How can I feel more confident with transference and countertransference issues?

This question was originally posed to me by one of my group members as “How can I feel more confident with transference and countertransference issues with trauma clients?”. I have decided to answer it more generally because transference and countertransference is part of all the work we do as therapists, whether people have a history of clearly identifiable trauma events or not. If you would like to hear me speak about it click here

Transference and countertransference sound incredibly complicated. But the reality is, they are just part of the relationship with the client. You don’t get to work with someone and not have transference and countertransference. The issue is, are you paying attention to it?

For those who are new to these words or a bit rusty on the concepts, the basic and most modern definitions of transference and countertransference are:

Transference: in modern therapeutic terms it means the general state of the therapeutic relationship. Is it positive and does it feel good or is there some conflict that blocks the therapeutic relationship?

In more traditional times transference meant the projection of feelings about a significant other onto the therapist. And in some cases, it was used to describe the loving/ romantic feelings that a client might feel towards a therapist.

Countertransference: is the therapist’s reaction to the client or the client’s content or both.

Countertransference can be incredibly helpful in the therapy and used as a way to shape the therapy. For example, feedback about the impact of a client’s behaviours on the therapist can be used to help the client gain insight of their impact on others.

Countertransference can also be unhelpful. For example strong reactions to beliefs held by the client that are different to the therapists own including religion, racism or homophobia can create hostile feelings in the therapist. This may prevent the therapist from providing helpful treatment responses.

Other examples of unhelpful transference is when the client reminds the therapist of a person in their life and they respond to the client in that template, rather than responding to the client’s need. An example of this can be having feelings of annoyance towards a client who behaves or looks similarly to your ex-husband.

How to increase confidence with transference and countertransference issues

• The first thing to help you develop confidence in transference and countertransference issues is to realise it is present in all therapy relationships and it is normal.

• The other is to make a decision to actively pay attention to it and work with it. Pretending it doesn’t happen or you aren’t affected by clients isn’t helpful. Similarly, not acknowledging that client’s have a response to us isn’t helpful either.

• Actively use supervision to discuss transference and countertransference.
• Read psychodynamic literature like that of Nancy McWilliams and Irvin Yalom to see how they work with transference and countertransference explicitly. Psychodynamic practitioners tend to be the masters of the topic.

• Talk to your clients about transference and countertransference in general terms. Make it part of the relationship. I often say to my clients sometimes I might do or say something that annoys or upsets you. If that happens, please share it with me as it will help our work together. It is also important to pay attention to the non-verbal cues of your clients for signs that a conflict is occurring in the transference. Although we can flag transference issues with clients, it is our responsibility to manage it and address any signs we see as clients will often struggle to feel comfortable to do so.

Get familiar with the signs of a client who is experiencing negative transference.

• hostile behaviours
• suspicious behaviours
• demanding behaviours
• fear of dependence
• anger and frustration
• disappointment

Use what you notice, to help the client understand themselves and their situation better. We can often be tempted to refer on clients when there is strong negative transference but it’s important to draw it to the client’s attention as they need to form a relationship with you as a therapist, not the image of the person you are symbolising to the client. They will likely be having similar issues in the world outside therapy.

However, in some cases, a client might decide they would rather work with someone who does not evoke negative transference and if the issue they present with is not related to relationships, this may be appropriate. This article explains it well

Get familiar with signs of therapists experiencing problematic countertransference and look out for them in yourself. Some examples of this include:

• excessive self-disclosure
• over interest in minor details about a client’s life
• over-involvement in the client’s life
• identify your own trauma and significant life events and beliefs and keep an eye on them where there is a potential for them to be triggered by a client’s presentation of similar life issues
• watch for strong negative feelings towards the cleint that seem disproportinate to the content or the clients general presentaiton.
• watch out for signs of attraction to a client. You must take active steps to manage this to avoid boundary breaches. Ensure that it is dealt with in supervision.

Transference and countertransference is a problem when it is ignored or not managed. Regardless of your therapeutic model, all therapists become better when they choose to acknowledge transference and countertransference issues. To improve your confidence, start taking steps to acknowledge it more, learn about it more as avoidance doesn’t help.

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