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AIDS: The Therapist's Journey

A Classic Case of Countertransference

Ernie had been a patient of mine for five years when John, his best friend of 25 years and roommate for the past eight became acutely ill with AIDS and decided to return home to the mid west. Ernie felt very guilty that he had not tried to talk John into continuing to live in New York in their small studio apartment. I fully supported his decision about the impracticality of John's continuing to live with him but this proved to be a mistake because I had not explored Ernie's feelings thoroughly enough. Two weeks after John left, Ernie came to session enraged at me. Appropriately, he yelled at me for not having urged him to explore options about having John continue to live with him. Ernie was overwhelmed by guilt that he had abandoned John in his time of greatest need.

As I listened to Ernie and encouraged him to tell me all his feelings, I knew I had messed up and would need to examine this. During supervision I learned why I had behaved as I did in not attempting to explore Ernie's ambivalence.

My failure was largely a result of my experience with my older brother Henry who was also gay. As adults we were not close and, in fact, our first conversation after a three-year silence was his announcement that he had been diagnosed with AIDS and was going to return to New York to live. My decision to allow Henry to move in with me was impulsive -- I did not like him and did not relish the prospect of having him live with me I also did not want to become his primary care-partner but being an AIDS activist, I didn't see how I could refuse to offer my destitute and homeless brother a place to live. Henry lived with me for 14 months until he died in my bed.

At the time I was working with Ernie on this issue, Henry had been dead for two years. Interestingly, it was while exploring my reactions to Ernie that my supervisor, reminded me that, years ago, I had only told her about my brother moving in the day before he was due to arrive. I had neglected to discuss this situation with her and to explore my own ambivalent feelings and possible options before offering to let Henry move in. Because this occurred years before Ernie became my patient, I was unaware it was influencing me. In my unconscious desire to protect Ernie from the horrors I experienced as I watched my brother deteriorate, I had not been neutral in my role as Ernie's therapist.


Disclosing the Therapist's HIV Status?
Discussing Death
Professional Challenges of Psychotherapy with People Living with HIV/AIDS
Avoiding Burnout
Other Articles by Michael Shernoff

Published in A Perilous Calling: The Hazards of Psychotherapy Practice, M. Sussman, Editor, 1994: John Wiley & Sons by Michael Shernoff, MSW
© 1996 Michael Shernoff

Permission is granted to copy or reproduce this article either in full or in part, without prior written authorization of the author on the sole condition that the author is credited and notified of reproduction.

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This article was provided by John Wiley & Sons. It is a part of the publication A Perilous Calling: The Hazards of Psychotherapy Practice.