Countertransference, an overview

I attended a very good lecture this week on contemporary views of countertransference.  It inspired me to write a brief overview of the concept here, with more to follow.

To understand countertransference, it helps to tackle transference first.  As I’ve discussed previously, transference was a word coined by Sigmund Freud to label the way patients “transfer” feelings from important persons in their early lives, onto the psychoanalyst or therapist.  Psychoanalysis was specifically designed to encourage transference.  Intentional opacity and non-disclosure by the therapist promotes transference; the patient naturally makes assumptions about the therapist’s likes and dislikes, attitude toward the patient, life outside the office, and so forth.  These assumptions are based on the patient’s experiences with, and assumptions regarding, other important relationships, such as childhood relations with parents.  In this way the patient’s formative dynamics are re-created in the therapy office for both participants to observe.  Patients discover that some of their assumptions about others, and themselves, are unfounded or outmoded and do not serve them well.  This is an important type of insight that can lead to lasting psychological change.

Freud realized that transference is universal, and therefore could occur in the analyst as well.  He did not write much about this, except to say that “countertransference” could interfere with successful treatment.  The analyst experiencing countertransference should rid himself of these feelings by having further analysis himself.

Since the 1950s, psychoanalysts and psychodynamic therapists have held a more benign view of countertransference.  It is no longer seen as an impediment to treatment (at least not inevitably), but instead as important data for the therapist to use in helping the patient.  Countertransference can serve as a sensitive interpersonal barometer, a finely tuned instrument in the field of social interaction.  For example, a therapist who feels irritated by a patient for no clear reason may eventually uncover subtle unconscious provocations by the patient that irritate and repel others, and thereby keep the patient unwittingly lonely and isolated.

In using countertransference this way, the therapist must consider multiple sources of his or her feelings.  Some feelings, positive or negative, may be evoked by the patient.  These are particularly helpful ones to notice, especially when the cause is not immediately obvious, as in the example just given.  Often, however, feelings may be stirred up by irrelevant characteristics in the patient (e.g., the patient physically resembles the therapist’s sibling or spouse), by the prior patient, or by factors unrelated to therapy (e.g., bad traffic getting to the office, a quarrel at home, an upcoming vacation).  This strongly argues for dynamic therapists to pursue such therapy themselves: It “tunes the instrument” to better distinguish countertransference evoked by the patient, versus similar feelings that arise from other causes.  Freud’s advice for analysts to seek additional analysis themselves in the face of countertransference is wise, although not for the reasons he gave.

I teach psychiatry residents to go through a mental checklist whenever they become conscious of possible countertransference:

(1) Is this feeling characteristic, i.e., does the resident have it much of the time?  If so, it may say a lot about the resident, but probably nothing about his or her patient.

(2)  Is the feeling triggered by something unrelated to the patient?  Feelings caused by hunger, one’s personal life, bureaucracy in the medical center, and so forth are not useful data for helping the patient.

(3)  Is the feeling related to the patient in an obvious way?  Feeling irritation toward a patient who is screaming obscenities and viciously destroying the office is countertransference of a sort, but not very illuminating.  And finally,

(4) Is the feeling uncharacteristic of the therapist, a reaction to one particular patient, and yet the exact trigger is not immediately obvious?  These are the most helpful feelings to notice in oneself, as they often shed light on subtle yet important dynamics in the patient.

Countertransference is not always helpful.  Particularly when it is unexamined — or, worse, unrecognized — it can indeed interfere with effective treatment.  This can occur even with positive countertransference, as when a therapist is so entertained by a patient’s jokes that the underlying bitterness is ignored, or when an attractive patient is never challenged because the therapist desperately yearns to be liked.  More often, though, countertransference is problematic when it is negative.  The therapist feels bored, irked, paralyzed, or contemptuous in the presence of a particular patient.  It is the therapist’s job to recognize these feelings and deal with them.  Occasionally a therapist must refer the patient to a colleague when the original therapist’s countertransference is unmanageable.  Fortunately, in most cases these uncomfortable feelings, once recognized by the therapist, can not only be understood but also used constructively in the treatment.

