In my last post, I tackled the concept of transference in therapy. That is, the transfer of feelings from a significant person, past or present, onto the therapist. These feelings are usually unconsciously held but are usually not about the therapist. How the therapist handles this is crucial when assessing the overall success of the therapy. While transference can be seen as mostly helpful, some schools of thoughts find it controversial. However, transference is a powerful way to improve a client’s ability to change their behavior and gain insight.
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Counter-transference is when the therapist transfers feelings onto the client. It can be thought of as a reaction to transference from the client. It is a great reminder that a therapist is a human being with feelings and emotions and often when clients open up in session, it can provoke a strong reaction. However, therapists must be aware of counter-transference at all times and it is their responsibility to find a solution and/or deal with any issues on a personal basis that might allow it to happen.
Counter-transference can be often seen in the following ways:
Subjective: the therapists own unresolved issues is the cause (can be harmful if not detected)
Objective: the therapist’s reaction to his client’s maladaptive behaviour is the cause (can benefit the therapeutic process)
Positive: the therapist is over-supportive, trying too hard to befriend his client, disclosing too much (can damage the therapeutic relationship)
Negative: the therapist acts out against uncomfortable feelings in a negative way, including being overly critical, and punishing or rejecting the client
Counter-transference can occur at any time in a therapeutic relationship and if not handled properly, can be very harmful to the client. It can happen if a therapist is young or old, male or female or experienced or inexperienced. In fact, it can be expected to happen at some stage and supervision of the issue is essential. There are some early warning signs that tend to happen before counter-tranference takes place and these should be heeded by client and therapist. These can be:
An unreasonable or excessive like or dislike for the client
Inappropriate emotional reaction to the client and a near “obsession” with the case.
Dreading the session or being highly uncomfortable in session.
Excessive and inappropriate self-disclosure.
The need for the client to comfort the therapist.
Inappropriate contact outside sessions.
Once counter-transference is recognized, it is important that the therapist acknowledge and work through those feelings. It can take on many shapes, some more problematic than others. A therapist impressed by a client’s appearance may avoid challenging that client, due to his or her own desire to be admired and liked by the client. A therapist who is under financial stress, or just had an argument with their spouse, may in turn allow those emotions to carry over into the session with an unknowing client. It is wrong to say that therapists do not on occasion, have fatherly, motherly, romantic, sexual or other strong feelings for a client. It can be a reminder for the therapist of past experiences or people who were in their lives. One area that must be strictly monitored is erotic counter-transference where the therapist transfers erotic, romantic or sexual feelings onto the client. There are strict ethical guidelines around relationships with clients in therapy and the pursuing of a romantic relationship or friendship by the therapist could be a sign that counter-transference is happening.
Therapists must be aware of counter-transference at all times and it is their responsibility to find a solution and/or deal with any issues on a personal basis that might allow it to happen.
It is important for the therapist to understand the role that of transference and counter-transference, and deal with those emotions in such a way that the core of the therapeutic relationship is not affected by these feelings. It can be used in a more positive way as well. A therapist may be able to use the feelings that have been generated by the client to gain insight into how other people in the clients life might also react to them. In the end, it comes down to a skilled therapist doing his or her job for the benefit of the client.
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I wish MDs would either stop treating patients like neurotics, or learn some of the ‘rules’.
We all have neuroses, but a lot of people want to improve, physically and mentally and neurotic behaviour is not what they are trying to share.
I have a white African doctor, er, had. He would say very nasty stupid things to me as I was leaving the room – passive-aggressive much? Obviously I would not respond when the entire waiting room could hear my response, as he finished opening the door at the end of whatever insult he was voicing.
Having been sprayed with a military grade insecticide (as you know) that destroyed my immune system and CNS … I confided some information to him in the early visits. He then wrote a referral to a Gynecologist … after telling me that is was “lucky” I hadn’t asked to see an Obstetrician at my age…. The tone of voice made it clear that I am supposedly so stupid I wouldn’t know the difference. The Gynecologist’s GP assistant interviewed me first and at the end of checking my information lowered her voice and told me not to worry, they understood my “years of a problem with laxatives”. I let her know in no uncertain terms that was the stupidest thing I have EVER heard in my life.I have never in my life taken a laxative.
