Box 7.

Case Vignette - Countertransference with the Complaining Patient

Therapist: This patient does not want to improve. She’s been in therapy for a long time, and she still wants to complain and complain that I feel sorry for her. She avoids working on herself, and I look incompetent. And she’s totally hysterical and overwhelming. I really cannot work with her. If only she were not so irrational. Supervisor: I understand. It’s hard for you to work with her. You say that she just complains and avoids working on herself. You say you look incompetent …. I noticed you said that in an angry tone as if the patient evoked strong emotions in you. Are you saying they have been going for a long time … according to everything you say, therapy does not work very well … ? I wonder if something went wrong … ? Therapist: Yeah, something went wrong … she’s not nearly as depressed as she was at the beginning … If only she did not overwhelm me with complaining about everyone, especially her children and husband … as if she wanted me to agree with everything … but she complains in front of them anyway … I understand that they avoid her … Supervisor: As I understand it, depression has been alleviated. It’s a success, and it must have been hard for you and her …. I know that she complains a lot, and it annoys you … you feel incomplete … and the fact that at that moment, you feel incompetent … is it a situation with someone else … in your life? Therapist: Mhm … you are right, she’s acting like my mother … she’s still complaining and crying, and does not let me say what I want … like she cannot hear me … I’d rather avoid her if I could … I’d like to help her, just feeling helpless and incapable in front of her intensity …. Supervisor: That’s a nice insight … is the situation different for you than the situation with your mother … ? Therapist: Definitely … I have a close relationship with my mother, and I like her, and it gets on my nerves, but I can tell her clearly what bothers me …, sometimes I get mad at her … I cannot tell my patient … she’s more fragile than my mother and I’d hurt her. Plus, it would be unprofessional. Supervisor: Is there anything you can think of that you could do differently with that patient now that you realize that you are reacting to her similarly to your mother? Therapist: Hmm … I do not know … but I could give her feedback that she’s complaining a lot … but before that, I have to praise her that she’s improved a lot and has managed to overcome depression and that it is admirable how she dealt with it. I could also ask her how I react to her complaining about her children and whether any other behaviour could bring better consequences.