Morality, Disgust, and Countertransference in Psychotherapy John D. Gavazzi, Psy.D., ABPP Sa uel !napp, "d.D.

, ABPP At the ost #asic level, successful outco es in psychotherapy re$uire a strong

therapeutic alliance #et%een psychologist and patient. A strong therapeutic #ond can #e cultivated in any different %ays including, #ut not li ited to, si ilarities #et%een psychologist

and patient &such as age, socioecono ic status, gender, etc.', psychologist e pathy and acceptance, and patient confidence in the psychologist(s s)ills. A si ilarity in oral #eliefs

li)ely enhances the %or)ing relationship and correlates %ith positive outco es in psychotherapy. Just as shared values and negative oral si ilarities can strengthen the therapeutic relationship,

oral *udg ents a#out a patient(s #ehaviors and #eliefs &#oth past and current' can oral *udg ents can lead to negative orally.driven e otion

erode or rupture the helping relationship. +n clinical ter s,

countertransference. ,hen a psychologist e-periences a negative, related to the patient, this dyna ic

ay adversely affect the $uality of the therapeutic any topics related to the patient(s

relationship. ,ithin the therapeutic discourse, there are values, personal responsi#ility, and

oral #ehaviors. Moral *udg ents and #eliefs, li)e

countertransference, are co ple-, intuitive, auto atic, and e otional. +n this article, %e %ill focus on one theory of level reactions oral origins to understand ho% these co plicated, instinctive, and gut.

ay pro ote negative countertransference. oral origins posits that the reaction of disgust is a funda ental oral opinions a#out others( #eliefs and #ehaviors &+n#ar 0 Pizarro,

/ne theory of

e-perience that shapes our

1223'. Disgust is a #asic, universal, e otional response that provides a rapid %ay of )no%ing

that so ething is very %rong. ,hether %e i agine a person eating feces or a foul.s elling, aggot.infected rotting corpse, the e-perience of disgust is so profoundly auto atic and instinctual that it leads us to recoil, e-hi#iting odd facial e-pressions, and feeling nauseous. 4hese e-a ples are intentionally star) in order to appreciate the gravity of disgust. 5urther ore, the ore disgust a person feels, the ore strongly the person is convinced of %hat is right and

%rong. "-trapolating fro this data, %hen a psychologist e-periences disgust during

psychotherapy, the psychologist is li)ely produce instinctive and unanticipated facial e-pressions and gestures that are li)ely %itnessed #y the patient. Additionally, the psychologist li)ely %ill have already for ed a oral *udg ent a#out the patient #ased on the e otional reaction. 4he oral *udg ents. During

stronger the psychologist feels disgust, the greater li)elihood of harsher

training, supervision, and self.reflection, psychologists need to )no% ho% disgusted or repulsed they are a#out certain #eliefs and #ehaviors in order to treat patients fairly and hu anely. Additionally, it is i portant for psychologists to #e a%are of culture that ay also #e otivated #y disgust. orality, any psychologists already oral #iases and pre*udices in our

+n ter s of negative countertransference #ased on

)no% %hat triggers disgust, outrage, and e otional tur oil. Given our politically divisive culture, certain political opinions e-pressed #y a patient ay trigger oral outrage %ithin the oral issues,

psychologist. Most psychologists li)ely )no% their reactions to o#vious current

such as a#ortion, sa e.se- couples, polyga ous relationships, assisted suicide, pedophilia, se-ual paraphilias, and pro iscuous #ehavior of arried adults. ,hile psychologists ay find it oral

easy to screen for so e of these issues prior treat ent, %e cannot assess for all of these issues prior to the onset of psychotherapy.

Consider this e-a ple6 4%enty sessions into treat ent, a psychologist finds that the patient engages in pedophilic activities, such as collecting digital pornographic pictures of children. 7e descri#es these activities in great detail. Depending on the level of disgust, can the psychologist treat the patient fairly and effectively given this ne% infor ation8 Can the psychologist %or) through his9her countertransference to continue to treat the patient effectively or is a referral necessary8 And, if a referral is needed, ho% does the psychologist patient8 +n the e-a ple a#ove, the feeling of disgust of pedophilic acts aligns closely %ith co on notions of orality and protection of vulnera#le persons in our society. At other ti es, ay represent oral shortco ings on the part of the psychologist. a)e the referral %ithout sha ing the

ho%ever, feelings of disgust

5or e-a ple, Puhl and Bro%nell &122:' found that individuals %ho have e-cess %eight face discri ination in the %or)place, educational settings, healthcare offices, and in the insurance ar)et. As psychologists %ho are part of society, %e ay not #e i une fro these

for s of unfair discri ination. Disgust for groups can #e culturally reinforced. Si ultaneously, cultural attitudes and #eliefs to%ard that group ay change. As one e-a ple, ;GB4< arginalization for a long stretch of

individuals and couples have #een the targets of scorn and

ti e in A erican culture. +n the past decade, A erican attitudes and #eliefs a#out the ;GB4< co unity have shifted fro disgust and ho opho#ia to%ard acceptance, respect, and e$uality. ay not have

Depending on a variety of factors, including religious #eliefs, so e psychologists

oved past their disapproval of ;GB4< individuals and cannot %or) effectively %ith this population due to negative countertransference.

Psychologists need to #e a%are of their negative e otional reactions to%ard clients to provide high $uality care. ,ithin the ongoing process of professional develop ent, psychologists ay %ant to e-plore oral values, e otional responses, and cultural #iases in

order to avoid negative countertransference. Self.reflection can focus on the pri al reaction of disgust, %hich have shaped of oral codes. 7o%ever, given a ore co prehensive understanding us of our oral opinions8 /r,

orality, do %e need to rely on disgust or revulsion to infor

can %e reflect on our instinctual, e otional reactions to deter ine if a can help us define %hat is right and %rong8 =eferences

ore reasoned opinion

+n#ar, >. and Pizarro, D. &:333, March'. Gri e and Punish ent6 7o% Disgust +nfluences Moral, Social, and ;egal Judg ents. The Jury Expert, :.:3. Puhl, =. 0 Bro%nell, !. D. &122:'. Bias, Discri ination, and /#esity. Obesity Research, 9 (12), ?@@.@2A.