Guest Blog – ‘Getting the Ick’

Phillip Ellington, a graduate of the Trust, recently had extracts from his Advanced Diploma research published in the February issue of Therapy Today.

We have published the full piece in which Phillip explores that we experience existential threats from other people in proportion to their difference from ourselves and that we may experience degrees of threat in every encounter including the therapy space.

Extracts originally published in Therapy Today, February 2025.

 

I first heard the ugly phrase in the title on TV’s Love Island. It seemed to me perfectly precise in articulating the first apprehension of disgust, the leading edge of cortisol trickling into the system. For Love Islanders it means that something queasily objectionable about a romantic prospect is just coming into view. If the ick should develop fully, any possibility of romance will be quite gone. ‘Icky’, like its etymological cousin “yucky”, evokes the sticky sound of revulsion. And this is indeed what the phrase ‘getting the ick’ is connoting, the activation of the autonomic disgust response. My interest in this complex emotion grew out of an eruption of exactly this kind of visceral disgust towards a female client. Approaching the end of an otherwise unremarkable session, a German-born, middle-aged woman, launched into a diatribe against the Jews and cast doubts about the true scale of the Holocaust. What she didn’t know was that I’m the middle-aged son of a German-born Jewish Holocaust survivor. In this respect we were uber-chalk and super-cheese. The shock was anaphylactic. This incident was explored as part of my advanced diploma qualitative research. What emerged from that process was a new appreciation of the role disgust plays in social relations. In this article I aim to explore disgust in a therapeutic context and some of the implications it raises for countertransference theory.

 

Thought to be unique to humans¹, the emotion of disgust likely evolved to help us avoid our greatest predator, pathogens. This is evident in how we are especially disgusted by vectors of disease like bodily fluids, vermin and insects. That disgust also helped our ancient ancestors avoid poisons is clear from how babies instinctively react to bitterness. But the disgust response only fully develops after the age of three. It needs a measure of life experience, social input, and cognitive capacity before it fully manifests. This points to disgust also having a socio-moral function. Differences in physical attributes, social norms, moral values or cultural practices can trigger the same perception of existential threat as faeces and poison berries. In this sense, disgust acts as a cultural cordon sanitaire, enforcing tribal boundaries against outsiders and reinforcing our own self-concept. That outsiders pose an existential threat is proven by colonial history, but studies show that even within a tribe dissimilarity can elicit disgust². For instance, something that gives me the ick is people talking with their mouths full. I know it’s silly, but I can’t help it. It’s a legacy of my parents’ small obsession with table manners. Because the purpose of table manners is not really the socialisation of children at mealtimes. These arbitrary constructions signal social status, identifying who is and who is not a member of the in-group. Sometimes that can be a matter of life and death. It is said that a French noblewoman fleeing the revolution disguised as a maid was betrayed to the guillotine by her refined table manners. And though I’m generally no stickler for table manners, my disgust model learned to see speaking while chewing as a lethal threat. Perhaps the added potential of spraying saliva helped activate my pathogen avoidance.

 

So, what gives you the ick? I don’t mean council tax or climate change. I mean the full-on, visceral, bowel-loosening, gut instinct associated with the fight flight reflex. What activates this in you?

 

Some of what you might find is likely wrapped in shame. Body odour, bodily functions, nudity and sex typically elicit shame as well as disgust. It seems there is a neural overlap in the areas of the brain involved in both. This is evident in the phenomenon of parcopresis, being ‘poo shy’. This is where shame over the imagined disgust of others elicits disgust towards the self. Such shame reactions may have originally developed to mitigate the potential social cost of disgust ³.

 

Other things that give you the ick are likely to be gustatory. The taste of olives or the look of oysters may induce a tell-tale queasiness. Yet other things might be entirely conceptual. The thought of stepping in dog shit can elicit the same level of disgust as actually doing it. What this points to is the social construction of the disgust response, it’s learnedness. How each tribe learns to exploit local resources becomes, over time, part of their cultural heritage, their distinct ‘disgust model’. In Sardinia, for instance, Casu Martzu cheese is best served with maggots still wriggling. Icelandic Hakari, or fermented shark meat, is famously revolting. (We, on the other hand, have lava bread, tripe and Marmite.) That’s not to say our tribal disgust models are fixed. Social attitudes constantly change and disgust models with them. Indeed, our capacity to adapt to changing conditions and new sources of calories has been crucial to our survival as a species.

