Professional Issues and Ethics in Counseling
Transference and Counter-transference
Transference is a concept in psychoanalysis that owes its origin and use to Sigmund Freud. It defines the unconscious revival of past psychological experiences with objects and other persons such as figures of authority (e.g. parents). The process involves the projection of these attitudes and feelings from earlier life into other people-such as the physician in cases of a counseling relationship set up. It may be termed as the patient’s active effort to re-enact or revive these attitudes and feelings from the past as though they belonged to the present time-time of analysis. Through the process of projection the psychoanalytic physician or nurse represents the figures or objects of desire from the patient’s early life.
The process is encouraged as a means through which a patient can explore their past so as to understand and gain insight into how its relation to the present life causes distortions in their present psychological state due to internalized experiences. On the other hand, counter-transference is also a Freudian term that defines the opposite reaction where the psychoanalyst transfers his/her reaction to the client via projection-the analyst begins to identify or develop feelings or a certain attitude towards the client based on what s/he perceives about the client through their interaction and relationship. Through time it has been recognized that analysts cannot be totally objective and neutral, a mirror or a blank screen because of their human nature and vulnerability to experiencing human feelings and emotions similar to the client’s (Alexander, 1956).
Counter-transference in analysts can be demonstrated by situations which an analyst begins to feel excessively sympathetic to the client concerning how other people treat the client. This kind of sympathetic feelings may lead to empathy which may impel the analyst to do something active for the client such as offering suggestions or advice. At such a point this clearly portrays counter-transference because the analyst has identified with client’s problematic situation and gone a head to actively engage him/her in the client’s predicament, and thus ceasing to be a mirror or blank screen through which the client should view and analyze him/herself in order to effect changes in their lives.
Another situation that demonstrates this concept or phenomenon occurs in cases where the analyst develops and an unreasonable dislike or excessive liking for the client. This kind of feelings may lead to development of prejudice or they may blind the analyst’s perceptions and analytic capacity. A liking or dislike demonstrates that the analyst is identifying characteristics that s/he likes or dislikes in the client, and thus; s/he is failing to act as a blank screen- a demonstration of lack of neutrality that characterizes counter-transference (Patterson, 2008).
Counter-transference can become a problem when the analyst’s own character and behavior induces the projection that causes the act of transference in the client (the analyst ceases to be a blank screen and acts as an active influence on the client). In such instances the analyst may greatly be misled to think that the transference is actually real and portrays the inherent factor causing the psychological distortions in the client. As a result, this may distort the whole session of analysis by leading it in the wrong direction.
Counter-transference can also become a problem when the analyst develops a strong dislike for the client or even a strong liking. The dislike for example may be as a result of lack of progress from the client or due to his character (Patterson, 2008). Once the analyst develops such as perception the subsequent results may be pre-occupation with the client’s behavior, lack of concentration and development of discomfort with the client. Finally, this distorts the sessions and the whole process may fail.
In order to address counter-transference problems the analyst should always be on the look out for tell-tell signs that indicate the presence of counter-transference; however subtle. Once identified, the analyst should find out the underlying reason of the counter-transference and try to gauge how it may affect the sessions. If the effect is going to be detrimental to the success of the sessions the analyst should try to develop neutrality by suppressing his/her own projections. Alternatively, the analyst can review the issues surrounding the phenomenon with the client in order to identify the source and the means to curb its occurrence (Patterson, 2008).
The concept of values involves that which is desirable: that which influences the choices from available means, modes and ends of actions that may be available. Values are relative across cultures and localities. Values are inculcated in individuals and they develop over time with influence from various quarters such as the environment and the surrounding people. Values create a code of standards that persists through time and determines the course and choice of actions. In psychotherapy, it is common for most therapists to find that their values differ greatly from those of their clients. Certain values may be universal, but they are not recognized as being absolute. For example killing may be permitted to eliminate a tyrant of a hardcore criminal or serial killer and lying may also not be a desirable value, but lying to save an innocent life may not be taken as an act of breaking values. Therefore, values can be said to be relative depending on the situation in which they are analyzed as well as how they are justified. Values may also vary across the vast cultural landscape.
It is clear that in any psychotherapy the client is dealing with conflicts that arise as a result of value problems and conflicts as brought by the client into the counseling session. The counselor needs to accept the client’s values, but not necessarily approve of them as a good step and way to start building up the sessions take off. Disagreement with a client’s values does not mean s/he is not accepted as a person. The manner in which the analyst handles the client’s value is of great significance in any counseling sessions.
The orthodox psychoanalytic view is that the psychotherapist should remain neutral and act like a blank screen upon which the client is supposed to project himself for evaluation and adjustments that constitute the reformatory process. An attempt of imposing an analyst’s values on a client is totally against stipulations of psychotherapy. However, it is not totally wrong for the analyst to express his/her values as long as this is not done explicitly and in a manner that suggests it’s the best and only value system to be followed. It should only be done at the client’s request (Palmer, 2002).
