Addressing Countertransference in Grief Counseling

• Jordan’s Angry Grief
• Magda’s Quiet Pain
• Dueling Countertransference
• Making Space in Therapy for Pain
• References

Jordan’s Angry Grief

Jordan walked into my office, smiled, and sat down in the chair across from me. Then she burst into tears. She sobbed uncontrollably for about two minutes, but it felt like hours. Ripping tissues from the box on the small table in front of her, she seemed intent, perhaps aggressively so, on showing me just how much she was suffering. When she finally looked at me, her face was blotchy, her nose was still running, and she hiccuped with the last of her sobs. “I’ve been waiting for days to be able to do this,” she said.

I asked her if she could tell me what she was so upset about. “You know!” she said, “we’ve talked about it so much. I’m still mourning my dad’s passing.”

Jordan was right. We had talked about her father’s illness and death many times in the course of our work together. But I found myself wondering if our talking was doing any good. Jordan’s father had died when she was in her mid-twenties. She was now in her early thirties. There was no question that his death had been painful and perhaps even traumatic for Jordan, but it seemed to me that it sometimes became more significant when Jordan needed to avoid dealing with a present-day difficulty. Further, I found myself thinking — with some guilt for even having the thought — that Jordan became particularly distressed about having lost her father when she felt criticized, whether at work or by someone with whom she was in a relationship, for instance, her mother, sister, or girlfriend.

As these thoughts passed through my mind, I asked myself, not for the first time since I’d begun working with Jordan, what was the matter with me? What kind of therapist was I that I couldn’t feel sympathy for a client who was so clearly suffering? I’m not normally so hard-hearted, so as I listened to her sobs and murmured sympathetic words, I wondered how to explain what was making it so hard to empathize.

As a psychotherapist, I recognize that my reactions to clients are based on a complex combination of factors, including their personalities, psychodynamics, personal styles, and histories — both mine and theirs. The interaction between who I am and who they are, what I have experienced and what they have experienced, and what we both expect from and see in our relationships can create a fascinating, complicated, and often confusing experience for both me and the client. The image I find most helpful when I’m thinking about this co-created experience is Winnicott’s concept of “the squiggle.”1

Winnicott worked for a time with young children, and during that time he devised a game that he called “the squiggle.” He used it to explain to therapists how we and our clients co-create an experience that has part of each of us in it but is not created or owned by either of us. In this game the therapist and the child each have a pen or a pencil, and they have a piece of paper between them. The child makes a mark on the paper, and the therapist makes a mark connecting to the child’s mark. Taking turns, they gradually make a design over the entire paper. It’s a design that they create together. Winnicott suggested that this is what happens in therapy.

In the room and in our work, Jordan and I were not yet able to talk about — or even formulate for ourselves — the ways that we were co-creating an experience that in some ways replicated old experiences, and in some ways represented new possibilities for us both. My job was to step back enough from what we were creating to be able to be curious about it. That curiosity, as the relational psychoanalyst Stephen Mitchell suggested in much of his writing, is a huge part of what makes therapy therapeutic.2

Changing the metaphor, Mitchell likened therapy to a dance. He suggests that a therapist’s job is to stop every so often, and ask “Why are we dancing to this music? And why this step?”

Instead of asking myself what the matter with me was — or, as I might also have done, what was the matter with Jordan — my job was to ask why Jordan and I were engaged in this particular relational interaction; this particular dance step, so to speak. But when you have a visceral reaction to someone, as I was having to Jordan’s pain, it’s hard to take that step back. It’s hard to ask those questions, and harder to get a reasonable response from yourself.

Magda’s Quiet Pain

As I was struggling to understand my powerful reaction to Jordan, Magda, a client of mine in her fifties, was grieving and trying to put her life back together after her husband died of a massive heart attack. I remember how she had walked into my office and started to cry. Unlike Jordan, Magda was embarrassed about crying and quickly got her tears under control. She smiled and said, “I don’t cry anywhere else but here. You keep encouraging me to let myself cry, so I do, with you. But I’m not sure what the point is.”

My reaction to Magda was very different from my reaction to Jordan. It wasn’t simply that I felt more sympathy toward Magda than Jordan. I felt something angry or aggressive in Jordan’s pain, almost as if she was trying to push it onto or into me, and I wanted to ward it off. Magda, on the other hand, was careful with what she brought into my office and gave to me to hold. With her, I had more of an impulse to let her know that I could handle her sadness, and that I thought she would find it helpful to share it rather than keep it inside her.

In other words, I wanted to stop Jordan’s outburst and I wanted to encourage Magda to allow her emotions into the room.

Among my psychodynamically-oriented colleagues, there is a recognition that our responses to our clients contain helpful information about them as well as about us. What did my reactions have to tell me that could help me work differently with each of them?

