What is a countertransference reaction?

Countertransference is simply all of the reactions of the therapist towards the client: the thoughts and emotions that arise in the therapist, during therapy. The reactions could result from patient factors (including the client’s personality or physical characteristics), therapist factors (including the therapist’s personality or personal history), or therapeutic factors (including the process of building rapport and familiarity, information revealed by the client, and way the client responds to the therapist).

Countertransference reactions can powerfully affect the health of the therapeutic alliance. In the past, countertransference was regarded as a barrier to effective therapy, and therapists where taught that they must overcome their reactions to clients. Today, countertransference is generally considered an inevitable and natural reaction by the therapist. Additionally, many clinicians feel that such reactions are crucial for gaining insight into their client’s lives, establishing rapport, and building the therapist-client relationship. These factors are very important predictors of therapy success.

A Brief History of Countertransference

Sigmund Freud felt that countertransference served as a barrier to therapy. Therapists were trained to remain completely neutral, in order and serve as mirrors for their client’s emotional responses. Over time, it became standard for therapists to have to undergo their own intense period of analysis, partially in order to reduce their levels of reactivate to their clients. This view was commonly held by therapists until the 1950s.

Paula Heimann was the first psychoanalyst to look at the benefits of countertransference. She argued that countertransference provided a window into the unconscious mind of the client. She hypothesized that all countertransference reactions are the result of client characteristics, and therefore could be re-conceptualized as originating from the client. While this view is now thought to overstate the role of the patient in countertransference reactions, Heimann was the first therapist to highlight the benefits of observing and understanding such emotional responses.

 Around the same time, D. W. Winnicott wrote that objective countertransference could be especially useful in understanding how a client functions in the world. Winnicott described objective countertransference as occurring when the patient brings out in the therapist the same feelings that the patient brings out in other individuals. In this way, objective countertransference allows the therapist to observe the impact that the client can have on other individuals, which can aid the therapist in understanding the client’s personal experiences and behavior that might be contributing to their mental health.

Heinrich Racker was also instrumental in developing a framework to understand the usefulness of countertransference reactions. Specifically, Racker conceptualized what he termed countertransference neurosis as an inevitable aspect of psychoanalytic therapy. In the early 1950s when Racker was writing, the predominant theory among therapists was that the analyst should remain emotionally neutral and intense emotional reactions to the client were interpreted to be detrimental. Racker dramatically countered this view when he argued countertransference was an inevitable part of psychotherapy.

Racker identified two distinct aspects of countertransference: direct and indirect. Direct countertransference is exemplified by reactions to the patient themselves. Indirect countertransference is reactions to persons outside of the therapeutic frame, such as the patient’s parents, or the clinicians own personal experiences. 

Racker further divided countertransference into concordant and complimentary subtypes. Concordant countertransference can be conceptualized as empathetic reactions to the client. Complementary countertransference is reactions to the patient’s unwanted projections. Projection is an unconscious process whereby the client “splits off” aspects of their self that are unwanted, and “projects” those aspects unto the therapist. In identifying two complimentary subtypes of countertransference, Racker allowed therapists to conceptualize countertransference as sometimes beneficial.

Building on the work of Winnicot, in the 1970s Giovacchi conceptualized countertransference reactions as consisting of objective and idiosyncratic reactions. Objective countertransference is homogenous with reactions that other individuals would have to the client.  Idiosyncratic countertransference reactions are a result of the therapists own personal history. Both of these reactions are common in the course of therapy and can provide valuable insight into the strength of the therapeutic alliance and the impact of the client on society. 

Some contemporary psychoanalytic psychologists feel that it is valuable to share aspects of a countertransference reaction with a client. The decision to disclose such reactions should be carefully considered before action is taken, and the therapist must remember that decisions to disclose should benefit only the client and not be used by the therapist for their own benefit. Even when such discloser is undertaken to assist the client, the therapist must remember that such reactions may not be universally appreciated by clients.

Working With Countertransference

How does a therapist work with a client who evokes strong reactions in them during therapy? The therapist is able to overcome barriers that occur through countertransference reactions by remaining introspective and aware of those interpersonal affective reactions. By remaining aware, the therapist can avoid reacting defensively. 

Additionally, the therapist needs to have undergone their own therapy so as to have successfully resolved major areas that might evoke negative countertransference reactions. Therapy for the therapist provides a venue for such conflicts to be resolved and thus reduces the likelihood that the therapist will later be driven to become defensive. Additionally, as in all cases in which the therapist is unsure how to proceed, consultation should be sought with colleagues.