 

But even while societal attitudes evolve, innate predispositions may resist change at the individual level. Our personal disgust model, rooted in our biological, psychological, social, and cultural identity, becomes closely tied to our worldview. The disgust model learned in childhood remains while the world around us changes. The table manners my parents drummed into me, for instance, were far less onerous than those drilled into them. My mum was taught to eat bananas with a knife and fork! So, the disgust response may also play a defining role in shaping intergenerational dynamics. Elders of the tribe feel disgusted by the progressive lifestyles of youth, while the young feel equally disgusted by their elders’ outdated values. There are many historical instances where violent conflict between generations is underpinned by disgust eliciting language. During the 1960s cultural revolution in China for instance, Maoists routinely described the older generation as “venomous vipers”. And in the 1978 Iranian revolution, the older generation of monarchists were denounced as “Westoxified”, implying they were contaminated by Western values³.

 

Not only is the disgust model adaptable, but it is also highly suggestible. In American prisons, noxious odours have been tried in aversion therapy treatments for sex offenders. In Mein Kampf, Hitler used the body as a source domain for metaphors of the German state, deliberately invoking the disgust response by describing Jews as “maggots in a festering abscess”⁴. Again, in Rwanda in 1994, the genocidal slaughter of Tutsi “cockroaches”¹, was presented as a matter of public sanitation. If Nazi Germany and Rwanda seem remote enough to reassure us that the same thing couldn’t happen here, it’s worth noting that both sides of the recent Brexit debate used similar dehumanizing metaphors, contamination rhetoric, and expressions of moral revulsion. In June 2016, for instance, The Guardian described Brexiteer Nigel Farage as a toad “flapping his greasy paws”. While the right-wing Daily Mail described remainers as “traitors”, the left-wing Mirror called Brexiteers “enemies of the people”. Meanwhile, The Times published a cartoon of Nigel Farage and Boris Johnson as two flies feeding on a Brexit turd. Across the media landscape, the rhetoric of disgust helped create the climate of hostility that emboldened fringe actors to engage in often violent public confrontations.

 

Rachel Herz argues that disgust plays a major role in social tensions around class, race and ethnic divisions¹. Ian Miller writes that disgust permeates “the contempt teenagers have for adults, women for men, servants for masters, workers for bosses, Jews for Christians, blacks for whites, the uneducated for the educated, and so on”². Neither Herz nor Miller extend their exploration of disgust into intersectionality theory which seeks to understand how forms of discrimination overlap and mutually reinforce systems of power and oppression in peoples lived experience⁵. Intersectionality theory doesn’t discuss the disgust response directly either. This is perhaps surprising given that the intersecting circles of intersectional advantage and disadvantage could also be seen as the boundary edges of clashing disgust models. And studies show that visceral disgust underpins the dehumanising of marginalised groups and is abundantly present in, for instance, manifestations of homophobia.

 

So far, I’ve shown how the disgust response is an adaptive shield against out-group infection. John Bowlby⁶ posits the innate fear of strangers as a protective stick-close-to-mama function. But from an evolutionary perspective, it may also represent the protection of group resources. Outsiders may carry alien pathogens, but equally they may be freeloaders bent on benefiting without reciprocal sharing. When calories are hard-won, freeloaders threaten the existence of the entire tribe. So, the activation of the disgust response towards strangers may have been as crucial to human survival as the instinct to form tribes.

 

I’ve used the word ‘tribe’ to denote social groupings, but this may not be the most useful term. We tend to associate it with distinct ethnic and cultural groups such as the Yoruba or the Cree. But as Zygmunt Bauman argues⁷, in our post-postmodern era, the ancient tribal bonds of ethnicity and common culture have been atomised. As sources of identity construction, Bauman suggests that social groupings now coalesce more around shared interests, patterns of consumption and lifestyle choices. Though he discussed the negative psychological impact of such unstable social bonds, he never commented on Bowlby’s opposing drives to become an insider and avoid outsiders. Though related, Bauman’s and Bowlby’s theories seem to occupy quite separate domains. The same seems true also of the disgust response and countertransference theory. I would suggest that the way we currently conceptualise countertransference, both in the classical concept of misdirected neurosis and the broader totalist concept of intersubjective dynamics, falls short by not integrating the role of the sympathetic nervous system. Indeed, the disgust response may be present in every therapeutic encounter to the degree that therapist and client disgust models differ. While countertransference theory encompasses the therapist’s reactions to their client, the sympathetic nervous system governs physiological arousal. On the surface, these two concepts belong in quite different domains with little empirical research or theoretical conjectures that explicitly explore psycho-physiological arousal in the therapist. Yet, it was exactly an incident of this kind, as described earlier, that brought the disgust response into focus.

