335religion, sexual orientation, socioeconomic status, and/or disability may raise issues
of countertransference. Stereotypes, fears, misunderstanding, or misinterpretation
may occur when the genetic counselor confronts a situation in which, to a greater or
lesser extent, his or her own background and experience provide less of a guide for
understanding the patient’s beliefs, values, expectations, and responses (Weil 2010 ,
pp. 183–184). For instance, a female genetic counselor may respond negatively to
the authoritarian role of the male in some cultures (e.g., English-speaking husband
dismisses the translator saying that it’s not important for his wife to understand the
conversation as he makes medical decisions for her).
Effects of Countertransference
Countertransference can have both negative and positive consequences. You should
be particularly concerned about negative effects. One possible negative conse-
quence is that countertransference can interfere with your empathy for a patient.
You may learn something from a patient that triggers your own experiences, and
soon you have stopped listening to your patient and are busy thinking and feeling
about your own situation (Kessler 1992 ). You may believe your thoughts and feel-
ings are about your patient, but they are actually (and usually unconsciously) about
you. Additionally, your patient’s situation may reopen current or old hurts, and
because this is painful, you may avoid exploring the patient’s feelings, especially if
your typical coping style is to distance yourself emotionally (Kessler 1992 ; Reeder
et al. 2017 ). One possible positive consequence of countertransference is that the
triggering of experiences from your past might give you increased empathy for
patients (to the extent that your experiences are similar to theirs). As already stated,
however, there is always the risk that you may listen less carefully to patients and
instead impose your experience on them.
As with transference, you must be careful to distinguish countertransference
from situations in which your reactions are a realistic response to your patient and
her or his behavior (Cerney 1985 ). For example, it’s natural to feel sad when a
patient is grieving over a pregnancy loss. If you become quite distraught over your
patient’s situation, however, it might indicate that you have unresolved feelings
about a past loss. It’s also natural to feel irritated at a patient who lies about being at
risk in order to get a genetic test. But if you become very angry with this patient, it
might suggest you’re acting from past experiences where you felt manipulated or
controlled by others (see self-involving responses in Chap. 11 , for a more extensive
discussion of realistic counselor reactions). It’s also important to distinguish coun-
tertransference from your natural, empathic response to patients. Empathy, as dis-
cussed in Chaps. 4 and 8 , involves the ability to experience patient feelings as if they
were your own while maintaining enough distance to realize they are not your feel-
ings. Empathy also involves the ability to listen to the patient’s story without impos-
ing your own assumptions.
12.1 Transference and Countertransference