Lately, I’ve confronted several patients/clients whom I’ve found myself struggling with in what I think of as a “family” of ways – a sort of mix of resentment, dislike, distaste, contempt, or even disgust. Thankfully, it’s a very small portion of my practice in which I’ve been confronting these countertransferential reactions, but as small as it is, these are people who think they’re coming to me to work together, and who are trusting and relying on me. So these reactions with which I’m contending start to feel not just unfortunate or difficult, but unprofessional/irresponsible/wrong. And not the reactions themselves – I can’t help how I respond to people, and I’m quite forgiving of my feelings. But the fact of my continuing to work with these people (for different reasons – grandiosity, greed, cowardice, masochism all are variously at play) in the face of my negative reactions to them.
We often wonder if we have the right not to work with certain people. I’ve been wondering lately whether I have an obligation not to work with certain people.
I’ve been consulting in supervision on the question – I’m fortunate to be in a lot of supervision, so I collect lots of opinions. But unfortunately, all the advice and feedback in the world hasn’t solved the problem. In one case, a patient left treatment of their own volition. I didn’t consciously push them away, but I was grateful when the treatment ended. And in two others, we limp along as I try to find a way either forward or out – a way that feels respectful and constructive and responsible, and that is informed by the patients’ histories and unconscious fantasies, one in which I either repeat past trauma by staying, or in which I repeat it by leaving….
