Toward effective service to individuals, divorcing families, and stepfamilies

 


Common Transference Issues with
Divorcing-family and Stepfamily Clients

By Peter K. Gerlach, MSW

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The Web address of this article is http://sfhelp.org/pro/basics/transference.htm

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        This article is one of a series on effective professional counseling, coaching, and therapy with (a) low-nurturance (dysfunctional) families and with (b) typical survivors of childhood neglect and trauma. These articles for professionals are under construction.

        This series assumes you're familiar with:

        Before continuing, pause and reflect - why are you reading this article? What do you need?

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        The purpose of this article is to hilight special risks of significant clinical transference when working with typical divorcing families and stepfamilies. Transference occurs when perceived behaviors or traits of an individual client - or of several client family-members - provoke reactions in the clinician that reduce or prevent appropriate professional objectivity, boundaries, and empathy. That is, significant transference dynamics between client and clinician hinder or prevent effective clinical work, and may stress or harm the client. All human-service professionals have an ethical responsibility to every client (and themselves) to guard against this happening.

        Clinical transference dynamics can occur between (a) a clinician and their client/s; (b) a clinician and their supervisor or program director, and/or (c) a clinician and one or more colleagues. The details may vary among these, but the transference causes, symptoms, and effects are similar or the same for all three. 

        This article explores...

  • five interactive roots of transference dynamics

  • common symptoms of significant transference

  • common transference triggers with divorcing-family and stepfamily clients, and...

  • clinical options for preventing or reducing significant transference.

Why Does Transference Occur?

        Most professionally trained clinicians have been taught what transference is, typical symptoms of it, and that it is harmful and unethical. Why does transference occur in spite of this, risking shame, guilt, professional disapproval and censure, and legal liability? My clinical training and 26 years' reflection and private-practice experience suggests five interactive root causes:

  • the clinician's psychological (false-self) wounds, and...

  • some unmet primary needs, and...

  • their unawareness and ignorance (lack of knowledge) of key topics, and...

  • little or no effective clinical supervision, and...

  • the client's (or clinician's) cooperation with the other person..

         Let's look at each of these briefly...

Interactive Psychological Wounds

        Typical professional clinicians and clients survived a low-nurturance childhood environment. Without effective personal recovery, this usually means they each bear mixes of two to six "false-self" (psychological) wounds:

  • a fragmented personality ruled by a "false self." This causes one or more of these wounds:

  • excessive shame and guilts

  • difficulty trusting one's self and others

  • excessive or unrealistic fears

  • excessive reality distortions, and...

  • inabilities to feel and to bond with others (i.e. inabilities to empathize, tolerate intimacy, and to feel, express, and receive genuine love

        Clinicians and clients may not know they have these wounds, what they mean, or what to do about them. This unawareness can promote ineffective or harmful strategies for filling primary needs, until the person admits their wounds and works proactively to reduce them. Lesson 1 in this nonprofit Web site is devoted to wound prevention, assessment, and reduction.

        Premise - the more a clinician or supervisor is controlled by a protective false self, the more s/he risks significant transference reactions with selected or many clients. The common wound of reality distortion promotes clinicians denying, rationalizing, minimizing, projecting, exaggerating, and/or idealizing transference dynamics - and denying, discounting, and/or justifying this

        The solution to this primal root of clinical transference is dedication to personal wound-recovery. Lesson 1 in this nonprofit, ad-free site - and the related guidebook - provide perspective, practical suggestions, and resources for effective recovery for any Grown Wounded Child (GWC).

Typical Unfilled Primary Needs

        Significant psychological wounds and unawareness usually hinder filling primary needs effectively. Transference dynamics suggest that the clinician's ruling subselves lack better strategies, and seek to fill unmet needs with the relationship with a needy, wounded client. Typical needs may include a mix of these:

  • needing to feel worthy, needed, and important

  • needing to rescue an appealing victim

  • needing to reenact and/or "re-do" (correct) significant childhood traumas

  • needing to feel powerful and impactful by defying social "rules" about transference

  • needing to distract from relentless inner pain

  • needing sensual / sexual excitement and pleasure

  • needing to take an exciting risk to offset chronic boredom and numbness

  • needing to please, help, and be appreciated by a needy, dependent client

  • filling one or more primary-relationship needs - specially needs for "love" and "intimacy."

