Our mind is protecting us from further damage to our feelings and emotions which can cause emotional blocks. This repressive mechanism can creative anxiety, depression, phobias, etc. Our natural defences shield us from hurtful feelings so as to protect us from hurt, loss and pain.
Human nature does not accept vulnerability, but tries to hide it away and suppress the pain. Being a vulnerable human being allows us to feel, understand and deal with empathy; an essential part of living. Clients who suffer from hurt, loss and pain often shy away from commitment and relationships, to shield themselves from being rejected or abandoned. By accepting their vulnerability, clients can understand its meaning and bring emotional blocks to light to enable healing.
We call this our Inner Child. Learning to accept, love and forgive past experiences is the key to ETC. As we grow, we learn to hide away the attacks on our personality and repress these feelings. Counselling Directory is not responsible for the articles published by members. Supervisors allow supervisees to discuss and identify what they believe to be the issues they are seeing in treatment, or the issues that supervision is needed for.
As with EFT, the supervisor is not concerned with content, any questions given to the supervisee are about the process of interactions with clients, focusing on themes that emerge related to the difficulties the supervisee is experiencing. If the supervisee is experiencing compassion fatigue or burnout, there will be themes of the therapist being frustrated, exhausted, or overwhelmed.
For example, the supervisee may identify themes of feeling helpless or maybe even anger with the client. Signs of self-of-the-therapist issues may include the therapist being annoyed with the client, dreading going to session, or spending a significant amount of time thinking about the client or treatment outside of the session. Heightened emotional expression, or avoidance of supervisor directives are indicators the therapist is experiencing a self-of-the-therapist issue, compassion fatigue, or burnout.
The core issue is the emotional experiences of supervisees impeding their ability to think clearly about their work, and that the emotional experience may also be affecting their personal life outside of the therapy room.
The supervisor avoids focusing on individual traits of the supervisees that are causing the experience, but instead focuses on the systemic interactions and experiences with their clients. The second step of EFT is focusing on the cycles of conflict, and especially the negative interaction cycles Greenberg and Johnson This step for supervision can be enhanced if the therapist is able to present video or audio recordings of the session. The supervisor will listen for patterns around the experience of compassion fatigue, and then describe the cycle of the experience for the supervisee.
The cycle of emotional response to treatment may become evident if the supervisor examines the core issues that lead a supervisee to bring a specific case to supervision. Once the theme is identified, the cycle surrounding this feeling should be traced.
The difficult part in identifying the cycle is that it can be rooted in a few different systems. If the issue is rooted in the therapist-client system, the supervisor may notice that the supervisee consistently brings a specific case, or similar cases, to supervision e. Long-term clients are likely to elicit feelings of hopelessness, confusion, or discouragement, or because of the engagement of empathy, any number of sensitive emotions the client was also experiencing.
To facilitate the process of understanding the cycle with a particular client, the supervisor can have the therapist bring in information on ongoing client progress assessments. The goal is to understand both sides, and help the therapist recognize both the context of this emotional reaction and its influence. The issue and the cycle could also be embedded in influences from the larger professional system.
As we discussed earlier, interactions with the professional system could lead a clinician to believe that short-term treatment is optimal and possible for all clients. Those feelings can transform and present as blaming the client for the lack of progress or even anger toward the client. Expectations can be traced to readings the therapist has done, trainings the therapist has been to, or colleagues the therapist has worked with.
Work systems can also cause an emotional reaction for a therapist working with a long-term client. A work environment, for example, may not allow a therapist to see a client for a prolonged period of time. Some treatment centers only allow clients to be seen for a maximum of 8 sessions, which places a lot of pressure on a therapist to create change quickly.
Not being able to complete treatment in this time period for every client, which is inevitable, can cause a feeling of helplessness or, again, discouragement.
Work load expectations may also contribute to a therapist feeling burned out. Again, understanding the context the emotion is developing in is crucial for the therapist.
It is important for the supervisee to recognize the compassion fatigue, or other emotions experienced, is part of a self-protection process. The compassion fatigue could be a sign of several different things. It could indicate that the therapist is engaging in a pursue-withdrawal pattern with the client, or it could be a sign the therapist is feeling ineffective or helpless. The main goal is to identify where the peaks of the compassion fatigue or burnout are, as they will provide information about the potential emotions experienced by the supervisee.