Countertransference Reactions & Dialectical Behavior Therapy

Dialectical Behavior Therapy (DBT) is considered a behavioral therapy, concerned with behaviors we can see and measure; it conceives of thoughts and emotions as behaviors as well. In contrast, countertransference is a concept derived from psychoanalysis, a very different type of therapy. A DBT therapist would not originally use the term countertransference; but, whatever the time, the concept is helpful- how the therapist reacts to the client.

In dialectical behavior therapy (DBT), therapists are supposed to be members of a therapist consultation team. These teams allow DBT therapists get to regular feedback, professional assistance, and emotional support. Providing DBT therapy can demanding, especially when working with suicidal clients, clients with difficult or disturbing trauma histories, and/or clients with borderline personality disorder (BPD). DBT therapy can, at time, get emotional, heated, or combative; at other times, clients can become highly attached to their DBT therapist. In either case, there is a strong potential for DBT therapists to struggle with countertransference which could get in the way of therapy, of they do not remain mindful, and seek regular consultation with other DBT therapists.

The history of how countertransference has been viewed by therapists is long and complex. While most modern therapists regard countertransference as inevitable, this inevitability does not preclude the fact that aspects of such reactions can be harmful to the therapeutic process. In working with adolescent clients, the therapist may be made to feel incompetent or anxious. They must avoid colluding with the client’s projections or responding defensively to them. If the therapist is able to remain aware of their reactions then successful therapy can be undertaken with this population. 

In reality, transference occurs within the context of relationships and represents a complex interplay of emotions, memories, and subconscious actions.

While transference is a phenomenon seen in daily life, relationships, and interactions, we will take a closer look at how it affects professional settings and examine practical ways to make it a beneficial aspect of therapy.

Before you continue, we thought you might like to download our three Positive Relationships Exercises for free. These detailed, science-based exercises will help you or your clients build healthy, life-enriching relationships.

What Are Transference & Countertransference?

Freud and Breuer (1895) originally identified and discussed transference and countertransference within a therapeutic context. These concepts were an important part of psychoanalytic treatment but have since been adopted by most forms of psychotherapy.

These concepts occur within any relationship, and the therapeutic relationship is no exception.

So what exactly are transference and countertransference?

Transference

Transference in therapy is the act of the client unknowingly transferring feelings about someone from their past onto the therapist. Freud and Breuer (1895) described transference as the deep, intense, and unconscious feelings that develop in therapeutic relationships with patients. They analyzed transference in order to account for distortions in a client’s perceptions of reality.

While Freud viewed transference as pathological, repetitive, and unreflective of the present relationship between the client and therapist (Wachtel, 2008), modern psychology has rebuffed this assessment.

Many psychological approaches recognize that the responses of a therapist can evoke reactions in the client, and the process of the interaction can be beneficial or harmful to therapy (Fuertes, Gelso, Owen, & Cheng, 2013).

Transference is multilayered and complex and happens when the brain tries to understand a current experience by examining it through the past (Makari, 1994).

There are three main categories of transference.

1. Positive transference is when enjoyable aspects of past relationships are projected onto the therapist. This can allow the client to see the therapist as caring, wise, and empathetic, which is beneficial for the therapeutic process.
2. Negative transference occurs when negative or hostile feelings are projected onto the therapist. While it sounds detrimental, if the therapist recognizes and acknowledges this, it can become an important topic of discussion and allow the client to examine emotional responses.
3. Sexualized transference is when a client feels attracted to their therapist. This can include feelings of intimacy, sexual attraction, reverence, or romantic or sensual emotions.

A therapist can gain insight into a client’s thought patterns and behavior through transference if they can identify when it is happening and understand where it is coming from. Transference usually happens because of behavioral patterns created within a childhood relationship.

Types of transference include:

• Paternal transference
  Seeing the therapist as a father figure who is powerful, wise, authoritative, and protecting. This may evoke feelings of admiration or agitation, depending on the relationship the client had with their father.
• Maternal transference
  Associating the therapist with a mother figure who is seen as loving, influential, nurturing, or comforting. This type of transference can generate trust or negative feelings, depending on the relationship the client had with their mother.
• Sibling transference
  Can reflect dynamics of a sibling relationship and often occurs when a parental relationship is lacking.
• Non-familial transference
  Happens when clients idealize the therapist and reflect stereotypes that are influencing the client. For example, a priest is seen as holy, and a doctor is expected to cure and heal ailments.
• Sexualized transference
  Occurs when a person in therapy has a sexual attraction to their therapist. Eroticized transference is an all-consuming attraction toward the therapist and can be detrimental to the therapeutic alliance and client’s progress.

