337your interpretations (“You told me that you are very angry, but I wonder if you
are also sad. I’m probably off base with that. It was just a guess. Forget I even
mentioned it.”), or you don’t allow patients to experience and express their pain-
ful feelings (“Everything will be OK. It will be fine.”) (Watkins 1985 ). Other
evidence that you may be overprotective includes talking in a low voice and
using physical gestures such as patting patients on the back, hugging them, or
patting their hands, all of which can be perceived as infantilizing (Watkins 1985 ).
An additional aspect of overprotective countertransference is worrying exces-
sively about a patient, even to the point of obsession (dreaming about the patient,
looking for reasons to contact the patient, etc.).- Benign countertransference: This type of countertransference is often due to an
intense need to be liked by patients or to a fear of strong patient affect, especially
anger (Watkins 1985 ). To prevent being disliked or to avoid strong affect, you
create an atmosphere that is the same across all patients and situations, one that
is characterized by shallow exploration of emotions; by optimistic, cheerful
interchanges; and by limited consideration of negative information or issues
(Watkins 1985 ). There may also be a lot of extraneous chitchat as you attempt to
be more like a friend than a genetic counselor or focus on facts and figures rather
than exploring emotional issues. - Rejecting countertransference: Like overprotective countertransference, you
may regard some or most patients as dependent and needy, but you react puni-
tively, becoming aloof or cold, and behave in ways that create distance between
you, either because you fear the demands patients might place on you or you’re
afraid of being responsible for their welfare (Watkins 1985 ). Examples of dis-
tancing behaviors are blunt explanations (“You know that you should be having
screening because your family history puts you at a really high risk for develop-
ing cancer.”), and dismissive responses to patient requests (“That’s your deci-
sion. I’m not you.”). The following two examples of rejecting countertransference
involve genetic counseling student statements made during supervision: “My
explanation of the genetic condition wouldn’t have been so confusing if the
patient had just given me a chance to explain!”; and “I don’t know where she got
the idea that I wanted her to terminate her pregnancy... She was just looking for
someone to tell her what to do.” In the first example, it’s important to note that
the patient did give the counselor the chance to explain, and in the second exam-
ple, the patient gave no indication that she wanted to be told what to do. - Hostile countertransference: This type of countertransference occurs when you
dislike something about your patient (e.g., a mannerism, a physical characteris-
tic, an attitude, a value), and attempting to be as unlike the patient as possible,
you try to distance yourself in both overt and covert ways (Watkins 1985 ). You
go even further than with rejecting countertransference, perhaps making harsh
statements (e.g., “I already told you that I’m not the one making this decision!”).
Your attitude is that the patient deserves what she/he is getting (Watkins 1985 ).
Even if you would never say these sorts of things to the patients, if you are think-
ing them, you probably are experiencing countertransference, and it may “leak
out” in subtle ways. Hostile countertransference may be more common in genetic
counselors who are experiencing some degree of distress and/or burnout. Perhaps
12.1 Transference and Countertransference