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The Use of the Self in Psychotherapy

Abstract This study was designed to investigate therapist's conceptualization and utilization of countertransference, through a comparative empirical study of pastoral counselors/psychotherapists and clinical social workers. Two major areas of investigation included the effects of religious training of psychotherapists on the use of the self in psychotherapy, and the interaction between attitudes toward countertransference and actual reported non-verbal enactments (both ethical and unethical). Both disciplines generally subscribed more to a “Totalist” than a “Classicist” view of countertransference as defined in the literature. Pastoral counselors were statistically much more likely to use prayer and ritual in their practice of psychotherapy, and claimed greater expertise in addressing clients' spiritual issues. With regard to enactments, a substantial number of therapists from both disciplines reported having engaged at least once in a number of behaviors deemed unethical by an independent panel. A statistically significant association was found, especially among religiously ordained male therapists, between the report of experiencing erotic feelings in psychotherapy, and non-erotic but unethical enactments. Enactments were most often justified by both male and female therapists under the rubric of the “real relationship.” In light of these findings, a psychodynamic consideration of therapists' need to be seen as warm, caring and special helpers led to three main recommendations for both pastoral psychotherapy and clinical social work: (1) a renewed clinical focus on interpretation of transference and countertransference dynamics in the context of an intersubjective relationship operating at conscious and unconscious levels; (2) greater use by therapists of in-depth clinical consultation and supervision with particular focus on countertransference and the intersubjective relationship; and (3) a de-romanticization of the term “empathy” and a recuperation of its diagnostic usefulness.