By Meagan Moore, MusicWorx Intern
Edited by Theresa Kwong, Communications Consultant
When I began my music therapy internship I couldn’t wait to begin working in a hospital. During my first week of shadowing my supervisor, I showed up each morning eager to start seeing patients. I felt energized by most sessions, despite the often heavy emotional undertones that were woven into patient interactions. One day while shadowing in the ICU, we visited a patient who was on a ventilator. Although the patient could not communicate verbally, they had a strong emotional reaction to the music. This was not an uncommon experience while working in the hospital. However, something about this patient triggered something in me. I felt my own emotions bubbling from my toes up to my head and my heartbeat began to race. I took deep breaths to control my own reaction, but the minute we left the patient’s room I could no longer suppress the tears. In my mind, all I could think was, ‘that patient reminds me of my brother.’
This was one of my first experiences of countertransference, or more specifically one of my first understandings of the concept.
What is Countertransference?
The term countertransference was originally developed by Freud (1910), who defined it as a ‘feeling or reaction that arises in the [therapist] as a result of the patient’s influence on his unconscious feelings’ (p 144). Today, this might look like feeling ‘triggered’ by a patient or client, like how I associated a patient with my brother. The physical ‘bubbling’ sensation I experienced was a somatic reaction, which can be an accurate indicator of countertransference. Other indicators may be having strong or unwarranted emotional reactions to a client, like how I began to cry after seeing this patient (Bruscia, 1998). Those working in the helping field will most likely experience countertransference at some point. These experiences can have positive or negative outcomes in the therapeutic setting, so it is important to learn tools for understanding, processing, and responding to countertransference.
Understanding the Experience
As a music therapy intern, my first experience of countertransference was confusing. I didn’t understand why I had such a strong reaction to a patient that I had never even spoken to. I hadn’t ever become emotional in the therapeutic setting, so why now? My first step in understanding countertransference was to process the experience with my supervisor. As a new intern I did not yet have the skills to recognize countertransference, so guidance from my supervisor was critical to processing the experience. Since then I have learned the physical, emotional, and energetic warning signs to be aware of, but I still ask for support from my supervisors when needed. Countertransference can be unpredictable and can affect even the most experienced music therapists. Finding support through supervisors or trusted colleagues allows for honest feedback and a deeper understanding of countertransference.
Personal Processing
Possibly one of the most challenging aspects of countertransference is uncovering the source of the reaction. In my experience, I recognized that I related a patient to my brother- that was the surface level understanding. The harder part was understanding why. Emotional processing may look different from person to person. Some may find journaling to be effective, others may use creative arts, exercise, or meditation. As a music therapist, I find that using music is one of the most powerful tools for processing my own emotions. After all, we use music to support our clients, so it’s only natural to use music to support ourselves. My go-to is music improvisation using guitar and voice. Although I may have intentions for the music, I never assert expectations. Allowing the music and the sounds to naturally evolve, I often find that my subconscious can break through, releasing deeply rooted emotions. When I took time to personally process through music, I was able to recognize that my reaction was based on an internalized fear for my brother’s health and wellbeing, and ultimately a greater fear of losing someone I love so dearly. After my own processing, I was then able to successfully visit the patient again without having the same reaction.
Habits that Help
As a budding music therapist, my experiences with countertransference are still limited and will more than likely continue happening throughout my career. But, like Sheryl Crow once said, “the first cut is the deepest,” so I have the benefit of fresh wisdom and knowledge passed down to me from supervisors and peers. One of the most helpful pieces of advice was to create a unique pre-session ritual to help me feel grounded before each patient interaction. My ritual involves a personal mantra and a body scan to check-in with my physical self. In the hospital setting, you can see many patients in a short window of time so finding ways to re-center helps to be present through each session. I also take moments throughout sessions to briefly check-in with myself as well. In doing this, I can better recognize any physical or emotional symptoms I could be experiencing during a session. Additionally, check-ins can create awareness in myself if my thoughts have shifted from the patient or client to myself. If I recognize any signs of countertransference during these check-ins, I am able to employ grounding techniques like deep breathing when needed. Outside of the therapeutic setting, I ensure to allow space for processing and personal reflection when needed.
I believe every clinician will experience countertransference throughout their career. It is a phenomenon that often cannot be anticipated. However, when you have the tools to move through the experience, countertransference could be viewed as a window of opportunity for personal growth. These moments can be tough – but it’s the tough moments that allow us to grow the most.
References
Bruscia, K. E. (Ed.) (1998). The dynamics of music psychotherapy. Gilsum, NH: Barcelona Publishers
Freud, S. (1910). Future prospects of psychoanalytic therapy. In J. Strachey (Ed.), The standard edition of the complete works of Sigmund Freud (pp. 139–151). London, England: Hogarth Press.
Further Reading
How Active Music Listening Can Make Our Brains Bigger – Psychology Today
