Wednesday, February 2, 2011

Countertransference issues in therapy: Schizophrenia & APD study critique

While there are a lot of interesting topics and sub-studies abundant in the field of psychology, nothing
intrigues this writer more than the wide path of Freudian theories so relevant still today. The concern
to account for, recognize and steer clear of countertransference issues is still a work in progress for any
professional. CT is understood to be reactions to clients on both the surface and underlying
motivational levels (Freud, 1910).
Just recently this writer was thinking about how often in professions new professionals are groomed in
kind to old professionals. Yes mentoring and teaching is a wonderfully inspiring thing, but to an extent,
is it possible that all one does is create machines in one's own likeness? This may happen on many
levels. For instance, psychology professionals are held to standards of the APA. Daily one goes about
their practice within these constructs and never really may push the envelope. Parallel to this thought
is the review and discussion of professional composure both on the conscious level and even that of
the subconscious level.
As we mix, mingle, and intertwine, are all we doing is convoluting ourselves and acting out the
Freudian schema of CT? How much of it happens via our shared collective unconsciousness (Jung,
1970)from being human having a shared history versus a methodical personality having the upperhand
in manipulation when one's personality is highly dominant? And if not personality strength, could
being placed in a position of authority tip the CT scale in one's favor?
While Scwartz, Smith, and Chopko in 2007 wove a study to outline CT in instances of schizophrenia and
anti-social personality disorder, daily professionals have to account for and reflect on how much of
their own issues help or hinder their work. Professionals need to ask themselves at the end of the day
how much they were fully present, in their game, and know where their course of treatment or scope
of duties may serve humanity. Ideally, professionals in the field of psychology and
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social work are some of the fiercest people in being even-keeled to any client that may walk through
their door, the reality is that their own issues can at times distract them from their best work.
As the study of Schwartz, Smith, and Chopko unravels, it presents the data that persons with
schizophrenia become endeared while those of anti-social personality disorder are managed more
harshly in experienced professionals (2007). More interestingly is the realization that often the
persons with schizophrenia tend to look toward the professional for additional guidance and steering
while quite predictably, the persons with APD continue in their path of being resistant to another's
influence of the situation, often challenging it. As these disorders and personalities collide with
therapist, much can be garnered in the effort to maintain professional best practices when one is of
the consciousness that we do not operate in a vacuum and that others will impact services rendered.
What this may boil down to is managing preferences and preferential treatment with patients and
what they bring to bare to the counseling dynamic. For instance, if it's psychometrically valid that
persons with schizophrenia may be holding their helper in high regard, this actually may work well for
the therapist to show them their flaws so as to level the playing field and to introduce more
unconditional positive regard about the human condition in general. This may alleviate feelings of guilt
or embarassment around their disorder.
Knowing that the person with schizophrenia is easy to ingratiate to the trust needed in clinical
relationships, how might the well-functioning client with schizophrenia in turn become empowered
from the counseling sessions to recognize a reversal in CT in that they may be an authority? Could they
do work in group sessions at their center for groups around the theme of coping with schizophrenia?
Let's take a recognized CT situation and realize it may not be so bad if used positively.
In instances of CT going out to APD types, what we need to do is be conscious of things that irritate us
and provide roadblocks. The APD personality in and of itself may constitute one of the most
challenging personalities to help. Perhaps reflection about that which we don't like about ourselves is
what we see in APD and become most critical of. Can a professional know of expert strategies to
minimize dislike of a patient of APD when they might be sharing aspects of the human condition?
Could sharing these flaws help ingratiate a relationship? While this remains a theory, the CT we come
to therapy with in these clients may unlock a lot of reflection potential in us all. This would be taking CT
and using it in a positive manner again.
While the research of Schwartz, Smith, and Chopko,( 2007) is very illuminating on the topic and
identification of a personality and disorder that lends well to extremes of CT, there was a major flaw to
the study that was not covered in the researcher's considerations of experimental drawbacks. This
writer is of the educational background understanding how media can control a message and behavior
in the masses. The fact that that clients were portrayed on video may need addressing. In reaction to
the experiment, the production, editing, message delivery, implied perceptions, actual perceptions are
all the artwork of a person or team and even within that may be an issue of CT. To be sure, there is a
reason and message that any media has in communicating. That needs to be accounted for in this
study. The clients in each scenario must be addressed for dependent variables of the production of the
video. Controls need to be offered.
In spite of the delivery of the media message, this writer approaches all potential clients with intrigue.
My emotion will be conveyed as curiosity and intrigue around how they function despite something
being outlying to "normal". This goes back to my concentrated interest in positive psychology and how
people persist towards being their authentic self and how this writer may help them capitalize on this.
For instance, in persons with schizophrenia, documenting the stories of their multiple selves may make
the work for a truly layered artistic expression. They have multiple stories to tell and it could be told in
so many fashions. They could paint, write, direct, or musically create their schism experiences if they
have an inclination to take a bad situation, embrace it and spin it positively. How many of us are not
ideas people? These patients may be full of potential if they see it that way. In
viewing this so positively, I may be counter-transfering my inclination to the arts on my clients. Is this
really that bad though?
In anti-social personality types, I would believe that there resistance towards the therapuetic alliance
may present me with some of the most challenging work possible. Within that dynamic this writer
imagines having to do an immense amount of preparation and research to break down barriers. It
should serve me well. Even if I don't succeed in creating an allegiance, I know that I will have at least
tried. It's never wrong to feel bad about a referral if the relationship is too difficult to be formed. I may
have to wonder of my own CT in abandonment issues as this writer approaches life quite individualistic
at times. However, that may lend itself to a strength area with APD clients as I am aware of functions,
professions, and networks of an individualistic nature.
One last thing to impress upon is the need for any professional to be networked for consultation and
referrals. One must be able to keep CT to a minimum especially when it's one's own issues that have
not been dealt with adequately. This is a field that must build consultation and support among
practitioners to consult on difficulties and shortcomings. Practitioners must do whatever is necessary
to be the rock in a seemingly volatile patient's world.
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Freud, S. (1910). The Future Prospects of Psycho-Analytic Therapy. London, U.K.
Jung, C. (1970). Collected Works, Volume 10. Routledge & Kegan Paul, London.
Schwartz, R. C., Smith, S. D., & Chopko, B. (2007). Psychotherapists' countertransference reactions
toward clients with antisocial personality disorder and schizophrenia: An empirical test of
theory.American Journal of Psychotherapy, 61(4), 375-393. Retrieved from EBSCOhost.

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