What is countertransference?

In countertransference, a mental health counselor or therapist develops emotions about a patient being treated. These emotions can be positive or negative. For example, the therapist may begin feeling loving or protective toward the patient, or the therapist might feel dislike or anger. Both types of feelings can create roadblocks to treatment. In all circumstances, it is unethical for therapists to act on countertransference. However, a good therapist will use his or her feelings to learn more about the patient and create a better outcome to the therapy.

Countertransference is the opposite of
transference
, which involves the patient projecting, or transferring, his or her feelings onto the therapist. Transference is common during mental health treatment. Some experts believe that transference occurs naturally as the therapist and patient develop a relationship that is based on trust and confidence. Experts say transference is a sign that the patient is making good progress.

Overview

The term countertransference was originally coined by Sigmund Freud (1856 – 1939), an Austrian neurologist who famously developed
psychoanalysis
, a method of treating mental disorders that examines the interaction between the conscious and unconscious mind. Freud considered countertransference to be damaging, unhealthy, and undesirable for mental health practitioners.

Although modern experts agree with Freud that acting
on countertransference is undesirable and damaging, they also believe that countertransference can be a tool for therapists to better understand their patients. Two types of countertransference exist: subjective and objective.

Subjective Countertransference

Subjective countertransference involves feelings that are rooted in the therapist's own issues and have little to do with the patient. These feelings may arise as irritation or anger toward the patient. At times, however, the therapist might begin to feel an irrational level of love or caring toward the patient. Additionally, countertransference may also take the form of sexual desire.

Subjective countertransference involves feelings that have to do with the therapist as a person. They can point to unresolved issues that are awakened within the therapist through his or her work with the patient. Sometimes these feelings are related to people currently in the therapist's life; other times they point to unresolved problems from the past. Whatever the case, these feelings are distracting and the therapist may have a difficult time treating the patient.

Objective Countertransference

Objective countertransference also involves the therapist's emotions. However, in objective countertransference, the therapist feels what the patient feels, experiencing the patient's feelings toward him- or herself. The therapist may also experience the feelings of important individuals in the patient's life, such as original caregivers, significant others, siblings, and children. The types of feelings that arise in the therapist are based in the patient's personality and interpersonal strategies. For example, patients who rely on strategies of
repression
(protecting themselves from threatening thoughts by blocking them out) or
denial
(refusing to face unpleasant facts or realities) may bring these out in the therapy session. Similarly, patients who interact with others using stonewalling (refusing to cooperate) or clinging (emotionally or mentally holding on to others too tightly) strategies will likely bring these out in the therapist.

Because these feelings arise from the patient, they provide important clues that the therapist can use to better understand the patient and to direct treatment. Objective countertransference is now widely acknowledged as a powerful clinical tool.

Dealing with Countertransference

A therapist often feels a combination of subjective and objective countertransference when working with a patient. It is important for the therapist to know how to distinguish his or her own feelings from feelings that belong to the patient. One simple technique is for the therapist to pay attention to how long the feelings last. If an emotional state quickly ends once the session is over, the feelings are likely objective countertransference that come from the patient. If the therapist continues to feel the emotions for an extended period of time after the session, however, the feelings may be subjective in nature and should be addressed.

When a therapist becomes aware of subjective countertransference, he or she should deal with the feelings appropriately. Therapists are encouraged to distance themselves from their feelings. They might choose to talk about them with a trusted colleague or a supervising therapist to grow both personally and professionally. Sometimes, the wisest course of action is to transfer the client to another therapist.

Ethics Code

The American Psychological Association (APA) is a respected professional organization that works to advance knowledge about psychology to help individuals and society. Most mental health practitioners are members or associate members of the APA.

The APA helps its members to stay committed to the ideals of the profession by behaving in ethical (moral or just) means. The APA promotes appropriate ethical conduct through a variety of means, including its Ethical Principles of Psychologists and Code of Conduct, also known as the Ethics Code. The Ethics Code sets forth broad rules and specific guidelines designed to help mental health practitioners make ethical professional decisions. One of these rules is to avoid harming the client. When applied to the experience of countertransference, this means that therapists should never act on their feelings toward patients. They should never attempt to have sexual or romantic relationships with patients and instead should focus on giving the patient the best treatment possible.

Bibliography

"About APA." The American Psychological Association. American Psychological Association. 2015. Web. 22 Jan. 2015. http://www.apa.org/about/index.aspx

Cartwright, C. "Transference, Countertransference, and Reflective Practice in Cognitive Therapy." Clinical Psychologist, vol. 15, 112-120. 2011. Web. 22 Jan. 2015. http://www.researchgate.net/profile/Claire_Cartwright/publication/258312764_Transference_countertransference_and_reflective_practice_in_cognitive_therapyc_p_30_112..120/links/02e7e527c8bcf97ac8000000.pdf

Rathe, Elissa Lin, Ph.D. "Transference and Countertransference from a Modern Psychoanalytic Perspective." North American Association of Christians in Social Work. North American Association of Christians in Social Work. 1 Feb. 2008. Web. 20 Jan. 2015. http://www.nacsw.org/Publications/Proceedings2008/RatheETransference.pdf

"Sigmund Freud." Bio. A&E Television Networks, LLC. 2015. Web. 20 Jan. 2015. http://www.biography.com/people/sigmund-freud-9302400#video-gallery