Therapy is a unique journey, where the human psyche is probed and examined, and where emotions run deep. It's no surprise that during these intimate conversations, the dynamics between therapist and client can be incredibly nuanced. Transference and countertransference are phenomena that occur when these emotions are transferred or mirrored between therapist and client, respectively.
Transference is the redirection of feelings about a specific person onto someone else (in therapy, this refers to a client’s projection of their feelings about someone else onto their therapist). These emotions can be both positive and negative, and they might be rooted in past experiences or unresolved issues. Transference can be thought of as a projection of one's past onto the therapist's present, creating a dynamic that mirrors past relationships or experiences.
Dede Kammerling, an NYC therapist and MyWellbeing community member, explains this dynamic: “For example, a patient who has lost a parent as a child looks to the therapist for unconditional love and acceptance. And while the therapist genuinely cares for her patient, it may not feel like enough. The therapist will inevitably fall short of what his/her patient believes he/she needs and insists on. The patient feels hurt, perhaps angry and deeply disappointed.”
For example, a client might feel a deep sense of attachment and admiration for their therapist, akin to how they felt towards a nurturing parent. Conversely, they could also feel intense anger or frustration, which may mirror unresolved conflicts from childhood or other important relationships. Transference can be powerful and, at times, unpredictable, but it offers a unique opportunity for exploration and healing within the therapeutic setting.
Therapists are trained to recognize and manage transference, as it can provide valuable insights into a client's inner world. By acknowledging and discussing these feelings as they arise, both therapist and client can delve deeper into the underlying issues and work together to address them. This process not only fosters self-awareness but also enables the client to break free from patterns of behavior and emotion that may have been holding them back. Here are a few example scenarios below.
A middle-aged client, Sarah, enters therapy to address her struggles with low self-esteem and difficulty in forming healthy relationships. During the course of therapy, she begins to express intense feelings of attachment and admiration for her therapist, Dr. Miller. Sarah often compares Dr. Miller to her absent father, who was emotionally distant and critical. She unconsciously transfers her desire for validation and approval from her father onto Dr. Miller. This transference provides an opportunity to explore her past relationship with her father and how it's impacting her current life.
John, a single man in his thirties, starts therapy to work through his struggles with anxiety and self-doubt in his romantic relationships. As therapy progresses, he begins to develop intense romantic feelings for his therapist, Laura. He confuses the therapeutic bond with romantic attraction, projecting his unmet romantic needs onto her. This romantic transference highlights his difficulties in forming healthy, intimate relationships and can be explored to address his patterns of seeking validation and love.
A client, Michael, who experienced childhood abuse, seeks therapy to address his deep-seated anger and resentment issues. During therapy, he becomes increasingly frustrated and resentful towards his therapist, Lisa. Michael's anger towards Lisa is a reflection of unresolved anger from his past. It allows him to express emotions he was unable to confront as a child and work through his unresolved trauma.
Countertransference is the redirection of a therapist’s feelings toward the client. Referring to Dede’s earlier example, the therapist whose patient longs for unconditional love and acceptance from them may “feel misunderstood and perhaps somewhat coerced by the client.“
Countertransference reactions can vary widely. Therapists might find themselves feeling compassion, frustration, sympathy, or even irritation in response to a client's transference. These reactions can be influenced by the therapist's personal history, values, and unresolved issues.
Recognizing countertransference is essential for therapists to maintain self-awareness and monitor their emotional responses, as unchecked countertransference can potentially hinder the therapeutic process. By acknowledging and exploring their own countertransference, therapists can better understand the client's experience and tailor their approach to meet the client's needs more effectively.
A therapist, Daniel, works with a client who is coping with the loss of a loved one. Daniel, too, has recently experienced a significant loss in his life. He finds himself experiencing deep sadness and grief while working with the client, and this emotional resonance can affect his ability to provide the necessary support for the client's grieving process.
Dr. Anderson, a therapist, begins to feel overly protective and nurturing towards his teenage client, Emily, who reminds him of his own daughter. He finds himself giving her more reassurance and support than he typically would with other clients. Dr. Anderson's countertransference could hinder Emily's therapeutic progress by preventing her from addressing her issues independently.
A therapist, Lisa, experiences intense anxiety whenever her client, Tom, talks about his childhood abuse experiences. Lisa, too, has a history of childhood trauma that she has not fully processed. Her countertransference might lead to her avoiding or overemphasizing discussions related to Tom's trauma, potentially hindering his progress.
