A Trans-theoretical Training Designed to Promote Understanding & Management of Countertransference for Trainee Therapists

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    • 00:14

      CLAIRE CARTWRIGHT: Hello.My name is Claire Cartwright.I'm an associate professor in the School of Psychologyat the University of Oakland, and Ihave the privilege of teaching in a Doctor of ClinicalPsychology program that trains young clinical psychologists.Today, I'm going to be talking about countertransference

    • 00:34

      CLAIRE CARTWRIGHT [continued]: and a training-- aspects of a training--that I've developed to assist traineesand also therapists to understand and managetheir countertransference.Before talking about that, we should reallytalk about definitions of countertransference.There is some debate in this area,but the common theme running through the different

    • 00:56

      CLAIRE CARTWRIGHT [continued]: definitions is that therapists can have and do oftenhave emotional reactions to their clients.We can think of countertransferenceactually as a cognitive effect of reactions.These include thoughts and feelingsthat a therapist has toward the client, maybe the client'sproblem, perhaps therapy as it's evolving,

    • 01:20

      CLAIRE CARTWRIGHT [continued]: and different situations that happen in therapy.And also the important thing about countertransferenceis that it can result in countertransference behaviors,or what psychodynamic therapists have referredto as countertransference enactments,and it sees countertransference behaviors thatare quite problematic for therapy, for the therapist,

    • 01:42

      CLAIRE CARTWRIGHT [continued]: and for the client.A recent meta-analysis-- and I've put this in the referencesso you'll be able to read about that--found what psychodynamic therapists have always thought,which is that if we can manage our countertransference,the therapeutic relationship will be protectedand we're likely to have better therapeutic outcomes.

    • 02:05

      CLAIRE CARTWRIGHT [continued]: On the other hand, therapists whohave difficulty managing their countertransference,perhaps generally or maybe to specific clients,will have poor therapy outcomes.So it's really important to be able to manageour countertransference and thereby strengthenthe therapeutic relationship.Research has also shown that if we

    • 02:28

      CLAIRE CARTWRIGHT [continued]: can be aware of our countertransferencein combination with having a way of understandingor conceptualizing countertransference--sometimes people refer to having a theoretical framework--then we're in a much stronger positionto manage countertransference.I've developed a training to help people

    • 02:48

      CLAIRE CARTWRIGHT [continued]: be aware of their countertransferenceto have a way of understanding their countertransferenceand thereby to be able to manage their countertransferencebetter.In designing this training, I wantedto make it accessible to traineesand to therapists from all different approaches.Countertransference has come out of psychodynamic therapy,as you will be aware, and it's somewhat

    • 03:09

      CLAIRE CARTWRIGHT [continued]: been neglected in approaches like CBT.So I've designed a method that is accessible to CBT therapistsand hopefully to therapists from a broad range of approaches.Now this is a study that was published in 2014.In this study, we engaged 54 clinical psychology trainees

    • 03:33

      CLAIRE CARTWRIGHT [continued]: in the study of countertransference.And they were asked to write about their countertransferencereactions that they had had toward a clientin a previous period of time.They were asked to write about a particular reaction, what theywere thinking and feeling, what was happening in the therapysituation, what the client was doing,

    • 03:55

      CLAIRE CARTWRIGHT [continued]: and also how they made sense of their feelingsand how they managed them and what they did.As you can see, there was a broad range of reactions.The first two could be what we callpositive countertransference.And I really want to make the distinctiontoday, though, that positive countertransference isn't good

    • 04:18

      CLAIRE CARTWRIGHT [continued]: and negative countertransference isn't problematic.Both types of countertransferencecan be useful if they're understood,but they can be really problematicif they're not managed.So some of the trainees had feelingsof wanting to protect or take care of,and this is quite common in therapists.And others were feeling empathic in identifying with the client

    • 04:39

      CLAIRE CARTWRIGHT [continued]: and actually having a little bit of trouble separating outwhat was them and what was the client.And then there were a range of whatcould be described as negative countertransferences-- thatis the feelings, the emotions had a negative valence.And some of these you could see, as traineeswrote about their experience, howthese countertransference reactions were actually

    • 05:02

      CLAIRE CARTWRIGHT [continued]: coming out of the interpersonal relationship with the clientand what was happening between them in therapy.For example, the small number of studentswho talked about feeling disengaged and having troubleconcentrating.When I described what was happening with the clients,it seems like the clients were quite disengaged too.

