Essay Grade

SOCIAL WORK CASE STUDIES: CONCENTRATION YEAR
Working With Families:
The Case of Brady
Brady is a 15-year-old, Caucasian male referred to me by his
previous social worker for a second evaluation. Brady’s father,
Steve, reports that his son is irritable, impulsive, and often in
trouble at school; has difficulty concentrating on work (both at
home and in school); and uses foul language. He also informed
me that his wife, Diane, passed away 3 years ago, although he
denies any relationship between Brady’s behavior and the death
of his mother.
Brady presented as immature and exhibited below-average
intelligence and emotional functioning. He reported feelings of
low self-esteem, fear of his father, and no desire to attend school.
Steve presented as emotionally deregulated and also emotionally
immature. He appeared very nervous and guarded in the sessions
with Brady. He verbalized frustration with Brady and feeling
­overwhelmed trying to take care of his son’s needs.
Brady attended four sessions with me, including both individual
and family work. I also met with Steve alone to discuss the state of
his own mental health and parenting support needs. In the initial
evaluation session I suggested that Brady be tested for learning
and emotional disabilities. I provided a referral to a psychiatrist,
and I encouraged Steve to have Brady evaluated by the child study
team at his school. Steve unequivocally told me he would not
follow up with these referrals, telling me, “There is nothing wrong
with him. He just doesn’t listen, and he is disrespectful.”
After the initial session, I met individually with Brady and
completed a genogram and asked him to discuss each member
of his family. He described his father as angry and mean and
reported feeling afraid of him. When I inquired what he was afraid
of, Brady did not go into detail, simply saying, “getting in trouble.”
In the next follow-up session with both Steve and Brady present,
Steve immediately told me about an incident Brady had at school.
Steve was clearly frustrated and angry and began to call Brady
hurtful names. I asked Steve about his behavior and the words
used toward Brady. Brady interjected and told his dad that being
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PRACTICE
called these names made him feel afraid of him and further caused
him to feel badly about himself. Steve then began to discuss the
effects of his wife’s death on him and Brady and verbalized feelings of hopelessness. I suggested that Steve follow up with my
previous recommendations and, further, that he should strongly
consider meeting with a social worker to address his own feelings
of grief. Steve agreed to take the referral for the psychiatrist and
said he would follow up with the school about an evaluation for
Brady, but he denied that he needed treatment.
In the third session, I met initially with Brady to complete his
genogram, when he said, “I want to tell you what happens sometimes when I get in trouble.” Brady reported that there had been
physical altercations between him and his father. I called Steve
in and told him what Brady had discussed in the session. Brady
confronted his father, telling him how he felt when they fight.
He also told Steve that he had become “meaner” after “mommy
died.” Steve admitted to physical altercations in the home and
an increase in his irritability since the death of his wife. Steve
and Brady then hugged. I told them it was my legal obligation
to report the accusations of abuse to Child Protective Services
(CPS), which would assist with services such as behavior modification and parenting skills.
Steve asked to speak to me alone and became angry, accusing
me of calling him a child abuser. I explained the role of CPS and
that the intent of the call was to help put services into place. After
our session, I called CPS and reported the incident. At our next
session, after the report was made, Steve was again angry and
asked me what his legal rights were as a parent. He then told
me that he was seeking legal counsel to file a lawsuit against me.
I explained my legal obligations as a clinical social worker and
mandated reporter. Steve asked me very clearly, “Do you think
I am abusing my son?” My answer was, “I cannot be the one
to make that determination. I am obligated by law to report.”
Steve sighed, rolled his eyes, and called me some names under
his breath.
Brady’s case was opened as a child welfare case rather than
a child protective case (which would have required his removal
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SOCIAL WORK CASE STUDIES: CONCENTRATION YEAR
from the home). CPS initiated behavior modification, parenting
skills classes, and a school evaluation. Steve was ordered by the
court to seek mental health counseling. One year after I closed
this case, Brady called me to thank me, asking that I not let his
father know that he called. Brady reported that they continued to
be involved with child welfare and that he and his father had not
had any physical altercations since the report.
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SOCIAL WORK CASE STUDIES: CONCENTRATION YEAR
5. What were the agreed-upon goals to be met to address the
concern?
The goal was to find solutions to alleviate their frustrations and
the discord in their relationship.
6. Did you have to address any issues around cultural competence? Did you have to learn about this population/group
prior to beginning your work with this client system? If so,
what type of research did you do to prepare?