In therapy, transference and countertransference can take many forms that can be difficult to perceive, and individual therapists have different approaches to address them. We spoke to our therapists about how they recognize transference and countertransference in the room, how to respond, and how supervision has helped them respond to countertransference.
“Transference and countertransference are fundamental aspects of every treatment relationship and awareness of them by both therapist and patient are crucial to successful work,” says Dede Kammerling. “Rather than just offering interpretations to one's patient, articulation of a patient's patterns of interacting needs to be observed and understood in the work.
“Transference and countertransference offer the opportunity to talk with our patient about their patterns of interaction with us and other meaningful people in their lives. Because those patterns have to do with earlier (and ongoing) familial relationships, our ability to recognize and understand them as they present themselves in the treatment relationship offers a unique and significant opportunity.
“Those old and often rigid patterns of interaction need to be recognized, understood and discussed in the treatment. It is in the process of unpacking and talking about those old patterns (the patient's transference and the therapist's response to them) that we are able to help our patient to gradually revise how he/she participates in other meaningful relationships. Needless to say, the therapist's self-awareness and ongoing observation of herself and willingness to talk about what's going on between herself and her patient are central to the ongoing therapeutic work.”
If you are struggling to recognize transference as a therapist, know that it gets easier. “In my experience, we get better at recognizing transference with time and experience,” says MyWellbeing community member and NYC practitioner Vanessa Kensing. “The longer we work with an individual, the more we are able to see patterns of emotions and interpersonal dynamics expressing themselves within the therapeutic relationship. Some clients appreciate hearing reflections of how these patterns may be playing out in the room and in their lives outside the room. In other cases, that may make someone feel exposed or judged. As transference often comes from developmental experiences, including developmental trauma, it is important to be gentle, non-judgmental, and attuned to the stage of the clinical relationship, the pace of rapport development, and how strong and safe the connection feels. This will allow you to explore transference sensitively and in a way that promotes healing.”
“Transference can be difficult to recognize because it’s largely dependent on the ability of the therapist to discern if the client’s response is grounded in the present moment or if it is being influenced by internalized blueprints of the way they are used to being and relating within relationships.,” adds Alexander Beznes. “These interpersonal patterns will often stem from early attachments, family dynamics, and relational trauma.”
Here's a few ways therapists can navigate these emotional currents effectively.
Regularly examine your own countertransference reactions. Ask yourself: What emotions are arising in response to this client, and why? Self-awareness is critical for effective countertransference management. Understanding your emotional responses will help you provide better care for your clients.
Seek supervision or consultation from experienced colleagues or mentors. Discussing your countertransference reactions with others in the field can provide valuable insights and guidance. It's an opportunity to gain a fresh perspective on the therapeutic relationship and your emotional responses.
When managed appropriately, countertransference can be a valuable tool for deepening your connection with the client and better understanding their needs. By recognizing your emotional responses and incorporating them into your therapeutic approach, you can become more attuned to the client's experience, which can enhance the effectiveness of therapy.
Maintain clear and professional boundaries. It's essential to establish a therapeutic space where the client can feel safe and supported. While acknowledging and managing countertransference is essential, it should not compromise the therapeutic boundaries that protect the client's well-being. Consult with supervisors or trusted colleagues if you ever feel uncertain about boundary issues.
“ I don't always use the name transference when describing what is happening in our relationship,” says Vanessa Kensing. “Oftentimes, I find it more relational to just come from a curious place. For example, I may ask how old a client feels in a particular moment? When else or in what other relationships they have noticed a dynamic occurring in our relationship? Or when else they have experienced a particularly strong emotion? Other times it may be helpful to give psychoeducation around what transference is and ask from a curious place if they are noticing it our relationship. How they answer will help you decide how to proceed.”
“I will frequently check in with the client about their experience in order to encourage feedback and establish a mutual understanding with them,” Alexander Beznes says. “There may be times in which a client has difficulty sharing or is unaware of feelings or beliefs they might have about their therapist. By facilitating a dialogue, a therapist can help clients recognize how they are relating to their therapist and give voice to feelings that they might otherwise be too intimidated to express. This may lead to reparative moments in which clients are able to have new experiences within a relationship and break familiar patterns of relating.”
One of the biggest anxieties we hear from therapists is around dealing with countertransference in the room.