Many clinicians suggest the use of diagnoses to help clarify what techniques are most useful with what clients. While I agree that an assessment of a client’s personality structure and psychodynamics can help pinpoint important factors that will influence their ability to respond to one sort of intervention over another, I also think it’s important to remember that assessments of clients can — and should — change over time. As a relationship with a client deepens as we get to know them and, conversely, they get to know us, some of the dynamics that may initially seem paramount turn out to be part of a temporary self-protection or façade that kept other things out of our awareness.

Further, diagnosis may capture our own hostility or negativity about a client. For instance, I found myself diagnosing Jordan as having a personality disorder, but when I questioned myself about this diagnosis, I realized it was a way of giving myself permission to keep my distance from her. The most obvious truth was that because of my own personality structure and dynamics, I was more comfortable with Magda’s sadness than with Jordan’s angry grief.

Dueling Countertransference

But there was, of course, more going on. Interestingly, I identified with the losses both women were facing. Like Jordan, I was mourning my father, who had died sometime before her father died. Our relationships with our fathers were quite different, but the sense of loss had many parallels. On the other hand, Jordan told me that she had always been “daddy’s little girl,” and that she didn’t think she could live without his constant praise and reinforcement that she was special. My relationship with my own father had been different, and I asked myself if I was envious of the special connection Jordan kept talking about.

As I opened myself up to the possibility that some of my reaction to Jordan was related to envy, I began to hear some of her words and view her actions differently. I began to wonder if Jordan unconsciously wanted me — or someone I represented — to feel envious of her relationship with her father. And if so, why? Was she angry at, or hurt by that other person? Did she need that reaction to get revenge on them? Or did she need to see their (my) envy to feel special? Was there something she had not internalized about the special relationship? Or was the relationship really not so special after all?

For quite a while I didn’t say anything about any of my thoughts to Jordan. As I was letting these ideas begin to gel, I was also working with Magda and exploring some of my countertransference reactions to her. While it’s easy to coast with positive feelings about a client, it can also be useful to try to understand what makes that person so much easier for us than someone else. I asked myself why I was so much more empathic to Magda’s quiet grieving than to Jordan’s loud, almost aggressive pain. There was the fact that it fit better with my own personality structure, but was there more to it?

I tried to put into words for myself what I admired about Magda’s way of expressing her feelings, and the words that immediately came to my mind were “elegant, self-contained, quiet dignity.” I realized that there were several personal connections in my life to those words, and that my countertransference to Magda also had something to do with my relationship with my own father. But as I was thinking more about some of these issues, I was also reading more about grief, and I realized that perhaps even more than the most obvious relational dynamics that were emerging in the work with each woman was the question of each of our relationship to grief itself.

I have always found the idea of stages of grief simultaneously useful and disturbing. On the one hand, it can be useful to know that some of the difficult emotions that emerge after a loss are a normal part of a process, and that many of them will gradually diminish as the process moves forward. On the other hand, I have never known anyone who goes through a neatly organized process of grieving that follows a particular outline. Of course, many of the current experts on grieving point this out as well. But once I began to add the idea of grieving to the “squiggles” that were emerging in my work with each client, our discussions took on more shape.

Making Space in Therapy for Pain

I began to gently explore with both Magda and Jordan some of the complexities not only of their relationships with the people they were mourning, but also with their respective feelings of loss. Not surprisingly, Jordan reacted angrily, telling me that I was trying to push her through the stages of grief, not letting her manage them on her own time. She was surprised when I replied that she might be right. “I’m not really sure what stage you’re in right now,” I said. “Can you tell me?”

Jordan turned out to be well-read in grief literature. “I think I’m in denial,” she said more quietly than usual. “I don’t want it to be true.” It turned out that Jordan had been angrily fighting the feeling of sadness, despite all the tears and sobbing.

Magda, too, had been fighting her feelings of grief. “If I don’t cry,” she said, “I think I won’t feel it. But when I come into your office, I get hit with all those feelings.”

“Is that a good or bad thing?” I asked.

“Probably good,” she said. “I think I need to let myself feel them.”

[editquote;as we made space for the pain in our different ways, Jordan and I found moments of connection, while Magda and I found moments of difference]Listening to both women talk in very different ways about their styles of mourning made me realize that an important part of my countertransference had been about my own ways of dealing with grief. According to some grief specialists, the hardest thing for most of us is to make emotional space for grief, and yet, making space for it is the only way to let ourselves move forward. As many of these specialists tell us, making space for grief allows us to make room to grow and to live, even with loss. Paying attention to my countertransference reactions to each of these very different clients’ grieving styles allowed all of us to find a new way to make space for this painful but unavoidable emotion. And making space allowed for growth. Jordan and I continued to struggle with many distinct aspects of our relationship, while Magda and I felt like a much more comfortable fit. But as we made space for the pain in our different ways, Jordan and I found moments of connection, while Magda and I found moments of difference. And all of us grew in a variety of interesting and often different ways.

References

1 Winnicott, D.W. (1989) “The Squiggle Game.” In Psychoanalytic Explorations, Routledge.

2 Mitchell, S. (1995). Hope and Dread in Psychoanalysis. Basic Books, Inc.

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