Countertransference can manifest itself in many different ways. The key to seeing
countertransference issues is awareness and consciousness-raising. The commitment to "do no
harm" to clients and their families, along with a desire to provide quality services, should be the
driving forces for willingly examining these issues.
Following are some common countertransference issues for providers working with substance
Fear of contagion
Fear of the unknown
Fear of death, dying, grief, and loss
Stigmatization (e.g., of people with mental health problems, "addicts," people who are
HIV positive, homosexuals)
Powerlessness, helplessness, and loss of control
Shame and guilt
Homophobia
Anger, rage, and hostility
Frustration
Overidentification
Denial
Differences in culture, race, class, and lifestyle
Fantasies of professional omnipotence
Burnout
Measures of success and personal reward
Issues
Homophobia
To be aware of homophobic responses among treatment professionals and of their own
countertransference issues, it is important that counselors understand how the client is handling
his homosexuality. The counselor should understand the possible link between substance abuse
and gay or lesbian identity formation. Substance abuse can be an easy relief, can provide
acceptance, and, more important, can mirror the "comforting" dissociation developed in
childhood. The "symptom-relieving" aspects of substance abuse help fight the effects of
homophobia; substance abuse can allow "forbidden" behavior, allow social comfort in bars or
other unfamiliar social settings and provide comfort just from the dissociative state itself. For
example, some men have their first homosexual sexual experience while drinking or being
drunk. This connection is a very powerful behavioral link--the pleasure and release of substance
abuse with the pleasure and release of sex--and is very difficult to change or "unlink" later in life.
In regard to the issue of homophobia, it is also critical to understand how stereotypes affect the
treatment options offered. The professional should take an inventory of these stereotypes to
assess her homophobia potential and should be aware of the roles countertransference can play.
