The Therapist And The Therapist - In - Training

Countertransference in a therapist who is “Filipino” in his upbringing, values, and life-style will be related to the experience of seeing much of himself in his Filipino patients. If he and the patient belong to the same social class, then this experience is brought even closer to home. Similarities in problems, attempted solutions, and subsequently encountered cultural limitations will then occur.

The only reliable boundary lines will come from psychological differences between himself and his patient. He has to be aware of these demarcation lines at all times in order to carry out his task objectively and effectively. There are pitfalls which the therapist may encounter in his own psyche. These are likely- to come in the following manner:

1. The patient may effectively feed his narcissism, especially in a transference situation. Viewed as an authority figure, a sexual object, an omnipotent and magical person, he will find the patient generously investing him with power and adulation which may be immensely gratifying to him.

2. The patient’s efforts, bolstered by cultural practice, to draw the therapist into an on-going, mutually beneficial and gratifying inter-personal relationship, may succeed and blur the therapist’s perception of what is going on.

3. The cultural attitude towards repressing and suppressing anger and other negative affects will be invoked by the patient of the therapist. The latter may, by conforming to cultural patterns and staying away from an open discussion of such affects, promote an unhealthy reinforcement of repressive and suppressive barriers.

4. The female therapist who has anxieties about discussing sex and the male therapist who needs his masculinity reaffirmed will find ready reassurances in the Filipino patient but will hardly be effective in helping the latter see any sexual problem.

The task of training and teaching a resident in the skills of psychiatry and, in particular, psychotherapy, is thus faced with the whole problem of how the role of culture (wherein he will practice his skills) will be integrated into his training. The question is where a Filipino doctor, aspiring to be a psychiatrist in the Philippines, should be trained. If he is exclusively and intensively foreign- trained, he may find his skills inapplicable, to a significant extent, when he returns to his country. On the other hand, if he is trained on home grounds, he may never see the cultural “blind spots” which he is likely to share with his patients.