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Section 12
Countertransference in Treatment of Child Sexual Abuse

Question 12 | Test | Table of Contents

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In the last section, I provided you with an Inner Child Visualization.

In this section, we will look at countertransference, and the use of a Losses and Gains exercise.

Do you find that you have preconceived ideas or reactions that come to mind when dealing with a particular client? If you are like I am, you do. As you may be aware, there are two different ways of viewing countertransference. The narrow definition refers to your reaction to the client's issues that has been generated by your own internal conflict or problems. This of course, interferes with keeping the therapeutic process neutral. The second broad definition means any emotional reaction on your part to the client's issues regardless of any personal conflict the material may or may not invoke.

♦ Three Self-talk Messages
As you know, countertransference can be a potential landmine, if you as the therapist aren't aware or in touch with your own hot buttons. I have found my reaction can be a valuable tool for the understanding of my client, if I am aware of three self talk messages:

#1 My unresolved past issues,
#2 The client's transferred issues, and
#3 Feelings that are being induced or created in me by my client.

These feelings, negative or positive, offer me insight into potential responses I can give to the client. A good example is found in Cassie, age 18.

Cassie came to me looking for help in dealing with and understanding, her alcoholic and emotionally abusive mother, and her passive father. She had been in therapy for approximately six months, when in the middle of a neurotic transference reaction, she brought up a dream in which the theme was a co-worker violating her "turf" and images of "sharks with teeth ripping her apart." Cassie had been struggling in previous sessions with three major issues. First, she was struggling with homosexual fears.

Secondly, she was struggling with the feeling that she couldn't hide anything from me. She said, "I feel over exposed and vulnerable. Like you see me without my clothes on." And the third issue Cassie was struggling with was summed up when she stated, "I feel pressured to talk about all my inner feelings. I just feel very vulnerable, that's all." The sexual abuse secret that Cassie was living with, was that she suspected her mother sexually molested her on several occasions when she was around four or five, while intoxicated.

On a countertransference level, my initial urge was to know more about Cassie's secrets and fears. As I became aware of these feelings, I realized that if I pursued this line of questions, I would be violating her boundaries. By giving Cassie time to understand the context of her past and the nature of transferences, she was able to come up with her own interpretation of her feelings and I was able to avoid violating her boundaries, by not imposing my ideas upon her.

I found I must be willing to deal directly with Cassie's issues, by slowing down and accepting her revelations and feelings calmly, and at her pace.

Focusing too much on the details and not on the issues, could have left Cassie feeling exploited and re-victimized.

Dr. Westin wrote in the article "Countertransference Phenomena and Personality Pathology in Clinical Practice: An Empirical Investigation" 'The broadband measure of countertransference processes can turn clinicians' experiences into definable interpersonal patterns, allowing clinicians who normally attend to countertransference phenomena to hone and systematize their self-reflections.'

♦ Technique: Losses and Gains
I find to minimize my countertransference; a Losses and Gains exercise is helpful for me. I asked myself, what loss issue does Cassie's molestation by her mother, trigger for me? For example, I have a loss issue of my father dieing of stomach cancer when I was ten. Cassie's negative feelings regarding her mother triggers my abandonment issues regarding my father. To resolve or release this issue, I then ask what was the long term gain from that loss.

For example, my self talk includes; even though my father died, I became a much more independent person because of it. What loss issue does a sexually abused client trigger for you? What is a gain that has resulted from that loss?

As you are aware, peer consultation and discussions with colleagues can help mental health workers regain the necessary professional perspective.

In this section, we have just reviewed countertransference and the use of Losses and Gains exercise.

In the next section, we will begin to look at the first two parts of the Healing Cycle for those living with the secrets of childhood sexual abuse of exposing the wound and re-experiencing the trauma.
Reviewed 2023

Peer-Reviewed Journal Article References:
Böge, K., Mouthaan, J., & Krause-Utz, A. (2020). Effects of dialogical mindfulness on psychopathology: A pilot study’s results from a seven-day psychosynthesis course about the inner child. The Humanistic Psychologist, 48(1), 84–99.

Daskovsky, D. (1998). The abuser and the abused: Sources of resistance to resolving splits in the countertransference in the treatment of adults who were sexually abused as children. Psychoanalytic Psychology, 15(1), 3–13.

Ensink, K., Borelli, J. L., Normandin, L., Target, M., & Fonagy, P. (2020). Childhood sexual abuse and attachment insecurity: Associations with child psychological difficulties. American Journal of Orthopsychiatry, 90(1), 115–124. 

Hayes, J. A., Gelso, C. J., Goldberg, S., & Kivlighan, D. M. (2018). Countertransference management and effective psychotherapy: Meta-analytic findings. Psychotherapy, 55(4), 496–507. 

Latts, M. G., & Gelso, C. J. (1995). Countertransference behavior and management with survivors of sexual assault. Psychotherapy: Theory, Research, Practice, Training, 32(3), 405–415.

QUESTION 12
What is the common concept in the narrow and broad definitions of countertransference? To select and enter your answer go to Test.

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