What is Countertransference in Therapy & How to Manage it

Countertransference is the transference of a therapist's emotions onto their client. It can be natural as transference, however, this unique dynamic poses a lot more risk so it is much more critical that therapists are mindful of their feelings and reactions during sessions. When therapists experience countertransference, they are experiencing some kind of emotional reaction which can go beyond what is appropriate in sessions.

Therapists must remain neutral and objective in their point of view, and countertransference poses a threat to that objectivity. Therapists are human and may encounter this on occasion. However, it is the exception and not the norm. Therapists must be aware of how and when countertransference is happening in sessions and ensure they are seeking their clinical guidance and taking appropriate steps to ensure therapy for the client remains ethical (Tishby and Wiseman, 2022).

Types of Countertransference

There are primary four main types of countertransference which can show up in therapy sessions. These countertransference types include:

1. Positive - Where the therapist is attempting to befriend their client or overly validate their client by sharing things about their own life.

2. Negative - Where the therapist responds in a critical way as a response to their own discomfort to what their client is bringing up in session.

3. Subjective - Where the therapist has their own unresolved issues which are coming up or being triggered in therapy which is informing their clinical intervention.

4. Objective - Where the therapist is remaining neutral and not judging or shaming their client for what they are bringing up, which is the primary function and benefit of countertransference (Tishby and Wiseman, 2022).

Examples of Countertransference

Countertransference can be overt or subtle, but it depends on the situation and circumstances to truly understand if countertransference or a breach in professional boundaries is occurring. The damage of countertransference can also depend on the type of emotions and conversations are happening in session and can vary in risk level. Some examples of countertransference in therapy include:

• Therapist self disclosing intimate details about their life
  • Lisa is a client coming into therapy with feelings of depression and isolation, she recently moved to a new state and lost her husband within the last year and is feeling really alone. Kelly, her therapist listens and validates her, and shares that she went through something similar 5-6 years age and had periods of feeling very depressed and unable to connect with others. Kelly goes on to use this self disclosure in a way to give hope to Lisa as Kelly has worked through it and can support Lisa through this time. This can be a positive use of self disclosure as long as the focus centers Lisa.

• Leading from personal emotions versus a therapeutic framework
  • Lisa could have shared this and Kelly could have responded differently. Kelly could have talked about her experience and her feelings about how she and Lisa both feel the same way, finding commonality, and leading Lisa to be the listener in the dynamic. This would be inappropriate to occur in therapy as there is no therapeutic framework being utilized.

• Inappropriate communication with clients
  • Kelly, the therapist, could tell Lisa to call her when she is lonely and begin a casual friendship outside of the therapy office. This would be very inappropriate, though Kelly may want to help Lisa, engaging with her outside of the office crosses many boundaries.

• Development intimate or romantic feelings for a client
  • In the same scenario, if Kelly doesn’t have good boundaries, her attempts to help and understand could trigger unresolved needs in her own self, such as feelings of loneliness. This can sometimes lead therapists like Kelly to develop feelings for their client.

• Therapist responding in extremes
  • In the same example, Lisa sharing her feelings of isolation could have led to Kelly responding in an over-the-top way. If Lisa appeared a little bit low, and Kelly responded to that as if Lisa had a lower affect or worse mood than she did, that would be Kelly’s countertransference leading the session and having her worry.

• Therapist lacking in professional boundaries
  • Kelly as the therapist is expected to maintain professional boundaries at all times, even if Lisa is a great client, there cannot be a relationship beyond therapist-client in this scenario. If Kelly invites Lisa out, shares her personal phone number, or begins to speak to Lisa as if she were her daughter or sister, these would all be poor professional boundaries.

• Therapist giving personal advice and solutions
  • Kelly as the therapist is here for the Lisa as the client. Kelly may have personal ideas and solutions, which she often may give to her friends and family, however in the therapy room, it is expected she remains unbiased and helps Lisa discover things on her own while facilitating this discovery. If Kelly begins to give personal advice from what worked for others she knows or herself in self-disclosing ways that are not beneficial , that is countertransference.

