What is Countertransference in Therapy? Let's open the doors - myShrink

What is Countertransference in Therapy?

It's a truly gratifying moment when a client's consciousness finally shifts. I can literally feel the penny drop. It's especially rewarding when, with just a glance, we wordlessly acknowledge their achievement.

Counseling Psychologist Dr. Susan LaCombe in a thoughtful pose about countertransference moments

Dr. Susan "Shrinklady" LaCombe, Therapy Coach

What I like most about these pivotal moments with clients is that it reminds me of my own experience.

 I want my clients to feel as I felt, so when they pass this milestone I'm filled with the warm memory of my own transformation.

This feeling of wanting more for my clients - sometimes more than they ever dreamed of - is actually a form of countertransference.


from Dr. LaCombe

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What exactly is countertransference?

 A modern definition of countertransference includes any feelings, thoughts or preoccupations, fantasies and sensations that a therapist experiences in regards to working with a client. 

On the positive, countertransference can serve as a useful therapeutic tool which mirrors to the client how others may be experiencing her similarly. 

On the negative, countertransference has the potential to cause serious disruptions in the therapeutic process if the therapist is not able to distinguish between his or her own issues and those of the client.

Countertransference is often the root cause of boundary crossings and boundary violations in therapy.

Types of countertransference 

Countertransference may be . . .

. . . benign: 

eg. Therapist thinks: "I hope he (ie. the client) gets through this bad patch." 

. . . false positive:

eg. Therapist thinks: “I’m so furious. I need to protect my client from that abuser.” (ie. the therapist is having a rescue fantasy). 

. . . negative:

eg. Therapist thinks: “Oh man, I’m so frustrated with my client - she’s not changing at all.” (ie. this therapist is feeling guilty about not being able to help the client change and has taken on too much responsibility).

. . . for further exploration: 

eg. Therapist ponders: “Uhm, I feel drained being with this client. It feels as if she wants me to “fill her up”. I wonder if she has a hard time keeping friends.”.

. . . for alerting a therapist to issues interfering with the therapy:

eg. Therapist laments: "She’s cancelling again. Gee whiz, doesn’t she like me?" (ie. the therapist’s own neediness to be liked is getting triggered.)

In the above example, if a therapist is overly concerned about liking her, she may be less than honest about some emotional issues the clients is revealing. 

In this way the therapist avoids the risk of pushing the client away - but of course at the detriment to the client's growth.)

Warning signs of countertransference

You've heard it before:

"Therapists become therapists because
they need therapy themselves."

It's our greatest fear - that our therapist's own issues will leak into the session and Yeeks . . . 

"I’ll be worse off than I was before
 I started therapy!"

(Seriously though, if you feel your therapist is not owning his or her own stuff or your therapy is stalled because too much is unspoken, consider a therapeutic consult.)

Here's my take on that. Yes, talk to talk to another therapist about your therapy

Countertransference: when you're a therapist:

  • You often get triggered into a negative mood after seeing the client.
  • You find yourself ruminating about the session. You can't shake the feelings that get stirred up within you.
  • You find yourself reacting differently than you do with other clients.
  • You're not maintaining the same boundaries as you do normally and feel this client is "special".

Countertransference: when you're a client:

As clients, we might notice countertransference in our therapist - sometimes even when our therapist doesn't see it

Here's a few examples:

  • Your therapist acknowledges that you're unlike other clients and that you are "special" in his or her eyes.
  • Your therapist challenges you so much you often end the session feeling worse than when you began.
  • Your therapist shares some of her own history. She leans on you to such a degree, you become worried for her.
  • Your therapist is lackadaisical and never seems to know what time it is. You've gotten used to telling her when the hour is up.
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Countertransference and boundaries

If countertransference is not acknowledged, the boundaries between the therapist and client can easily become blurred.  

Here's a classic example. If I'm going through a particularly bad divorce at the same time as my client - it'd be very important that I not let my feelings for my ex-husband interfere with my client's own feelings regarding her divorce. 

Countertransference in friendships?

Oh for sure . . .  countertransference shows up in all relationships. We just don't call by that name. Like in the following vignette, you'd say Joanna is "taking on" Lynda's stuff.

This vignette is not a therapy scene. However, it'll likely be somewhat familiar to you. I'm using it as a way to show you - in a body-based way - how countertransference and blurred boundaries could potentially interfere with your therapy. 

