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The struggle to contain countertransference reactions to patients is among the major sources of stress for the beginning psychiatric resident (Garrad and Berg, 1983; Herzog et al., 1984). Certain patients may evoke feelings of hatred, frustration, hopelessness, or incompetence. The resident may become overly involved, protective, or preoccupied with some patients, or may become cynical, avoidant, and unmotivated with others. Punctuated by enactments, these states may add to the inevitable sense of distress that accompanies the first few months of residency. Very often, residents are confused by their lack of understanding of the origin of their emotional turmoil. If this state of anxiety is not properly addressed, a sense of demoralization and a potential for dysfunctional behavior ensues.
Although few would dispute the central role countertransference plays in the beginning resident's response to patients and the hospital milieu, the literature on the topic is surprisingly scarce, and a structured approach to the issue is often left to the creativity of supervisors and training directors (Book, ; Goine, ; Hunt, 1981; Stern et al., 1993; Tucker, 1994). It is an essential part of the resident's training to address how countertransference reactions are used or misused within the context of psychiatric treatment, how they can be properly addressed in the supervisory process, and how they can be used to help the trainee grow without intruding on the resident's privacy or turning supervision into psychotherapy. At our institution, we have developed a model to deal with countertransference that provides a structured and formalized approach to the problem. First, we set out to identify the most important factors affecting countertransference reactions in our residents. We carefully avoid touching on individual