Therapist reactions to a client facing terminal illness: a test of ego and countertransference

Abstract

When a therapy client presents with thoughts, emotions, or behaviors that trigger a therapist's own unresolved conflicts, the therapist may experience countertransference. Client concerns that may trigger countertransference include sexuality, aggression, and death (Gelso, Fassinger, Gomez, & Latts, 1995; Latts & Gelso, 1995; Hayes & Gelso, 1993; Lacocoque & Loeb, 1988). Countertransference has been found to relate negatively with client outcome (Hayes, Gelso, & Hummel, 2011), but countertransference management can mitigate the negative effects of countertransference, and can even result in curative therapeutic responses (Gelso & Hayes, 2007). A phenomenon known as ego depletion may cause a therapist to be more vulnerable to countertransference. Ego depletion occurs when self-resources related to impulse control, decision-making, and willpower are low (Baumeister, Vohs, & Tice, 2007). Because of the relation between ego depletion and impulse control, the effect of ego depletion on countertransference was tested. Forty-five participants were randomly assigned to either a neutral or ego depletion condition, and were then presented with a scripted analogue client who discussed a potential terminal illness diagnosis. Participants responded verbally to the client, and their responses were transcribed and coded for behavioral indicators of countertransference. Participants also completed measures of affective and cognitive countertransference. Countertransference management and ego defense maturity were assessed as potential predictors of resilience to ego depletion. The participants in the ego depletion reported higher levels of content-specific affective countertransference (death anxiety), but general affective (state anxiety), behavioral, and cognitive countertransference did not differ between conditions. Countertransference management and ego defense maturity did not significantly account for variance in the relation between ego depletion and countertransference. However, the relation found between ego defense maturity and countertransference management suggests that ego defense maturity could be a precursor to countertransference management. Overall, ego depletion led to increased death anxiety, but therapists were resilient to having this content-specific reaction generalize to other forms of countertransference.