In this instance, it's a case of someone taking too much responsibility for another person. In my experience, it's one of the more common issues that surfaces in clinical supervision ie. the therapist is taking too much responsibility for the client's progress.

As you read the following, imagine yourself as Lynda siting with your friend Joanna. Notice how the boundaries of Lynda's situation is getting blurred by Joanna's own unresolved history.

--------------------------------------

Lynda is sitting with her girlfriend Joanna. She's close to tears as she gingerly shares the details of her predicament. It's hard putting into words what's happened as the shame is overwhelming.

Her boss had been making sexual advances for some time - she hadn't told anyone. Neither had she openly addressed it - she just kept putting him off. She preferred to think that her years of long hours and strong work ethic would get her recognized - and ultimately promoted. Now she's learned she's being passed over for a promotion she was promised. 

Joanna is incensed. Her own work history was marred by a similar situation. Watching Lynda struggle through her shame triggers Joanna's early wounding and the shame of her own upbringing with a father who was blatantly disrespectful.

She jumps out of her chair and exclaims "why that jerk" she says. "He can't do that. This is outrageous."

Joanna's on a roll. She's clearly worked up - even more than Lynda who is now patiently sitting trying to absorb what Joanna is saying. 

Countertransference and your therapist

You can see that Joanna has taken up Lynda's cause. The reality is her 'worked up' feelings have arisen from her own history. She's "carrying" Lynda's load and making it her own.

Now step back and imagine that Joanna is Lynda's therapist.

If Lynda's therapist had reacted as Joanna had, the countertransference would have been clearly evident. You'd recognize that Joanna is reacting from her own painful past and less from the perspective of her client. 

In this instance, Joanna's feelings (ie. the therapist's feelings) are known as countertransference. 

You might also imagine how unhelpful this over reaction is to Lynda. In fact, if you were to ask Lynda, she might agree that the more worked up Joanna got, the less Lynda felt distressed over her situation. It was as if Joanna had taken up her cause and she didn't have to deal with it.

However if Lynda is to face and deal with her work situation she will need own her "distress" to marshal her energies. She'll need to take responsibility for her predicament rather than let her friend take the helm.

Let's see Lynda back in therapy . . .  

At this point, she needs her therapist to help her move through the feelings that are popping up. If she feels supported, she can ultimately deal with her situation herself.

It won't help if her therapist gets triggered by her own experience (ie. the countertransference). Like if her therapist is locked into a countertransference she's blind to, she's liable to miss the cues Lynda is giving her. She might for instance, goad Lynda into taking steps that she's not yet ready to take. Her therapist cannot take on the cause as her Joanna has.

Rather if her therapist is able to hold her own feelings at bay and allow Lynda the time and space to arrive at her own answers Lynda just might be able to overcome these feelings. And in the end, Lynda'll be freer to make her choice for the next step on her journey.

Examples of countertransference

The flip side of what can go wrong with countertransference is that a lot can go right. Seeing yourself reflected by your therapist can often be a good thing. 

Indeed, it can be very useful when you're able to talk about what's surfacing between the two of you.

It's sometimes a bit of a risk to share one's countertransference with a client  . . . as you can imagine . . .

(Therapist to Client)

Example #1

"You know, this is what I felt as you described the situation. When you told me what you had said to her - with that amount of energy - you know what, I was a little scared."

Example #2

"As I sit here with you, I realize how revved up I'm getting. Are you feeling that way right now? I wonder do you know, is it a problem in your life?"

Example #3

You know you're a funny guy and I admit that I've gotten caught up in that at times and I've avoided taking you deeper. So shall we talk about that?

Example #4

"So you have romantic feelings towards me. Yes, I will admit to noticing that and being pulled into wanting more from you."

"I want you to know - and let me be very clear about this - nothing will happen between us. I'm going to keep you safe. Our work will continue and we'll also address these dynamics. You've done nothing wrong. These dynamics do occur in therapy from time to time." 

This last example was inspired by a visitor' comment. Here it is:

I (female) recently admitted to my (male) therapist that I was experiencing transference, he was very sensitive to the issue and told me everything was going to be okay. Since we have talked about it, he has admitted to experiencing countertransference with me. I don't know that this is a good thing, but it sure feels that way. I feel more comfortable and willing to be more honest because he is with me.

