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Navigating Countertransference with Challenging Clients

Working with clients who have severe anxiety or OCD can bring with it a host of challenging experiences for the therapist,including countertransference. Oftentimes these clients have seen multiple other clinicians and/or psychiatrists prior to coming to see you. They may feel hopeless and have expectations for you that feel impossible to live up to. There can be other barriers as well. Some clients are unable to leave their house due to agoraphobia and other clients need you to leave your office to truly expose them to the things that trigger their fears. All of these challenges can create an experience that leaves you feeling depleted and overly responsible for the well being of your client.

I like to think I am always up for the challenge. It stimulates me and pushes me to think creatively. I tell my clients that I will go to the ends of the earth for them as long as we are a team and working well together. The successes make me want to work even harder and, if I am going to be honest, probably feed my ego. It seems inevitable that I will have a client that I struggle with and eventually develop countertransference because I feel stuck, exhausted, and upset.

My countertransference often looks like this: I am angry at the client or their family for not doing enough. Maybe they aren’t making appointments a priority. Maybe they contact me frequently for direction in their therapy and I don’t have time in my schedule to call them back. Maybe they won’t consider medication which feels like it makes my job more difficult. Maybe they would be better served in an intensive treatment setting but don’t have the resources to go which, again, makes me feel responsible for their care.

I don’t think these are unusual experiences when you are working with severe anxiety and OCD. I often tell my clients, “The problem isn’t that the big feelings happen, it’s what you do with those feelings.” So when I feel overwhelmed, unbalanced, or angry towards a client, I have to stop and do a couple of things.

First, I check in with myself. Why do I feel I have to live up to everyone’s expectations?  Is this really something the client has done or does it have to do with how I am setting boundaries with the client?  Can I communicate in a clearer way? Am I feeling overwhelmed in other areas of my life that need my attention and more balance?

Second, I check in with a colleague who I feel safe to share my struggle with. Often, I find I need someone just to listen, and in telling the story, I begin to understand my struggle better. It also feels good to hear that my colleague also struggles so I recognize that these cases can be trying and exhausting but oh so rewarding! Finally, I need to get back to my relationship with my client by nurturing it and setting clearer boundaries.

Counter transference can feel pretty awful but it is an opportunity to grow, both as a clinician and in our relationships with others.

Go to  https://anxietytraining.com/case-consultation/ for help with your tough cases.
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