It is always prudent to let clients develop their own values. However, it is also appropriate to let the clients learn about values in society. However, prior to presenting these values the analyst should ensure that the client has shown interest in learning values that may be slightly or totally different from his/her values. This may be through an explicit request by the client or a suggested interest. The communication of these values should be done in a manner that the client should not feel obliged to adhere to them. This can be done through the analyst’s disclaimer statements that should state explicitly that the expressed values are those of the analyst or the society (Patterson, 2009).
However, at times an analyst may be obliged to offer guidance on values that are seemingly universal-such as honesty, self determination, respect etc. This may be done at the client’s request after s/he sees that the analyst’s direction may be the right direction or in instances where the client displays a total lack of direction. This should not be done in a direct and compelling manner, but rather in a way that will help the client to view himself through the reflection of these values and choose the appropriate direction in life. This is actually constructive and not an act of imposition of values because most universal values expressed to the counselee are usually the same or they may have very subtle differences, and as such expressing these values implicitly to the client for his/her own exploration and choice may actually not be termed as an open value imposition act.
The professional relationships that counselors or therapists share with their patients have to eventually come to an end. However, how these relationships end is of great significance ethically and legally. The end also has clinical implications on the client. There are numerous issues that result whenever a therapist chooses to cease his/her practice. The cessation may be temporary, sudden, permanent, well planned, gradual or not planned. The cessation may be due to death, disability sickness, family engagements or retirement. Whatever the reason, there is a protocol set for cessation procedure by the APA, and as such all counselors or therapists should adhere to it, failure of which may result in a legal suit being filed against them in the courts of law.
Basically, client abandonment entails the sudden un-informed cessation of provision of therapeutic or counseling services to a client without informing them early enough for re-adjustment. The practitioner has an ethical as well as legal obligation to mind the welfare of his/her clients after the cessation of his/her practice. This is important because some clients are totally dependant on his/her services, and their disruptions may cause great inconveniences to their lives. Therefore, it is the onus of the practitioner to inform his/her clients early enough of any plans to terminate his/her services offered to them before his official cessation. This should be coupled with a plan on how the clients can continue obtaining similar services or how they can carry on without his or her services. Failure to offer this information and procedures that can enable clients to move own without the practitioner’s services may attract a legal suit. This is more especially triggered due to issues on how to handle the confidential records of the patients held by the practitioner.
Failure to obtain informed consent:
Failure to obtain legal consent is an issue that is related to counseling and psychotherapy, especially; in the management of the client’s records. This issue is closely related to client abandonment and cessation of practice. A practitioner whether still practicing or not, still has an ethical and legal obligation to maintain the records of his clients in confidentiality and adhere to obtaining of legal consent in the securing and disposition of a client’s records (Jenkins, 2002).
At times during cessation practitioners may decide to pass on their clients to peers in the profession, this may also involve the passing of records to the peer practitioners. These activities involving record and clientele transfer have to be done with the informed consent of the clients. Failure to do so may result to a breach of confidentiality in record and client transfer, both of which may attract a legal suit. Therefore, any action involving the clients has to be carried out with the full, informed consent of the client.
Sexual Relationship with Clients:
In therapeutic relationships the practitioner is supposed to always consider his/her actions under the concepts of fiduciary duty and conflict of interest. Under fiduciary relationship between the practitioner and patient, the practitioner is always supposed to act in the best interest of the client. Under the conflict of interest the practitioner is not supposed to use his relationship to obtain any favor or good that is supposed to be for his own benefit from the client as a result of their professional relationship (Jenkins, 2002).
These lead to the issue of dual relationships where the practitioner acts in different capacities when dealing with the client either professionally or in a non-professional state. Engagement into sexual relationships with clients constitutes dual relationships which are not recommended for the practice of counseling of psychotherapy. Despite the fact that these relations may not be prohibited in some quarters, they may later lead to legal suits where the clients may claim vulnerability of exposing themselves to the practitioner who may have in turn taken advantage based on some considerations. Therefore practitioners in this field are cautioned to tread carefully when dealing with dual relationships (Jenkins, 2002).
Alexander, F. (1956). Psychoanalysis and Psychotherapy. New York: Norton.
Jenkins, P. (2002).Legal issues in Counseling and psychotherapy. Sage Publishers.
Palmer, S. (2002). Multicultural Counseling: A reader. Sage Publishers.
Patterson, C. H. (2008).Transference and Counter-transference. Retrieved on 13th October, 2010 from http://www.sageofasheville.com/pub_downloads/TRANSFERENCE_AND_COUNTERTRANSFERENCE.pdf.
Patterson, C. H. (2009). Values in Counseling and Psychotherapy. Retrieved on 13th October, 2010 from http://www.sageofasheville.com/pub_downloads/VALUES_IN_COUNSELING_AND_PSYCHOTHERAPY.pdf