Countertransference in therapy is one of the basic tenets taught in our therapist training right from the beginning.
But I’ve found that over the years, I have changed my views on countertransference. I want to share how and why my opinions have shifted.
As is always the case, this article reflects my opinions. It does not constitute any professional advice. So, keep that in mind while reading.
Let’s Define Some Terms
Before diving in, let’s define countertransference. According to the APA Dictionary of Psychology, countertransference is “the therapist’s unconscious (and often conscious) reactions to the patient and to the patient’s transference.”
We should probably also define transference. Transference is “in psychoanalysis, a patient’s displacement or projection onto the analyst of those unconscious feelings and wishes originally directed toward important individuals, such as parents, in the patient’s childhood.” (According to the APA Dictionary of Psychology)
My First Beliefs About Countertransference In Therapy
When I learned about countertransference as a grad student I had an understanding that I needed to try to inhibit any countertransference coming up at all costs. I felt that it would cause some sort of disruption to my clients.
I don’t think that’s what was explicitly taught. That was largely my projection. So in other words: my countertransference towards learning about countertransference. 😵💫
I felt like I needed to “fix” myself to be a better person. My underlying belief was that the person I was by default was not a good person and was going to cause problems. So I thought my countertransference was a problem, and I needed to nip it in the bud so it wouldn’t disrupt therapy.
My perspective has since changed.
Types of Negative Countertransference
Let’s be clear: not all countertransference in therapy is bad. Or harmful. Or disruptive.
Countertransference is just a data point.
But, let’s go through some of the more common types of negative countertransference that tend to come up in therapy.
According to William H. Sledge in the Encyclopedia of Psychotherapy, three kinds of problematic countertransference include:
1) Turning Away Countertransference
- Sledge states: “The turning away countertransference includes those kinds of reactions that represent some kind of reduction in interest or investment in the patient.”
- This is when you express boredom when listening to a client. You can’t pay attention, keep your eyes open, and are struggling to recall what the client said earlier in the session.
2) Activated Countertransference
- Sledge goes on to say: “Another form of countertransference that we identified is the activated countertransference. In this instance, empathy is hampered by an intensely positive or negative feeling toward the patient.”
- This is the type of countertransference that brings on the desire to fix something for your client or give them direct advice. It activates the therapist into motion rather than holding space for the client or developing some insight.
3) Unconscious Enactments
- Sledge explains that “another form of problematic countertransference are unconscious enactments. These problematic reactions entail the acting out of a technical failure without the experience of a conscious reaction in the form of a judgment of the failure.”
- This is when the therapist is unaware that they are repeating the same problematic dynamic that the client has experienced with other folks in their lives.
- Sledge gives the example of a client who has parents who always forgot about their appointments and important life events, and were not present. If their therapist forgets about the scheduled appointment, that would be an example of an unconscious enactment.
Does Countertransference Always Have To Be Negative?
Personally, when I learned about countertransference in therapy and heard about all the negatives, I tried to figure out how I could manage my countertransference.
That is why I resonated with a quote from a review of the book, Countertransference and Therapist’s Inner Experience: Perils and Possibilities by Charles J. Gelso and Jeffrey A. Hayes. The reviewer says, “Unfortunately, the authors emphasize the ‘management’ of countertransference, not ‘use’ of countertransference. No mention is made of more nuanced countertransference-related concepts.”
Does countertransference sometimes have the capability to be quite destructive? Absolutely yes. If it’s left unchecked and we don’t have any awareness of it, it will cause problems.
Does countertransference also have the potential to be incredibly helpful and beneficial? YES!
I think when we perpetuate a more negative reaction towards countertransference we can increase the likelihood of preconscious self-deceit around the countertransference. We don’t even know that the countertransference is there. When we mentally check in with ourselves we don’t see the issue. When in reality there is something there that needs to be looked at.
I’ve seen this happen in my own personal therapy. And then when I call out my therapist (yes, I love calling therapists out when I see them doing things they shouldn’t be), there is typically a defensive reaction. They say, “I’ve been doing it this way for 20 years.”
Can I Convince You That Countertransference Can Be Good?
The reason this topic is important to me is because I want to see countertransference as good. Even if the narrative of the countertransference is telling us to do something that might be harmful.
In other words, finding the good in countertransference doesn’t mean we have to act out whatever the countertransference is encouraging us to do.
For example, even if you believe countertransference is good, it doesn’t mean you should enact your attraction towards a client if that is how you are feeling. That is not what I am advocating for at all.
But, because you are human, you may find yourself in the position of feeling attraction towards your client. Rather than holding the narrative, “That’s bad. Shut it down. Do something about it.” You can shift the inner dialogue to, “Huh, that’s interesting. I’m feeling attracted to my client. Let’s take a look at that.”
I want to encourage us to see the countertransference as not inherently bad, but rather just as information. That way we can have a much healthier approach to it. It neither has to be repressed or enacted on. It’s just data.
Countertransference Is So Common
The example of feeling attraction towards your client is a textbook example of countertransference. And one that is a little more extreme. But, countertransference is happening all the time.
It’s manifesting in all the emotions that we have for our clients. If there is a lack of emotion, that is also a type of countertransference. Further examples of countertransference include all of the conscious and unconscious thoughts we have about our clients, as well as our body language.
Marie’s Opinions About Countertransference In Therapy
All of this to say, I believe:
- Countertransference in therapy is good.
- It offers useful data.
- We should approach it with curiosity.
If you are like me, and you have seen countertransference as a negative thing to avoid, I want to encourage you to shift your perspective. Instead, see it as something to observe and curiously explore.
Small Perspective Shifts Can Be Helpful
Even small tweaks in our language in consultation and supervision contexts can be beneficial.
In the past I have often posed this question to colleagues: “Do you think there could be any countertransference there?” And the nature of that question leaves the option that there may not be any countertransference at all.
So a question as simple as, “Can we explore your countertransference?” might be a more helpful question. When we ask the former question, folks may get defensive and may feel like they have done something wrong.
The Main Takeaway
The most important takeaway for me is that countertransference validates our humanity.
I think historically with the blank slate Tabula rasa mentally that we are often taught, it can feel like we need to try to eliminate all traces of our humanity to be an effective therapist.
As I mentioned before, I think when we do that it creates an environment that fosters unconscious self-deceit.
So it is much more helpful to say: I’m a human being. I have countertransference because that’s the way it is supposed to be.
So let’s embrace it and take a look at it. And then see what kind of puzzle pieces that adds to the full therapeutic frame that we’re working within.
Want More Of This Type Of Content?
If you like hearing my thoughts on therapy skills, I have a video that might interest you. This video dives into some research and my thoughts on how to actually improve our effectiveness as therapists.
Until next time, from one therapist to another: I wish you well!
-Marie
Image by Gerd Altmann from Pixabay
Photo by Sander Sammy on Unsplash
Photo by Jon Tyson on Unsplash
Image by Andrea Piacquadio on Pexels
Leave A Reply