Stress in Psychotherapists Quotes

“Hearing directly from a person who has been hurt in a profound way gives the listener a secondary trauma. When a Swedish colleague, Anders Svensson, asked me to offer support and supervision (Sinason and Svensson 1994) it was because his patient, a severely learning-disabled patient, claimed she had been raped. As the therapy proceeded she began to provide details of rape, sadomasochistic activities, necrophilia, pornographic films, bestiality and, finally, the murder of a child. The police were called in and she was given extra security. Week by week a more harrowing tale evolved of night-time rituals, of men in masks, the drinking of blood and eating of faeces. It took me over eight months to find the term ‘ritual abuse’.”
― Ved P. Varma, Stress in Psychotherapists

“Winnicott talks about how ‘mothers do in one way or another identify themselves with the baby growing within them, and in this way they achieve a very powerful sense of what the baby needs. This is a projective identification’ (1976:53).”
― Ved P. Varma, Stress in Psychotherapists

“Every therapist will, over the course of his career, encounter a patient whose problem sufficiently mirrors a difficulty for the therapist which is still unresolved. In this situation, unless the therapist is aware of the existence of their own pathology and can take it into account, they may respond to the patient in a defensive, resistant or blaming manner. Technically, this would be called ‘counter-transference resistance’.”
― Ved P. Varma, Stress in Psychotherapists

“Some patients who are profoundly multiply disabled are incontinent, smear faeces, cut themselves, dribble, smell, spit, bite, eat mucous, pull their hair, poke their eyes and are hard to understand. Shock at feeling a primitive response of disgust can make the therapist unable to think properly. (...) Sexually abused children and adults who display eroticised behaviour in the therapy room—stripping, exposing themselves, masturbating—can also cause stress for the therapist, especially on the first such occasion.”
― Ved P. Varma, Stress in Psychotherapists

“They behave towards their therapists as they perceive themselves to have been treated by their absent parents. They make their therapists feel very fully what it is like to be discarded, ignored, despised, helpless or even unreal and non-existent. (...) What needs to be understood in such situations is not that the child is perceiving the therapist as the insufficiently caring parent of his past experiences and revenging himself. Beyond this the child is also reversing the original situation. This time the child is identifying himself as the cruel, rejecting but powerful person and it is the therapist who is to feel rejected, hurt, helpless and…to feel the pangs of betrayal of trust and affection. In such situations the therapist cannot become genuinely trustworthy in the child’s eyes until experience has shown that he has the strength to contain the projections of the feelings that the child finds intolerable.”
― Ved P. Varma, Stress in Psychotherapists

“If, for example, it is the weak, defenceless, vulnerable part of the self which cannot be tolerated, than this will tend to be split off and projected as a whole into a suitable ‘container’—usually an obviously weaker or more vulnerable child—where it can be attacked by the sadistic part of the self, but now ‘inside someone else’.”
― Ved P. Varma, Stress in Psychotherapists

“Although there are areas of overlap between working with psychotic and borderline children and with severely deprived children, some of the stresses involved are different. Deprived children are generally more in touch with reality and able to use language more or less effectively to communicate their thoughts and feelings. Even if they shut you out and are silent and apparently unresponsive, there is often little doubt that there is ‘someone there’ whom you could make contact with should they allow it.”
― Ved P. Varma, Stress in Psychotherapists

“He came to believe that, in addition to getting rid of parts of the self, projective identification was sometimes the only way in which some very fragmented patients could communicate. The problem lay in recognising, understanding and making sense of what was being communicated by the patient, in such a way that the patient could better understand what was happening in his internal world. Before any of this can happen, however, the therapist has to be capable of receiving, and holding on to (that is, containing) ‘inside of himself what the patient has projected into him. These unprocessed, raw, fragmented, and sometimes ‘unthinkable’ thoughts and feelings were called by Bion, ‘Beta Elements’, and the capacity to process and think about them, was referred to as ‘Alpha Function’. It follows from this that an increase in Alpha Function will also lead to a greater capacity in the therapist to contain and manage stress.”
― Ved P. Varma, Stress in Psychotherapists