“I Feel Stupid and Contagious:” Countertransference Reactions of Fledgling Clinicians to Patients Who Have Negative Therapeutic Reactions

Patients who are prone to having negative therapeutic reactions seem to be increasingly common in clinical practice. These patients pose special problems for graduate students, psychoanalytic candidates, and other clinicians who struggle with anxiety regarding their new role and their feelings of incompetence and helplessness associated with the belief that their therapeutic efforts will result in treatment failure. The fledgling clinician thus provides fertile ground for this kind of patient to project her or his concerned, depressed, and guilty self-representation into the clinician. The fledgling clinician, owing to an incomplete integration in her or his own internal object world, is also capable of projecting dead or damaged and dying object-representations into this kind of patient, who sometimes responds by withdrawing from or leaving treatment. It is argued that although we must acknowledge the limitations of our therapeutic technique with this kind of patient, identification and interpretation of projective identification are essential to increase the likelihood of therapeutic success. Finally, rigorous education in severe psychopathology, exploration of one’s intrapsychic conflicts, and participation in individual or peer clinical supervision, are recommended, as well as an interpretative emphasis on both the deeply buried love for the internal object world as well as its destruction.