• Wanting to rescue your client
  • Kelly may engage in solution-focused ways to help Lisa uncover her own strengths, however it’s important as therapists that we do not interrupt the natural process of therapy by attempting to force a solution. This is often referred to as rescuing behaviors and when a therapist engages in these behaviors, it is usually about their own unmet need or an unresolved issue of their own.

• Strong emotions, either negative or positive, for your client
  • Kelly having strong feelings for Lisa in any example would be inappropriate and be a reflection of what is going on internally for Kelly in that moment versus her ability to remain objective for Lisa. This would be inappropriate and important for Kelly to take inventory of where she is so she can be emotionally present in the appropriate way for Lisa.

• Thinking about your client after sessions often
  • Kelly, like many therapists, may have genuine care and concern for clients, however there is a line that is crossed if Kelly thinks about Lisa all day, for most days of the week. Kelly may believe this is due to her compassion, and it may well be a part of it, however thinking about Lisa so often is often a reflection of a need Lisa may be filling in her life. This type of countertransference can become very messy quickly and can be difficult to notice.

• Breaking HIPPA
  • Any violation of protected health information (PHI) is breaking HIPPA. Kelly could break HIPPA by talking about other clients to Lisa and talking to Lisa about other clients. Kelly could also break HIPPA and confidentiality by texting information about Lisa to others or posting about Lisa online or even identifying herself as Lisa’s therapist online or in public settings. There is a lack of authorization from Lisa in these scenarios where Kelly is sharing what the scope of their relationship is.

How To Manage Countertransference

Countertransference can be therapeutic for clients to a degree to help them learn appropriate empathetic responses, however as therapists, its important to understand the limits and risks of countertransference. There are many potential pitfalls to look out for such as clients developing a dependence on their therapists, feelings for their therapists and seeking out ways to see their therapist more often. When these boundaries are violated, it becomes very challenging to reset to remain in a safe and healthy therapeutic relationship.

Therapists must make sure they are holding themselves accountable and behaving with integrity and this can be done by joining group supervision to discuss client cases for additional professional development. Newer therapists are more at risk for falling into patterns where they are experiencing a lot of countertransference (Prasko, et al., 2022).

When therapists use countertransference, it is important for them to consider how they are using self disclosure to inform their client of what is happening and how they are leading the session. It is important to self disclose only if there is a positive impact expected for the client, otherwise therapists may be crossing a boundary. When this boundary is crossed, a conflict of interest arises and working together can be challenging and unethical for the therapist to do, especially if the therapist can no longer remain unbiased. Maintaining professional boundaries is critical in this work (Baumann, Rye, & Harney, 2020).

Therapists must practice their own self-care to ensure they are able to manage the demands of therapeutic work. The emotional and mental demands of the job can be profound so therapists must make sure they are prioritizing things in their life to help them balance the needs of others and their own needs. Specific types of therapy work can come with greater risk for burn out and secondary trauma.

Many individuals disclose deep personal and traumatic events they’ve experienced and sometimes, therapists may have limited capacity to continue to hold space for so much pain. While this can be a natural occurrence, it is crucial that therapists have a network of other therapists they can discuss cases with, bounce ideas off of and find ways to manage the work more effectively (Abargil and Tishby, 2022).

Sometimes, therapists may refer their clients out to another therapist if they are unable to continue to work with certain clients. This happens when therapists uncover they may have unresolved issues of their own which is skewing their perspective and they want to give their clients the best experience in therapy. Sometimes it better to refer out as keeping clients with whom there is a lot of countertransference with can do more harm than good.

References

Abargil, M., & Tishby, O. (2022). Countertransference awareness and treatment outcome. Journal of counseling psychology, 69(5), 667.

Baumann, E. F., Ryu, D., & Harney, P. (2020). Listening to identity: transference, countertransference, and therapist disclosure in psychotherapy with sexual and gender minority clients. Practice Innovations, 5(3), 246.

Prasko, J., Ociskova, M., Vanek, J., Burkauskas, J., Slepecky, M., Bite, I., ... & Juskiene, A. (2022). Managing transference and countertransference in cognitive behavioral supervision: Theoretical framework and clinical application. Psychology research and behavior management, 2129-2155.

Tishby, O., & Wiseman, H. (2022). Countertransference types and their relation to rupture and repair in the alliance. Psychotherapy Research, 32(1), 16-31.