Case Study


Case Study

Crossing Cultures: The Surprising Complexity of Countertransference

By Anatasia Kim, Lambers Fisher

July/August 2020


I wish my mom was more like you,” Kevin, my 16-year-old client, blurted out just as our session was wrapping up. His voice was sheepish as usual, but his tone was clear and decisive. No sooner had he spoken these words then his head fell downward. Staring at his mop of unkempt black hair, I opened my mouth to respond but realized I was at a loss for words. Even though we’d been working together for a few months, something about Kevin’s confession had caught me off guard.

Transference is nothing new in therapy. For those of us who work with children and teens, comments like Kevin’s are not uncommon. And if we’re being perfectly honest, we too may have thought, Why can’t my client’s parent be more like me? That is to say, countertransference is also nothing new in therapy.

Over the years, I’ve responded to many confessions like Kevin’s with the conventional clinical approach: wonder aloud about the feelings my young clients are attempting to redirect; gently explore their fantasy further; and then, even more gently, connect it back to their challenges with their own parent or caregiver. But Kevin’s case was different—more personal, in a way that took me by surprise. It made this ordinary occurrence of transference much harder to process. But in doing so, I learned some valuable lessons about examining my countertransference, especially when there’s a shared cultural element.

Kevin was first-generation Chinese American, and his relationship with his mom was consistent with a type of parent–child dynamic found in many East Asian cultures. As first-generation Korean American, it was one I intimately related to. Though my cultural familiarity was an initial asset in understanding Kevin and his mom, that proximity also made maintaining my objectivity and clarity in therapy more challenging at times.


Seeds of Countertransference

When Kevin’s mom, Julie, initially called me about her son, she came across as serious and discerning. She’d done her homework—about me, different types of therapy, and what sorts of questions to ask a prospective therapist.

“He’s behind in his schoolwork and really needs to get it together. He has finals coming up soon and two AP tests in May,” she told me. “I know you work with teens, but how exactly would you help Kevin? And how long will it take to see results?” Speaking with her felt like being cross-examined for a job I hadn’t applied for. But as a mom myself, I sympathized with Julie’s concerns, so I did my best to answer her directly and honestly. The next day, she emailed to set up the first session. I’d made the cut.

When we met the following week. Kevin presented as a typical teenager, with blue jeans, a well-worn gray hoodie, and little eye contact. Julie sat self-assuredly at the edge of my couch, and with surgical precision relayed her son’s recent challenges and her concerns about their impact on his upcoming college applications. Kevin had started feeling overwhelmed by the academic pressures of his junior year. He’d became anxious and depressed, and his sense of confidence had begun to wane.

Kevin took a backseat as Julie talked. Within minutes, he’d managed to slump so deeply into the cushions that his body looked like the bellows of an accordion that’d been carelessly dropped. I turned to him and asked, “Kevin, what do you think about what your mom just shared? Does that seem accurate to you?”

It took Julie nudging him, but he answered, “I don’t know, I guess. My mom thinks therapy will help.” For a second, it seemed he might really believe that, but a moment later he vacillated. “I don’t know,” he repeated, his voice trailing off.

Julie stared at him. The frustration and distance between them were palpable. The intense, personal familiarity of this moment percolated inside of me, and I had to remind myself that this mom and son were strangers to me: I’d only met them that day.

Julie was more than just the no-nonsense, take-charge parent; she was her child’s spokesperson and the executor of his experiences and feelings. What’s more, Julie was my mom, and I was Kevin. In a way, I was also Julie, and Kevin was my own teenage son. A complicated countertransference had started to brew, but I had yet to become fully aware of it. We had to move fast, after all: Kevin’s exams were coming up, and the goal of treatment, Julie had made crystal clear, was to get him unstuck as soon as possible.

The intense, personal familiarity of this moment percolated inside of me, and I had to remind myself that this mom and son were strangers to me: I’d only met them that day.

In the following weeks, I focused on providing Kevin with a safe and supportive space to unpack his emotional distress about school and his exams. Without Julie in the room, he was freer when he spoke, pushing his hair back and gesturing into the air as he described how he used to enjoy studying, tackling the challenge of it. Lately, all he wanted to do was avoid it, which only compounded the internal collapse he experienced at the thought of failure. I listened, I empathized, and we quickly developed a strong rapport.

Soon Kevin started to open up about his stress from tensions at home, mainly between himself and his mom. He admitted that he wished his mom would leave him alone instead of constantly trying to “help” him. He admitted feeling irritated and frustrated with her concerned pushing. Then came that sheepish declaration: that he wished his mom was like me. Thankfully, only a few minutes remained in the session, and after shaking myself from the surprise of it, I said, “What you just shared sounds important. Can we continue this next time?” It wasn’t a great ending, but we managed to say our goodbyes, and Kevin zipped up his sweatshirt and left.

