Countertransfence & Transference
What is Transference?
Essentially, transference refers to the transfer of feelings from the past to the present. It is the client’s reaction to the therapist.
Transference must be managed; in order to be managed, transference must be tolerated and subsequently understood.
Simply put, because individual therapy is a complex relationship with two people involved, “the two complex human beings who are interacting in the course of psychotherapy are mutually influencing one another all the time and are evoking a variety of feelings toward one another” (Gabbard, 2004, p. 132).
What is Counter Transference?
Clinicians also have their own history of emotions, fears, and desires which permeate into the therapeutic relationship.
Countertransference is the clinician’s reactions to the client’s material.
As emerging professional clinicians, we must explore these abstract concepts within the therapeutic room, without explicitly acting out on them, in order to benefit our clients’ process of change and insights because “ the more sophisticated its management, the better the results of treatment will be” (Basch, 1980, p.39).
Transference and counter transference is to be expected, welcomed, and discussed openly in order to reflect on rather than reacting and act out on.
What the therapist and client chooses to do with this material shapes the outcomes and effectiveness of therapy.
Transference & Countertransference is Useful
The rich material offers insight into one’s inner world, beliefs, patterns, dynamics, assumptions, and thoughts.
Clients who struggle with boundaries outside of therapy will most likely struggle with boundaries in therapy with their therapist. A client who is more perfectionistic and rigid will be on time for sessions and feel anxious if they are late.
Clients who struggle with anger and overwhelming emotions will most likely struggle with overwhelming emotions and anger in therapy. A client who acts out their anger outside of session will most likely act out their anger in session.
Clients who have issues with people in authority and power will most likely transfer their past experiences and patterns onto the therapist who has more power in the therapy room. This could look like wanting the therapist to like them (over valuing) or devaluing the therapist.
Clients who have unresolved issues with their parents and if their therapist reminds them of parts of their parent(s), these unresolved thoughts and feelings will transfer onto the therapist and impact the treat ent
And more
In turn, this material usually affects the way we treat others like our clients or our therapist.
By reflecting on this material, we can use it to enrich the therapeutic process.
Examples of Counter Transference
The therapist…
Has poorer/looser boundaries or no boundaries with a client
Gives the client extra session time consistently
Gives the client compliments consistently
Self discloses consistently with no clinical rationale
Looks forward to seeing the client consistently
Does not look forward to seeing the client consistently and dreads sessions with the client
Is bored in session consistently and yawns consistently
The client may be employing defenses/protectors and avoiding talking about intimate details and the process
Content vs. process (talks about thoughts vs. talking about feelings and emotions and experiences)
Is annoyed, frustrated, and/or angry at the client consistently
Inappropriately self discloses with a client for no reason at all that is related to the therapy
Reacts vs. reflects in session when triggered/overwhelmed/etc.
Yells at the client
Engages in passive aggressive communication vs. assertive communication
Offering advice instead of listening
Tells a client what to do
Tells a client what not to do
Feeling discomfort around certain topics a client brings up
Avoids topics around money
Avoids topics around sex
Avoids topics around race and ethnicity
And more
Is reminded of someone else/a family member/friend/colleague with a client
Maybe the client reminds the therapist of a friend they like and enjoy spending time with
Maybe the client reminds the therapist of a family member who they do not have a good relationship with
And more
Examples of Transference
The client…
Placing unrealistic demands/pressures on the therapist
Idealizes the therapist
Sees the therapist as perfect
Devalues the therapist
Over values you and puts you on a pedestal like a perfect person/object
Admiring the therapist
Praising the therapist
Flattery
Complimenting the therapist
Giving gifts
Often leads to depending on the therapist
People pleasing tendencies
Fear of criticism and conflict
Anxiety
Shame
Helplessness
Fawning/people pleasing
Difficulty looking at therapist in the eyes
Mistrust
Difficulty divulging personal and vulnerable topics
Overly explains
Apologetic
Doesn’t take up space
Lower sense of Self
Tends to end therapy earlier
Is aggressive and angry at the therapist
Feelings of anger and fear
Speaks with a loud and angry voice
Blames
Threatens
Needs to show their power and autonomy/independent so the client will not be taken advantage of
Erotic transference
Falling in love with the therapist
Is attracted to the therapist
Wearing expressive and provocative clothing
Fantasizes
Intense desire
Infatuation
Being reminded of the therapist as a friend/family member/etc.
Has material transference (therapist reminds them of their mom)
Has paternal transference (therapist reminds them of their dad)
What Happens if Counter Transference Isn’t Explored or Managed?
Assuming things about the client (bias)
Ruptures, misunderstandings, and disagreements
Poorer therapeutic outcomes and progress
Telling or advising the client what to do based on personal beliefs and values
Not exploring and talking openly topics that are important such as: sex, money, race, ethnicity, trauma, disability, gender, sexuality, ability status, etc.
Acting out one’s feelings and lashing out at the client
Having a dual relationship with the client (hiring them, becoming friends, dating, etc.)
Sexual inappropriateness due to sexual counter and intimate transference (having sex, getting into a relationship with a client)
Ending treatment prematurely due to discomfort without properly exploring everything before making the decision to end therapy
And more
What Happens if Counter Transference Is Properly Explored or Managed?
Offering the client a corrective emotional experience they did not receive prior
Example: A female client who has had consistently negative experiences with men could have a positive experience with her male therapist which offers her a new, corrective experience with men in treatment which can be healing and eye opening that not all relationships with men will be negative
Example: A client who has rarely had a provider or person with more power apologize for making mistakes who has a therapist who models apologizing can learn that some providers are accountable and have the ability to apologize
And more
Healing and growth
Deeper awareness and insight
Deeper empathy and understanding of one’s feelings and thoughts
The therapist grows and becomes more effective
The therapeutic alliance becomes stronger
And more
What Can I Do To Manage Counter Transference?
Things we can do include: Scanning our thoughts, feelings, associations, and body sensations during a session.
Tolerating and managing anxiety is another way.
Attending therapy, seeking clinical supervision, seeking peer consultation, and learning more about transference and counter transference are other methods.
Transference and countertransference are drastically altered when considering differences such as: gender identity, gender expression, sexual orientation, ability status, class, race, ethnicity, and other areas of difference.
Instead of assigning binary labels to these feelings, ask yourself where these feelings may stem from and whether they are helpful or unhelpful in your work with a client.
References
Gabbard, G. (2004). Long-term psychodynamic psychotherapy : A basic text (Core competencies in psychotherapy). Washington, DC: American Psychiatric Pub.