    • 05:23

      CLAIRE CARTWRIGHT [continued]: The clients were intellectualizing,talking about something that really wasn'trelated and wasn't central to their concerns.And so, in some ways, the therapist countertransferenceof disengagement was reflecting whatwas happening with the client.Another thing we do in this trainingis we think about two different aspects of countertransference

    • 05:45

      CLAIRE CARTWRIGHT [continued]: that are sometimes discussed.These can be called objective andsubjective countertransference.Objective countertransference refers to the kind of reactionsthat therapists can have in therapy that are evokedby the clients way of relating.

    • 06:06

      CLAIRE CARTWRIGHT [continued]: With this sort of countertransference,the therapist, in some ways, is having feelingsthat people in the client's life might have when the person--the client-- engages in problematic behaviors.For example, a client who is withdrawn and tendsto push people away and not open up and act as if they distrust

    • 06:30

      CLAIRE CARTWRIGHT [continued]: others might lead or evoke feelings of withdrawalin the therapist.As we'll see later, though, what's importantis that the therapist doesn't withdraw from the client.In terms of the personal countertransference--and this is really important too--this is what the therapist bringsto the countertransference.

    • 06:51

      CLAIRE CARTWRIGHT [continued]: Therapists have unresolved issuesand they have their own sensitivities,or we could say they have hang ups.And these can come in and affect how peopleare responding to clients.And so when we have a countertransference reaction,it's important to think how much of thisis being evoked by the client's way of relating to me

    • 07:11

      CLAIRE CARTWRIGHT [continued]: and how much of it is to do with me and my personal issues.Now another strategy that we use,and trainees say they really like,is to make use of Eric Berne's PACmodel, or parent-adult-child model,as you can see in this diagram.I draw it up so that it represents--

    • 07:32

      CLAIRE CARTWRIGHT [continued]: it can represent the interpersonal relationshipsthat are happening between the client and therapist.Now, as you can see with this figure on the left,the therapist has moved into a parental typeof position in relation to the client,who is in a child position.Now, for example, take a client who

    • 07:54

      CLAIRE CARTWRIGHT [continued]: has been criticized and judged a lot as a childand has come to expect that in their relationships.In this stage, the client is actuallyexpecting that perhaps the therapistis going to be critical of them and annoyed with thembecause, for example, they didn't do their CBT homework.So the client approaches the therapist

    • 08:16

      CLAIRE CARTWRIGHT [continued]: in a prickly or defensive way and the therapiststarts to feel annoyed and maybe critical of the client.Alternatively, it could be a needy client who really wantsto be looked after, and the therapist actuallystarts to feel like they really want to perhaps step uptheir behavior and give a lot more guidance

    • 08:38

      CLAIRE CARTWRIGHT [continued]: to this particular client.What's important is that the therapist is aware of thisand, as you can see in the second figure,actually works to move back into the adult.The adult is the professional self.This is the wisest self.This is where the therapist aims to be in therapy.So, even if the client stays in the child or moves

    • 09:00

      CLAIRE CARTWRIGHT [continued]: between the child and the parent,the therapist aims to move back into the adult.In terms of managing countertransference,there are a number of things we can do.First of all, it's really importantto notice when we've been triggered.When we have been triggered, it'simportant to use the calming strategy.The type of calming strategy that you teach clients-

    • 09:21

      CLAIRE CARTWRIGHT [continued]: for example, doing a breathing technique--think about what's happening for you and the client.If you don't really have time to do this,if you're at your early stage of development as a trainee,then you can think about this later.But what's really important is that youwork toward moving back into your adult,and it helps to be empathic toward the client

    • 09:43

      CLAIRE CARTWRIGHT [continued]: to try and think, well, what's happening for the client.Maybe they're feeling a little bit unsafe in the situation.They're expecting perhaps that I'mgoing to be critical of them because they haven't donetheir homework and, in fact, I can show themthat I can move back into my adult and respond from there.So I hope you found that interesting,

    • 10:04

      CLAIRE CARTWRIGHT [continued]: and I've included some references for youthat I've referred to throughout.And you'll be able to read more about these studiesthat we've done in this method.Thank you.

A Trans-theoretical Training Designed to Promote Understanding & Management of Countertransference for Trainee Therapists

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Abstract

Claire Cartwright introduces the underlying conceits and theories utilized in her team's training for the management of countertransference in therapy. Cartwright explains a model that can be used in this process.

A Trans-theoretical Training Designed to Promote Understanding & Management of Countertransference for Trainee Therapists

Claire Cartwright introduces the underlying conceits and theories utilized in her team's training for the management of countertransference in therapy. Cartwright explains a model that can be used in this process.

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