41 comments to Countertransference, an overview

  • TK

    Isn’t this the greatest countertransference, in this age of fee-for-service psychotherapy as opposed to psychotherapist-on-salary: How do I work around my own economic motivation in deciding whether to continue with a patient or terminate?

    In other words, how does one reconcile the consistent economic incentive to keep a client coming back to your office, particularly when one is being paid by the therapy hour instead of by salary? After all, there’s always something to work on, to improve, to understand better…

    In other, other words — and this is only partially tongue-in-cheek….Is there truth to the adage that you don’t ever want to see any psychotherapist who has openings in their practice? 🙂

    Great blog post.

  • t

    This was a very interesting and enlightening post. i have read much about transference, but very little about counter-transferesce.
    i often feel that my Psychiatrist/therapist is irritated at me and i can think of a few reasons he might be, however i am very afraid to bring any of this up. i am often way too sensitive and wonder if i am imaging all of this or even worse, projecting my own feelings on to him. (Perhaps because i had an excellent Resident as therapist whom i was very attached to and, after almost 2 years, have yet to “get over”). i like this Psychiatrist and feel we have made a good connection, with some “bumps along the road’, yet i still have yet to feel completely “right” with the relationship…i guess it is because of the third person in the room.

  • TK: Thanks for your comment. I have a lot to say about this, so I’ll address some of your points in another post. My short answer is that feelings about money loom large both in transference and countertransference.

    t: I hope you’ll be able to share your concerns with your psychiatrist. After all, you just shared them anonymously with the whole internet. 🙂 Seriously, it’s better to shine a light on such feelings than to let them linger. Perhaps a short discussion will put your mind at ease, or at least clarify the situation. Thanks for writing.

  • TK

    Am looking forward to your post on money and (counter)transference. Love your blog.

  • t

    Dr. Reinbord,
    i apologize for taking so long to thank you for your reply. i really do appreciate it and your writings.
    i will bring up my concerns with my Psychiatrist-scary-as i know it’s the only way to work through it all.
    Thank you again,
    t

  • anonymous

    in your opinion, what does it mean when transference fails to take place? when the therapist is so “successful” at presenting a blank slate that he manages to persist as a cipher throughout the process? is there a time when he should begin allowing some of his personality to show through (assuming he has one) to engage his patient more fully? to avoid the patient losing interest in the process?

    • Hi Anon, thanks for writing. Transference is not unique to therapy or psychoanalysis; it happens all the time, every day, in all sorts of interpersonal situations. Any time we lack emotionally important information about someone, we fill in the blanks with assumptions learned from our previous experience with people. Seen in this broad way, it’s hard to imagine that “transference fails to take place” in therapy when it happens everywhere else.

      An apparent lack of transference suggests two possibilities to me. One is that the therapist is too disclosing or too structured, leaving nothing to the patient’s imagination. This is sometimes a good strategy with very disturbed, e.g., psychotic, patients. Such patients already imagine too much. However, in most cases therapists try to encourage transference by being less disclosing, and by structuring the interaction less. Being a cipher is a good way to promote transference, although it can be taken to absurd extremes.

      The other possibility is that the patient is resisting feeling or expressing transference. This happens quite often in my experience, particularly in highly rational people who want the world to “make sense.” As I like to tell my patients, feelings aren’t rational. Emotional assumptions about the therapist may be immediately dismissed as unfounded or irrational, and not even consciously entertained. But they’re there. If nothing else, the feeling that the therapist is overly withholding (or has no personality) is a type of transference, one that can be usefully discussed in therapy.

      All that being said, I believe good dynamic therapy, including transference work, can be conducted by a therapist who allows some of his or her personality to show through. I certainly do.

      • Susie

        I have just found your blog and it is so helpful at a very difficult time as I try to end therapy. My therapist is psychodynamic and I have just found the transference too hard to take, my therapy has felt like an awful replaying of my painful childhood. Hearing others experience helps me feel less like the awkward and difficult client. thank you for some relief at a very painful time.