Once the cycle has been identified, the focus moves to the emotions experienced by the therapist. When the therapist is feeling compassion fatigue, when she or he is feeling exhausted, what else is the therapist feeling? Is the therapist feeling overwhelmed, insecure, embarrassed, afraid, helpless? The therapist may describe his or her emotion as being anger, frustration, or annoyance even, but these emotions are secondary emotions. The supervisor works to identify the primary emotion behind the defensive mechanism.
Emotional expression and experience can be divided into four categories: adaptive primary emotions, secondary emotions, instrumental emotions, and maladaptive primary emotions Greenberg and Johnson This can include anger, hatred, and revenge.
An instrumental emotion might be one where a person expresses fear to gain comfort from another person, whereas a maladaptive primary emotion could be something like having a fear of intimacy in response to interpersonal trauma. Primary emotions, on the other hand, may not be fully within the consciousness of the individual. They are the more vulnerable emotions a person may feel, and may even be accompanied by physical sensations or vivid images. This can include hurt, fear, and helplessness.
The therapist experiencing compassion fatigue or professional burnout may be experiencing any of these emotions, and the supervision process will seek to identify the primary emotions and identify their type. As is the case for therapists working with clients who have experienced trauma, listening to the life stories of the long-term client could incur a feeling of helplessness Pearlman and Saakvitne Listening to how life events have created lasting and persistent outcomes can lead to a sense of grief for the therapist recognizing the permanence of the impact of some life events Pearlman and Saakvitne In this case, the therapist may be experiencing the same primary, or secondary, emotions as his or her client.
This list may not be exhaustive, but can provide the supervisor with areas to consider for the source of emotionality in the supervisee. Our list here focuses on the potential primary emotions the therapist may feel, but certainly supervisees will express a variety or secondary emotions to mask these vulnerabilities. The supervisor accesses these emotions the therapist is experiencing in supervision, and focuses on the primary emotions. I can see you care about your client a great deal, what are you feeling when you see that pain over and over again?
It must hurt you quite a bit. It must be scary to see that someone could be hurt that deeply. Step 4 of supervision is to focus with the therapist on this reframe, on this understanding of his or her emotionality as part of a cycle and part of a larger context. At this point in treatment, the supervisor focuses the supervisee on the primary emotion she or he feels during treatment, not on blaming the client or focusing on what the client did to elicit the feeling.
Is it hard for you to go to group supervision and hear your colleague discuss a successful termination and then have to discuss this case that is taking longer than usual? You start to feel like a failure at those times? The supervisor continues to bring issues back to the cycle where appropriate until the supervisee can recognize and verbalize the cycle her or himself.
Traditionally in EFT, step 5 of treatment is meant to have couples enact the cycle and practice expressing their emotional needs to break the cycle Greenberg and Johnson Again, since the client is not involved in the supervision, this step looks a little different in this supervision process. At this step in supervision, the supervisee and supervisor will identify how the emotions that are being experienced point to needs that the supervisee has to maintain her or his emotional health. In this supervision approach the supervisor may have to play a role similar to what the partner traditionally would, and help provide the need to the therapist.
This could mean providing resources, identifying evidence that they are effective, or reframing the process for the therapist. If a therapist is feeling deficient because they could not produce results with the client, the supervisor can work with the supervisee to determine times when they did feel effective or how they could feel effective, whether with this particular client or with others.
This could mean refocusing on smaller indications of client progress, and adjusting expectations for the outcomes in long-term treatment. What do you need at these times? What evidence do you have that your work is effective? If a supervisee is feeling inferior to other clinicians who only engage in short-term treatment, the supervisor could reframe this as the therapist taking a chance on a client, working with a client where others may have refused to take the case.
You start to feel guilty and like a failure. That sense of failure starts to make you become more directive in therapy then trying to prove your worth. I wonder what your clients appreciate about how you work? Perhaps the therapist breaks up a block of time that is set aside for case notes and distributes it throughout the day so there is more time between sessions. In this step, the supervisee will be able to acknowledge their emotional reaction to the cycle, and will be able to identify and pursue means for fulfilling unmet needs.
The sixth step in the process of treatment is focused on acceptance. The supervisor can have the therapist practice identifying the sources for self-of-the-therapist issues or compassion fatigue, and acceptance of it. What are you starting to recognize about what it means to have this type of case?
How can you see your role as different with this case? Even though it is difficult for you, what reasonable expectations for your own work or that of the client are you starting to have? Self-of-the-therapist issues, compassion fatigue, and professional burnout are not therapist deficits. The emotional exhaustion that a therapist faces in treatment is a normal reaction to an emotionally laden environment.
