Transference and countertransference
Transference and countertransference:
In a therapy context, transference refers to redirection of a client's feelings from a significant person to a therapist. Transference is often manifested as an erotic attraction towards a therapist, but can be seen in many other forms such as rage, hatred, mistrust, parentification, extreme dependence, or even placing the therapist in a god-like or guru status. When Freud initially encountered transference in his therapy with clients, he felt it was an obstacle to treatment success. But what he learned was that the analysis of the transference was actually the work that needed to be done. The focus in psychodynamic psychotherapy is, in large part, the therapist and client recognizing the transference relationship and exploring what the meaning of the relationship is. Because the transference between patient and therapist happens on an unconscious level, psychodynamic therapists who are largely concerned with a patient's unconscious material use the transference to reveal unresolved conflicts patients have with figures from their childhoods.
Countertransference is defined as redirection of a therapist's feelings toward a client, or more generally as a therapist's emotional entanglement with a client. A therapist's attunement to his own countertransference is nearly as critical as his understanding of the transference. Not only does this help the therapist regulate his/her own emotions in the therapeutic relationship, but it also gives the therapist valuable insight into what the client is attempting to elicit in them. For example, if a male therapist feels a very strong sexual attraction to a female patient, he must understand this as countertransference and look at how the client is attempting to elicit this reaction in him. Once it has been identified, the therapist can ask the client what her feelings are toward the therapist and examine the feelings the client has and how they relate to unconscious motivations, desires, or fears.
There is always a level of transference and counter transference, as therapy is a relationship, us as therapists have a vested interest in our role and want to provide a valuable intervention, we care. We have feelings for people that we have relationships with, client and therapist alike. Those feelings can be positive or negative. It is worth bearing in mind that the very reason that has brought someone to see us may predict some of the likely transferences that may occur. Likewise, some counter transference can be predicted sometimes from our own histories.
We may be the only people some of our clients come into contact with that do not judge or marginalize them, instead we try to understand and normalize whenever we can. That is in itself can have a powerful emotional impact. But here are a few specifics:
-Anxiety and social isolation may lead to the therapist being central in a client’s life; as such they may be one of their only social contacts
-Reduced opportunities for romantic interests (Asperger’s, LD, etc.)
-People with ‘Borderline Personality Disorder’ or very difficult interpersonal relationship styles, where they shift rapidly from loving and hating and see self and others as ‘all good’ or ‘all bad.’ This can be played out in the therapy room.
-Clients may have low self-worth, and feel that you as the therapist are a good role model and over identify with you.
-We may be asking clients about very difficult things that evoke negative emotions. We then may be central in re-experiencing those emotions, almost as if we are the personification of them
Potential difficult outcomes
~We may reject the client, or fear we will.
~We May being complicit to their ‘maladaptive’ relationship patterns
~We may disclose information, which we are later uncomfortable about, so that the client is not so hurt (e.g. I am married with children)
~Difficulty in managing boundaries
~Breakdown in therapeutic alliance
We pretty much all have clients we ‘prefer’ over others, that may be due to them being motivated, or us just liking them more. Equally, there are some we are relived to have DNA on us. These feelings are to do with the counter transference.
Counter transference-some examples
~Client reminds us of someone we have or had strong feelings for (positive or negative)
~We over identify with them (difficulties we have resolved in the past/similar personality/social standing/age/gender etc.)
~Feeling parental towards client
~Sexual attraction – just to normalize this a bit and Pope & Tabachnik, (1993)* found that the vast majority of therapists (87%) had been sexually attracted to at least one if not more of their clients.
Potential Difficult Outcomes
-Inappropriate levels of disclosure that compounds transference
-Not working with the countertransference
-Not acknowledging the countertransference
-Therapeutic alliance breaking down
-Unable to discuss case reflectively in supervision
-Reinforcing Client’s and own relationship patterns
-Difficulty ending therapy
What can we do?
~ Am I responding in a way that feels like me?
~Do I associate this client with anyone else?
~What feelings do I have about them?
~Are those feelings only those that I as a professional have towards all my clients or are there differences?
~Why am Feeling this?
~How is it impacting on my work with this client?
-Use supervision, more not less
-Reflective and reflexive practice is key
-Accept that feelings towards a client is normal, and work with that
-Talk about the relationship in the therapy room
-Be consistent with boundaries
*Pope, K.S. & Tabachnick, B.G. (1993). Therapists' anger, hate, fear, and sexual feelings: national survey of therapist responses, client characteristics, critical events, formal complaints, and training
Professional psychology, research and practice.
vol. 24, no2, pp. 142-152
Giorazonlina, T. (2004) The therapeutic relationship in CBT. Counselling Psychology Review, 19, 14-20.
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