336
Reeder et al. ( 2017 ) surveyed clinical genetic counselors about their counter-
transference experiences. They identified four types of negative effects: disruption
in rapport building, over-identification, conversation does not reach its fullest poten-
tial, and counselor is drained emotionally. They also identified one positive type of
effect, namely, repaired empathy (a better relationship develops between the genetic
counselor and patient).
Types of Countertransference
Kessler ( 1992 ) describes two primary types of countertransference in genetic
counseling:
- Projective identification: Projective identification occurs when you mistakenly
believe your feelings are your patient’s feelings. So, for instance, if you feel a
great deal of discomfort, but you think this is what your patient is feeling, you
might encourage the patient to focus on less distressing ideas or images. When
this happens, you will only, at best, have shallow empathy, because you will avoid
going deeply into feelings that are too upsetting to you. Projective identification
also occurs whenever you have the misperception that you understand exactly
what a patient is going through because you’ve had a similar experience. - Associative countertransference: In associative countertransference, your
patient’s experience taps into your inner self, and you begin to focus on your own
thoughts, feelings, and sensations. Like projective identification, associative
countertransference is triggered by your own past or current problems or situa-
tions that are similar to your patient’s. A major difference, however, is that you do
not think your feelings are the patient’s feelings. You know they are your feelings.
When you experience associative countertransference, you find yourself losing
focus. Your attention shifts from the patient to yourself. You may find yourself
daydreaming about your situation and realize you haven’t fully heard anything
the patient has said for a few seconds or longer. Associative countertransference
can be quite common. As Kessler ( 1992 ) points out, genetic counselors must deal
with patients whose situations are similar to difficulties and problems the coun-
selors are currently experiencing or experienced in the past. He further states,
“Bad things do happen to genetic counselors. But even if they do not, we are as
vulnerable as the next person to experience loss and pain. Disappointment, loss,
feelings of being rejected and misunderstood, of failure, embarrassment, hurt,
and so on are ubiquitous human phenomena. No one is exempt” (p. 304).
Watkins ( 1985 ) identified four types of countertransference that can either occur
occasionally, with some patients, or can be more pervasive, occurring with many
patients: - Overprotective countertransference: You regard some or most patients as child-
like and in need of great care and protection, so you cushion the information you
give (“Most of the time the results of this test will be normal.”), or you qualify
12 Genetic Counseling Dynamics: Transference, Countertransference