Countertransference

Countertransference has been viewed as the therapist’s reaction to projections of the client onto the therapist. It has been defined as the redirection of a therapist’s feelings toward a patient and the emotional entanglement that can occur with a patient (Fink, 2011).

While Freud viewed countertransference as dangerous because a psychoanalyst is supposed to remain completely objective and detached, those views have since been challenged (Boyer, 1982).

Racker (1988) built the idea that the therapist’s feelings have significance and can lead to important content to be worked through with the client. His definition of countertransference is “that which arises out of the analyst’s identification of himself with the (clients) internal objects” (Racker, 1988, p. 137).

When these reactions surface, they can be dealt with and lead to a healthy therapeutic relationship.

6 Real-Life Examples

1. I have a crush on my therapist

This video provides a good description of erotic or sexual transference. This is the most dangerous form of transference and has the potential to harm the therapeutic alliance and process.

2. The Sopranos

The famous TV series The Sopranos provides us with a dramatic example of sexualized transference that would break all ethical codes of conduct for a therapy session.

3. Example of negative transference

Amanda (a 32-year-old woman) becomes furious with her therapist when he discusses assigning homework activities. She sighs loudly and states, “This is NOT what I came to therapy for. Homework? I am not in elementary school anymore!”

The therapist remains calm and states, “It sounds like you are upset about homework assignments. Tell me what you are experiencing right now.”

After exploring the emotions that surfaced, Amanda and her therapist come to realize that she was experiencing unresolved anger toward a verbally abusive authoritarian elementary school teacher.

4. Role-play

This video was created by a therapist to demonstrate several types of transference and countertransference. The therapist plays both roles (clinician and therapist) to act out/role-play examples of how transference can transpire in a session.

5. She’s Funny That Way

In this comical clip of famous actress Jennifer Aniston pretending to be a therapist, we can see exaggerated examples of countertransference. In this case, there are no professional boundaries, ethics, or appropriate therapeutic practices taking place.

6. School counseling

Countertransference is particularly hard in school counseling settings.

According to American Counseling Association (ACA) member Matthew Armes, a high school counselor in Martinsburg, West Virginia, “all counselors went to school and have associated memories.” Armes goes on to say that “working with students who are dealing with their parents’ expectations and relationship struggles can trigger countertransference for him because his parents were divorcing just as he was starting high school” (Notaras, 2013).

Armes initially rejected his father during the divorce but eventually repaired the relationship. He states that because so many students experience divorce, it is an issue he strongly empathizes with. It is important to set strong boundaries around this connection and empathy to effectively “let [students] know [they are] not alone and that there are ways to become a stronger person.”

Psychology Theories Behind the Concepts

Are there theories to explain these specific examples of transference? Transference and countertransference are rooted in psychodynamic theory but can also be supported by social-cognitive and attachment theories.

These theories have different approaches to examine how maladaptive behaviors develop subconsciously and outside of our control.

Psychoanalytic theory

In psychoanalytic theory, transference occurs through a projection of feelings from the client onto the therapist, which allows the therapist to analyze the client (Freud & Breuer, 1895).

This theory sees human functioning as an interaction of drives and forces within a person and the unconscious structures of personality.

Within psychoanalytic theory, defense mechanisms are behaviors that create “safe” distance between individuals and unpleasant events, actions, thoughts, or feelings (Horacio, 2005).

Psychoanalytic theory posits that transference is a therapeutic tool critical to understanding an individual’s repressed, projected, or displaced feelings (Horacio, 2005). Healing can occur once the underlying issues are effectively exposed and addressed.

Social-cognitive perspective

Carl Jung (1946, p. 185), a humanistic psychologist, stated that within the transference dyad, both participants experience a variety of opposites:

“In love and in psychological growth, the key to success is the ability to endure the tension of the opposites without abandoning the process, and that this tension allows one to grow and transform.”

This dynamic can be seen in the modern social-cognitive perspective, which explains how transference can occur in daily life. When individuals meet a new person who reminds them of someone from their past, they subconsciously assume that the new person has similar traits and characteristics.

The individual will treat and react to the new person with the same behaviors and tendencies they did with the original person, transferring old patterns of behavior onto a new situation.