Has anyone experienced this? He says it's the first time he has, but he has encountered transference in the past. What was the outcome to your experience?

Lynn, Kansas City, USA

Hi Lynn, first off, generally speaking, it's important to understand that transference is happening to some degree in all our relationships. We all have a history and we perceive others around us from this frame of reference. In other words, we are all human - including therapists.

You can't have transference from a client and no countertransference from a therapist. Where you have one, you have the other.

However, if you're asking me how common it is for a client to have a positive "loving" transference towards a therapist at the same time as the T has a similar "loving" transference, then I don't have an answer for you.

Absolutely, it does happen. How often it occurs, I don't know. However, it's probably the main reason why some therapists who cannot manage the intensity of the feelings that get triggered, end up violating the sanctity of the client's boundaries. (And why it's critically important for therapists to do their own personal therapy.)

I'm pleased that your therapist disclosed his countertransference. I can see that it's been helpful to you already. In time, I imagine this will prove to be a great learning experience for the both of you.

I wish you best on your journey,

Shrinklady

Dealing with your therapist's countertransference

When people think of a therapist’s countertransference they usually imagine the therapist falling in love with the client. This is not the only form of countertransference of course, but it does happen.

In some cases the therapist never discloses his or her feelings towards you, and works through the attraction by consulting a supervisor or by getting personal therapy. 

In this scenario, the therapist is owning the feelings and never attributes these feelings to anything you have done no matter how convincing or seductive you might be. (Most therapists in this situation will keep their feelings under wraps, unless they're incompetent or prompted by the client.)

"My therapist says he loves me"

In other cases the therapist openly discloses his or her feelings towards you in the session (possibly because you raised the issue). 

Ideally, your therapist never blames you for these feelings. It may be discussed as part of the work especially if you openly inquire about it (though I'd think this rarely happens as it would take a lot of courage). 

Your therapist may choose to refer you to another therapist (which is bound to trigger your feelings of abandonment), or may choose to be honest about it and maintain strict boundaries in all subsequent sessions.

Working through countertransference

Sometimes open disclosure of a “romantic" type of countertransference can be extremely useful. For example, imagine that you routinely seduce others in position of power as a way to deal with feelings of powerlessness (Not saying that it's intentional - you just start feeling overly amorous). 

If your therapist fell for this same maneuver it says something about his or her own emotional dynamics (and the need for the therapist to seek consultation or therapy). 

However, this scenario may also say something about your tendency to level the playing field through these seductive ploys. (Remember that this is a learned behavior). 

You can imagine how fruitful the therapy sessions could be if your therapist assertively expressed and enforced strict boundaries as you both explored these dynamics.

When countertransference is not addressed properly

But let's say your therapist does not own the feelings, nor does he or she fully understand the countertransference. Your therapist is completely seduced believing that it’s coming from you

So your therapist is in love with you and cannot objectively see the countertransference in play. Indeed, your therapist welcomes and titillates his or her own ego by encouraging your transference.

Here the therapist violates the sacred boundaries of the therapeutic bond. The consequences for the client will be dire in most cases.

Countertransference "crazy-making"

In addition to these "romantic" versions, countertransference commonly shows up in other subtle, though still harmful ways. These are potentially “crazy-making” because it’s hard to tell whose emotional baggage is being triggered - yours, or your therapist’s.

For instance, let's say your therapist has unresolved issues related to workaholism. She feels you're resisting efforts to push yourself to attain your goals. You sense an edginess in her voice that feels like irritation, and you take it to mean that you’re not progressing “ as you should”. (That is, your therapist believes you’re "resisting", instead of seeing that you're not resourced enough to take the next step).

You react by shutting down in the session, believing you've been a “bad” client (just as you believe you've been a bad child, a bad partner, bad friend, etc.). 

In this scenario it's hard to separate your own historical issues and those of your therapist.

It’s especially “crazy-making” when your therapist exhibits a caring attitude but you don't sense any emotion coming from them. I have an example of this from my own personal therapy.

                                Personal Case Example

I was in a therapeutic retreat, working with two therapists who were a married couple - a team approach to my treatment. The female therapist began the work by asking me extremely triggering questions - with no containment or even an attempt to resolve the pain she was eliciting.

I was a complete "puddle on the floor". I didn't feel any emotion coming from her. What helped is that I did sense some nurturance from her partner.

