Countertransference, schema modes and ethical considerations in cognitive behavioral therapy

BACKGROUND: Transference and countertransference could be significant sources of insight about the patient’s, therapist’s and supervisor’s inner worlds. Transference phenomena are viewed as a reenactment in the treatment relationship of key elements of previous significant relationships. Countertransference occurs in CBT when the relationship with the patient activates automatic thoughts and schemas in the clinician, and these cognitions have the potential for influencing the therapy process. Countertransference also occurs during supervision and is an indispensable part of the supervisor’s response to the supervisee. CBT is typically short-term treatment – intensity of transference is usually much lower than in longer-term, dynamically oriented psychotherapy. Nevertheless during the long-term CBT of the personality disorder or other complex cases, high intensity of transference and countertransference can develop. SCHEMA MODES AND COUNTERTRANSFERENCE: Schema therapy shares the view that schemas are crucial to understanding of personality disorders, but also can help to understand the emotional reaction of therapist. A mode is the set of schema operations that are in one moment functioning for a person. It is a circumscribed complex pattern of emotional, cognitive a behavioral experiences, which operate in typical situations. When therapist suspects that countertransference may be developing, he/she could try to identify her/his automatic thoughts and schemas. More comprehensive approach is to quickly identify in which mode him/her are at that moment and reflect it such reaction is for the patient benefit or not. Understanding therapist countertransference reactions and theirs management are a significant point of supervision. Self-reflection and realizing the countertransference can therapist help to overcome it and may be necessary for overcoming stagnation in therapy. CONCLUSION: Understanding own mode and their flipping into the therapeutic session is an important tool in psychotherapy and supervision.