Countertransference and Inpatient Psychiatry: Theoretical and Clinical Aspects

Few aspects of psychiatric trammg are more troubling to beginning resid ents than the emerging awareness of their own co untertransferences. This is often viewed with a mixture of disgust and em barassment as a sign of incompetence and lack of professionalism. Conflicting views on th e or igi ns of, and appropriate responses to countertransference furth er add to the di fficul ty and anxiety of psyc hiatric training. The frustration a nd se nse of helplessness which often accompany these feelings can lead to disillusionment a nd various degrees of acting out which ul timately compromise patient ca re and resid e nt education. Ironicall y, th e feeling of being overwhelmed by co untertra nsference can often occur several months into a psychiatric resid ency. Once beginni ng residents have acquired th e basic clinical skills needed for acute diagnosis and treatment, subtler issues in patient management arise . The greate r degree of psychiatric patient contact and greater difficulty in maintaining professiona l distance through procedures and lab stud ies makes this inevitable. It is often no t until th e outpatient yea rs when residents begin to treat " h igher func tion ing" patients that psychodynamic ed ucatio n is deemed clinically useful. Co untertransference, like other psychodynamic topics, ma y be view ed as " ir re leva nt" to inpatient psychiatry, which emphasizes biological and behavioral inter ventio ns. At all levels of training, howe ver, acquiring a systematic understanding of cou ntertransfere nce ma y be one of the most anxiolytic and educat iona lly use ful advances a resident can make.