I was aware and sensitive to the fact that they were a gay couple.
I was cognizant of the possible biased reactions they might
have received from administrators at Jackson’s school and their
surrounding community. I inquired into their interactions with
the adoption agency and the school to get a sense of any negative interactions that might have impeded service delivery. I also
suggested a support group for lesbian and gay couples who adopt.
7. How would you advocate for social change to positively
affect this case?
I would advocate for better education for foster and adoptive
parents on the resources they may be eligible to receive.
8. How can evidence-based practice be integrated into this
­situation?
Using weekly scaling questions would be one way in which
evidence-based practice could be implemented.
Working With Families: The Case of Brady
1. What specific intervention strategies (skills, knowledge, etc.)
did you use to address this client situation?
I used structural family therapy, particularly the use of a genogram. I addressed issues of grief and loss and child d
­ evelopment.
Finally, I used education to help them learn about services available and crisis intervention.
2. Which theory or theories did you use to guide your practice?
I used structural family therapy.
3. What were the identified strengths of the client(s)?
Brady’s bravery in disclosing the altercations between himself
and his father showed great motivation and strength.
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APPENDIX
4. What were the identified challenges faced by the client(s)?
Steve was resistant to his own mental health needs and the effect
on his relationship with Brady. Brady was not receiving proper
evaluation and intervention for his presentation of developmental delays/disabilities. Brady and Steve were clearly dealing
with unresolved grief due to the death of Brady’s mother.
5. What were the agreed-upon goals to be met to address the
concern?
The goal was to obtain a second evaluation and then provide
suggestions of services to improve Brady’s behavior in the
home and at school.
6. What local, state, or federal policies could (or did) affect
this situation?
The child abuse reporting laws were relevant to this case.
7. How would you advocate for social change to positively
affect this case?
I would advocate for more education and support for children
with developmental disabilities and their parents. It was clear
that Brady had an intellectual disability that had not been previously acknowledged nor properly addressed.
8. Were there any legal/ethical issues present in the case? If
so, what were they and how were they addressed?
While the reporting laws and ethics for clinicians are very clear
in a case like Brady’s, there is always the concern that a parent
might file a lawsuit against the social worker for making the
report. These are cases in which the clinician’s documentation
of the sessions needs to be accurate and thorough to justify the
CPS report.
9. Describe any additional personal reflections about this case.
I am often asked by students, “Do you find it difficult to make
calls to Child Protective Services and does it get any easier?”
My answer to that question is no, I do not find it hard to make calls
to CPS because those institutions are there to help. However,
I do continue to find it hard to hear stories of abuse from children. That will never get easier. I have learned a great amount of
humility in these cases. If a child (or adult) finds my office space
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SOCIAL WORK CASE STUDIES: CONCENTRATION YEAR
safe enough and is able to disclose such complex issues as these
to me, I feel honored. It is because a client trusts me enough to
tell me these things that I feel responsible to do my job.
Working With Families: The Case of Carol and Joseph
1. What specific intervention strategies (skills, knowledge, etc.)
did you use to address this client situation?
This case required extensive use of active and passive listening
and patience to enable the client to become sufficiently comfortable with me and to arrive at a point where she could work on
her issues. Initially she was very angry, hostile, resistant, and
very much in denial.
2. Which theory or theories did you use to guide your practice?
I work with people in their homes, which is their territory, not
mine. I think it is very important to be aware of how I would feel
if I were in their shoes. The person-in-environment perspective
and Carl Rogers’ person-centered approach are crucial here.
3. What were the identified strengths of the client(s)?
She was smart and had a good support system in her husband
and mother, who were very supportive during her treatment.
4. What were the identified challenges faced by the client(s)?
Carol was a severe alcoholic and had a drug problem to a lesser
extent. She had psychological issues as well, including low selfesteem, depression, and anxiety. She also had transportation
and legal problems as a result of losing her driver’s license after
the DUI.
5. What were the agreed-upon goals to be met to address the
concern?
The primary goal was to protect her child by keeping Carol
sober and finding the intervention method that would be most
appropriate for her to do that. This took time due to the resistance to treatment.
6. How would you advocate for social change to positively
affect this case?
