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Countertransference issues in therapy with HIV-positive street-involved individuals.
Scott M; Tucker P; Flood K; Rodrigues J; The Street Project, Vancouver,
January 30, 1997
Int Conf AIDS. 1996 Jul 7-12;11(1):182 (abstract no. Mo.D.1744). Unique

Issue: Creating and maintaining a therapeutic alliance with HIV-positive street-involved individuals involves unique issues of countertransference for the therapist. Project: In a group discussion format, therapists with different levels of experience in this field examined and identified factors and issues specific to working with street-involved HIV-positive persons, what our responses are, how they affect the course of therapy, identifying problem areas in the therapeutic relationship, and what to do about them. Results: Factors identified which contribute to the uniqueness of therapy with this population in addition to their HIV status include the frequency and severity of past and present stressors in our clients' lives, their lack of resources, and the prevalence of violence and early death in their lives. A survey of issues our clients face reveals recurrent themes: multiple trauma, multiple losses and chronic grief, addictions, isolation, poverty, identity issues, system involvement and dependency (i.e. social services, child welfare, judicial), other health issues and mental heath concerns. Add to this list HIV/AIDS related issues such as confidentiality and disclosure, fear, anticipatory grief, body image, family and relationship issues, and future planning, among others. The interaction between these issues and the therapist's cumulative experience evokes intense and sometimes overwhelming countertransference responses and may contribute to burn-out'. Feelings of isolation, withdrawal, helplessness and powerlessness, chronic anticipatory grief reactions, blaming the victim', heroic' rescue efforts, and blurred boundaries have been noted in our work. Incidences of vicarious traumatization were also observed. Strategies to work through countertransference included a high level of immediacy with clients, extensive case review, case conferencing and peer support, clinical supervision, education, and self-care. Lessons Learned: Therapeutic relationships with street-involved People Living with HIV/AIDS necessitate therapists' observations of and working through intense countertransference responses.

*Countertransference (Psychology) *Homeless Persons *HIV Seropositivity/THERAPY *Life Style