Have you ever experienced restricted judgment during a therapeutic encounter? If so, you are not alone. More often than not, such a situation arises from countertransference. From an early psychoanalytic perspective, countertransference can be defined as the influence of a client's problems on the therapist's unconscious feelings and emotions. It may serve as an obstruction in the therapeutic alliance and overall therapeutic outcome. It is essential to manage countertransference as it interferes with the therapist's rational decision making and objectivity.
Moreover, 'beneficence and nonmaleficence' is one of the general principles of the APA code of ethics, but countertransference brings the opposite energy to the therapy room. It may cause harm to the client. If you are going through the same problem, then worry no more. We have got you covered. Let's dive into the 5-step model (Cartwright and Read, 2011) and see how to deal with countertransference.
1- Identifying triggers and countertransference responsesThe first step is to acknowledge your countertransference responses that can either be physiological or emotional. If the client's abusive marital life makes you cringe, that might be because of your own unresolved traumas. You have been there, right? Every therapist has to go through a tiring journey of self-actualization before they can finally unravel their triggers, leading to positive or negative countertransference. Maintaining a self-reflection journal may deem beneficial in this regard.
2- Understanding countertransferential thoughts within the context of therapyBoth therapist and client bring their idiosyncratic vulnerabilities to the relationship, and clients may provoke emotional responses in the therapist. Therapy is a two-way confidential transaction in which the client and therapist work mutually. Therefore, it is important to reflect on your and your client's individual contributions in evoking countertransference.
3- Conceptualization of countertransferenceThe next step is to understand the client's template for the relationships. You need to understand the client's representation of self and others that the client has built through past experiences. If the client feels unloved and resented in her life, she might assume that the therapist may feel the same about her. As a therapist, you may feel irritated by your client's misconception and acts on your feelings in the form of withdrawal from the client or annoyance. Once you do so, the client's transferential expectations will be fulfilled. It will bring the therapist's worst dream to life, i.e., sabotaging the therapeutic relationship. So, try understanding the client's need and work on it without being emotionally drawn to it.
Transactional Analysis model of Parent, Adult, ChildAccording to transactional analysis (Berne, 1961), there are three ego states – Parent (demanding, critical), Adult (healthy, rational), and Child (emotional, irrational). Clients often move to the parent or child mode to which the therapist's countertransferential responses may elicit. As a therapist, you may also shift to parent or child mode, complementing the client's ego state. You need to analyze the situation and identify your and the client's ego state to understand countertransference in a better way.
4- Using calming strategies to manage countertransferenceTo manage your emotions evoked by the client in session, you can use breathing techniques to soothe your nervous system. Try to give positive and calming messages to yourself, such as "It is okay. I am having a countertransference response", or "I am aware of my emotional state". By doing so, you signal your brain that you have emotional responses under control and try to calm yourself with mindful strategies.
5- Moving back into the Adult ModeBy this step, you will be aware of the triggers, countertransferential thoughts and feelings, yours and your client's contribution to the countertransference. Now you will be ready to move yourself back to adult mode (from either parent or child mode). Use the calming strategies to strengthen your impartiality and healthy self.
These steps will help to understand and manage countertransference in therapy. Moreover, it will eventually help regain empathy and compassion towards your client. It also helps you understand your emotions and vulnerabilities and teaches you to regulate your emotional responses while working with the client.
Hina Babar, Psychology Intern
Berne, E. (1961). Transactional Analysis in psychotherapy. New York, NY: Evergreen.
Cartwright, C., & Read, J. (2011). An exploratory investigation of psychologists' responses to a method for considering" objective" countertransference. New Zealand Journal of Psychology, 40(1), 46-54.
Lets start with the issue of attraction…it may not be an issue at all. During my psychotherapy training, it was a reassuring relief to learn that attraction - whether from client to therapist or therapist to client - could simply exist apart from the therapeutic process. It is human to find someone good-looking, and simply acknowledging this fact to yourself goes a long way to keeping the therapeutic relationship healthy and intact.
However, when it comes to love, one of two things could be happening:
• A client could begin to develop sexual or intimate feelings for the therapist. This is the most common occurrence.
• A therapist could also ‘fall in love’ with a client. If this is the case, the therapist must keep the client’s emotional well-being at the core of the therapeutic process and reflect upon and process his or her feelings via therapy and supervision. The therapist may need to refer the client to another therapist.
When a client tells you they love you, be aware of these key aspects:
1. The client is most likely experiencing transference, whereby he or she is redirecting unconscious feelings from another person onto you. So, it is best to discuss what the transference is and work it through.
2. Usually, clients who fall in love with their therapists have struggled to feel loved. They find that their therapist is filling unmet needs, and strong reciprocal feelings can result. Therefore, treat this occurrence as a way to unravel your clients’ core wounding.
3. It has probably taken a fair amount of courage for your client to admit the intensity of his or her feelings, so it is best to treat the matter while still ensuring the client is aware that the feelings are not mutual (if you suspect your client has fallen in love with you but hasn’t mentioned anything, also have the courage to bring this up and to work through it). Continued personal growth and self-reflection will enable you to better meet the client, and be as holding and authentic as possible.
4. A therapist’s main role is to support clients in developing intimate relationships outside of the therapeutic relationship. Dependency may exist at the start of therapy, but self-intimacy and ‘other-intimacy’ are the goals beyond client-therapist intimacy.
It is important to acknowledge that the therapy room is a loving space. How else do people heal? Greater intimacy and emotional well-being is why people seek therapy in the first place. Good therapists should feel loving towards their clients. Call it what you will: unconditional positive regard, a healing bond, a safe acceptance; what therapists offer most is their love. And with good enough love, clients can progress through any traumas linked with the lack of it.
Ellen Evans, Transpersonal Psychotherapist