Monday, April 1, 2013

Fear and my counter transference reaction

It does not happen often these days, that I get that so moved working with a client. Especially with someone whom I have never seen before and will probably never see again. I tend to get more effected by clients who I know quite well but in this case, as I say, I will probably only ever see him the one time that I already have. But with this man who I recently counselled I was certainly emotionally moved by him and his plight

After counselling for 30+ years I have heard a lot of things. I hope I have not become too hardened by some of the things I hear in my work but I did notice this the other day and I noted the exceptional nature of my counter transference reaction.

Dont look

A man in his mid 50s came to see me with his wife of about the same age. He initially presented what we call in the psychotherapy business a ‘calling card problem’. Typically these problems are the more socially acceptable issues like wanting to loose weight, wanting to give up smoking or maybe something like insomnia. People tend to see these as ‘normal’ people problems. As the client gets to know the therapist more the hidden issue tends to comes out which can happen in the first session or sometimes it can take quite a number of sessions to come out. The calling card problem gives the client time to assess the therapist and then can decide if they want to mention the underlying reason for seeking counsel.

His initial request was did I think he was depressed and if so what could be done about it. So I asked him questions which he answered and his wife was commenting also about their life, him and their work. As I acquired more information it became obvious there was another matter which troubled them both. The man was showing some clear symptoms of early onset dementia.

I decided to bring it right out into the open and stated there could be some signs of dementia. When I mentioned this they were not taken by surprise or shocked. They had obviously talked about this before and may have suspected something like this. By this time the question of possible depression had been forgotten and the ‘real’ issue was being openly discussed.

Nude with gun

They had come to see a trained person, me, to confirm if I thought what they thought was dementia. I stated to him that he was showing some common symptoms of that condition and referred him onto someone else who specializes in that area. As I said this I saw the fear in his face as he knew what was coming with the probable demise of his memory and intellect and this is what moved me so. One could see the true fear in his face.

Indeed my referral probably was a reflection of a counter transference reaction on my behalf. My Adult reason for referring was because this is a serious matter and I did not want to get it wrong and therefore he should see one who has special expertise with dementia It is highly likely he will get a diagnosis of some kind of dementia and probably my Child ego state was so moved by his fear that I did not want to be the one who gave the final answer. Hence the real reason for the referral.

So it seems he presented me with a calling card problem because of his fear and I left him with a calling card referral because of my fear.

shark swimmer
My fear met his fear

But it is one of those ones that you don’t forget about. Some clients you just don’t seem to forget over time and it is quite possible this will be one of those for me, even though I only ever saw him one single time.



  1. My initial brilliant comment got lost somewhere in cyberspace. So here is my second attempt!!

    I always believe that if I ever stop having an emotional response to clients that it is time to get out of the job.

    Well done, Tony for recognizing what was happening and for not getting so “hard” that clients don’t affect you sometimes.

    We need a certain amount of “hardness” to survive in this field. But if we ever completely lose the Child (and Nurturing Parent) empathy, then it is time to quit.


  2. Thanks for your comment Madeleine,

    I also find it a fine line to walk, as you say. I hope i don't deviate to far off that line at times