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October 21, 2018

Effectively Handling Transference and Countertransference

women shaking hands and smilingFew dynamics in life are as subtle and nuanced as the therapist-client relationship, which involves a complex system of boundaries designed to protect both while providing a safe, healing environment. Unlike other relationships, however, boundaries within the context of a therapeutic relationship can be difficult to navigate. Intense feelings and unprocessed emotions can easily arise and trigger conscious or unconscious responses. Within the therapeutic context, this phenomenon is known as transference and countertransference— concepts originated by Sigmund Freud and later adopted by therapists worldwide.

Two Common Pitfalls in Therapy

Transference describes the act of unknowingly transferring feelings for someone from the past onto a therapist. For example, a young male client may find himself behaving rudely and aggressively toward an older female therapist. He may become argumentative, resistant to any suggestions, and even find himself despising the therapist despite their genuine concern and effort to help. This could be because of an unconscious association by the client, who relates the therapist with his mother for whom he still harbors resentment— or perhaps a grandmother, teacher, or aunt who triggers similarly negative emotions.

Countertransference is a mirror image of this process, and occurs whenever the therapist unknowingly transfers their unresolved thoughts, feelings, and emotions onto a client. In the context of a therapeutic relationship, this can be highly problematic and may appear in the following attitudes and behaviors:

  • Pushing or forcing a client into action before they are ready
  • Desiring a relationship outside of the therapeutic dynamic
  • Harshly judging or condemning perspectives differing from their own
  • Offering unsolicited advice instead of honoring free will and self-determination
  • Transferring bad moods or unresolved emotions onto a client

How to Handle Transference and Countertransference – Practical Tips for Therapists

Fortunately, there are a variety of methods that prove useful for therapists dealing with countertransference, which inevitably occurs throughout the course of clinical practice. Whenever therapists find themselves offended or emotionally triggered by something a client says or does, clear, open communication can go a long way toward bringing about a satisfactory resolution. For example, if a client is consistently late for appointments, or habitually exhibits offensive body language or verbal communication, a therapist can calmly, directly ask them what is triggering the behavior they are observing. This helps de-escalate a potentially confrontational or unpleasant situation and simultaneously shows respect for the client despite their aggressive behavior. Even if it fails to produce the desired effect, empirical evidence suggests that such a conscious, empathic approach almost always results in improved outcomes when compared to confronting a client or internalizing a negative reaction.

Even the most experienced therapists can become overwhelmed on occasion, or suffer from the psychological, spiritual, and emotional issues triggered by intense therapeutic dynamics. Practical application of the following, time-tested principles help boost your own clinical practice while achieving more favorable therapy outcomes:

  • Consult a colleague, supervisor, or clinical director whenever your own emotional responses to a therapeutic relationship are challenging and causing you to inappropriately sacrifice empathy and objectivity.
  • Apply continual self-care and self-reflection to prevent compassion fatigue, burnout, excessive stress, or inability to do focused, quality clinical work.
  • Deeply explore your own feelings toward a client or clients and, if necessary, write down the ways in which you are consciously or unconsciously defensive or reactive.
  • Establish clear, appropriate boundaries regarding scheduling appointments, payment (if in self practice), and acceptable in-session behaviors.
  • Never make assumptions when in doubt about any aspect of a therapeutic relationship or behavior. Instead, kindly and conscious discuss them with the client instead of allowing any unnecessary misunderstandings from occurring.
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