Tempering the Untempered: Reflections on Growth and Countertransference

After a long and tiring clinic day at outpatient child and adolescent psychiatry, I start co-signing trainees' notes.One sentence toward the end of a note draws my attention: "Of note, throughout the appointment, mom was overelaborative, constantly made demands, was irritable at times."I search my memory to make sure I remember correctly, but I don't recall the mother being unreasonable or demanding.I think she was appropriately concerned and wanted to understand how we conceptualized her child's difficulties.I feel baffled for two reasons.First, I couldn't believe that my trainee and I, both mental health professionals, had such different perceptions of a shared experience.Second, I question my own teaching skills for not creating a space where my trainee could vent and debrief.I am by no means the most self-aware person in the world.Despite being a psychiatrist, I sometimes miss subtle nonverbals.I sometimes say awkward things and feel bad afterward.Like any psychiatrist, I have "mental patient encounter recordings" that I "replay" from time to time, the moments that make me cringe but help me make sure I don't repeat the same mistake.I know I am human.I also know that trainees are human.Yet I wonder how this skill can be taught without shame or guilt.Gabbard reminds us that countertransference is not merely a reaction to the patient but a mirror into the clinician's inner world, a tool for understanding rather than judgment [1].Every psychiatry trainee knows what countertransference means, but how can they notice it in the moment?And for us, as supervisors, how do we correct them tactfully without wounding and making trainees feel vulnerable?How can we help them grow to be appropriately boundaried without making them perceived by their patients as cold, insensitive, or even worse, indifferent?