A Slave For Two Masters: Countertransference of a Wounded Healer in the Treatment of a “Difficult to Treat” Adolescent by Ralph Cuseglio A case study submitted to the School of Social Work Rutgers, The State University of New Jersey in partial fulfillment of the requirements for the degree of Doctor of Social Work Graduate Program in Social Work New Brunswick, New Jersey October 2015 A Slave For Two Masters: Countertransference of a Wounded Healer in the Treatment of a “What is to give light must endure burning.” “Difficult to Treat” Adolescent -Viktor Frankl Ralph Cuseglio The referral seemed straightforward enough, a “softball,” I thought. A woman named Ruth called Abstract my office seeking counseling for her fifteen-year- The aim of this case study is to analyze intense old son. He’d recently returned home, blackout countertransference experienced by a therapist drunk after his girlfriend ended their three-month while treating a “difficult to treat” adolescent relationship. Teenage breakup was a subject with patient. During treatment, the therapist struggled which I had become quite familiar. Having worked to recognize much of his subjective with hundreds of teens, I had listened to countless countertransference and its impact on the tales of woe. Lending an ear and the passage of treatment. This paper will discuss the reasons for time was usually enough to mend the young heart. this and the manner in which both subjective and Not this time. And that softball…well, it clocked objective countertransference played a role. In me upside my head and brought me to my knees. doing so, the therapist discusses how his This paper has arisen out of a desire to childhood experiences and the subsequent understand the countertransference reactions I assumption of Carl Jung’s wounded healer experienced while working with the archetype fueled the countertransference in ways aforementioned patient; most of which came in that were concurrently beneficial and detrimental hindsight long after treatment ended. During to the treatment. The patient’s symptoms, treatment, I struggled to recognize much of my behavior, and family system are also examined to subjective countertransference and its impact illustrate how they uniquely contributed to the upon the therapeutic relationship. This paper will intense feelings evoked in the therapist. Topics of discuss the reasons and manner in which abandonment, omnipotence, curative fantasies, subjective countertransference impacted the Borderline Personality Disorder, biblical myth, treatment of the patient. In doing so, I will discuss and childhood trauma are explored throughout how my childhood experiences, and subsequent this paper, as they uniquely intersected to create a assumption of the Jungian wounded healer complex web of psychodynamics between archetype, fueled the countertransference in ways therapist and patient. This is demonstrated that were both beneficial and detrimental to the primary through an interpretation of the patient’s treatment. The patient’s symptoms, behavior, and final session and the therapist’s dream following family system will be examined to illustrate how treatment. Finally, implications for wounded they uniquely contributed to the intense feelings healers’ self-disclosure are examined, reflections stirred up in me during the treatment. This will be of the treatment are offered, and suggestions explored primarily through an interpretation of made for the recognition and management of the patient’s final session and a dream that countertransference wounded healers are prone occurred after treatment ended. Finally, the to feel while working with ‘difficult to treat’ implications of wounded healer self-disclosure patients. and stigma are discussed, reflections of the treatment are offered, and suggestions are made for exploring intense countertransference reactions wounded therapists are prone to experience while working with “difficult to treat” patients. Carl Jung first coined the term “wounded healer” in 1951. It is a phenomena that philological and psychological scholar Karoly Kerenyi (1959) referred to as the ability “to be at *Privacy Disclaimer: The names and identifying home in the darkness of suffering and there to find details of the patient and his family have been germs of light and recovery with which, as though significantly altered to protect the privacy of the by enchantment, to bring forth Asclepius, the individuals. sunlike healer” (n.p.). The archetype suggests that A Slave For Two Masters healing power can derive from the healer’s own find a therapist who has not had a diagnosable woundedness. It is based in part on the mythical mental disorder at some point in their lifetime. Greek character Chiron. Chiron, a centaur, born One only needs to look as far as Adjustment half man-half horse to sea-nymph Philyra and Disorder diagnoses in The Diagnostic and Olympian God Cronos, was rejected at birth. Statistical Manual of Mental Health Disorders, Considered too disfigured, Chiron was abandoned Edition 5 (DSM-5) to validate this claim. It is likely, by his parents, and raised by Apollo, who too, that patients would go unaware of this, as a educated him in the art of medicine. As an adult, majority of therapists choose not to disclose such Chiron was revered as a wise teacher and mentor, information. It is neither good nor bad when a and for his child rearing qualities. Accidently shot therapist has struggled with mental health issues, by a poisonous arrow, he sustained a wound that, emotional trauma or psychic wounds, but rather it ironically, he could not heal. This wound did not is their ability to draw on their woundedness in prove fatal, however, due to his god-like the service of healing that is important (Zerubavel, immortality. Thus, Chiron was forced to live his Wright, & O’Dougherty, 2012). Therapists who can life in endless pain while continuing to serve and successfully navigate challenges and have heal others until bargaining his death with Zeus. processed their pain and identified their strength The wounded healer archetype is a prevalent as a result of their wounds are in a better position yet seldom researched and discussed theme to ensure more positive treatment outcomes in within the mental health field. The archetype their patients proposes that a healer’s own pain can have a For these reasons, investigating the wounded curative effect on patients. Viktor Frankl (1965) healer archetype and its dichotomic nature is writes, “I believe that my handicap will only essential for understanding its impact on the enhance my ability to help others. I know that therapeutic relationship. Gilroy, Carroll, and without the suffering, the growth that I have Murra (2001) assert that wounded healer achieved would have been impossible” (p. 179). therapists may have a greater ability to empathize Psychotherapists are often drawn to the mental with their patient’s pain, can have a more health field by personal experiences of emotional profound understanding of that pain, and show turmoil and pain. Anna Freud once said, “The most more patience and tolerance during treatment. sophisticated defense mechanism I’ve ever Research further indicates that the wounded encountered was becoming a therapist” (Norcross healer’s countertransference can have a positive & Guy, p. 1). Many mental health practitioners use influence on therapy as well. Gelso and Hayes the profession as a way to heal their own psychic (2007) cite that wounded healers who have wounds (Russell, Pasnau, Zebulon, & Taintor, sufficiently addressed their mental and emotional 1975). Sussman (2007) reports that therapists health issues can make uniquely talented cite childhood experiences of woundedness as a therapists. However, there are also caveats to primary motivation for entering the profession. consider when a therapist fits the wounded healer This notion is supported by research that archetype. Briere (1992) cites decreased ability to psychotherapists, as compared to the general be emotionally present, poorly managed population, come from emotionally withdrawn countertransference, overidentification, and and unstable homes (Burton, 1972; Ford, 1963; projection as common negative aspects that Groesbeck, 1975; Racusin, Abramowitz, & Winter, impact treatment with patients. Cain (2000) 1981). Chu (1998) furthers that the reasons illustrates this in his qualitative study of therapists get into the mental health field are therapists with histories of psychiatric personal and related to their own painful feelings hospitalizations, of having been lost, disenfranchised, or victimized. Wounded healers are also commonly represented I started working rather heavily with people in the substance abuse field, many having with multiple personality disorder. And, for struggled with addiction themselves (White, the most part, they were like other clients for 2000). It is well documented that several me except that I had a phenomenal ability to esteemed psychological theorists including Carl shift with them. But then I got one particular Jung, Lawrence Kohlberg, and Marsha Linehan case, and it turned out that the girl had a have suffered from mental health issues. Given the background that was very, very similar to my frequency with which the wounded healer own, that I myself had multiple personality archetype exists within the mental health disorder. It had been buried since I was 10 professions, patients would be hard pressed to years old, and it suddenly reemerged…I was -2- A Slave For Two Masters spending just