Treatment options and access to them need to be improved
in rural areas. There were not many choices for this client,
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The Petrakis Family
Helen Petrakis is a 52-year-old heterosexual married female of Greek descent who says that she
feels overwhelmed and “blue.” She came to our agency at the suggestion of a close friend who
thought Helen would benefit from having a person who could listen. Although she is
uncomfortable talking about her life with a stranger, Helen said that she decided to come for
therapy because she worries about burdening friends with her troubles. Helen and I have met
four times, twice per month, for individual therapy in 50-minute sessions.
Helen consistently appears well-groomed. She speaks clearly and in moderate tones and seems to
have linear thought progression; her memory seems intact. She claims no history of drug or
alcohol abuse, and she does not identify a history of trauma. Helen says that other than chronic
back pain from an old injury, which she manages with acetaminophen as needed, she is in good
health.
Helen has worked full time at a hospital in the billing department since graduating from high
school. Her husband, John (60), works full time managing a grocery store and earns the larger
portion of the family income. She and John live with their three adult children in a 4-bedroom
house. Helen voices a great deal of pride in the children. Alec, 27, is currently unemployed,
which Helen attributes to the poor economy. Dmitra, 23, whom Helen describes as smart,
beautiful, and hardworking, works as a sales consultant for a local department store. Athina, 18,
is an honors student at a local college and earns spending money as a hostess in a family friend’s
restaurant; Helen describes her as adorable and reliable.
In our first session, I explained to Helen that I was an advanced year intern completing my
second field placement at the agency. I told her I worked closely with my field supervisor to
provide the best care possible. She said that was fine, congratulated me on advancing my career,
and then began talking. I listened for the reasons Helen came to speak with me.
I asked Helen about her community, which, she explained, centered on the activities of the Greek
Orthodox Church. She and John were married in that church and attend services weekly. She
expects that her children will also eventually wed there. Her children, she explained, are
religious but do not regularly go to church because they are very busy. She believes that the
children are too busy to be expected to help around the house. Helen shops, cooks, and cleans for
the family, and John sees to yard care and maintains the family’s cars. When I asked whether the
children contributed to the finances of the home, Helen looked shocked and said that John would
find it deeply insulting to take money from his children. As Helen described her life, I surmised
that the Petrakis family holds strong family bonds within a large and supportive community.
Helen is responsible for the care of John’s 81-year-old widowed mother, Magda, who lives in an
apartment 30 minutes away. Until recently, Magda was self-sufficient, coming for weekly family
dinners and driving herself shopping and to church. But 6 months ago, she fell and broke her hip
and was also recently diagnosed with early signs of dementia. Through their church, Helen and
John hired a reliable and trusted woman to check in on Magda a couple of days each week.
Helen goes to see Magda on the other days, sometimes twice in one day, depending on Magda’s
needs. She buys her food, cleans her home, pays her bills, and keeps track of her medications.
Helen says she would like to have the helper come in more often, but she cannot afford it. The
money to pay for help is coming out of the couple’s vacations savings. Caring for Magda makes
Helen feel as if she is failing as a wife and mother because she no longer has time to spend with
her husband and children.
Helen sounded angry as she described the amount of time she gave toward Magda’s care. She
has stopped going shopping and out to eat with friends because she can no longer find the time.
Lately, John has expressed displeasure with meals at home, as Helen has been cooking less often
and brings home takeout. She sounded defeated when she described an incident in which her son,
Alec, expressed disappointment in her because she could not provide him with clean laundry.
When she cried in response, he offered to help care for his grandmother. Alec proposed moving
in with Magda.
Helen wondered if asking Alec to stay with his grandmother might be good for all of them. John
and Alec had been arguing lately, and Alec and his grandmother had always been very fond of
each other. Helen thought she could offer Alec the money she gave Magda’s helper.
I responded that I thought Helen and Alec were using creative problem solving and utilizing their
resources well in crafting a plan. I said that Helen seemed to find good solutions within her
family and culture. Helen appeared concerned as I said this, and I surmised that she was reluctant
to impose on her son because she and her husband seemed to value providing for their children’s
needs rather than expecting them to contribute resources. Helen ended the session agreeing to
consider the solution we discussed to ease the stress of caring for Magda.