 

When I reflected on my reaction to my antisemitic client, it wasn’t actually her denial of the Holocaust that unhinged me. I’d usually meet that notion with the same patronising smile I give flat-earthers. But what she denied in one breath she justified in the next, saying “They brought it on themselves, and everyone benefited!”. Her bland dismissal of institutionalised mass murder as simply expedient evoked the existential threat Hannah Arendt described as “the banality of evil”⁸.

 

My adverse reaction could be seen as activated negative countertransference arising from my own unresolved psychological difficulties. In this context dislike is seen as a countertransference projection rather than an authentic response to disagreeable aspects of the client. Indeed, the theory fails to distinguish between the client whose personality might evoke dislike in any therapist from those whose particular characteristics might energise a particular therapist’s emotional wounding. As Linn Walton & Pardasani⁹ point out, such a distinction is important since working with displaced emotions is very different from working through genuine blocks toward the client based on the therapist’s personal history. The ethical code demands respect for a client’s autonomy, regardless of their personal beliefs. But the therapist is also responsible for their own safety and well-being and in this respect, the concept of negative countertransference doesn’t adequately account for intersectional factors. In effect, my second-generation Holocaust survivor reaction to an apologist for the Holocaust is pathologized as dysfunctional. The same might be said of a black therapist’s negative reaction to a white supremacist, a Muslim therapist’s negative reaction to an islamophobe, or a gay therapist’s negative reaction to a homophobe. Many therapists openly declare their unwillingness to work with paedophiles. Perhaps this personal embargo is acceptable because it marginalises individuals who would outrage most disgust models. But I wonder if the same acceptance might be extended for similar embargoes against racists, fascists, or indeed, Holocaust deniers.

 

The experience left me feeling demoralised and deeply unskilled. Apparently, this is not unusual. Linn Walton & Pardasani⁹, find that while therapists disliking a client is common it is rarely conceptualised as negative countertransference, but for the most part it is seen as a personal failing. Judith Herman¹⁰ also speaks of trauma in countertransference leaving therapists feeling helpless and personally incompetent. I was definitely in that camp.

 

In supervision, I was advised to view the incident as an opportunity for personal growth and professional development. In a way, this is what I did. On reflection, my client’s attitude towards the Jews may have stemmed from the same traumatic world events which disrupted my own family history. We were two sides of the same coin, a child of the murderers meeting a child of the murdered. I wrestled with the notion of disclosing my feelings and perhaps using this material as part of the therapy process. Views around the disclosure of negative countertransference are conflicted. Freud would never have endorsed it, but his student Sandor Ferenczi believed that withholding any authentic feelings would be a “trauma inflicted on the patient”¹¹. His approach was “to make the source of the disturbance in us fully conscious and discuss it with the patient”¹¹. Kernberg, a countertransference totalist, also suggests exploring negative feelings with clients. Winnicott advises that well-timed disclosure enables the therapist to discharge negative feelings in a controlled way “enabling me to tolerate the situation…”¹². A general body of opinion formed around the tactical disclosure of negative countertransference as promoting clarity and authenticity within the therapeutic dyad. Diana Whitmore sees this as the counsellor emerging from anonymity to offer “authentic human relating”¹³. A more radical approach also emerged, which sees disclosure as an everyday part of the therapists’ repertoire. Harold Searles in particular, argues for an almost aggressive use of disclosure, writing of his willingness “to needle and infuriate the apathetic… patient into more overt relatedness”¹⁴. But there are negative feelings, and there are negative feelings. There’s boredom, irritation, anger, even open hostility, but could it ever be in service of the client to disclose that they disgust you? To calmly say, “I notice I feel disgusted by you” seems to me as destructively final for a therapeutic alliance as for any other kind of interpersonal relationship. So, in this instance, I inclined towards Paula Heinmann, who writes that “such honesty is more in the nature of a confession and a burden to the patient”¹⁵.

 

I probably should have referred my noxious client on to another therapist. But referral is itself not harmless. And should I explain myself to the client and risk the harm potential in that, or excuse myself with a white lie? As it was, the dilemma was resolved by her deciding to withdraw from therapy. I’m still not sure if she left because she felt my skin crawling. This uncertainty is apparently typical in withdrawal ruptures where it is hard to know if the cause was interpersonal between therapist and client, or intrapersonal with the client alone¹⁶. Perhaps this ambiguity is why therapists report withdrawal ruptures leaving them feeling guilty, less ‘present’ and less competent than other kinds of rupture.