Dealing with countertransference starts with becoming aware of it. “Being aware of your own body and state of mind can help you differentiate and recognize the impact that the client may be having on you,” says Alexander Beznes. “It’s also important to identify your interpersonal tendencies in order to be mindful of how they might be impacting the therapeutic relationship.”
Recognizing countertransference comes from having a deeper sense of your own feelings and experiences as a practitioner. “Recognizing countertransference is an exercise in being trusting and accepting of 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, both emotional and physical. The more we can tolerate from ourselves, the more able we will be to contain and hold our patients’ unacceptable feelings.
“This means allowing ourselves to feel anger, rage, sexual attraction, jealousy, love, deep sadness and all other sorts of feelings about our patients that might overcome us in a session.
“Having these feelings is a natural and important part of becoming a more present therapist. if you can build the muscle to allow yourself to experience and accept these feelings, you will have more tools to work with your patients.”
Mindfulness can also be an anchor. “For me, mindfulness has helped me attune 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 and/or heighten. For example, I might notice my stomach clenches, or I'm holding my breath or that I have shifted in feeling from a present place to anxious, annoyed, or protective. In the therapeutic relationship the bigger an emotion is for me, the more likely it has something to do with countertransference.”
Molly Eliasof, a New York City therapist, uses a framework to identify whether countertransference is occuring: “You can ask yourself: ‘Why do I want to say this thing? What is making me want to say it in this way? What could be helpful or a teaching moment in the way I say it to this client? How else can I frame it so that it can become a moment that’s pivotal in the clinical room?’ All of this can be extremely tricky.
“Grief is [a form of countertransference] that is easy to see within myself, as well as heartache. I’ve seen it in my own clinical work. It is difficult to have raw feelings happening and sit with someone who is experiencing something similar.
“Self-soothing and self-regulation is a huge key. Grab a cup of tea, wear your softest sweater. Use sensory integration and breathwork to self-regulate. It is important to remember that you don’t have to share your own story in that moment, but you can show the person a depth of empathy that someone else not going through what you’re going through might miss.
“Say to yourself: ‘it’s going to be okay. This moment is really painful. They don’t need to know what’s going on in your life. Be there for them in the way that other people have been there for you or that you wish they had been.’”
“I believe that countertransference tells us something about ourselves and our clients,” notes Stephanie Rojas, an NYC therapist and MyWellbeing community member. “It’s important to listen to that feeling that comes up to distinguish if this is something personal that may need to be addressed and processed. This is something that you as a therapist might be picking up that the client is having difficulties expressing that can be brought up effectively and can be worked through in sessions.”
“Pat yourself on the back :),” affirms Vanessa Kensing. “If you're attuned enough to notice when you're feeling countertransference you're in a great place! Now, pause. Perhaps you are feeling big emotions. Some self-compassion and a deep breath would likely be nice in this moment. Once you've done that, you can mentally explore if sharing this may be helpful. Or if you need to do some self-care in the moment to re-ground. If you're unsure, that's ok. Care for yourself so that you can stay present with your client. Recently I found myself in this position. And I chose to share my present-moment experience with my client. I asked, "Can I share what's coming up for me?" (asking is always nice!). With my client's consent, I shared that I was experiencing a strong desire to protect the client and to help the client escape. She shared she was feeling that too, the desire to escape. This allowed for us to deepen into a conversation about the next steps the client wanted to take, and trying to honor her own feelings of urgency while trying not to be reactionary and impulsive. I think is important to note that I did not have to share with the client where those feelings of wanting to protect and "rescue" originate in my own personal history. That is something I can and do process in my own therapy and in clinical supervision. Owning and naming these feelings in that moment allowed us to deepen our exploration into what my client needed, but also reminded me that I have my own work to do!”
“The clients we encounter will remind us of others we've met in life, and acknowledging that to ourselves helps us keep perspective,” explains Jenny Maenpaa. “Being an active participant in the therapeutic relationship means that therapists will have to hold multiple ideas at once while also creating space for the client experience. This might look like silently acknowledging to one's self that the client is triggering emotions or memories and taking deep breaths or pausing before responding to ensure that the response is measured and appropriate, not coming from a reactionary place that may damage the relationship. In the same way we would counsel clients who struggle with emotional self-regulation to slow down and be conscious of the thoughts and emotions, we must do the same in the room. Once the session is over, we should be bringing these challenges to our supervisors and colleagues for feedback and processing.”