The Petrakis Family
Magda Petrakis: mother of John Petrakis, 81
John Petrakis: father, 60
Helen Petrakis: mother, 52
Alec Petrakis: son, 27
Dmitra Petrakis: daughter, 23
Athina Petrakis: daughter, 18
In our second session, Helen said that her son again mentioned that he saw how overwhelmed
she was and wanted to help care for Magda. While Helen was not sure this was the best idea, she
saw how it might be helpful for a short time. Nonetheless, her instincts were still telling her that
this could be a bad plan. Helen worried about changing the arrangements as they were and
seemed reluctant to step away from her integral role in Magda’s care, despite the pain it was
causing her. In this session, I helped Helen begin to explore her feelings and assumptions about
her role as a caretaker in the family. Helen did not seem able to identify her expectations of
herself as a caretaker. She did, however, resolve her ambivalence about Alec’s offer to care for
Magda. By the end of the session, Helen agreed to have Alec live with his grandmother.
In our third session, Helen briskly walked into the room and announced that Alec had moved in
with Magda and it was a disaster. Since the move, Helen had had to be at the apartment at least
once daily to intervene with emergencies. Magda called Helen at work the day after Alec moved
in to ask Helen to pick up a refill of her medications at the pharmacy. Helen asked to speak to
Alec, and Magda said he had gone out with two friends the night before and had not come home
yet. Helen left work immediately and drove to Magda’s home. Helen angrily told me that she
assumed that Magda misplaced the medications, but then she began to cry and said that the
medications were not misplaced, they were really gone. When she searched the apartment, Helen
noticed that the cash box was empty and that Magda’s checkbook was missing two checks.
Helen determined that Magda was robbed, but because she did not want to frighten her, she
decided not to report the crime. Instead, Helen phoned the pharmacy and explained that her
mother-in-law, suffering from dementia, had accidently destroyed her medication and would
need refills. She called Magda’s bank and learned that the checks had been cashed. Helen cooked
lunch for her mother-in-law and ate it with her. When a tired and disheveled Alec arrived back in
the apartment, Helen quietly told her son about the robbery and reinforced the importance of
remaining in the building with Magda at night.
Helen said that the events in Magda’s apartment were repeated 2 days later. By this time in the
session Helen was furious. With her face red with rage and her hands shaking, she told me that
all this was my fault for suggesting that Alec’s presence in the apartment would benefit the
family. Jewelry from Greece, which had been in the family for generations, was now gone. Alec
would never be in this trouble if I had not told Helen he should be permitted to live with his
grandmother. Helen said she should know better than to talk to a stranger about private matters.
Helen cried, and as I sat and listened to her sobs, I was not sure whether to let her cry, give her a
tissue, or interrupt her. As the session was nearing the end, Helen quickly told me that Alec has
struggled with maintaining sobriety since he was a teen. He is currently on 2 years’ probation for
possession and had recently completed a rehabilitation program. Helen said she now realized
Alec was stealing from his grandmother to support his drug habit. She could not possibly tell her
husband because he would hurt and humiliate Alec, and she would not consider telling the
police. Helen’s solution was to remove the valuables and medications from the apartment and to
visit twice a day to bring supplies and medicine and check on Alec and Magda.
After this session, it was unclear how to proceed with Helen. I asked my field instructor for help.
I explained that I had offered support for a possible solution to Helen’s difficulties and stress. In
rereading the progress notes in Helen’s chart, I realized I had misinterpreted Helen’s reluctance
to ask Alec to move in with his grandmother. I felt terrible about pushing Helen into acting
outside of her own instincts.
My field instructor reminded me that I had not forced Helen to act as she had and that no one
was responsible for the actions of another person. She told me that beginning social workers do
make mistakes and that my errors were part of a learning process and were not irreparable. I was
reminded that advising Helen, or any client, is ill-advised. My field instructor expressed concern
about my ethical and legal obligations to protect Magda. She suggested that I call the county
office on aging and adult services to research my duty to report, and to speak to the agency
director about my ethical and legal obligations in this case.
In our fourth session, Helen apologized for missing a previous appointment with me. She said
she awoke the morning of the appointment with tightness in her chest and a feeling that her heart
was racing. John drove Helen to the emergency room at the hospital in which she works. By the
time Helen got to the hospital, she could not catch her breath and thought she might pass out.
The hospital ran tests but found no conclusive organic reason to explain Helen’s symptoms.
I asked Helen how she felt now. She said that since her visit to the hospital, she continues to
experience shortness of breath, usually in the morning when she is getting ready to begin her
day. She said she has trouble staying asleep, waking two to four times each night, and she feels
tired during the day. Working is hard because she is more forgetful than she has ever been. Her
back is giving her trouble, too. Helen said that she feels like her body is one big tired knot.