       Typical clinicians will have one or more inner conflicts about doing this, which will usually promote (or increase existing) anxiety, guilt, shame, and perhaps confusion. For example, one or more subselves urge continuing the transference behavior to fill immediate needs like those above. Other subselves like the true Self, Inner Critic, Catastrophizer, Practical Adult, Scared Child, Guilty Child, and Moralizer all insist "Don't do this!" for various reasons. If the resident Self is not able to moderate this conflict and negotiate a healthier way to fill the clinician's unmet needs, the transference behaviors will probably continue or increase, despite disapproving moral injunctions and occupational risks.

Clinician Unawareness and Ignorance

        Unawareness (skewed or no conscious perception) is different than ignorance (lack of accurate, relevant information). Both can promote transference - specially with clinicians guided by a false self. Once detected and admitted, each of these may be intentionally reduced. The worst case (from a client's perspective) occurs when a clinician and their supervisor or consultant/s are both unaware and ignorant - and are unaware of (vs. denying) this and it's implications.

Unawareness

        Premise - In most professional situations, clinicians and their supervisors need to be aware of...

  • their own inner dynamics - now, and patterns over time: thoughts, feelings, senses, key values (attitudes), needs, expectations, and which subselves control them in general, and in clinical meetings;

  • each client family-members' current and long-term, stated and unstated primary needs - in general, and in the clinical process;

  • the (a) roles and (b) relationship and communication dynamics between client, clinician, and supervisor - particularly awareness of whether appropriate boundaries are being effectively asserted and respected by everyone involved; and

  • how everyone involved responds to problems anyone has in any of these domains - effectively or not. And paradoxically, in every client case, the professionals involved...

  • need to be aware of these awarenesses, or lack of them.

        Pause and reflect - would you edit this awareness summary in any way? Do you agree that lack of awareness of these domains could promote transference dynamics among the client, clinician, and supervisor or colleagues? Who would you say is responsible for monitoring the level of professional awareness in any particular client case?

Professional Ignorance

        Even if all professionals involved in a client case are aware enough, one or more of them may lack relevant information on key topics like these:

  • systems theory, and how to use it strategically to assess and improve the functioning of subself, family, and client-clinician systems;

  • personality-subself systems, traits, and dynamics; psychological wounds, symptoms, and impacts; and wound-recovery options;

  • effective thinking, communication, and problem-solving basics and skills;

  • the three levels of healthy grief, the phases in each level, how to assess for blocked grief, and what to do about it; and typical clinicians need accurate knowledge of...

  • typical human and family developmental stages, and common primary needs of adults and kids at different developmental stages; and...

  • "good practice" professional ethics and responsibilities - in general, and in each specific case.

  • (a) how psychological and legal divorce affects kids and adults in a typical family system, and (b) how to assess a family's degree of adjustment to divorce changes and losses; and...

  • typical stepfamily basics - e.g. norms, family structures, uniquenesses, developmental stages, hazards, and stressors; and how to empower clients to resolve case-specific stressors.

        Premise - clinician's and supervisors' lack of knowledge on mixes of these topics can promote (a) skewed systemic assessments, (b) toxic attitudes (biases), (c) fuzzy, conflictual, and/or inappropriate role definitions in the client - clinician - supervisor (or agency) metasystem, and (d) unrealistic clinical-process goals and expectations. Combinations of these and psychological wounds and unawarenesses can promote significant transference dynamics.

        The general protection against lack of knowledge is for private practitioners and agency clinical-directors to have a comprehensive plan for (a) assessing clinician's knowledge and (b) filling key knowledge gaps with individual and group education.

Ineffective Supervision

        Try saying out loud your definition of "effective clinical supervision," and meditate on whether you have experienced that. Then compare that your definition with this proposal: Common goals of clinical supervision include protecting...

  • clients from ineffective or harmful clinical work;

  • clinicians from making "mistakes," and promoting their professional competence and skill-building;

  • the sponsoring agency and funders from legal liability; and protecting...

  • the clinical profession from public distrust and disparagement.

Effective supervision clearly accomplishes all four goals, in the opinion of all people involved. When any professionals are often ruled by a false self, this is less likely.

        The risk for harmful transference behaviors is highest for wounded, ignorant clinicians without qualified supervision. The next highest risk is if the clinician seeks to deny or hide such behaviors from a wounded supervisor, program or case manager, and/or clinical director.