Alone in the office, I started diving deep. No doubt there was the initial ego boost. How flattering, I thought. But then the complexity of the situation quickly took hold. His comment wasn’t that unusual, so why did you freeze up like that? That’s not like you. What gives?

Over the next week, I sought consultation with colleagues, admitting to the strong reaction Kevin’s comment had triggered in me. I knew that my countertransference, if left unexamined, might interfere with our work. At first, I framed the situation with critiques of Julie. “She really should ease up on her kid. So what if he’s not getting the best grades? She needs to let him take charge of his own life and make his own mistakes.”

But the more I talked about it, the clearer the truth became. Although not my style as a therapist, in my personal life, I was the tiger mom that Kevin complained about. One needed only to ask my own teenage son.


Lost in Translation

East Asian parenting is fraught with complex love communications that can be easily misunderstood through a Western lens. The seemingly ceaseless parental push for excellence in children can appear self-serving, depriving, unsympathetic, and even cruel.

But for those of us living it, the perspective from the inside is different. Our parents put in endless hours helping children succeed so that they might have fruitful and comfortable lives of their own and perhaps one day help support the family and contribute to our more collectivist cultures. Raising children differently could not only violate cultural norms, but also undermine their well-being. What we can see in our parents’ relentlessness that Westerners often can’t is devotion, great love, and a certain cultural selflessness.

On the whole, my own acculturation was a good thing for my family: it allowed me to navigate American society more easily, including helping my parents translate and broker systems and customs they struggled to understand. But growing up as first-generation Korean-American, I also struggled to reconcile the increasing cultural divide between my parents and me.

Of course, the longing to pull away during adolescence crosses cultures, and a therapist working with teens of all backgrounds could easily fall into the same countertransference trap I found myself in. But competing cultural views and practices made the situation more complex—and personal. Like any teenager, Kevin wanted to test boundaries, challenge conventions, and individuate. But he and Julie also found themselves at the crossroads of two diverging worlds, where basic expectations were in conflict. I understood this intimately—from both sides.

As much as Kevin knew his mom was trying to help, he was seeing her love through an American lens, which made her strict rules and stern lectures feel intrusive and oppressive. For Julie’s part, the more he challenged and resisted her cultural values, the more her anxiety grew, and the stronger her need for control.

The divide between Kevin and his mom was the same one I feared might grow between my own teenage son and me. Even though I’d become more American than my mother, I was and will remain more Korean than my son. What had left me speechless in my session with Kevin was the sobering realization that even second-generation parents and their children can become painfully separated when cultures collide.

Suddenly, what I needed to do became clear. Beyond helping Kevin prepare emotionally for his upcoming tests, I knew I needed to help mother and son find their way back to each other. In his own way, I could see that Kevin wanted this. And by bringing him to me instead of a tutor, Julie seemed to have been asking for it too.


Finding Our Way Back Home

The following session, I picked up where Kevin and I had left off. “I’ve been thinking a lot about what you said at the end of our session last week,” I began. “Could you tell me a little more about what you meant when you said you wished your mom was more like me?” Having unpacked my own countertransference, I felt ready to explore whatever emerged.

Kevin shared his feelings readily, especially his frustration about how different his life felt compared to that of his friends, how much freer they were to goof off and be themselves. “Why can’t she just focus on something besides grades and the future?” he asked. “I’ll get into college, and you know what? I can’t wait! It’ll mean I can finally get away from her.”

He said his mom being more like me would mean she would be calm, understanding, and supportive. But even as he admitted this, I could see his mouth tighten. He sat back deeper into the couch and took a breath. “I mean, I know she loves me. I don’t know. . . . Maybe I’m not grateful enough.”

“You’ve been holding in a lot,” I said. “Thank you for sharing it. It may not always be obvious to the both of you, but at the end of the day, there’s clearly a deep love between you and your mom. And it makes sense that sometimes the two of you lose your way. She’s unwilling to let you fail, so she digs in just when you want her to leave you alone. You’re 16, so you don’t want her constantly hovering. Maybe even when you could use help, you don’t ask for it because it means she’ll hover more. You want to be in control of your life, but no matter how much you tell her that, she doesn’t seem to get it. Does that sound right?”

Kevin nodded, but his gaze remained on the floor. “And to complicate things,” I continued, “you were raised to respect your elders, so you go along with mom on the surface but inside you’re miserable. I also wonder if being Chinese has something to do with this.”

At this, he looked up and his eyes widened. For a moment, I thought he might be offended, but then I realized he was curious. Treading carefully, I explained how in many immigrant and multicultural homes, family members relate to each other from divergent cultural views that can increase the risk of misunderstandings and relationship ruptures. We discussed stereotypes of East Asian parents and how they “obsess” about their kids’ grades and college, how they communicate love by constantly worrying and controlling. We talked about how East Asian children, like him and me, straddle two worlds, which constantly pull us in different directions. It was an unapologetically honest and much needed discussion.