I suggested that her symptoms could indicate anxiety and she might want to consider seeing a
psychiatrist for an evaluation. I told Helen it would make sense, given the pressures in her life,
that she felt anxiety. I said that she and I could develop a treatment plan to help her address the
anxiety. Helen’s therapy goals include removing Alec from Magda’s apartment and speaking to
John about a safe and supported living arrangement for Magda.
(Plummer 20-22)
Plummer, Sara-Beth, Sara Makris, Sally Brocksen. Sessions: Case Histories. Laureate
Publishing, 02/2014. VitalBook file.
The citation provided is a guideline. Please check each citation for accuracy before use.
Petrakis Family Episode 3
Petrakis Family Episode 3
Program Transcript
FEMALE SPEAKER: And you’re sure Alec is stealing from her? Pills. From his
own grandmother.
FEMALE SPEAKER: I can’t call the police. He’s still on probation! Possession.
FEMALE SPEAKER: Have you spoken to him about it?
FEMALE SPEAKER: He denied it. But I found them. He got her oxy prescription
refilled so he could take them himself. How old are you?
FEMALE SPEAKER: Excuse me?
FEMALE SPEAKER: I said, how old are you?
FEMALE SPEAKER: I don’t see what that has to do with anything.
FEMALE SPEAKER: You’re too damn young to be doing this job. That’s it. You
don’t know what you’re doing! None of this would have happened! It was your
bright idea! You’re the one who told me to have him move in with her and take
care of her!
FEMALE SPEAKER: I did tell you to do anything! I only suggested it. And we
talked about it together.
FEMALE SPEAKER: No, no. That’s not true. I followed your advice. You’re going
to have to fix this. You have to do something. I don’t know what else to do. I can’t
call the police. He can’t go back to jail. Awful things will happen to him. I can’t let
that happen. I won’t!
Petrakis Family Episode 3
Additional Content Attribution
MUSIC:
Music by Clean Cuts
Original Art and Photography Provided By:
Brian Kline and Nico Danks
©2013 Laureate Education, Inc.
1
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8
CHALLENGES TO
THERAPEUTIC PRESENCE
If you think you’re enlightened go spend a week with your family.
—Ram Dass
To optimize the moments of kairos (opportunity) in the therapy relationship, in ourselves, and with our clients, therapists must be aware of and
work through the potential barriers to relational therapeutic presence. A level
of intimacy with the moment is needed for therapists to go deeper through
the levels of therapeutic presence, which can be scary and make one feel vulnerable. In particular, it can be more challenging to rely on one’s self and the
deepest strata of one’s being to facilitate a response or choose a technique in
resonance with what is most poignant for the client in the moment than to
rely on a therapy plan or a particular technique. The challenges to engaging
intimately in the moment in a psychotherapeutic encounter can arise from
within the therapist (internal barriers) or from the client, the relationship, or
other demands (external barriers). Although it is helpful to conceptually categorize challenges as internal or external, even those that emerge externally
(e.g., the client’s anger) are ultimately internal challenges to the therapist to
be aware of and work through.
The challenges we examine in this chapter include internal ones such
as countertransference, trust in the process, and personal barriers (stress, lack
of self-care, appropriate use of energy) as well as external factors such as working with challenging clients (e.g., clients with dual diagnoses or receiving
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http://dx.doi.org/10.1037/13485-008
Therapeutic Presence: A Mindful Approach to Effective Therapy, by S. M. Geller
and L. S. Greenberg
Copyright © 2012 American Psychological Association. All rights reserved.
end-of-life care, trauma survivors). However, first we invite you to pause briefly
to uncover your own personal obstacles to being present with a client.
PAUSE MOMENT. Stop and notice any obstacles to presence:
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䡲
䡲
䡲
䡲
Take a moment to pause from reading and turn your attention
inward. Close your eyes, soften your gaze in front of you, or jot
down some notes.
Focus briefly on your breath and allow yourself to bring your
awareness to your bodily experience of breathing.
What are you first aware of as you pause? Notice the busyness of
your mind, judgments, or discomfort in your body that may prevent you from feeling centered or still. Notice any rushed feeling,
as in wanting to get to the next page, the next moment, or the
next task. Notice it without judgment, keeping awareness on your
breath without following the thoughts about what you are experiencing, allowing each breath to take you back to the moment.
Now reflect about the difficulties in being present with a client.
What kinds of obstacles emerge in session with a client that hijack
your focus or attention? Notice what they are. Then let them go.