  • anonymous

    so i am too rational? i know that he’s purposefully not disclosing, so i purposefully block the feelings that i’m having toward him? or i know that they’re not real feelings– that they are just transference– so i block them for that reason? it sounds sort of woo-woo

    • Since I don’t know you, I don’t presume to know what’s happening in your therapy. It sounds woo-woo unless and until it makes sense for you personally. To take the two possibilities you mention, purposefully blocking feelings tit-for-tat may be a way of expressing anger about your therapist’s cipher-like approach. Conversely, blocking feelings because they are just “unreal” transference may suggest anxieties about being humiliated or ashamed — duped into reacting to something simulated. Either of these ideas are plausible, and there are surely others… maybe contempt for a therapist who lacks a personality? This is the essence of therapy: to pay attention to one’s own reactions and learn from them. You don’t have to like your therapist to have very useful therapy.

  • TK

    You wrote…

    “Transference is not unique to therapy or psychoanalysis; it happens all the time, every day, in all sorts of interpersonal situations. Any time we lack emotionally important information about someone, we fill in the blanks with assumptions learned from our previous experience with people.”

    This is a great point.

    It leads me to this question: Why, then, in dynamic psychotherapy, is the assumption made that the transferential feelings of a patient expressed or externalized toward a therapist are in some way of mirror of the patient’s feelings toward early-life objects like parents/siblings, etc.? Those folks self-revealed, and the patient as a child learned to adapt and shape himself or herself in synch with their emerging understanding of the those objects.

    Isn’t it more likely that what you’re seeing in the room is how a patient deals with the unknown, and especially with unknown people in positions of power? While there’s some value to that, certainly, it’s a highly artificial situation and relationship. Most people — okay, CIA interrogators are an exception! — reveal with some degree of reciprocity as relationships unfold. Not many therapists, though.

    • TK,
      As I replied to the anonymous commenter above, in my opinion some therapists take the cipher thing too far. A silent, unrevealing therapist is acting abnormally in a social sense. Typical patient reactions include curiosity and frustration — normal reactions to an abnormal social situation. These reactions aren’t particularly helpful therapeutically (unless they are notably absent), and if anything, they may interfere with the “working alliance” needed to conduct therapy. However, this abnormal social situation does set the stage to maximize transference: the thoughts and feelings brought from important relationships in the past. You might say that dynamic therapy has to be (socially) weird to work, but not so weird that the weirdness itself interferes too much.

      And yes, the therapy relationship is highly artificial. It is unlike other relationships, not only by virtue of its asymmetry, but in many other ways as well. The therapist does not aim to act like a parent (except in certain types of “reparenting” therapies, not our topic here), nor to re-create the relationship the patient had with a parent. The aim is to see what aspects of the parental relationship “rub off” on other relationships, like the relationship with the therapist, where they don’t apply or serve the patient well.

      TK, you’ve now given me yet another topic for a blog post. I hope to have time one of these weeks to write them up.

  • anonymous

    maybe that’s why i bolt– it’s not that great being set up to have feelings for someone (transference), and then watching him cooly watch me have them, all the while hearing him tell me that he’s not allowed to reciprocate and that anyway they’re not really “real”, but that i should keep coming back to endure more of the same (therapy). it seems pretty sadistic. if i were describing this to you as my relationship (outside of therapy), wouldn’t you, as my therapist, suggest that i reconsider and possibly even recommend that i walk away?

    • Have you read my post on therapist disclosure?
      http://blog.stevenreidbordmd.com/?p=11
      Your comments really apply more to that post than this one. The one-sidedness of dynamic therapy is not inherently sadistic, although some patients experience it that way. A competent, ethical therapist takes no pleasure in making the patient uncomfortable, and aims ultimately to be helpful. Feeling victim to a sadist may be transference from prior important relationships. Of course, it always needs to be said that a (small?) number of therapists out there really are incompetent, perhaps even sadists. But what you’ve described so far sounds like typical therapy, except for the “not allowed” to reciprocate part, and the “not really ‘real'” part. I’d frame these differently. Not reciprocating is ultimately in your best interest (and I’d explain why), it’s not that there’s an arbitrary rule against it. And feelings in therapy are absolutely real, as real as feelings anywhere else. I hope you can raise these issues with your own therapist.