The next time my problem was supposedly that I am paranoid. COVID is not about me. It would be nice if this MD would keep his white African background in Africa and deal with his patients.
As you well know one’s country of origin and national differences is very important to actually HELPING others. I used to think people understood that, but more and more the “first rule of communication” pops into my head: The message IS the message understood.
I think it’s very important that people realize that their mental health should be treated by someone conversant with the myriad of details a real therapist needs to learn and understand.
There are lot of people who can listen and allow you to let things out, and sometimes a good vent is all you need. None of these people are trained therapists.
My first university degree was physiological psychology. People would say bizarre things like not wanting to speak to me becuase I would try to “shrink them”, or …
I spent a lot of energy trying to teducate people that there are many different areas of psychology, and if they want help they should see a properly trained clinical psychologist.
More and more I find foundation for this as so many people thing anyone can help them with mental health issues.
I wouldn’t have a paediatrician look after my gynaecological requirements.
Reading your articles is very good for clarity. Thanks!
Thank you Chey
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There are many good points that have been outlined in this article that has been well put together.
As you say, therapists are human beings too and do have their own feelings, concerns and situations that are nothing to do with the client, which they have to be aware don’t spill over onto their clients.
The client cannot expect perfection from a therapist. From time to time they may say perhaps something a bit off or that comes across weird. Sometimes misunderstandings can occur, and translation issues. But what clients I guess should be able to expect is a consistent professionalism.
Therapists have a way of compartmentalising their clients, and dealing with each one as they are present.
What must be difficult is when one perhaps takes over, and bleeds over more in the present.
Here is where you need a skilled therapists who has the ability to be able to deal with this situation successfully, and yet still keep the therapeutic process healthy and stable.
Some therapists need everyone in a box so to speak, but people often do not fit in boxes psychologically speaking. We are complex, and often damaged individuals and some may just need some new tyres…and an oil change….others need a full m.o.t., engine change, and a full reset.
I have heard, read, and even watched movies where it’s sometimes portrayed where therapists and clients get very much entangled with one another that it almost becomes like a symbiotic relationship where one “needs” the other to such an extent that they cannot live without one another. Afterall this is a very intimate journey that they take together. But then that can damage the therapeutic relationship.
I do not think there is any harm in the therapist having motherly or fatherly type feelings over their clients, because many clients perhaps never had mothers and fathers who cared for them or loved them. And therefore they take on that role to a certain extent.
The therapist has to be very much grounded and know what they are and what their objective is.
I can only speak from personal experience in the fact that whatever situations have come up with myself as far as transference or even counter-transference, Dr Jenner was very much on the ball, and successfully dealt with all these issues, as they came along. He was prepared for them, and was happy to talk them through with me, reassuring me along the way. Keeping the connection in tact and healthy but not damaging the therapeutic process.
This is a somewhat difficult but necessary balancing act that the therapist takes on as and when is needed.
Some of these feelings can have the potential to stop the therapeutic process and even end the therapy process and that’s why as Dr Jenner explains that in the end….yes it does come down to a skilled therapist to do his or her job for the benefit of the client.
Thank you for the very profound comment
I like the car analogy. 🙂
On NPR there is a story telling show called The Moth. One of my favorites is called, “We’ll Have To Stop Now”. Its about a man in therapy. His therapist’s name is Phyllis. I recommend it for anyone reading this blog (Google Moth podcast “We’ll Have To Stop Now). It’s a sad story, but it’s the Moth so the man brings in some humor as well. It’s relatable to this as it is based around a man in therapy having assumptions about his therapist. He notices visual changes in her appearance like weight loss, changing her hair styles often, etc.
He compliments her changes and she asks if the changes make him uncomfortable. She laughs at his jokes and is appalled when he says appalling things. Like she is actually listening to him and having human responses…unlike his girlfriend of 16 years, he says. He’s in therapy bc his girlfriend suggested it, 3 years before. And he’s been going bc he likes the escape of talking to Phyllis. But on this particular day, something is different. He is having an emotional response and making assumptions based on her changes. But her changes had nothing to do with him.
I won’t spoil the end but it is a beautiful piece that I feel relates to this topic.
Thank you Erin