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.