Sunday, November 13, 2011


We don't often admit it, but all therapists have patients they don't like very much.  It's usually a relatively infrequent occurrence.  Over time, however, a pattern tends to become apparent; for an individual therapist, there is a certain "type" of patient that consistently evokes a negative response.

Personally, I have trouble working with patients who excessively and consistently complain about their problems but show no real interest in making any changes.  They often respond to feedback or suggestions with a litany of reasons why these ideas won't help them.  They frequently fail to attempt any therapeutic strategies in between sessions, despite my encouragement.  Sometimes, they insist that they only way to make things better is to change the circumstances in their external environment.  Inevitably, these are circumstances over which they have absolutely no control.  I fairly consistently point out that they have no control over this particular aspect of their external environment but suggest that they can learn to cope with it more effectively.  Usually, this makes them angry.  I find this exceedingly annoying.  I just don't think there is anything to be gained from repeatedly complaining about circumstances you can't change.

One of my coworkers recently gave a brief presentation on countertransference that made me start to think about how I react to certain patients.  Countertransference refers to any emotional response on behalf of a therapist that stems from his or her therapeutic interactions with the patient.  The idea is that a therapist's emotional reactions to a patient frequently have to do with the therapist's own unresolved issues.  Instead of being annoyed with the patient for causing a negative emotional response, the therapist should look at herself to figure out why she is reacting the way she is.

Honestly, I can't tell you why this one particular type of patient bothers me so much, at least not yet.  I did, however, find a good suggestion for dealing with my countertransference by a psychologist named Dr. John Martin (  When dealing with a patient who triggers strong emotions, Dr. Martin suggests setting aside one full session with that patient to pay attention to myself.  In other words, I should avoid any challenging or deep conversations during that session so that I can pay attention to what I am thinking and how I am feeling.  Specifically, I should notice my feelings about my interactions with the patient (e.g., How do I feel about what I say to the patient?  How do I feel about how he/she responds to what I say?, etc.) and about my relationship with the patient overall.  As my feelings change throughout the session, I should try to notice what is happening to the patient's behavior.  After the session, I should ask myself, "How am I contributing to the dysfunction in my relationship with this patient?"

It's funny how things always seem to point back to mindfulness.  It seems to offer a solution (or at least an approach) to every negative thought, feeling, behavior, or situation that life presents.  Dr. Martin doesn't call his approach to countertransference "mindfulness," but that is exactly what it is.  Giving my nonjudgmental attention to my emotions as they arise will make me less reactive to them.  Dr. Martin offers this as a technique that will prevent me from being drawn into a patient's "emotional drama."

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