Therapy is a unique journey where emotions run deep. During these intimate conversations, the dynamics between therapist and patient can be incredibly complex. Transference and countertransference are phenomena that occur when emotions are transferred or mirrored within the therapeutic relationship.
The concept of transference involves a client redirecting feelings about a specific person onto their therapist. Transference in therapy can be positive or negative. These emotions are often rooted in past experiences or unresolved conflict.
Transference involves creating a dynamic that mirrors past relationships or experiences. When a client transfers feelings onto their therapist, it provides an opportunity to gain insight into their inner world.
Dede Kammerling, an NYC therapist and MyWellbeing community member, explains: "For example, a patient who lost a parent as a child looks to the therapist for total love and acceptance. While the therapist genuinely cares for her patient, it may not feel like enough. The therapist will inevitably fall short of what the patient believes they need."
For example, a client might feel deep attachment and admiration for their therapist. This is similar to how they felt towards a nurturing parent. They could also feel intense anger or frustration. This may mirror unresolved conflict from childhood.
Transference can be powerful and sometimes hard to predict. However, it offers a unique opportunity for exploration and healing. Therapists are trained to recognize and manage transference. It provides valuable insight into a client's inner world.
Parental Transference Sarah, a middle-aged client, enters therapy to address low self-esteem. She also has difficulty forming healthy relationships. During each therapy session, she begins expressing intense feelings of attachment for her therapist, Dr. Miller.
Sarah often compares Dr. Miller to her absent father. Her father was emotionally distant and critical. She transfers her desire for validation from her father onto Dr. Miller. This creates a strong emotional reaction that helps both therapist and patient understand her patterns.
Romantic Transference John, a single man in his thirties, starts therapy for anxiety. He also struggles with self-doubt in romantic relationships. He develops intense romantic feelings for his therapist, Laura. He confuses the therapeutic relationship with romantic attraction. This highlights his difficulties forming healthy, intimate relationships.
Countertransference in therapy occurs when a therapist redirects feelings toward their client. Referring to Dede's example, the therapist whose patient longs for total love may "feel misunderstood and somewhat forced by the client."
Therapist feelings can vary widely during countertransference. Therapists might feel compassion, frustration, sympathy, or irritation. These are emotional responses to a client's transference. These reactions can be influenced by the therapist's personal history. Values and unresolved issues also play a role.
Recognizing countertransference occurring is essential for therapists. It helps maintain self-awareness and monitor emotional responses.
Sadness and Grief A therapist, Daniel, works with a client coping with loss. Daniel recently experienced significant loss too. He finds himself experiencing deep sadness and grief during each therapy session. This strong emotional reaction can affect his ability to provide necessary support.
Overprotective Feelings Dr. Anderson begins feeling overly protective toward his teenage client, Emily. She reminds him of his own daughter. He gives her more reassurance than he typically would with other clients. This countertransference in therapy can potentially hinder her progress. It prevents her from addressing issues on her own.
"In my experience, we get better at recognizing transference with time and experience," says MyWellbeing community member Vanessa Kensing. "The longer we work with an individual, the more we see patterns of emotions. We see relationship dynamics expressing themselves within the therapeutic relationship."
"Transference can be difficult to recognize," adds Alexander Beznes. "It depends largely on the therapist's ability to tell if the client's response is grounded in the present moment. Or if it's influenced by old patterns of relating."
Recognizing different types of transference requires careful observation. Therapists must pay attention to strong emotions that seem disproportionate to the current situation.
"I don't always use the name transference when describing what's happening in our relationship," says Vanessa Kensing. "Often, I find it more relational to come from a curious place. For example, I may ask how old a client feels in a particular moment. Or when else they have noticed a dynamic occurring in our relationship."
"I frequently check in with the client about their experience," Alexander Beznes says. "This encourages feedback and helps establish mutual understanding. By creating dialogue, a therapist can help clients recognize how they're relating to their therapist. It gives voice to feelings they might otherwise be too scared to express."
These conversations can help both therapist and patient gain insight into relationship patterns. They strengthen therapeutic alliances through honest communication.
"Being aware of your own body and state of mind can help you," says Alexander Beznes. "You can tell the difference and recognize the impact the client may be having on you."