“I often get an out-of-body feeling when I’m experiencing countertransference—it’s as if I’m being pulled to respond to the client in a way that feels unnatural or unfamiliar,” says Alexander Beznes. “In these cases, I will share my observation in a way that facilitates exploration and elaboration by the client. In a nonjudgmental way, I might say, “I’m noticing that I’m feeling concerned that I might disappoint you by making a mistake or saying the wrong thing.” Then I’ll follow up with a question to invite the client to reflect on their experience, “Can you relate to that feeling?” or “Has anyone ever told you that before?”
“It’s important to note that you do NOT have to do anything when you become aware of your own countertransference in the room,” Joshua Ring reminds us. “In fact, one of the amazing things about having a greater understanding of your own countertransference is now that you are aware of your feelings you don’t have to be ruled by them. As a therapist, you now have options that can bring forth a fuller, more layered experience for you and the patient.
“If you are comfortable with your own feelings it will free up energy to allow lots of thoughts and emotions to come into the room. When you’re comfortable allowing this to take place you can start working in a way that is multilayered, where both manifest and unconscious communication coexist.
“In essence, the less resistant we are to our own feelings, the more capable we will become in accepting those of our patients.”
While many practitioners are concerned about the ways that countertransference can play out in therapy, some therapists believe that countertransference can be legitimately helpful.
“It is information about work you may want to do personally in your own therapeutic process, or if you're already doing it, it's information about possible self-compassion, gratitude, and grace you can send to yourself,” explains Vanessa Kensing. “If it's something you chose would be helpful for the client to know, it can help both of you be on the look-out for interpersonal dynamics that could impact progress or deepened personal understanding and self-compassion.”
“Countertransference in a therapist can be helpful when it supports and enhances the treatment,” says Jenny Maenpaa, an NYC therapist and MyWellbeing community member. “For example, if a therapist is finding that the client reminds the therapist of a family member, and the therapist actually has a healthy relationship with that family member and has effective strategies that they use to communicate with that person, then the countertransference can be useful. The therapist might be able to ask a question like, "I'm wondering if X is happening" based on their experience with this family member. The client can always say, "No, that's not really how I'm feeling." and take the conversation in a different direction, and nothing has been lost or damaged by doing this. Conversely, the client may say, "Yes, I didn't even think of that, and also that reminds me of..." and illuminate something the therapist didn't know but was able to lead the client to gain insight on by asking the question.”
“Recognizing and processing one’s countertransference is vital to the therapeutic process as it often signifies that the therapist is being impacted by the work,” adds Alexander Beznes. “Countertransference can be conducive to bringing awareness to subtle dynamics in the therapeutic relationship. For example, you might be working with a client that is very articulate and expressive, yet you frequently find yourself feeling unresolved or uncertain at the end of a session. Reflecting and processing your countertransferential response can facilitate a client to get in touch with emotions, dynamics, and self-states that might be outside of their awareness.”
“There was a recent experience where I wasn't as attuned to my countertransference, which lead to me not being in present time and ignoring the pacing of the reflections I was offering the client,” says Vanessa Kensing. “Subsequently, I noticed my client begin to emotionally withdrawal and her body language shifted. My immediate response was panic and guilt ("Oh no, I made a mistake!"). Once I acknowledged was I was feeling and noted that I would care for myself after session, I was able to refocus my attention to my client. I asked if we could take a pause and I shared I felt I had "gone too quickly" and asked how she was feeling. Taking accountability and acknowledging my client’s emotional shift aided in re-establishing safety and grounding in the session.”
“Depending on what happened and the level of functioning of the client, the most beneficial action may be to acknowledge what happened and process it together,” Jenny Maenpaa says. “This can allow the client to see the therapist as human, but still a professional rather than a peer. This conversation can hold the boundaries while affirming that therapists aren't perfect and don't always say the right thing. If it's not appropriate to address it directly, the next best option might be to repeat the conversation but respond differently this time, explaining any rationale behind the thinking this time in order to "override" the previous interaction in some way. Practice role-playing these conversations with your supervisor prior to your next session. If you don't have a supportive supervisor or peer group, consider seeking outside consultation, even if you have to pay for it and it doesn't count towards supervision hours. Learning best practices early in your career will save you so many headaches over time.”
