Rorschach and a Case of Countertransference

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CASE VIGNETTE

Annie, aged 25 years, starts therapy at the request of her parents, because she continues to abuse alcohol, does not perform adequately in the family business, and makes irresponsible financial decisions. Over the course of psychotherapy, the therapist, Dr M, takes on a more directive and authoritarian stance when Annie begins to behave in a manner that is reminiscent of how she behaves with her family. In the midst of a session during which Dr M was trying to control the patient’s behavior, Dr M has a sudden flash to her sister’s face during an argument in childhood. The therapist recognizes that there is some resonance between what is happening with her patient and what happened with her younger sister.

Countertransference

In this scenario, there is a perfect “hook” for the therapist that is triggered by the patient’s behavior because of her past relationship with her sister. A therapist with different life experiences and relationships may be more resistant to the pressure to take on the role of punitive parent. Contemporary experiences in the therapist’s life that mirror what is going on in the patient’s life may also trigger intense countertransference feelings. It is commonplace, for example, for a therapist to feel uncomfortable when a patient’s marital conflicts mirror his own.

The key point here is that not all therapists will have the same countertransference responses to the patient. The notion of a “hook” (or lack of it) in the therapist and a good “fit” between patient and therapist implies that the therapist’s internal world will determine to some extent the nature of the response to the patient’s transference.

For more information, please see "Of Two Minds," by Gabrielle S. Hobday, MD, on which the case and discussion are based.

Related content:
Through Analysis, Gut Reaction Gains Credibility (NY Times)
How Psychiatry Changes the Brain

Image: Wikipedia.

This article was posted on February 3, 2015 and has since been updated.

Disclosures:

This is the third in a set of 10 Rorschach images that are in the public domain and can be seen in its entirety on Wikipedia.