Attachment theory

Attachment theory is another theory that can help explain transference and countertransference. Attachment is the deep and enduring emotional bond between two people.

It is characterized by specific childhood behaviors such seeking proximity to an attachment figure when upset or threatened, and is developed in the first few years of life (Bowlby, 1969). If a child develops an unhealthy attachment style, they may later project their insecurities, anxiety, and avoidance onto the therapist.

4 Signs to Look for in Your Sessions

The key to ensuring that transference remains an effective tool for therapy is for the therapist to be aware of when it is happening.

1. Unnecessarily strong (or inappropriate) emotions

When clients lash out with anger or distress in a way that seems excessive for the topic that is being discussed, it is a clear sign that transference may be taking place.

Clients may even demonstrate inappropriate laughter surrounding issues that are not funny, which can be a signal for the therapist to intervene (Lambert, Hansen, & Finch, 2001).

The therapist can address the strong or inappropriate emotions and get at core issues.

2. Emotions directed at the therapist

An obvious sign of transference is when a client directs emotions at the therapist. For example, if a client cries and accuses the therapist of hurting their feelings for asking a probing question, it may be a sign that a parent hurt the client regarding a similar question/topic in the past.

3. Unreasonable dislike for the client

Therapists also need to be aware of countertransference, when they are projecting feelings onto a client. One of the most common signs of countertransference is disliking a client for no apparent or obvious reason (Lambert et al., 2001).

This is a good opportunity for the therapist to examine personal values, beliefs, and emotions surrounding the characteristics of the client and past relationships.

4. Becoming overly emotional or preoccupied with a client

Another red flag for countertransference is if a therapist notices that thoughts and feelings for clients are taking up a significant amount of time outside of sessions.

It is natural for therapists to think of their clients outside the therapy room, but when they are joined with strong emotions or become intrusive or obsessive thoughts, the therapist may have to refer the client to another practitioner.

5 Ways to Manage It in Therapy

Psychological, spiritual, and emotional issues can trigger the most educated and experienced therapists within the therapeutic dynamic.

Some ways to manage transference and countertransference in therapy include the following.

1. Peer support

Consult a colleague, supervisor, or clinical director when feeling an emotional trigger or response. When a session is especially challenging, it can cause a therapist to sacrifice empathy and objectivity.

Regular peer support and clinical therapy meetings can be helpful. Brickel and Associates has more information on options for finding online peer support.

2. Continual self-reflection

Explore feelings toward individual clients, and write down ways you are consciously or unconsciously reacting to them in session.

Our introspection and self-reflection article outlines practical ways to explore self-reflection.

 

3. Clear boundaries

Set appropriate boundaries regarding scheduling, payment, and acceptable in-session behavior. Discuss any misunderstandings of intent and emotional projection as soon as it occurs.

4. Mindfulness

Practice mindfulness inside and outside of sessions to explore personal thoughts and feelings.

Gain insight into compassion fatigue, burnout, excessive stress, or an inability to do quality clinical work. Observe the space between stimulus and response, and make appropriate thoughtful reactions.

5. Empathy

Lichtenberg, Bornstein, and Silver (1984) formulated that empathy is the foundation of human intersubjectivity, and that failing to demonstrate it is the largest impediment to treatment.

Lack of empathy can be a precursor to countertransference. When we employ empathy as practitioners, we are looking at the situation and client outside of our own view, making countertransference less likely.

Is Countertransference Bad? Ethical Considerations

The Social Work Dictionary defines “countertransference” as a set of conscious or unconscious emotional reactions to a client experienced by a social worker or professional, and has established specific ethical issues to consider in practice (Barker, 2014).

Just like transference, countertransference is not always bad and can be an effective tool in therapy if used properly. The ethical considerations set forth by the ACA and the Newfoundland and Labrador Association of Social Workers (2018) include:

• Professional boundaries
  When experiencing countertransference, it is important to consider how professional boundaries can be impacted. Professionals need to ensure that the relationship always serves the needs of the client first.
• Conflicts of interest
  Countertransference may create a conflict of interest that impedes the professional’s ability to remain unbiased or objective. Practitioners can get wrapped up in their own emotional and personal issues, which interferes with the ability to provide effective treatment and impartial judgement.
• Self-disclosure
  When considering self-disclosure, a professional must examine the benefits/risks and ask whose needs are being met. It is also important to think about whether the client is experiencing transference and how this influences the therapeutic relationship.
• Competence in practice
  Professionals in the field of mental health should offer the highest quality service possible, and the therapeutic relationship must be terminated if countertransference affects the ability to practice competently.

