Therapist Emotions in CBT (Are Behaviorists Allowed to Talk About This?)

Often it is assumed that psychodynamic therapists talk about emotional responses to clients, in terms of countertransferrence, but that behaviorists either have no emotional responses or ignore their emotional responses. This is a topic that has not been emphasized a lot in behavioral circles but it has been discussed intermittently for years. A clinical round-table on this topic was filled to capacity. Antoinette Zeiss emphasized the importance of making this a more explicit part of behavioral and cognitive-behavioral training and texts. She argued that we need to develop our own vocabulary for doing this since the terms transferrence and counter-transferrence imply additional meanings which are not very compatible with behavior therapy. All the panelists agreed that both positive and negative responses in therapy can have important impacts on treatment and need to be addressed.

A wide variety of clinical situations were discussed ranging from misgivings about working to help an elderly Nazi rocket scientist overcome his depression to noticing that affection and sympathy for nice elderly clients led to a temptation to be more of a friendly companion and less of a therapist.

Panelists emphasized:

• It is important to recognize and accept emotional reactions to clients.
• We need to managing our feelings so that they do not impede therapy.
• We need to recognize our own stimulus value, the types of responses we tend to elicit from our clients.
• It is valuable to recognize the times when our response to the client provides a sample of the impact the client has on others.
• My reactions to the client are one of the many factors which influence whether I can be an effective therapist for this client.
• A variety of populations are particularly likely to elicit strong reactions, positive or negative, from us (geriatric patients, sex offenders, cancer patients, ...)
• If we understand our reactions we can used them as a barometer and can be quite useful at times.
• Emotions are private events which our culture teaches us to conceal and avoid.
• Revealing emotions implicitly involves self-disclosure.
• We often encourage clients to engage behaviors (such as facing negative emotions, expressing emotions, speaking assertively) which we avoid ourselves.
• We need to have the same ability to face feelings, experience them, express them, and modulate them which we want our clients to develop.
• At times it can be quite valuable have our emotions be present in the moment and to model ways of being a reasonably healthy, emotional human being. (Several presenters modeled this, i.e. they were in tears while talking re some of their more intense clinical experiences)
• It can be really important not to try to be the Lone Ranger, to be part of a team, to have supervisors/consultants/colleagues who give us honest feedback and support.
• We can use cognitive interventions ourselves to deal with our problematic emotions.
• At times we fall into the pool, we start thinking the way the client does.
• Emotions interfer with good decision-making at times.
• The therapist role can be problematic. Being a therapist does not make us superhuman. Overemphasizing the role can distance us from our emotions.
• Talking about emotions may not be enough. Exposure to strong emotion can be an important part of supervision and training.
• As mental health professionals, we often act as though there is a terrible stigma to having any mental health problems ourselves. In many settings, no one acknowledges having any issues of their own.

There was a consensus that supervision of therapists-in-training needs to include considerable attention to the emotional reactions the therapist experiences. However, supervision is not therapy. The goal of supervision is to help me become an effective therapist, not to delve into emotions for their own sake or to overcome my problems.

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