As he stood up to leave, Kevin paused and hesitantly asked, “You have kids, right?”

“Yes, two,” I told him, and then I answered the question that I knew he wanted to ask. “Yes, I’m a total Asian mom at home.”

He seemed amused and relieved. “See you next week,” he said.


The Road to Repair

In the following weeks, Kevin and I revisited our cultural conversation as I expanded our treatment goal: beyond continuing to help him overcome barriers to his schoolwork, I aimed to help mom and son find their way back to one another.

When I next checked in with Julie, I took some time to self-disclose about my own cultural parenting struggles. She was tearful and I tried to normalize her pain. We met a few times more, just Julie and me, before she and Kevin traveled to China for summer break. It was clear how much she’d needed to be seen and affirmed.

After the break, I resumed work with Kevin, now a senior. He brought me a gift from abroad, a pretty jade hair clip that his mom had picked out. It was a conventional cultural gesture of gratitude, and I accepted it without hesitation. When Julie appeared to pick up Kevin after this session, she told me, “Kevin has been in such a good mood this summer. I know in part it’s because he didn’t have school, but I think it’s also because of you. I haven’t had such a pleasant time with him in years.” Mom and son were finding their way back.

When Kevin got accepted into several respectable colleges that year, Julie insisted he could’ve gotten into better schools if he’d taken his SATs a third time. But when she emailed me a graduation picture of Kevin, sandwiched between his parents and beaming in his cap and gown, I saw her eyes were dancing with pride.

It would’ve been easy for me to criticize Julie at first for what seemed on the surface to be a lack of compassion and support for her son. But then I would’ve failed to capture the full story—the nuanced intersection between intentions and meanings I understood from a personal, cultural perspective. And yet, my experience with Kevin and Julie taught me that even when we share cultural similarities with our clients—or perhaps especially when we do—we need to take the time to deeply examine our familiar views and hidden biases.

It also reminded me that regardless of cultural backgrounds, parenting is one of the most humbling and challenging jobs there is, especially given the intense competition to succeed and the problematic social critique of all parenting styles around the world.

I realized my training as a child psychologist hasn’t immunized me against my own cultural struggles as a parent. As my son begins to prepare for the college application process, not surprisingly, I find myself helping (read: hovering over) him. When I catch myself, I try to take a step back. Some days this is easy, other days not so much. But I keep close the insights I gained from working with Kevin and Julie: in spite of inevitable missteps, we each have a deep capacity to find our way back to those we love.

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CASE COMMENTARY

By Lambers Fisher

Therapists are often tempted to conclude that the existence of countertransference is a therapeutic failing or a sign of unprofessionalism—as if a “good” therapist should be immune to the experience of countertransference in the first place. On the contrary, it’s the attempt to somehow ignore countertransference that damages therapeutic rapport and effectiveness. Anatasia Kim’s case offers the example of a clinician who processed her feelings professionally, including the unique influence of culture in her internal struggle, and was able to use them in ways that benefited her client.

Not everyone from the same broad cultural group has exactly the same experiences, so sharing this identification can lead to wrong assumptions and misunderstandings. Yet, when used appropriately, recognizing cultural similarities and values can enhance the therapeutic bond, speed up the process of trust building, and reduce the likelihood of a clinician making offensive comments or coming to biased conclusions. As in this case, it can also help in more clearly identifying clients’ needs and choosing appropriate treatment strategies. Here Kim was able to use her own cultural background to better understand the mother–son bond in a way that enabled her to empathize with both of them and assist them in coming to better understand each other.

Since culture encompasses more than just ethnicity (and includes age, gender, family roles, socioeconomic status, religion, and more), there are many ways in which we all may find similarities between our cultural experiences and those of our clients. All mental health professionals can learn from Kim’s experience about making intentional efforts to better identify countertransference feelings when they arise, maintain healthy boundaries to reduce unhealthy biases, and strategically use cultural similarities to increase understanding and therapeutic rapport.

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Anatasia Kim, PhD, is an associate professor at The Wright Institute in Berkeley, CA. She has a private practice and provides consultations and trainings to organizations on matters related to diversity, equity, and inclusion. She’s the coauthor, with Alicia del Prado, of It’s Time to Talk (and Listen): How to Have Constructive Conversations About Race, Class, Sexuality, Ability & Gender in a Polarized World. Contact: anatasiakim.com.  

Lambers Fisher, LMFT, MDiv, is a marriage and family therapist, national speaker, and adjunct instructor at Crown College on topics of multicultural awareness and diversity. His Diversity Made Simple trainings help increase the cultural competence of professionals in fields of mental health, education, clergy, and law enforcement. Contact: lambers@lambersfisher.com.

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ILLUSTRATION BY SALLY WERN COMPORT



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