Finally, if you acted on your countertransference in a way that could be harmful to the client, it is important to take responsibility and make a plan to move forward.“In order to avoid reenacting harmful relational patterns and mystifying our clients, it’s important to acknowledge when you acted on your countertransference and be prepared to take responsibility in order to repair the relationship and seek out supervision,” says Alexander Beznes.
Transference and countertransference are inherent aspects of the therapeutic relationship, and they can't be entirely avoided or prevented. These phenomena emerge naturally due to the dynamics and emotional interactions between the client and therapist. Instead of trying to eliminate them, the goal is to recognize, understand, and manage transference and countertransference effectively. Here's why they can't be entirely avoided:
Transference and countertransference are rooted in fundamental aspects of human psychology. People naturally project their feelings and experiences onto others, especially in situations of emotional vulnerability like therapy.
Clients bring their past experiences, including previous relationships and emotional patterns, into therapy. These experiences are the seeds from which transference grows.
Therapists, like all individuals, have their own emotional responses to various situations. It's impossible for therapists to remain entirely neutral, as they are also affected by the emotional content of the therapeutic work.
While transference and countertransference cannot be entirely avoided due to their inherent nature in therapy, they can be acknowledged and managed in a way that enhances the therapeutic process.
Supervision was one of the main resources our therapists mentioned to deal with questions around transference and countertransference, and to figure out how to move forward if you act on countertransference.
“My supervisor has always taught and guided me in listening to and naming my countertransference because it has always been a useful tool to determine what is happening in the room,” Stephanie Rojas said. “It’s very helpful to talk it out and explore gently what this means for you as a therapist and how you can bring this up to your client, if deemed appropriate and will benefit the client. Other times it might be because of a personal experience and my supervisor has helped me work through that to ensure it doesn’t come up unethically in the session.”
“Just like a therapeutic alliance 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 to identify possible countertransference and how it might be affecting your work with a client; your supervisor will also be able to tailor his/her feedback to you individually, perhaps taking extra care to be sensitive about things that are "sore spots" for you. Because countertransference can come from tender places in our past, if you find yourself getting defensive, this may be a clue you and your supervisor that your strong emotions may be grounded in past experiences. Using a framework of compassionate curiosity will help you soothe yourself and gather information to help you assess whether or not countertransference is at play!”
“Supervision has been tremendously helpful for my own experience of understanding the effect of countertransference in treatment,” said Joshua Ring. “I have found group supervision especially meaningful when it comes to this.
“In my experience, hearing other therapists talk about cases and their own feelings when it comes to patients made me feel like I wasn’t alone. What we do as therapists is really quite unusual, and if you embrace the work then you will be entering into the place of the unknown.
“To me, having a group of colleagues who are on that same journey makes me feel grounded. From this, I get the assurance that it is OK to feel anything and everything and, in fact, that is the goal.
“I once had a patient who was abused as a child. He was very aggressive toward and often acted in a demeaning and bullying way. I didn’t know how to react to this, but my instinct was to be quite timid and passive and absorb this attack. I was so on guard during these sessions that I was quite out of touch with any other feelings other than the fear that I was having. This was part of the patient’s transference toward me. I believe that these were induced feelings and I was feeling what the patient was feeling, and we were stuck in this awful place together.
“It was through supervision that I was able to talk through and become connected to feelings of deep rage toward this patient and connect those feelings to earlier experiences in life where I was bullied and picked on at a very young age. Once I was able to make this connection it freed me up. I was now able to be aware of how I was feeling and how this was separate from him related to my own experience.
“Now I could work with the countertransference. 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; challenge his anger as he was being a bully. Once I started doing this he was able to relax and settle down. His unchecked rage only made him feel less in control, and this wasn’t good for him or me. This was an excellent learning experience for me to realize how I can use my own feelings to advance my understanding of how to work with a patient.”
Remember, transference and countertransference are the threads that weave the tapestry of your therapeutic journey. Embrace them, understand them, and use them as tools for positive transformation. The complexities of the human psyche are both challenging and enlightening, and it is by navigating these emotional currents that we find the profound potential for healing and personal growth.
Our therapists left us with a few words of wisdom and reassurance.
“Transference and countertransference are normal parts of the therapeutic process—in fact, it has been argued that a treatment can only be successful if both the therapist and client are impacted by the work!” says Alexander Beznes.
“There’s never a thing that is a mistake,” Molly Eliasof notes. “You’re just constantly trying to grow. That said, when we’ve gotten to something that’s harmful, we need to rethink our approach.”
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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.