Having shared experiences with a client can enhance empathy, but therapists and those in the mental health field must work through ethical considerations to inform decision making.

Self-reflection and self-awareness are some of the most powerful tools to guide ethical decisions. The following worksheets and resources can help with this.

2 Helpful Worksheets for Therapists and Clients

For some helpful materials to strengthen your and your client’s understanding of transference, check out the following worksheets.

1. Awareness Transference Worksheet

This basic worksheet helps both clients and clinicians identify specific people in their life and their cognitive and emotional reactions to them. This exercise can highlight how past relationships are being transferred to the present moment.

2. Transference Exercise

This free exercise was designed to help teach clinical psychology students about transference. It can be a helpful exercise to revisit, even among seasoned clinicians.

PositivePsychology.com’s Relevant Resources

You’ll find even more resources around our blog around the topics of transference, communication boundaries, and the therapeutic relationship.

Check out some of the following free materials to get you started:

• 3-Step Mindfulness Worksheet
  Mindfulness is an important tool for both therapists and clients to practice on a consistent basis. This simple but effective worksheet can bring both parties to a place of self-awareness and decrease the likelihood of unproductive transference.
• Levels of Validation
  This short self-assessment helps therapists and counselors consider the level at which they typically validate the feelings and experiences of their clients, ranging from mindfully listening to radical genuineness.
• Listening Accurately Worksheet
  This handout presents five simple steps to facilitate accurate listening and can be used to help establish communication norms at the beginning of a therapeutic relationship.
• Assertive Formula
  This three-part worksheet lays out a formula to help you or your clients clearly and respectfully communicate when someone else’s behavior is causing a problem.

Besides these tools, these articles are excellent supplemental reading material:

A Take-Home Message

Mental health professionals practice in a very lonely world bound by confidentiality and ethical concerns. We must be simultaneously aware of the emotions and feedback clients project and the emotions and thoughts that are personally experienced.

Transference and countertransference can be a double-edged sword. They can destroy the therapeutic process or provide an avenue to healing. They can break down the therapeutic alliance or become its most effective tool.

Identifying examples of transference and countertransference is a wonderful starting point to prevent negative interference in therapy.

Self-reflection, mindfulness, empathy, and ethical boundaries are excellent tools to ensure that when transference arises in session, it is directed in a helpful and therapeutic way.

We hope you enjoyed reading this article. Don’t forget to download our three Positive Relationships Exercises for free.

• Barker, R. (2014). The social work dictionary. NASW Press.
• Bowlby, J. (1969). Attachment and loss: Volume I attachment. Basic Books.
• Boyer, L. B. (1982). Analytic experiences in work with regressed patients. Unknown publisher.
• Fink, B. (2011). The fundamentals of psychoanalytic technique: A Lacanian approach for practitioners. W. W. Norton & Co.
• Freud, S., & Breuer, J. (1895). Studies in hysteria. Penguin Books.
• Fuertes, J. N., Gelso, C., Owen, J., & Cheng, D. (2013). Real relationship, working alliance, transference/countertransference and outcome in time-limited counseling and psychotherapy. Counseling Psychology Quarterly, 26(3), 294–312.
• Horacio, E. (2005). The fundamentals of psychoanalytic technique. Karnac Books.
• Jung, C. (1946). The psychology of transference. Princeton University Press.
• Lambert, M. J., Hansen, N. B., & Finch, A. E. (2001). Patient-focused research: Using patient outcome data to enhance treatment effects. Journal of Consulting and Clinical Psychology, 69, 159–172.
• Lichtenberg, J., Bornstein, M., & Silver, D. (1984). Empathy I. Analytic Press.
• Makari, G. J. (1994). Toward an intellectual history of transference. The Psychiatric Clinics of North America, 17(3), 559–570.
• Newfoundland and Labrador Association of Social Workers. (2018). Standards of practice for social workers in Newfoundland and Labrador. Retrieved June 15, 2021, from https://nlcsw.ca/sites/default/files/inline-files/Standards_of_Practice.pdf
• Notaras, S. (2013). Attending to countertransference. Counseling Today, 9, 29–31.
• Racker, H. (1988). The meaning and uses of countertransference. In B. Wolstein (Ed.), Essential papers on countertransference. New York University Press.
• Wachtel, P. L. (2008). Relational theory and the practice of psychotherapy. Guilford Press.