Transference vs Countertransference: How do they Differ?

Transference and countertransference are natural occurrences in therapeutic relationships. Transference happens when a client projects their emotions onto the therapist, and countertransference happens when a therapist projects their reactions onto the client. Transference happens more commonly when clients feel safe and comfortable to open up and share parts of themselves and countertransference happens less frequently as the pitfalls of countertransference can be very damaging to the therapeutic process due to the power imbalance in therapy. Both, however, can play a major role in the healing process for the client and is important to think about (Bax, Nerantzis, & Lee, 2022).

How does Transference and Countertransference work in Therapy

When a therapist and client engage in therapeutic discussions, transference happens on an unconscious level by the client. Many times, clients project their feelings and experiences onto their therapist and the therapist creates a safe space for them to express themselves, regardless of what those feelings are. This enables clients to feel free to dig into their feelings in a space that is safe and secure. When they feel this safety, that is when they can begin to open up and look at deeper feelings. Through this journey, the therapist can support the client's self-discovery. (Ensink and Normandy, 2023).

Countertransference is just as natural as transference, however, it is much more critical that therapists are acutely aware of their own emotional reactions during sessions. When therapists experience countertransference, they are experiencing some kind of emotional reaction that goes beyond the extent of a neutral and objective point of view. To a degree, therapists as humans may encounter this from time to time. 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 proper supervision and taking appropriate steps to ensure therapy for the client remains ethical (Tishby and Wiseman, 2022).

Differences between Transference and Countertransference

These psychological concepts, as common as they are, often reveal themselves most often in a psychodynamic approach to therapy. Psychoanalytic theory, which drives psychodynamic therapy, tells us that the client's interactions with their therapist give light into the unconscious thoughts of the client. When the client projects their feelings, it is an opportunity to learn about hidden belief systems. This is the foundation of transference.

Sometimes clients utilize these projections to keep themselves safe as these projections can create distance between themselves and their therapist. Therapists however are trained to recognize the resistance and gently challenge it. Transference can be a great teacher for both the client and therapist to learn about displaced feelings and how to learn where feelings come from to better manage them (Scott, 2021).

Attachment theory is also a significant supporter of the importance of transference and countertransference in therapy. Attachment theory explains how children attach to their caregivers and how as adults, their childhood patterns of attachment may show up. In therapy, clients may show their attachment styles as a result of how they are projecting on their therapist. This is another way in which transference can occur. It is important for therapists to be aware of a client's history and understand what is appropriate and unusual emotional expression for them. At the same time, therapists need to balance this need with appropriate boundaries as countertransference can occur.

The difference here is that clients are expected to project in safe therapeutic environments however therapists are often cautioned against it. In doing the work, if they are not mindful, therapists may become preoccupied with their clients' emotions and begin to respond to them as their individual selves versus as their therapist. It is critical therapists have the training needed to ensure they are maintaining appropriate boundaries (Roddy and Eccleston, 2023).

Countertransference can be helpful for clients to a degree and help them learn appropriate caring responses, however, as therapists, it is important to understand the limits of using this and the potential pitfalls to look out for. When therapists use countertransference, it is important for them to consider how they are using self-disclosure to inform their clients of what is happening and how they are leading the session.

A major difference between transference and countertransference is the power balance that needs to be maintained for ethical practice. 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.

Ultimately, both transference and countertransference can be expected to a degree in therapy, and how the therapists manage these projections and personal reactions reflects the effectiveness of the therapy. The individual awareness of both the client and therapist is critical in therapy, and the therapist has a significant responsibility to ensure appropriate boundaries and professionalism remain in place.

Techniques for Therapists to Manage Transference and Countertransference

Transference

• Support clients in identifying and understanding their projections
  • This can be done with a variety of therapy modalities such as CBT to help them learn where their automatic thoughts and responses come from. When clients are empowered to name their emotions, they can begin to make meaning of what these emotions mean to them. When clients are feeling a lot of different emotions, it can be hard to understand for themselves what they feel and make it hard for them to articulate it. You can help them articulate it by helping them identify their feelings.

• Explore where the emotions first came from
  • When therapists help clients dig into deep feelings, they are helping them go through a heavy emotional journey that they may not feel prepared to go on. When they have the support to go on this journey, they learn about themselves and what they are capable of doing. Therapists have a big responsibility to help uncover deep emotions and experiences to help clients learn to manage them and find ways to make peace with all these different parts.

• Maintain boundaries
  • Maintaining professional boundaries is critical through all of this to ensure the appropriateness of engaging in the deep emotional work. Making sure that you are keeping good boundaries ensures that clients are getting unbiased and ethical care.

Countertransference

• Self-reflection and clinical supervision
  • Therapists need to make sure they are seeking peer/clinical supervision and practicing self-reflection often to ensure they are not becoming biased. Objectivity is the foundation of a healthy therapeutic relationship and therapists have a big responsibility to make sure they are emotionally and mentally available in therapy to focus on their clients. Self-reflection work gives therapists the space to explore their own feelings about what they are seeing and feeling in their work and processing with another clinician can be a great way to improve clinical skills and reinforce beliefs around appropriate professional boundaries.

• Therapy for therapists
  • Therapists can also use therapy for themselves to work through the kinds of issues that are coming up in their work. It’s important that therapists know and can discern when they may need to consider professional help for themselves. Their care can be compromised if they are in need of mental health care that they are not seeking out. Therapy to work through personal traumas, triggers or emotions that come up during sessions is important to consider while also seeing clients.

• Mindfulness practices during sessions
  • Therapists can learn ways to manage their own emotions and reactions which can come up in sessions through mindfulness based techniques. Many mindfulness based techniques can be adapted to many situations and circumstances, and therapists can use the same skills they teach their clients and use it for their own wellness as well.

References

Bax, O. K., Nerantzis, G., & Lee, T. (2022). Transference-focused psychotherapy as an aid to learning psychodynamic psychotherapy: qualitative analysis of UK psychiatry trainees’ views. BJPsych bulletin, 46(1), 57-63.

Ensink, K., & Normandin, L. (2023). Trust in therapeutic work with adolescents with and without personality disorders: A transference-focused therapy perspective. Journal of Personality Disorders, 37(5), 580-603.

Roddy, J., & Eccleston, S. (2023). Understanding Attachment and Transference. In Working with Client Experiences of Domestic Abuse (pp. 60-72). Routledge.

Scott, S. K. (2021). Psychodynamic theories: Approaches and applications. Foundations of Couples, Marriage, and Family Counseling 2nd Edition, 103-124.

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