  • anonymous

    yes, i have read that. i guess that i just don’t find therapy very therapeutic.

  • TK

    Not wanting to change this thread from an examination of countertransference to an examination of the theory of transference, BUT…

    I get the theory of transference. I really do. I even get it’s origins in Freud’s discussion of the Anna O. case, and Anna O’s love for Freud’s colleague Breuer. I understand the notion, as you wrote above, that “Any time we lack emotionally important information about someone, we fill in the blanks with assumptions learned from our previous experience with people.”

    What I don’t get is how dynamic psychotherapeutic theory makes the leap to patients filling in the blanks on the basis of their relationships with their parents or siblings etc. — people who as a rule self-revealed to their child and were not time-limited relationship, and with whom self-revelation deepened with the operational maturation of the child, as opposed to other relationships which were and are much more akin to the therapist’s room.

    Example? Nursery school. Elementary school. Where you have a certain kind of interaction with an adult in a power position, the student knows practically nothing of the teacher’s personal life or feelings, the relationship is time-limited by the duration of the school day, and — like psychotherapy! — the relationship is created with the idea and goal that it will end (with promotion to the next grade).

    Now, I ain’t saying Freud was wrong. But I have a feeling the paragraph above is just one example among many. And if you’re going to blog on this subject at some point, I’d love for you to address it.

    Thanks again for this forum.

  • marymac

    Hello
    Countertransference/transference…for this very reason, many times I wish I never began therapy. Has it been helpful to me? yes. Have I grown? yes. Did it ‘work’? well, kind of.
    The problem lies in the artificial relationship aspect. I can imagine a psychotherapist would insist that I still have unresolved issues that need to be worked on…. but it seems very common sense to me–almost sad for the therapist–when taking on a client who has never experienced “love,” or has never been cared for…the therapist should be on high alert. I somewhat agree with the poster who called the practice ‘sadistic,’ because in cases of major emotional deprivation or maltreatment/dysfunction, the client may perceive the therapuetic process as hurtful.
    It’s just kinda like, Oh–for the first time, here is someone who actually wants to help, who acts like they care, who is available consistently, who has great qualities (within the therapy hour), and who is (of course) smokin’ hot.
    Then comes the loooonnngggg pause and the “BUT.”
    But, the relationship is aritificial. This person doesn’t really care–er, they care within professional boundaries. Which is nice, but really…how much self-control can people be expected to have ? It’s like smoke and mirrors, it’s like a mirage, it’s like a fantasy. Let’s be wide-open and loving and caring and sharing for 50 minutes a week, but as soon as you walk out that door, forget about it. your therapist is forgetting it, they almost have to.
    I’m not saying this is the case for most therapy patients, but there is a small minority who (I’m speaking for myself, minority of one), perhaps should just be told to take heavy medication and long walks. Because give them an inch and they will need a mile, a nice therapist is like 3 drops of water in the desert, and only makes things worse.
    I’m not trying to be a downer here, just wanting to express these things. It’s kind of like, you cant wish for something you have never experienced.
    Hopefully I’ll work through this in a few months.

    • billy

      I fully agree with marymac. I have found therapy to be sadistic too. More painful than anything else I have ever experienced. If you have experienced multiple abandonments, extreme neglect and other horrible things throughout childhood and have spent most of your life trying to bury the pain, severing off parts of yourself to help you survive…. opening up to someone creates a transference that so blindsides you with the extreme pain that you buckle to your knees. I too often wish I never began. I didn’t sign up for this. I didn’t understand it would happen and would never have begun if I had known. I’ve come to call this experience the transference trap. You can’t go backwards, you’ve lost all your defense mechanisms that have enabled you to survive and function thus far and yet the pain is too intense to move forward… It’s as if you have to go through a violent storm to just allow yourself to trust enough to open up. You land in some surreal world (why not call it Oz) where you no longer control what you think or do. You’re completely at the mercy of emotions you hardly recognize. Only to realize that the Wizard is a fraud and the only way out is through a storm of pain that you feel might just kill you. So where does that leave you? In a far worse place than when you began as far as I’m concerned. Is there any way out of this trap? Is there any release possible? Without the storm of pain.

