Countertransference: Penetration of the Therapists Psychological Skin

by Frank C. Sacco, Ph.D., CSI President, Scholar in Residence

Trauma creates personality disorders and inflames addictions.  A key element to personality disorders is the level of narcissism involved and the primitive and intense nature of their psychological defenses.  These are crude and rough ways to handle daily life.  The early terrors of life experienced in childhood remain packaged in personality disorders.

When you take the personality disorder into the social context, this is where the problem becomes monumental with clear cut implications for the overall wellbeing of the community.  Parents become involved in the drama perpetrated by the personality disorders and children become exposed to toxic stimuli, experience abandonment, and are left to fend for themselves in a violent and unpredictable world.  Parenting requires the opposite of narcissism; it is a one way, child-focused street. Herein lies the rub.

Psychotherapy with these adults is designed to be long-term and involve a strong harm reduction philosophy.  These are very difficult clients with complicated lives and biographies from hell.  Trauma infests every aspect of their lives and threatens to pollute generations to come.  The goal of therapy is to follow the drama and support the most positive coping strategies under the circumstances.

Therapy with this type of client involves the ability to take a psychological puncturing of the psychological skin.  This concept of piercing of the psychological skin has been used to describe the impact of malevolent prejudice in Arab nations.  In a way, this puncturing lead to an injecting of venom soaked up in the client’s life.  This is deposited into the therapist to the point where she or he feels like another person, acting and thinking differently, even taking on somatic complaints.

Here are some common unconscious therapeutic moves indicating countertransference at work:

  • Missed appointments, no shows, and missed psychiatry: mixed signals (splitting)
  • Rescue: taking unusual advocacy steps that are in the grey
  • Lovesick: increasing personal interest and involvement leading to boundary problems
  • Feeling Unappreciated: anger at client for not benefiting from therapist’s efforts
  • Blaming the victim: unable to see the client’s viewpoint
  • Dependency: constantly solving client’s problems for them
  • Drama Reinforcement: pulled into daily drama of survival and romance; Jerry Springer fascination with weird details, erotic misadventures, and distracting stories
  • Deprivation: stop supporting medicines that create a sense of wellbeing
  • Omnipotence: trimming or cheating in time or documentation

Many of these sound really bad, but they are all part of every therapist’s mistake bag.  The key is to be on the watch; use supervision and peer consultation to keep an eye on it.  Long-term work demands that you stay fresh, keep in mental shapes, and be enthusiastic about positive steps forward.  Most of all, stay in shape physically, read and be mentally tough, and keep writing baby.

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