 

So, this was the incident that prompted my research into how other psychotherapists met and managed situations of activated disgust response with their clients. My research participants were four psychosynthesis practitioners, a transpersonal modality founded by Roberto Assagioli, a one-time student of Freud and a friend of Carl Jung. Three of the four used words and phrases redolent of an activated disgust response in their descriptions of therapeutic encounters. Lucy described a woman who habitually arrived unkempt and unwashed. Body odour is a universal trigger for pathogen-avoidance¹ and this effect is evident when Lucy says she felt “threatened they were going to engulf me”. Sarah, a psychotherapist and supervisor, described a client’s self-pity as “repulsive”, saying she had “that sort of feeling just before you gag”. This reference to bodily elimination strongly indicates the activation of pathogen avoidance. Or, perhaps her client’s identification as victim activated a survival instinct known as “perpetrator disgust”¹. This is seen in combat where winners in battle show excessive cruelty towards losers who become entirely dehumanised. Halima, also a psychotherapist and supervisor, and a Muslim actually used the term “icky” about a particularly objectifying client. Being objectified doesn’t in itself suggest the activation of pathogen avoidance, but her client’s overtly sexualised behaviour may have impacted her in ways specific to her belief system. Intersectional outrage may have triggered Halima’s disgust response. Halima also reported focusing on her breath to enable herself to remain in physical proximity to a client who, after two years working together, admitted to historical child abuse and murder.

 

Despite finding many instances of the activated disgust response, none of my participants reported referring their clients to another therapist. All of them relied, to varying degrees, on supervision, though one stated a resistance to disclosing the intensity of her negative feelings for her client. All four spoke of the use of a key principle in psychosynthesis, “bifocal vision”¹⁷. This concept, unique to psychosynthesis, involves maintaining conscious awareness of the client as both a personality mired in existential circumstance and as a soul with meaning and purpose reaching for a fuller expression of self. While one lens holds a therapeutic focus on dysfunctional patterns and defences, the other holds awareness of the client’s fundamental wholeness and higher potential. Across the data, it was this bifocal vision that helped my research participants engender empathy and sustain the therapeutic alliance, however hair-raising the presenting personality might be.

 

The disgust response formed only a part of my dissertation and from the dearth of studies on the subject will likely attract further research. In the meantime, I hope to have raised some awareness with this article. The intense social competition the Love Islanders endure makes them highly sensitive to the early signs of cortisol trickling into their own sympathetic nervous systems. It seems important that we therapists are equally alert to the same signals.

 

References

1. Herz, R., 2012. That’s Disgusting. New York: Norton & Co.
2. Oaten, M., Stevenson, R. & Case, T., 2009. Disgust as a disease-avoidance mechanism. Psychological Bulletin, 135(2), pp. 303-321.
3. Miller, I., 1997. The Anatomy of Disgust. Cambridge (Mass): Harvard University Press.
4. Rash, F., 2005. Metaphor in Adolf Hitler’s Mein Kampf.
5. Crenshaw, K., 1989. Demarginalising the intersection of race and sex. University of Chicago Legal Forum, Issue 1, Article 8.
6. Bowlby, J., 1969. Attachment and Loss. New York: Basic Books.
7. Bauman, Z., 2000. Liquid Modernity. l.:Cambridge Polity Press.
8. Arendt, H., 2022. Eichmann in Jerusalem: A Report on the Banality of Evil. London: Penguin
9. Linn-Walton, R. & Pardasani, M., 2014. Dislikable Clients or Countertransference: A Clinician’s Perspective. Clinical Supervision, 100-121.
10. Herman, J., 1992. Trauma and Recovery. New York: Basic Books.
11. Ferenczi, S., 1988. The Clinical Diary of Sandor Ferenczi. Cambridge Mass: Harvard University Press.
12. Winnicott, D., 1949. Hate in the Countertransference. International Journal of Psycho-Analysis, Issue 30, pp. 69-75.
13. Whitmore, D., 1991. Psychosynthesis Counselling in Action. London: Sage.
14. Searles, H., 1965. Collected Papers on Schizophrenia and Related Topics. New York: International Universities Press.
15. Tansey, M. J. & Burke, W. F., 1995. Understanding Countertransference. New York: Psychology Press.
16. Eubanks CF, B. L. G. M., 2018. Clinical Consensus Strategies to Repair Ruptures in the Therapeutic Alliance.. Journal of Psychotherapy Integration, 28(1), pp. 60-76.
17. Assagioli, R., 1965. Psychosynthesis: A manual of principles and techniques. New York: Penguin Books.

 

About the author

Phillip Ellington is a psychosynthesis psychotherapist holding a level 7 diploma from the Psychosynthesis Education Trust. The content of this article is drawn from an original piece of qualitative research into the nature of love as an aspect of the therapeutic alliance undertaken as part of my advanced diploma dissertation.