Psychotherapy of the victims of massive violence: countertransference and ethical issues

• Published in: American journal of psychotherapy Vol. 47; no. 1; pp. 90 - 102
• Main Authors: KINZIE, J. D, BOEHNLEIN, J. K
• Format: Journal Article
• Language: English
• Published: Bronx, NY Association for the Advancement of Psychotherapy 1993; American Psychiatric Association
• Subjects: Adult; Beneficence; Bioethics; Biological and medical sciences; Combat Disorders - psychology; Combat Disorders - therapy; Countertransference (Psychology); Cultural Diversity; Ethics, Medical; Female; Humans; Male; Medical sciences; Mentally Ill Persons; Personal Autonomy; Post traumatic stress disorder; Psychiatry; Psychology; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychotherapies. Psychological and clinical counseling; Psychotherapy - methods; Refugees - psychology; Stress Disorders, Post-Traumatic - psychology; Stress Disorders, Post-Traumatic - therapy; Survival - psychology; Treatments; Trust; Veterans - psychology; Violence; Violent crime; Case study; Human; Ethics; Therapeutic process; Transference countertransference; Analytical psychotherapy; Posttraumatic syndrome; Social interaction; Treatment efficiency; Anxiety disorder; Therapeutic relation; Stress; Professional Patient Relationship; Mental Health Therapies
• ISSN: 0002-9564; 2575-6559
• DOI: 10.1176/appi.psychotherapy.1993.47.1.90

Psychotherapy with severely traumatized patients is a long, draining process that often produces strong countertransference reactions. It is difficult to therapeutically and ethically handle these personal responses. We feel that at different stages in therapy different ethical principles should guide the therapy. At the early stages, fidelity and nonmaleficence should be the guiding principles. As trust and confidence develop, therapists may have more personal freedom to act; beneficence, i.e., providing specific confident care then becomes the primary ethical principle. In later stages of therapy, promoting the principles of autonomy and justice come into play. As therapy further progresses, therapists' own needs, the principle of self-interest, may be utilized in the therapeutic relationship. Throughout therapeutic contacts with traumatized patients, therapists need to monitor their own needs, and find appropriate ways outside of therapy to cope with these often intense feelings. Continuing to feel therapeutically competent and ethically grounded, yet maintaining the personal strength and balance to treat traumatized patients, pose major challenges for therapists.