Work with long-term clients is unique in that there are increasingly significant factors in the professional system or the work system that may have the unfortunate circumstance of creating tension for the therapist, and increasing the likelihood of having compassion fatigue or professional burnout. We believe that following the recommendation of other scholars, self-care Figley a ; b or other treatment approaches e. However, taking into account the systemic influences, and the challenges this type of client brings to treatment, we do not believe that the directive of self-care for a supervisee is adequate to resolve the emotionality that is activated for a therapist.
We believe that the emotionality of the therapist should be directly accessed in supervision. The emotional experience of the therapist is a valid reaction, not just a result of a lack of self-care, but instead a result of a system interaction. We suggest an approach for supervision that is inspired by Emotionally Focused Therapy EFT and that directly accesses and addresses the emotionality of a clinician.
This approach to supervision follows the first six steps of the traditional EFT approach Greenberg and Johnson and adapts them for the process of supervision. The primary goal is on identifying the primary emotions that a supervisee is facing.
The focus here, although incorporating and addressing emotionality, is to relate it back to how it is interacting with treatment to help therapists work more effectively with their clients. Other approaches to supervision already address these pieces e.
Accessing these core emotions may be difficult for some clinicians and supervisors alike, but when it has become a matter of impeding progress with a client, it may be more of an ethical issue not to.
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Journal of Clinical Psychology, 58 , — Galatzer-Levy, I. Depression and Anxiety, 30 , — Gelso, C. Countertransference management and therapy outcome: An initial evaluation. Gingerich, W. The specific facilities involved in the present study are focused on the treatment of borderline disorders and it may be that their therapists are able to work at the required emotional level with this kind of patients.
Conversely, as different PDs are thought to have a different impact on therapy relationship, mostly based on their typical interpersonal schemas [ 9 ], therapists that works in the present facilities may have found more intense reactions working with less common schemas than usual. This may be true not only for A and C clusters that were related to negative therapist emotional responses, but also for other PDs related to B clusters a part from borderline.
This is an interesting element showing that working with patients with antisocial traits can be related with intense anger and irritation even for therapists of this area of expertise. A and C clusters were related with difficult-to-manage emotional responses in the therapists. More specifically, A cluster traits were positively associated with detached emotions and negatively related with proximity patterns such as involved or sexualized patterns.
In particular, the presence of obsessive-compulsive trait in different kinds of emotional response of the therapist is very interesting: the clinical interpretation of this data could lead us to highlight the difficult involvement in the treatment that characterizes this type of patient. The presence of positive and significant correlation between the psychological functioning of the patient [Q depressive neurotic high functioning] and the positive satisfying emotional response by the therapists is in line with previous findings [ 5 ].
Finally, the low level of sexualized emotional response of the therapist is a common factor that goes beyond personality traits. This is probably due to the public or institutional setting used for all the treatment.
The results of the present study confirm the influence of specific personality traits on the emotional response of the psychotherapist. This finding confirms the idea that personality characteristics and interpersonal functioning of patients is related with distinct emotional responses in therapists [ 8 ]. This may be related to the fact that therapists considered in Liebman and Burnette paper [ 11 ] belonged to very different areas of expertise. This study does not come without limitations.
Consequently the present results should be interpreted cautiously as they reflect the perception that the clinicians have about their patients and their emotional reactions as well. Although SWAP scales have previously showed high level of interrater reliability [ 17 ] and we controlled the results for setting variables i.
This multiple testing may lead to Type 1 error i. Finally, the sample is representative of patients with severe mental disorders, but the limited number of patients prevents us from more general conclusions.
Moreover, the present paper evidenced that most of the significance considering the effects of patients and therapists variables related to a very specific clinical setting. This result stresses the need to take in high consideration the features of the psychotherapist.
As the results of the Third Interdivisional APA Task Force on Evidence-Based Relationships and Responsiveness showed [ 24 ], each psychotherapeutic treatment presents more possibilities to reach a good outcome if the psychotherapist will be able to tailor his approach and his personality features in relation to personality, culture, and preferences of the patient. Future research could assess the effectiveness of the PD treatments based on common factors that can integrate the knowledge of the scientific community and professional expertise.
The present reactions, and therefore the patient-therapist relationship could be particularly context-dependent and may be influenced by the therapist area of expertise, which is an aspect with both clinical and scientific implications. The datasets used and analysed during the current study cannot be made publicly available due to IRB restrictions, but may be available from the corresponding author on reasonable request. Kernberg O. Borderline conditions and pathological narcissism.
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