How do you know when you are not present with a client; what
are the clues? How do you bring yourself back to the moment in
session? What is one way you can work on noticing your barrier
to being present and bringing your attention back in session?
INTERNAL CHALLENGES TO THERAPEUTIC PRESENCE
In this section, we explore some of the internal challenges that therapists
can face as they open up to the contact that therapeutic presence entails. Being
fully in the moment with a client requires having a level of self-awareness and
inner health and integration. Presence is not just a passive state but an active
engagement with one’s whole being, which demands a level of engagement
with the other that requires that we take care of ourselves on a personal and
professional level. Even so, we are human beings, and the challenges that can
arise for us include countertransference, tolerance of uncertainty, the role of
stress, and appropriate use of energy.
Countertransference
Countertransference is defined as “the therapist’s internal or external
reactions that are shaped by the therapist’s past or present emotional conflicts
and vulnerabilities” (Gelso & Hayes, 2007, p. 25). Although the notion of
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THERAPEUTIC PRESENCE
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countertransference may have originated in the psychoanalytic tradition,
the possibility of countertransferential reactions, or feelings in the therapist in relation to clients, can occur in any therapeutic modality. Note the
perspective of Gelso and Hayes (2007):
Countertransference is universal in psychotherapy . . . by virtue of their
humanity, all psychotherapists, no matter how experienced or emotionally healthy, do have unresolved conflicts and vulnerabilities, and that
the relational intimacy and emotional demands of psychotherapy tend to
exploit these conflicts and vulnerabilities, bringing them into play in the
therapeutic work. (p. 133)
We believe that countertransference reactions, such as therapists’ emotional reactivity, are highly possible in present-centered work because therapists are open and in direct emotional, physical, cognitive, spiritual, and
relational contact with their clients as well as present in these domains within
their selves. In the presence process, the therapist is using the self as a sensor
or an indicator. Therapists are taking in the depth of the client’s experience
and accessing and attending to their own internal experience as a key indicator in understanding and responding or offering an intervention from
moment to moment. We also believe that being aware of one’s self and the
other, in the way that therapeutic presence evokes, allows therapists to recognize countertransference reactions when they do emerge and either work
with them internally to let them go and not act them out or use them in a
positive therapeutic manner to reflect what the client is experiencing or may
be evoking in the other.
No matter how great the intention to clear and manage the therapist’s
own issues outside of session, therapists are human beings, and even resolved
issues could rise to the surface in session. However, the level of self-insight,
self-awareness, and commitment to one’s own growth that cultivating therapeutic presence demands, such as attending to one’s own inner experience,
serves both as protection from countertransference and as an antidote to
countertransference reactions. Furthermore, the cultivation and experience
of presence can help therapists to quickly distinguish intense countertransference reactions from intense emotional reactions that may be therapeutically useful.
Self-awareness and a continuous attending to one’s internal world are
keys to recognizing and managing countertransference reactions. Gelso and
Hayes (2007) described self-insight as a necessary precondition to connecting the therapist’s experience with the experience of the client. To use the
self as a sensing instrument, “therapists must be able to see themselves, to
understand their fluctuating needs and preferences and shortcomings and
longings” (Gelso & Hayes, 2007, p. 108).
CHALLENGES TO THERAPEUTIC PRESENCE
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VanWagoner, Gelso, Hayes, and Diemer (1991) compared therapists
who were perceived as excellent by their peers with general therapists. They
found that master therapists were viewed as having greater self-insight,
empathic ability, anxiety management, and self-integration. Interestingly,
these qualities, which are a part of mastery, are also aspects of therapeutic presence, such as self-insight, self-integration (grounded and centered), attunement to the other, and ability to manage anxiety. These skills are central to
mastery, as therapists who are perceived as excellent are better able to notice
and manage countertransference reactions before they become problematic or
manifest in therapy and potentially impede the client’s process. Hence, the
practice of presence can also protect against countertransference reactions.
In addition, therapists’ insight, self-awareness, self-care, and psychological health as well as their training and professional experience, which are all
a part of cultivating presence, will support the therapist in effectively using his
or her own receptive openness to understand and facilitate the client’s therapeutic process toward healing. In fact, openness to one’s own feelings has been
associated with less countertransference behavior (Robbins & Jolkovski,
1987). It is often the therapists who have lost touch with what they are feeling or are unaware of their own experience in the moment who do not notice
what is interfering with their ability to help or be