Counter-Transference and the Clinical Ethics Encounter: What, Why, and How We Feel During Consultations

Abstract

One of the more draining aspects of being a clinical ethicist is dealing with the emotions of patients, family members, as well as healthcare providers. Generally, by the time a clinical ethicist is called into a case, stress levels are running high, patience is low, and interpersonal communication is strained. Management of this emotional burden of clinical ethics is an underexamined aspect of the profession and academic literature. The emotional nature of doing clinical ethics consultation may be better addressed by utilizing concepts and tools from clinical psychology. Management of countertransference, the natural emotional reaction by the therapist toward the patient, is a widely discussed topic in the psychotherapeutic literature. This concept can be adapted to the clinical ethics encounter by broadening it beyond the patient-therapist relationship to refer to the ethics consultant's emotional response toward the patient, the family, or other members the healthcare team. Further, it may aid the consultant because a recognition of the source and nature of these reactions can help maintain ‘critical distance’ and minimize bias in the same way that a psychologist maintains neutrality in psychotherapy. This paper will offer suggestions on how to manage these emotional responses and their burden in the clinical ethics encounter, drawing upon techniques and strategies recommended in the psychotherapeutic literature. Using these techniques may improve consultation outcomes and reduce the emotional burden on the clinical ethicist.

Clinical recommendations for psychotherapists working during the coronavirus (COVID-19) pandemic through the lens of AEDP (Accelerated Experiential Dynamic Psychotherapy)

“…Often, the recommendation for therapists experiencing the same concern as their patients is to seek additional consultation, supervision or personal therapy (Macran & Shapiro, 1998;Redinger & Gibb, 2020). In addition to the challenge of experiencing a parallel concern, there also lies the opportunity for therapists to better understand their patient's experience and potentially build stronger rapport or intimacy through sharing in the experience together (see clinical recommendations below) (Boulanger, 2013;Boulanger, Floyd, Nathan, Poitevant, & Pool, 2013).…”

Navigating Neurologic Illness: Skills in Neuropalliative Care for Persons Hospitalized with Neurologic Disease

“…60 These accompany empathy and can impact success in clinician-patient encounters. 60,61 Naming This skill acknowledges an observed emotion. For example, "I hear a lot of anger around the room."…”

Visualising emotion in support of patient-physician communication: an empirical study

“…Senior providers, however, used EMVIS as an analysis tool for rehabilitation situations (AW5) and as a tool for the evaluation of treatments while also regarding it as reference information (AS11). Moreover, senior providers expected EMVIS to help them discover how patients influenced their own unconscious feelings, which is described as counter-transference [51,52] , and which is essential for therapies, especially for relationships and interactions in psychological therapies [53,54]. Hence, senior providers hoped for an additional camera to catch their own emotions during conversations, to present their own personal and unconscious feelings.…”