        The fifth and last element that promotes transference is...

The Client's or Clinician's Cooperation

        Transference dynamics between a clinician and their client or supervisor requires that the "other person" must also have some unfilled needs, and must lack steady true-Self guidance on filling them more appropriately than via the relationship with the clinician.

        A wholistically-healthy, aware clinician can assess and incorporate the client's unfilled needs in an appropriate treatment plan. ("Let's talk about what prevents you from finding someone other than me to confide in?") The clinician can also respectfully confront a supervisor who seems out of balance, unaware, and/or uninformed ["I sense you've lost your objectivity with me (or "...you're Self is often disabled...) as we discuss my work with the Martinez family. Can we talk about that?"]

        Recap - we just surveyed five interactive factors that can contribute to harmful clinical transference dynamics in working with typical client families. Pause, stretch, breathe, and reflect - how do you feel about the premises above, so far? If you don't agree with some of them, what do you believe? Are you getting what you need yet?

Symptoms of Significant Transference Dynamics

        Have you experienced transference dynamics in yourself or a co-worker? Though every case is unique, see if your experience (or intuition) compares with these common symptoms...

the clinician loses professional objectivity and becomes critical of, emotionally dependent on, over-responsible for, and/or attracted to, a client adult or child or a co-worker or supervisor. Restated: the clinician develops some version of significant codependence with the other person;

the clinician denies this, and/or tries to hide it from other people. Variation:- the clinician avoids or discounts appropriate supervision; 

the supervisor (and/or coworkers) deny or trivialize this, and/or avoid confronting the clinician on it;

the clinician has significant inner conflicts and guilts about their fantasies about, and/or conduct with, the other person;

the client feels "significantly uncomfortable" with the clinician, and may or may not assert for some change in their roles, boundaries, and relationship;

the other person agrees to form a social and/or sexual relationship with the clinician, during or soon after the clinical process;

one or more other client-family members become uncomfortable with the clinician's (perceived) conduct, and may c/overtly complain or criticize it. They may file an ethics complaint with the state organization that regulates professional conduct and licensure, and/or with the relevant national professional organization (e.g. NASW, AMA, APA, NAMFT, etc).

coworkers grow suspicious of and/or concerned about the clinician's conduct and relationship with the other person, and may or may not confront the clinician on this.

        Regardless of specific symptoms like these, the client's, clinician's, and/or supervisor's subselves know when inappropriate professional thoughts or behaviors are occurring. What they do with that knowledge depends on many interactive factors.

Common Transference "Triggers"

        A wounded, unaware, ignorant clinician or supervisor may initiate or join in transference dynamics when certain situational "triggers" occur. A "trigger" is some combination of client-personality, client-family, and case factors that cause the clinician's pro-transference subselves to overcome anti-transference subselves (including the Self (capital "S"), to seek to fill unmet needs. The mix of possible triggers is limitless. These are common possibilities:

  • The client's false-self behaviors activate clinician's needy subselves, which disable his or her true Self;

  • learning about the client's family system activates unfinished issues with the clinician's own childhood and/or current family (resentment, hurt, sadness, grief, guilt, horror, etc);

  • the client or supervisor acts seductively, activating clinician's subselves which need sensual and/or sexual fantasies, excitement, and fulfillment;

  • the client c/overtly invites the clinician to rescue (take responsibility for) him or her, implying a one-down  (inferior) relationship stance and admiration (or illusion) of  the clinician's efficacy, compassion, and wisdom. The clinician's subselves may have a complementary need to protect, nurture, and/or rescue the client (i.e. their needy inner kids) - i.e. need to feel competent, worthy, and powerful.

        A similar trigger occurs when (a) a clinician over-depends on their supervisor or other co-worker to be the "good parent" they never had as a child; and (b) the other person's controlling personality-parts need to nurture the clinician's needy subselves and feel competent, wise, useful, and worthy.

  • the clinician identifies with a particular client-family child, and is moved to 'rescue" and/or nurture her or him to act out adult acceptance, protection and nurturance that the clinician never got. This is specially likely in divorcing and stepfamilies where one or more minor kids or grandkids is floundering, needy, rejected, and/or neglected.

