Managing Countertransference In A Therapeutic Relationship

The relationship between a person and their therapist can play a role in the effectiveness of the psychological treatment process. While it can be a delicate relationship at times, it should always remain professional. Clients typically invest their trust, time, and money into their sessions, and finding someone who abides by the profession's ethics can be crucial to their recovery. Countertransference generally occurs when a therapist allows their own feelings, opinions, or personal experiences to shape how they guide a client, or when they have an emotional response to the topics being discussed. Although it is not always problematic, countertransference can become an ethical violation if it impacts therapists' ability to provide appropriate care to their clients. Therapists struggling with countertransference may benefit from speaking to another licensed mental health professional in online or in-person therapy.

Transference and countertransference

Understanding more about the relationship between therapist and client can clarify the potential effects of countertransference. 

What is transference?

According to the American Psychological Association, countertransference can be defined as “the therapist’s unconscious (and often conscious) reactions to the patient and to the patient’s transference.” However, to fully understand countertransference, it can be helpful to familiarize yourself with the concept of transference.

In psychotherapy, transference typically refers to instances in which the client unconsciously projects their feelings and wishes toward someone else onto the clinician. For example, someone who experienced childhood neglect may express anger or frustration with their parents at their therapist. 

In theory, this process can bring repressed emotions to the surface, potentially enabling the therapist to help the client work through these emotions. Transference can happen unintentionally, or the therapist may encourage it, as it can be an effective tool. 

Despite this, transference can be challenging, and how the therapist uses and responds to it can significantly affect the therapeutic process. 

Types of countertransference

In general, there are four types of countertransference of which clinicians and clients should be aware.

Subjective countertransference

Subjective countertransference can occur when a therapist’s personal experiences cause them to react emotionally to the client. For example, they may see a part of themselves in the client or have multiple things in common with them. If the therapist is unaware of this type of countertransference, it can harm the therapeutic process. 

Objective countertransference

When a therapist has a reaction to their client’s maladaptive behavior that mirrors the client’s life outside of therapy, it is usually called objective countertransference. The emotions that the client brings out in the therapist may reveal important information, particularly as the client is likely to bring out these feelings in other people in their lives.

Positive countertransference

This may be the most problematic form of countertransference. In positive countertransference, the therapist may feel overly connected to the client. These personal feelings can lead to crossing an ethical line by initiating a friendship or more. An example of this type may be an erotic countertransference, in which it may be tempting to the therapist to engage in an inappropriate relationship with the client.

Negative countertransference

Experiencing countertransference of this type may cause the therapist to be overly critical of the client. They may feel bored, aggressive, or irritated during sessions with clients, or they may feel an intense hatred toward them. The client may believe that they are disliked and stop coming to sessions.

Signs of countertransference

Countertransference can show up in many ways. Many forms can be harmful to the client, so mental health professionals generally need to be able to recognize signs of countertransference. Even though some forms of countertransference can benefit the therapeutic process, it can still be essential for the therapist to recognize when it is occurring. 

Here are some telltale signs of countertransference:

• Worrying about your client between sessions
• Becoming overly emotional during sessions
• Telling your client personal details about your life
• Dreaming about your client
• Being overly critical
• Being angry with your client frequently
• Becoming over-invested in a client’s situation
• Offering strong opinions about other people in a client’s life
• Allowing sessions to go over the scheduled time or cutting sessions short
• Making exceptions for one client that you don’t for others
• Asking for details about their life that do not apply to treatment
• Feeling sexual attraction toward your client
• Developing romantic feelings for your client
• Making sexual advances toward a client
• Feeling disappointed in the progress a client is making
• Wanting to “save” your client
• Getting angry at an opinion a client expresses
• Talking about yourself frequently
• Crossing other professional and ethical boundaries

How to manage countertransference

Some recent research argues that countertransference can be ubiquitous and that who the therapist is as a person may be inevitably intertwined with the outcome of therapy. They argue that therapists bring “their unique ways of relating to others, their vulnerabilities, emotions, sense of humor, creativity, and much more” to each session. While there may be some truth to this, and countertransference can have its place in effective therapy, it can still be vital to identify it and ensure it is not negatively affecting the therapeutic process.

Here are some possible ways to manage countertransference for therapists. 

Self-care

Getting enough sleep, establishing a regular exercise routine, eating a healthy diet, and engaging in activities you enjoy can help you increase your resilience and well-being. Self-care can help you maintain good mental health, which may impact how you work. When you enter sessions with a healthy mental baseline, it can help you better manage reactions.

Mindfulness meditation

Some research shows that although mindfulness meditation does not necessarily reduce countertransference, it can allow therapists to relate to their countertransference experiences in a different way. Being more open and accepting of countertransference can open the door to managing it effectively.

Knowledge and learning

Therapists can also increase their knowledge about countertransference and how to manage it. This sort of learning may encompass many things, including the different types of countertransference, attachment styles, addressing and repairing ruptured client relationships, and more. 

Supervision 

Supervision normally requires another professional to sit in on a therapy session to help the therapist identify and manage countertransference. The supervisor may encourage the therapist to be aware of their feelings, thoughts, and moods and how they may affect automatic thoughts and the session overall.

They should generally remind the therapist that countertransference can be a natural part of therapy, and that identifying and correcting it to benefit the client is a skill that therapists should learn.

Supervisors may use a range of techniques when working with therapists in this way, including education about various types of countertransference and giving the therapist homework to encourage self-reflection and the identification of suppressed feelings. They may use role-playing, guided discovery, and other problem-solving techniques, or ask therapists to keep a record of automatic thoughts that occurred during therapy sessions and identify more appropriate responses.  

Therapy

In general, therapists must be aware of their own core patterns and other beliefs, as well as the problems they have with people in their lives who may have contributed to these patterns and beliefs. Therapy can be an effective way for therapists to learn more about themselves to uncover what could be triggering countertransference when working with clients. 

Benefits of online therapy

If you’re a therapist who wants to learn more about yourself to help identify and manage countertransference, or if you need support in coping with other mental and emotional challenges, online therapy through a platform like BetterHelp may be a good option. You can book sessions that fit into your existing schedule and attend them from wherever is convenient.

Effectiveness of online therapy

A 2021 study found that online therapy can be just as effective as in-person sessions, joining a large body of research supporting the idea that online and in-person therapy typically produce the same results.