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Counter-Transference and the Clinical Ethics Encounter: What, Why, and How We Feel During Consultations

Published online by Cambridge University Press:  11 March 2020

MICHAEL J. REDINGER  and
TYLER S. GIBB
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Abstract

One of the more draining aspects of being a clinical ethicist is dealing with the emotions of patients, family members, as well as healthcare providers. Generally, by the time a clinical ethicist is called into a case, stress levels are running high, patience is low, and interpersonal communication is strained. Management of this emotional burden of clinical ethics is an underexamined aspect of the profession and academic literature. The emotional nature of doing clinical ethics consultation may be better addressed by utilizing concepts and tools from clinical psychology. Management of countertransference, the natural emotional reaction by the therapist toward the patient, is a widely discussed topic in the psychotherapeutic literature. This concept can be adapted to the clinical ethics encounter by broadening it beyond the patient-therapist relationship to refer to the ethics consultant's emotional response toward the patient, the family, or other members the healthcare team. Further, it may aid the consultant because a recognition of the source and nature of these reactions can help maintain ‘critical distance’ and minimize bias in the same way that a psychologist maintains neutrality in psychotherapy. This paper will offer suggestions on how to manage these emotional responses and their burden in the clinical ethics encounter, drawing upon techniques and strategies recommended in the psychotherapeutic literature. Using these techniques may improve consultation outcomes and reduce the emotional burden on the clinical ethicist.

Keywords

clinical ethicsclinical ethics consultationclinical ethicistcounter-transference
Type
Departments and Columns
Information
Cambridge Quarterly of Healthcare Ethics , Volume 29 , Issue 2 , April 2020 , pp. 317 - 326
Copyright
© Cambridge University Press 2020

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References

Notes

1. Aulisio, MP, Rothenberg, LS. Bioethics, medical humanities, and the future of the “field”: Reflections on the results of the ASBH survey of North American graduate bioethics/medical humanities training programs. The American Journal of Bioethics 2002;2(4):3–9 CrossRefGoogle ScholarPubMed.

2. Fox, E, Myers, S, Pearlman, RA. Ethics consultation in United States hospitals: A national survey. The American Journal of Bioethics 2007;7(2):13–25 CrossRefGoogle ScholarPubMed.

3. American Society for Bioethics and Humanities. Core Competencies for Health Care Ethics Consultation. Glenview, IL: ASBH; 1998; American Society for Bioethics and Humanities. Core Competencies for Health Care Ethics Consultation. 2nd edition. Glenview, IL: ASBH; 2011.

4. Kodish, E, Fins, JJ, Braddock, C III, Cohn, F, Dubler, NN, Danis, M, Derse, AR, et al. Quality attestation for clinical ethics consultants: A two‐step model from the American Society for Bioethics and Humanities. Hastings Center Report 43, no. 5 (2013): 26-36.CrossRefGoogle ScholarPubMed Hastings Center Report 2013;43(5)26–36CrossRefGoogle Scholar.

5. Bredlau, A-L. Where do you put the pain? JAMA 2016;315(10):983 CrossRefGoogle Scholar.

6. Rotenstein, LS, Ramos, MA, Torre, M, Segal, JB, Peluso, MJ, Guille, C, et al. Prevalence of depression, depressive symptoms, and suicidal ideation among medical students: A systematic review and meta-analysis. JAMA 2016;316(21):2214–36CrossRefGoogle ScholarPubMed.

7. Center, C, Davis, M, Detre, T, Ford, DE, Hansbrough, W, Hendin, H, et al. Confronting depression and suicide in physicians: a consensus statement. JAMA 2003;289(23):3161–6CrossRefGoogle ScholarPubMed.

8. Goldman, ML, Shah, RN, Bernstein, CA. Depression and suicide among physician trainees: Recommendations for a national response. JAMA Psychiatry 2015;72(5):411–2CrossRefGoogle ScholarPubMed.

9. Care2’s Day of Solidarity to Prevent Physician Suicide; available at http://www.care2.com/care2blog/prevent-physician-suicide (last accessed 8 May 2017).

10. DuVal, G, Sartorius, L, Clarridge, B, Gensler, G, Danis, M. (2001). What triggers requests for ethics consultations? Journal of Medical Ethics 2001;27(suppl 1):i24–i29 CrossRefGoogle ScholarPubMed.

11. See note 3, ASBH 1998; ASBH 2011.

12. Fiester, A. Neglected ends: Clinical ethics consultation and the prospects for closure. The American Journal of Bioethics 2015;15(1):29–36 CrossRefGoogle ScholarPubMed.

13. Ford, PJ, Dudzinski, DM, eds. Complex ethics consultations: Cases that haunt us. Cambridge: Cambridge University Press; 2008 CrossRefGoogle Scholar.

14. Bliton, MJ, Finder, SG. Traversing boundaries: Clinical ethics, moral experience, and the withdrawal of life supports. Theoretical Medicine and Bioethics 2002;23(3):233–58CrossRefGoogle ScholarPubMed.

15. Shelton, W, Geppert, C, Jankowski, J. The role of communication and interpersonal skills in clinical ethics consultation: The need for a competency in advanced ethics facilitation. The Journal of Clinical Ethics 2015;27(1):28–38 CrossRefGoogle Scholar.

16. See note 15, Shelton et al. 2015.

17. See note 15, Shelton et al. 2015.

18. See note 15, Shelton et al. 2015.

19. See note 15, Shelton et al. 2015.

20. Wasson, K, Parsi, K, McCarthy, M, Siddall, VJ, Kuczewski, M. Developing an evaluation tool for assessing clinical ethics consultation skills in simulation based education: The ACES project. HEC forum 2016;28(2):103–13CrossRefGoogle ScholarPubMed.

21. Agich, GJ. Defense mechanisms in ethics consultation. HEC forum 2011;23(4):269–79CrossRefGoogle ScholarPubMed.

22. Gabbard, GO. Basic principles of dynamic psychiatry. Psychodynamic Psychiatry in Clinical Practice. Washington, DC: American Psychiatric Publishing; 2014:3–31 Google Scholar.

23. Noorani, F, Dyer, AR. How should clinicians respond to transference reactions with cancer patients? AMA Journal of Ethics 2017;19(5):436 Google ScholarPubMed.

24. Rentmeester, CA, George, C. Legalism, countertransference, and clinical moral perception. The American Journal of Bioethics 2009;9(10):20–8CrossRefGoogle ScholarPubMed.

25. Alfandre, DJ. (2009). Do all physicians need to recognize countertransference? The American Journal of Bioethics 2009;9(10):38–9CrossRefGoogle Scholar.

26. Hoffmaster, B, Hooker, C. What reason can do for clinical moral perception? The American Journal of Bioethics 2009;9(10):29–31 CrossRefGoogle Scholar.

27. See note 26, Hoffmaster, Hooker 2009.