"Recognizing countertransference is an exercise in trusting and accepting one's own feelings," explains Joshua Ring. "As therapists, when working with patients we will be subjected to the deep reservoir of our own feeling states. These are both emotional and physical. The more we can tolerate from ourselves, the more able we will be to contain and hold our patients' difficult feelings."
"For me, mindfulness has helped me tune in more to moments when countertransference is occurring," says Vanessa Kensing. "Practicing being in present time helps me note when my emotions and bodily experience shift. For example, I might notice my stomach clenches. Or I'm holding my breath. Or I have shifted from a present place to anxious, annoyed, or protective."
Mindfulness helps therapists recognize their emotional response as it happens. This awareness prevents strong emotional reactions from affecting the therapy session.
"Pat yourself on the back," affirms Vanessa Kensing. "If you're tuned in enough to notice when you're feeling countertransference, you're in a great place! Now, pause. Perhaps you are feeling strong emotions. Some self-compassion and a deep breath would likely be nice in this moment."
"The clients we encounter will remind us of others we've met in life," explains Jenny Maenpaa. "Acknowledging that to ourselves helps us keep perspective. Being an active participant in the therapeutic relationship means therapists will have to hold multiple ideas at once. We must also create space for the client experience."
This process helps therapists manage their own feelings. It ensures the focus remains on the client's needs during each therapy session.
"Countertransference in a therapist can be helpful when it supports and enhances the treatment," says Jenny Maenpaa. "For example, if a therapist finds that the client reminds them of a family member, this can be useful. The therapist actually has a healthy relationship with that family member. They have effective strategies they use to communicate with that person. Then the countertransference can be useful."
"Recognizing and processing one's countertransference is vital to the therapeutic process," adds Alexander Beznes. "It often shows that the therapist is being impacted by the work. Countertransference can help bring awareness to subtle dynamics in the therapeutic relationship."
When managed properly, therapist feelings can provide valuable insight. They help both parties understand the client's relationship patterns better.
"There was a recent experience where I wasn't as tuned in to my countertransference," says Vanessa Kensing. "This led to me not being in present time. I was ignoring the pacing of the reflections I was offering the client. I noticed my client begin to emotionally withdraw. Her body language shifted. Once I acknowledged what I was feeling, I was able to refocus my attention to my client."
"Depending on what happened and the level of functioning of the client, the most beneficial action may vary," Jenny Maenpaa says. "It may be to acknowledge what happened and process it together. This can allow the client to see the therapist as human. But still a professional rather than a peer."
These moments can actually strengthen the therapeutic relationship. They show that mistakes can be addressed and repaired.
"My supervisor has always taught and guided me in listening to and naming my countertransference," Stephanie Rojas said. "It has always been a useful tool to determine what is happening in the room. It's very helpful to talk it out. We explore gently what this means for you as a therapist."
"Just like therapeutic alliances with a client, building authentic trust and rapport with a supervisor takes time," Vanessa Kensing added. "If you can achieve a secure and trusting relationship, your supervisor can get to know you well enough. They can identify possible countertransference. They can see how it might be affecting your work with a client."
Joshua Ring shares a powerful example: "I once had a patient who was abused as a child. He was very aggressive and often acted in a demeaning and bullying way. My instinct was to be quite timid and passive. Through supervision, I was able to talk through strong emotional reactions. I became connected to feelings of deep rage toward this patient. I connected those feelings to earlier experiences where I was bullied. Once I made this connection, it freed me up. I was aware that he needed for me to be stronger than him. Not only did I need to contain his rage but I needed to stand up to him. This was an excellent learning experience."
Transference and countertransference are normal parts of the therapeutic process. They can't be entirely avoided. They're rooted in fundamental aspects of human psychology. Instead of trying to eliminate them, the goal is different. We must recognize, understand, and manage them effectively.
"Transference and countertransference are normal parts of the therapeutic process," says Alexander Beznes. "In fact, it has been argued that a treatment can only be successful if both the therapist and client are impacted by the work!"
Remember, these dynamics are the threads that weave the tapestry of your therapeutic journey. Embrace them, understand them, and use them as tools for positive transformation. When both positive or negative feelings arise, they offer opportunities to gain insight into the therapeutic relationship.
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Mariah was Head of Growth at MyWellbeing. She is a marketing expert in the areas of content strategy, digital advertising, business growth, and anything related to helping therapists grow their practice.