  • if the clinician is psychologically or legally divorcing - specially if s/he has one or more kids - a divorcing client adult or child may activate unfinished issues for the clinician and cause him or her to become critical and/or over-empathic, and lose appropriate professional boundaries and objectivity. Themes that can trigger transference include divorce-related losses; parenting topics like child custody, visitations, financial support, health, holidays, relations with relatives, boundaries, religion, education, and discipline, the custodial parent dating too soon, and/or having a new partner stay overnight.

  • If the clinician or supervisor has biased attitudes and/or unrealistic opinions about stepfamily roles,  realities, structures, merger tasks, and dynamics - specially if s/he was or is in a troubled stepfamily and/or lacks realistic stepfamily information - dominant subselves may promote transference dynamics. Typical stepfamily structures, complexities, and stressors offer a mosaic of transference-triggers not found in intact biofamilies.

        The possible triggers above apply, as well as an array of new ones like...

stepparent and stepchild roles and responsibilities

 first and last names, and role titles

"ours-child" conceptions

loyalty and values conflicts

geographic relocation

ethnic, cultural, and gender differences

stepfamily membership (inclusion / exclusion)

stepparents adopting stepkids

ex-mate responsibilities and relations

re/marriage plans and timing

household privacy and sexuality

stepsibling responsibilities and behaviors


The odds of these triggering transference rise with clinician and supervisory ignorance and biases about these aspects of stepfamily life.

        These examples are meant to be illustrative, not comprehensive. The point is that clinicians, supervisors, and clinical and program directors need to be empathically alert with each client case for possible unique or repeated transference triggers in themselves and each other.

Clinical Options

        Premise - Individual clinicians are implicitly responsibility of assessing themselves for significant psychological wounds, and proactively working to reduce any they find. Paradoxically, clinicians dominated by a false self may deny, avoid, postpone, or trivialize this self-assessment, and/or distort or ignore the results. Option - guard against this by asking a knowledgeable, objective, Self-led other person (like a supervisor or colleague) "Do you see any evidence of significant psychological wounds in me?"

        In an agency setting, perhaps the most impactful way of reducing the odds for transference is to carefully screen clinician applicants for significant psychological wounds and effective self and process awareness. To do this, interviewers must be (a) clearly aware of and (b) fully accept the personality-subself concept, and (c) be able to recognize common behavioral symptoms of false-self dominance. They also need to be steadily guided by their true Selves. Similarly, clinical and/or program directors need to weigh any evidence of psychological wounds in deciding who to trust with clinical supervision, co-therapist, and/or consulting responsibilities.

        Option - program and clinical directors need to ensure their professional staff is clearly aware of transference, what causes it, how to spot it, and what to do about it. This can merit periodic in-service programs to refresh everyone on these topics, and inform new workers.

        Option - supervisors and case managers can encourage clinicians to feel safe in discussing transference by intentionally avoiding critical and shaming connotations, and framing transference as normal and an opportunity for self-growth and increased professional competence. This does not imply endorsement of or indifference to these dynamics.

        Option - in clinical case-review meetings, participants can help each other (a) frame transference as an opportunity, not a "fault;" (b) stay alert for transference symptoms, and (c) proactively discuss options for preventing and reducing transference dynamics.

        Option - if transference dynamics are too persistent and/or harmful to a given client case (a subjective judgment), the clinician and/or supervisor are ethically responsible for making an appropriate clinical referral and explaining why they're doing that to the client.

        Reflect - can you think of other practical options for preventing and managing significant transference dynamics in your professional setting?  

Recap

        A hazard to effective clinical work with any individual, marital, or family client is the risk of significant transference dynamics among client-members, clinician's, and their supervisors, co-workers, and or superiors. Based on this clinical model, this article proposes five common interactive roots of these dynamics: the clinician's...
  • psychological wounds, and...

  • unfilled primary needs, and...

  • unawareness and ignorance (lack of accurate knowledge), and...

  • ineffective or no professional supervision, and...

  • the client's accepting and cooperating with the transference behaviors.

        The article also outlines (a) typical symptoms of transference dynamics among clients, clinicians, and their supervisors, and (b) common triggers for the dynamics. Triggers are specially likely with typical divorcing-family and stepfamily clients, if the clinician is divorcing and/or in a stepfamily. The article closes with some options for avoiding and reducing this clinical dynamic.

        Pause and reflect - did you get what you needed from reading this? If so, what do you need to do with these ideas? If not - what do you need now?

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Created 09-29-15