Countertransference and Inpatient Psychiatry: Theoretical and Clinical Aspects

Few aspects of psychiatric training are more troubling to beginning residents than the emerging awareness of their own countertransferences. This is often viewed with a mixture of disgust and embarassment as a sign of incompetence and lack of professionalism. Conflicting views on the origins of, and appropriate responses to countertransference further add to the difficulty and anxiety of psychiatric training. The frustration and sense of helplessness which often accompany these feelings can lead to disillusionment and various degrees of acting out which ultimately compromise patient care and resident education. Ironically, the feeling of being overwhelmed by countertransference can often occur several months into a psychiatric residency. Once beginning residents have acquired the basic clinical skills needed for acute diagnosis and treatment, subtler issues in patient management arise. The greater degree of psychiatric patient contact and greater difficulty in maintaining professional distance through procedures and lab studies makes this inevitable. It is often not until the outpatient years when residents begin to treat \u22higher functioning\u22 patients that psychodynamic education is deemed clinically useful. Countertransference, like other psychodynamic topics, may be viewed as \u22irrelevant\u22 to inpatient psychiatry, which emphasizes biological and behavioral interventions. At all levels of training, however, acquiring a systematic understanding of countertransference may be one of the most anxiolytic and educationally useful advances a resident can make