  • Cynthia

    When you get to talking about money and transference/countertransference, I have heard therapists say that they hope that financial concerns won’t enter the realm of the therapist-client relationship. But seems to me that is like hoping that sex won’t enter the realm of the husband-wife relationship!

    What would you think about a patient asking a therapist at the outset of therapy to report to her at the start of each session how many client/patient hours you have scheduled for that week? That would give her real insight into what’s going on in the therapist’s practice, and would help determine how important it is for the therapist for her to keep coming back. Would you personally be willing to provide that kind of information?

    To me, this seems far more important to know than any therapist personal life information that would arouse normal patient curiosity.

    • Cynthia, thanks for writing. You rightly note that financial concerns are an inescapable part of the therapy relationship. But I would no more agree to report my weekly patient schedule, and thus my weekly income, than any other hired professional would. Your plumber and electrician won’t supply this information, nor will your lawyer, music teacher, or physician. And yet in all these cases the information might help you “determine how important it is” to them to have you keep coming back. The missing factor here is trust. Not blind, gullible trust, but trust based on evidence and one’s personal experience. If you feel your therapist is just filling an hour and taking your money, no weekly report will quell this concern. If you trust that your therapist has your best interests in mind, the weekly report would make no difference.

      See also my reply to the comment below.

  • Catrenia

    My therapist can be a too much of a blank slate. He allows me to ask a certain amount of questions regarding his personal life. Very basic stuff. I do get very curious about him though as with every therapist, because I wonder if they really get it. If they really do understand what I am going through on a personal level. Not just on an analytical level. I feel like my therapist has no personality sometimes. It’s extremely frustrating. it would be helpful to see an honest reaction once in a while. He seems nervous sometimes lol. He is too into patient centered therapy. He definitely goes by the old adage ” I want to help you help yourself” Sometimes i need to be told what to do, and sometimes I need to know what he thinks is important in terms of treatment. It’s annoying when I really need his opinion, and he asks “what do you think?”. Do you think transference could fail to happen, because a therapist doesn’t want it to?

    • Thanks for commenting. See my post on therapist self-disclosure. Therapists are entitled to some privacy. Your accountant asks your income, but you do not ask his or hers. Your primary care doctor asks you to take off your clothes, but you can’t ask the same of him or her. Likewise, your therapist asks about your personal thoughts, feelings, and fantasies, and yet is not open to sharing his or her own. Your curiosity is perfectly natural, but the relationship is inherently asymmetrical. Part of a therapist’s professional judgment is deciding when, and in what fashion, to satisfy a patient’s curiosity. (Or to tell a patient what to do, even if she asks.) Part of a patient’s “job” in dynamic therapy is to tolerate some anxiety and frustration in the service of learning more about oneself.

  • Catrenia

    I totally understand that. They are entitled to a lot of privacy. I am not asking for his life story, nor would I ever do that. I am fine with the amount of personal questions he has allowed me to ask. I know he doesn’t have to do that. I keep my curiosity to myself. It’s not like a burning need to know. Just a natural curiosity like you said. Just a simple wondering what he is really thinking? Does he really get it? Sometimes therapists seem to be reading a script. that is when I start to wonder.

    I know you are exactly right about the patient tolerating anxiety, and the therapist using his judgement. What if you really feel his judgement is wrong, and the anxiety is really becoming too much? Is it reasonable to tell a therapist that, and emphasize your need for an answer relating to treatment or a particular struggle I am having? I don’t expect him to indulge my every curiosity or alleviate my anxiety by just telling me what to do.

