David Earl Johnson, LICSW

4 minute read

Mental Nurse posted a wake up call for caregivers today. Please note she writes with tongue firmly inserted in cheek.

Service users are time-wasters. They want to be in hospital, are happy to be dependent on professional carers and are ready, willing and eager to become institutionalised as soon as they fall into our grasping hands. Sound familiar to anyone out there? …probably not, but now replace the general with the specific, and I wonder how many staff have either heard these words uttered from the mouths of colleagues…or even, dare I say it, have said it themselves: “Patient x shouldn’t be here, s/he’s just wasting our time…..not mad, but bad. S/he really likes being in hospital/getting a community service, and (the final convincer for anyone who thinks this is just prejudiced opinion……..) we need to discharge him/her before they get institutionalised/too dependent on us.” The last comment of course refers to the mystical processes of institutionalisation and dependence that have nothing to do with the behaviour of the professionals who are supposed to care for them. I’ve heard these comments all my nursing career, and have always thought…[GEEZ!]. How bad do their lives’ have to be that they would want to live in a mental health unit or have the likes of you visiting them at home?” I’m afraid both caregivers and consumers have witnessed this phenomena. It’s called countertransference.

Freud introduced the term countertransference a few years before he wrote the bulk of his papers on technique, although he never devoted a special study to it. It was considered roughly as the obverse of transference, the repetition of the analyst’s irrational, previously acquired attitudes, now directed toward the patient, and was assumed to be absent except in situations in which the therapist was inadequately analyzed. Freud deemed it to be the obligation of the analyst to eliminate such unconscious reactions as obstacles to treatment.

Caregivers, being human beings, get frustrated and overwhelmed and tempted to blame others for their feelings. Unfortunately, despite all the admonitions about “unprofessional behavior” in graduate school, in my experience, it’s a topic that comes up in the professional setting less often than it should. As students, at least some professionals are humbled by the experience of intensive supervision. Topics such as the students’ mood, recent stressors, feelings about their clients, as well as tone and choice of words come up as a routine part of supervision. I had that experience and am forever grateful, as are, I’m sure, my clients.

After graduating and becoming licensed, I thought everyone experienced this level of supervision. How wrong I was. It was a baptism of fire when I discovered as a budding supervisor, few professionals are prepared to tolerate that level of feedback. That is not suprising if one considers that so many never experienced it before. Instead of seeing it as another opinion in the context of doing one’s best to provide quality service, too many react as if their competence has been challenged. Indeed, the license says we are competent to provide independent professional practice, and many professionals think that means they don’t need supervision or personalized feedback. Most readily accept they must seek consultation with their peers on a regular basis. I’m sure there are settings where co-workers are more trusting and supportive and such topics do come up.

Perhaps I’m coming to this discussion from an unusual point of view and I’ve worked in relatively hostile work environments. But I don’t think so. I don’t know many friends who would dare to offer the feedback we all need from time to time. Hopefully, most of us have someone in our lives who will tell us when we’ve crossed the line, because we all do. I believe part of what it takes to provide quality service requires one to seek out intensive consultation. Without that regular personal check up, the intuitions we gain from our emotional responses to our clients can quickly impose themselves on the treatment process, as Mental Nurse effectively reminds us.

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