is very special and unique, and thinks that he needs to be treated specially, demands very excessive praise, and hopes that others can obey their expectations. has a sense of power, exploiting others in interpersonal relationships, and using others to achieve their own goals.
They lack empathy and cannot identify and feel the feelings and needs of others. They are usually very jealous of others and also show arrogant behavior.
above are some clinical manifestations of narcissistic personality disorder.
Picture/Kohut (photo taken in 1964)
Here we need to mention a very important figure in autologous psychology - Kohut . Because Freud first believed that narcissistic patients could not develop empathy, they could not be analyzed.
Kohut's research proves that narcissistic people have a special way of empathy, so he adopts a "scientific" approach to enter the patient's spiritual life for observation.
He believes that narcissism is like air and is necessary for people to survive. Kohut divides narcissism into exaggerated sexual autologousness and idealized parents.
corresponds to the exaggerated autologous body and needs to obtain the mirror reflection of the auto-object, thereby obtaining self-affirmation, corresponding to the idealized parents, and idealized auto-object to obtain a feeling of intimacy.
Kohut believes that narcissism is also divided into healthy narcissism and pathological narcissism.
Their empathy manifestations mainly include twin transfer relationships, idealized transference relationships, mirroring and exaggerated transference relationships.
Idealized transference is the idealization of the therapist, reflecting the activation of the idealized parental image.
Kohut believes that this strong dependence on idealized objects is due to the patient's desire to replace the part of the mental structure he lacks, and the patient maintains a balance of narcissism by paying attention and praise to the current replica of the auto-object lost in past trauma.
pic/pexels
When working with clients with narcissistic personality disorder, the counselor's countertransference will be reflected in: feeling strongly belittled by the client and will become very angry.
For example, some visitors will say, "You are a consultant with too poor level, not professional at all, and you will not empathize with at all", "You often interrupt me and knock out my free association."
The consultant will also feel unnecessarily needed, because the client will treat the consultant as air, from beginning to end, and will not give the consultant any chance to give back.
consultants will also be treated as tools and are asked to answer various unanswered questions.
For example, the client says, "My husband and I divorce. What do you think I should do next?" Some clients will say, "I am going to graduate now. Can you tell me, should I go on the postgraduate entrance examination or go abroad? Or work?" These realistic questions from
make the consultants feel that they really have no way to respond directly to them, just like a tool to answer questions.
pic/pexels
3. Particular personality
Particular personality disorder clinical manifestations are: they generally have distrust and suspicion about others , and suspect that others are using him, hurting him or deceiving them.
They will unfoundedly doubt the loyalty of their friends or colleagues, hold a grudge against insults, hurts or contempt, and feel that their character or reputation is under attack, even if it does not seem obvious to others; they will repeatedly and unreasonably doubt and suspicion of their spouse's integrity. Visitors like
may have very good husbands, or good relatives and parents.
However, she would feel that her husband had other women outside and was disloyal to her, and then repeatedly checked and did all kinds of very extreme things, such as stalking, listening to phone calls, etc., but she could not find it every time, but this idea always exists.
pic/pinterest
counselor reasoned with them and said, "Your family is actually very good to you." It is of no use at all, and may even make the client even more angry because she feels that she is not really understood by the counselor.
3. Passive attack personality
Passive attack personality is manifested in: passively rejecting opportunities that can fully utilize their work ability and social ability. This rejection of is not expressed directly, but in an indirect way.
For example, procrastination, deliberately appearing to be incompetent or fragile, and in a tactful way, without directly expressing rejection. The result is that social and work-related poorly demonstrated serious and lasting abilities, and actually has potential, so it is a passive expression of covert attack. The countertransference generated by the consultant can be very strong anger and sometimes even want to blame the client.
For example, the visitor will release the consultant pigeon countless times. When the consultation time comes, he will be late, 15 minutes and a half hours or even 40 minutes late. When it is 40 minutes, he called and said that I will not come today. I was late countless times, I said I canceled the consultation countless times, etc.
If you discuss this part with the visitor, will say lightly, I do have something to do. Then he started to distract the topic, making the consultant feel very confusing and unable to speak.
Image source: pexels
The consultant's countertransference often feels that the client is like an unreasonable child. reasoning with him has no effect at all, which will make the consultant feel very frustrated and powerless.
No matter how hard the consultant works to help the client, they always doubt whether the consultant is trustworthy, which makes the consultant, especially the consultant who has spent a lot of effort, very sad and disappointed.
above provides a brief overview of the transference caused by clients with these four personality disorders and the countertransference that counselors may have.
Source: pexels
Not all consultants will have consistent countertransference, it depends on everyone's experience. Sometimes, due to personal experience, we will have some very strong countertransference to the client's reaction, and some parts may also come from our own parts.
So we say that when working with clients with personality disorder, you must need supervision. It is best to have one-to-one supervision and must have a self-experience counselor. In this process, you must learn to experience your countertransference and distinguish which parts are their own and which parts are evoked by the visitors. The distinction ability of
is actually very necessary to train, and can only be achieved through a large amount of clinical work and the process of being experienced and supervised.
Next, needs to understand what the client's transference is and what the client's various defense mechanisms are. At the right time, this experience can be fed back to the client. We can also call it empathy or explanation.
And finally, it is very important to carry all kinds of unbearable anxiety among visitors, just like Bion said: "Train yourself to be a container"
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