Therapist reactions in self-experienced difficult situations: An exploration

Abstract

This article describes a qualitative study of 63 difficult therapeutic situations described by 26 therapists. The study was part of research on specific reactions of therapists to traumatized clients. The research questions for the current analyses focused on the categorization of difficult situations, of short-term therapist reactions, and the exploration of situation-specific reaction patterns. The therapeutic style of the therapist was also explored. Three types of difficult situations were found: ‘traumatic situations’, ‘interactional situations’ and ‘existential situations’. Therapist reactions were sorted in to 20 categories; 10 of them were part of a situation-specific pattern. The therapeutic style of therapists was defined by a first dimension reflecting a continuum of experiencing versus actively intervening and a second dimension of feeling responsible. The relevance for therapist self-reflection, supervision and training is to acknowledge the specific difficulties in different therapeutic situations related to therapist-specific reactions, and to enhance constructive coping in accordance with the therapist's therapeutic style.

Keywords:

• Therapist difficulties
• countertransference
• traumatic countertransference
• therapeutic style
• supervision

We thank the participants for their willingness to share their personal experiences of difficult situations that they encountered in their work as psychotherapist. They made this research a challenging, moving and enriching experience. We also thank Leo van Dijk, who read and commented on all versions of this article, and Jan Pols en Harry van Tienhoven for their comments on an early version. We are grateful to the management of Centrum '45 for their support of this research.

Notes

¹A detailed description of the method of analysis is available on request to the first author.