Language: ASPPB offers a French form of the EPPP (the FEPPP) where a licensing authority legally requires one. ASPPB has not yet published the competency statements in French, so our questions and cards are in English until it does.

5.B.4

Consulting about your own reactions

ASPPB's competency statement 5.B.4: Consult with others to examine and address one’s reactions and behaviors in relation to others when indicated

Every psychologist has reactions to clients, colleagues and situations: attraction, irritation, fear, boredom, the urge to rescue or to please. These reactions, often called countertransference, can quietly shape conduct, and self-assessment alone tends to miss them. Consulting a supervisor, colleague or peer group when a reaction begins to change one's behavior helps the psychologist understand it, keep it out of the work and use it to understand the client.

Key ideas

Countertransference: Countertransference here means a therapist's reactions to a client that draw on the therapist's own history and vulnerabilities. A meta-analysis of 14 studies found such reactions modestly related to poorer therapy outcomes, with wide variation across studies.
Managing reactions: Countertransference management factors, such as the therapist's self-insight and ability to manage anxiety, were found to dampen countertransference reactions, and successful management was related to better outcomes in a further meta-analysis.
Limits of self-assessment: Clinicians overrate themselves: in one survey a quarter of mental health professionals placed their skill at the 90th percentile and none below average. Clinicians also rarely predict which clients will fail to benefit, so outside views and outcome data add what introspection misses.
When to consult: Standard 2.06 calls for consultation once psychologists become aware of personal problems that may interfere with their work. A reaction that has begun to change conduct, such as giving way on the frame, avoiding a topic or arguing with a client, is a clear occasion.
Attraction to clients: Pope and colleagues documented that sexual attraction to clients is a common experience that training long neglected. The feeling itself is not misconduct; Standard 10.05 bars sexual intimacies with current clients, and consultation helps keep the feeling out of the work.

Worked example

A psychologist is treating Dr. Kessler, a prominent surgeon, for insomnia and work stress. Over six weeks she has agreed to four last-minute schedule changes, skipped the sleep diary review whenever he waved it off, and rehearses what to say before each session.

Notice the conduct first: repeated concessions and skipped treatment steps show that a reaction is shaping the work, whatever she tells herself about flexibility.
Name the reaction as well as she can: she feels intimidated by his status and wants his approval, which may echo her own history with authority figures.
Take it to peer consultation without identifying details, asking both what the reaction says about her and what it may show about how others respond to him.
Use the consultation to act: restore the agreed schedule and the diary review, and later check whether her conduct has changed, not only whether she feels better.

When a reaction starts to change what you do, consult, then turn the insight into a change in conduct.

Check yourself

In a survey of mental health professionals' views of their own clinical skill and results, which pattern emerged?

Practise 5.B.4

Sources

Hayes, Gelso, Goldberg and Kivlighan (2018), Countertransference management and effective psychotherapy: meta-analytic findings, Psychotherapy (PMID 30335461), Abstract: the three meta-analyses; body of the article on definition and management factors
Walfish, McAlister, O'Donnell and Lambert (2012), An investigation of self-assessment bias in mental health providers, Psychological Reports (PMID 22662416), Abstract: results
Hannan and colleagues (2005), A lab test and algorithms for identifying clients at risk for treatment failure, Journal of Clinical Psychology (PMID 15609357), Abstract: clinicians rarely predict who will not benefit
APA (2017), Ethical Principles of Psychologists and Code of Conduct (2002, amended 2010 and 2016), Standards 2.06, Personal Problems and Conflicts; 4.06, Consultations; 10.05, Sexual Intimacies With Current Therapy Clients/Patients
Pope, Keith-Spiegel and Tabachnick (1986), Sexual attraction to clients: the human therapist and the (sometimes) inhuman training system, American Psychologist (PMID 3963610), Survey results on the prevalence of attraction and on training