Where it became crazy-making was trying to decide whether I just imagined that she had no feelings towards me, that she was merely “mouthing” the words (in which case her countertransference was blocking her emotional availability). Alternatively, was she actually taking me in but I didn't realize that she felt some of my pain (which is absolutely essential for any progress)? 

One might hypothesize that I have issues with female therapists (I’ve had over ten of them), and was blocking her emotionally. I've never noticed this, though I certainly suppose it’s possible.

But that’s how the crazy-making happens - was it me, or was she being dishonest about her feelings?

What’s clear is that she was not attuned to me, and never bothered to check in with me and find out.

(By the way, with the new therapeutic techniques there is absolutely NO NEED to dredge up painful memories for so-called “assessment purposes" (unless the goal is to work with whatever comes up right there and then). If the therapist cannot contain the client's emotions as they arise then she shouldn't keep digging!)

So what should you do if you feel your therapist’s countertransference is interfering with your therapy? Bringing it up would be the ideal step to take. It does have its risks. But it also has the potential for moving your forward.

What to do if you believe your therapist is purposely "feeding" his own ego and is immune to your remarks?

You could “vote with your feet” and make a statement by terminating the therapy. This is where it gets complicated, because you may feel quite torn about what you should do. 

If a part of you is quite attached to your therapist, leaving can feel almost like death. But if you stay then any resentment you might feel towards your therapist will probably hold you back in your work.

Make a formal complaint to a regulatory body

If your therapist's countertransference takes the form of violating or crossing your boundaries (eg. inviting you into a relationship outside therapy, making accusatory statements, being harshly critical etc.) or abandons you for no reason you can make a formal complaint to the regulatory body associated with your therapist's profession (eg. College of Psychologists).

Owing to the fact that this process can be particularly unsettling, it's wise to find another therapist to help you navigate the process.

How therapists can deal with countertransference

By far the easiest way for a therapist to recognize his or her own countertransference is by being body-based and taking periodic 'check-in' breaks throughout the session.

Periodic 'check-ins' allow the therapist the time and space to identify and then interrupt any pattern that's going off in the wrong direction (which can easily happen when there's lots going on in a session).

Take pause button moments

In other words, the therapist must put the pause button on - particularly as things are getting heated up - and both therapist and client should take the time to ground themselves.

These quiet moments give rise to reflections from both parties - sort of like "meta-cognitions" that wouldn't be available otherwise (ie. as you step back and allow yourself to be curious about the kinds of thoughts you're having, other thoughts come to you).

If a interactional pattern is left to being identified at the end of the session not only has the therapist lost a chance to immediately rectify the situation - and to set a course for new learning - it risks entrenching that very same pattern.

Be mindful only after you ground

Note that I'm not referring to immediately taking a "mindful' moment. You'll be doing that anyway after you ground. By grounding your energy first you'll be reducing the charge in your body - in essence changing your state - which will automatically enhance your thinking. 

If you don't take this grounding step, you're liable to come to the same conclusions you were having just moments before the check-in. You see, your state - at any given moment - shapes your perceptions, thoughts and feelings.

So changing your state gives you a much greater advantage - and often greater clarity.

Additionally, it helps the client avoid being overwhelmed at the end. By far the most complaints I read about from visitors to this site (ie. from therapy goers) is the feeling of being worse off at the end of the session.

Re-visit the session in your mind

When you're writing your notes for a session - imagine being back with your client.

Re-visit the sense of what it was like being with that client and compare it to being with another client. Sometimes this last step can give you real insights to what's going on for your client.

Track your reflections

Be sure to note these reflections so you'll remember to track them for next time.

For example, I may find that it was hard to pull the session together at the end - maybe my client tended to bring stuff up as I was attempting to wind down. If I see that in my notes I'll remember to start winding down sooner.

I might even bring this up with my client:

"I noticed I was having a hard time winding things down in our last session. Was that me? Or is it possible you have a hard time with ending things?" 

This could lead to some interesting conversations about abandonment issues.

Get clinical supervision

Therapists for the most part are a pretty isolated bunch so clinical supervision or case consultations are not uncommon. 

Of course if you're a therapist in a large practice with other professionals  you have the advantage of being able to grab a few minutes to run something by a colleague.

However, if an issue is continuing to surface securing some clinical supervision is a great idea.

Go to therapy

This is a big "duh" for anyone outside of the therapy field 😉

For some reason you rarely hear this mentioned. Our field seems to suffer from the same stigma that we hear about.

Actually, a lot of therapists do go to therapy - I think it just hasn't reached a critical mass where we're all talking about it openly.

I mean for us it should be the most natural thing to say something along the lines of "oh, yeah I was dealing with that in therapy a while back".

(My biggest beef: we should be able to write off psychotherapy on our taxes as professional development.)

A countertransference story
with a bad ending

Comment from a myShrink visitor:

I once had a really good therapist / alternative practitioner - After seeing her twice a week for six months, she terminated the sessions saying that she could no longer be my therapist/healer because of the way she felt about me. - I of course had real feelings of attatchment and love, but knew about transference and therefore had ignored those feelings.

She on the otherhand chose to act on hers and invited me to have a sexual relationship with her...... 10 years on we are no longer together - the relationship was short-lived on her part - but I am left unable to achieve resolution and have been left with acutely painful feelings of rejection, sadness, low self-esteem, and anger at what now feels like un-requited love.

What am I to do?

Tania, London, UK​

Tania, I'm so sorry that this happened to you. It's such a flagrant violation of therapeutic boundaries.

I know these things happen but when I first read your post, it shook me up. As such, it's taken me some time to pull my reflections together.

As you know, we depend on our therapist to create and maintain strong boundaries to keep us safe, particularly as we are often not able to do so for ourselves . . . that's why we go to therapy.

That this caregiver transgressed the bounds of her profession, makes the violation that much more damaging. You placed your trust in this woman and she did not do what was necessary to keep you safe. Her behaviour was professionally unethical and personally selfish.

Tania, I can't imagine that your healing can begin unless you return to therapy. I'm reminded of a phrase a friend of mine always quotes, "wounded in relationship, healed in relationship". A corrective emotional experience goes a long way in healing relational trauma.

It may feel that you're putting yourself back in the frying pan. The idea might even feel quite frightening so it's so important to remember that you were in tune with your feelings (i.e. the transference) when you were seeing this practitioner. This self-awareness will serve you well should you choose to work with someone new.

I wish you well Tania and I hope you find the freedom you surely deserve,

Shrinklady​

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My Personal Musings

Reflecting back when I was a newbie therapist I can see how I often tried to “fill up” my clients who suffered from a lack self-worth. I think it's a mistake a lot of new therapists make.

I finally learned these efforts were not helpful to them not to mention that with a full practice, it was unsustainable for me. I was drained at the end of the day.

Yes, too much of my own agenda was hooked into feeling my own worth through the success of my client’s progress. 

Yup, I hadn't worked through my own early wounding where, in a large and busy family, I took on a caretaking role with my siblings. As it turns out, I took this on as a compensation for my own unmet needs. It was a way to feel noticed, to feel special.

Yet, so blended in with this role I didn't recognize it for what it was. My own therapy was so helpful in this regards.

Ironically, I discovered that the more I worked on myself, the more I could tolerate my client's emotional struggle and the deeper the work and the faster the result. 

I won't say I'm immune to countertransference - heavens probably far from it - but as I continue to work on myself, I become less hooked into helping people for my own needs – it becomes more about them. And that's how it should be.

References

Systematic review of studies about countertransference in adult psychotherapy, Trends Psychiatry Psychotherapy. Vol. 36 no.4 Porto Alegra Oct./Dec. 2014.

One interesting factoid is that Freud hesitated to write about countertransference (CT) suggesting instead that clinicians talk privately about these dynamics. He was worried that CT would make psychiatry a target in regards to sex scandals.

Notes


  1. As with transference, countertransference feelings are not limited to therapist and client. These feeling can surface in any type of professional relationships. Indeed as in the vignette above, it's evident in personal relationships as well.
  2. Contrary, to what you might think, countertransference is not necessarily always negative (Though Freud would say all countertransference is bad). Like any feeling, it just is.
  3. Freud felt that all analysts should embark on their own analysis so they could avoid countertransference. Personally, I think it's unrealistic to think a therapist is never going to have a countertransference reaction. Rather it's more productive for a therapist to recognize one's issues and when their stuff is getting triggered and what stuff clearly belongs to the client.
  4. An emotionally healthy therapist welcomes input from clients about possible instances of countertransference in the work (which speaks to the idea that therapists continue their own therapy as part of their professional growth).

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