    Thanks,
    ~Catrenia

  • Delilah

    What would you think of a therapist who just started screaming at a patient? I told mine that I thought a joke he made was mean and suddenly his face turned red and he started yelling that I was always bullying him. He stood up and yelled “You don’t know ANYTHING about me,” and then after pacing around yelling at me more, stood over me and said, “YOU aren’t so perfect.” I ended the therapy, but I still feel shattered–and I can’t make any sense of it. He sort of apologized for making the mean joke, but he never apologized for yelling at me. I just can’t make any sense of the whole thing. It seemed so unrelated to what we were discussing and so crazy, but he insisted that “he was just being firm.” I know that sometimes doctors tell you unpleasant truths you don’t want to hear, but is this a legitimate way to convey that information, even if it is true (which I don’t think it is–that’s not what I hear from other people in my life, anyway).

    • Obviously, a therapist who just starts screaming at a patient is unprofessional, damaging (and damaged), and should be avoided. All kinds of people become therapists, and some are not too stable themselves. This is particularly tragic when you have placed yourself, vulnerably, in their care.

      I need to point out that on rare occasions, a patient of mine later complained that I “screamed at” him or her, and it didn’t really happen. I said something unwelcome or embarrassing, and the patient’s sensitivity to criticism magnified it into something far more harsh than it was. If you and your therapist disagree over what really happened, it’s worth discussing before fleeing. Sometimes the therapist’s actions won’t seem as harsh to you as they originally did. Sometimes they were harsh, the therapist apologizes, and you both learn something from it. And sometimes you conclude that the therapist is beyond redemption, and you leave. I hope you find another therapist who is more helpful.

  • Alicia

    I believe that every therapist should explain transference/countertransference in the beginning…..Quite frequently contact with a therapist might be the first time a client feels validated, heard…..these are powerful feelings.

    Since transference/countertransference (except for the Freudian….)…..are present in most relationships, these feelings, etc….should be discussed up front. Kind of ironic that in a “talking” feeling profession, there is no training in this area.

    I fell in love with my therapist years ago (contacted him for a business dispute) …..I told him of my feelings and am still with him 7 years later…..he has said: “If I were not married, I would probably go for it.”

    He sexualized our relationship (no sex), but a LOT of innuendo and at times…..touching; he sits next to me on the couch. “You are in my heart and in my head.” These are only a miniscule, tip of the iceberg……comments.” “Who wouldn’t fall in love with you?!”

    I feel he plays what I call….push me…pull me….come here, go away….professional and then not….His struggle.

    I am conflicted and angry……..If he had stayed professional, I would have dealt with it; knowing that that is the way it is supposed to be……

    but it is apparent he has been involved in his own struggle (as he said…”torn and confused, scared and conflicted.”)…..that is okay for a client, but not for him!! LOL

    I am in training for the same profession. More than once, I have contacted another therapist to discuss what is going on between us, but have not met with anyone yet. Unfortunately, most therapists have not dealt with, nor have no experience with a client whose therapy has been compromised.

    In short, I love him, but feel anger that he has had his “cake and eaten it, too.”

    Thanks for ‘listening”

    • I’m sorry you’ve had to deal with your therapist’s problems with boundaries. I don’t know how many therapists have experience working with clients whose prior therapy was compromised in this way. But if one is in this field long enough, it comes up. I’ve seen at least one patient whose main focus in our therapy was dealing with a prior therapist who exploited her sexually.

      Ostensibly nonsexual touching in the form of cradling, holding, etc was reported by surveyed psychologists 26% of the time in their own therapies. This is a surprisingly high figure, and in my view raises concerns regarding professionalism and boundaries. While it is no doubt rationalized as supportive, consoling, and so forth, I wonder how much more often it occurs in therapist-patient dyads of concordant sexual orientation, versus in dyads with discordant sexual orientation. In other words, I’d wager that heterosexual male therapists do not cuddle and touch male patients nearly as often as they do female patients. If this is true, it is presumably being done at least in part for the sexual gratification of one or both parties.

      All therapists should explain their treatment approach in the beginning; if this includes a strong emphasis on transference/countertransference, these should be mentioned and explained to some extent. (Exactly how much is open, I’m sure, to stylistic differences.)

      Alicia, I took the liberty of editing your website link out of your name, as it would compromise your confidentiality on this sensitive topic. If you’d like me to add it back in, I will. Just reply to this comment, and I’ll do as you wish (and then will delete the meta-comments). Thank you for sharing.

  • Wendy

    It’s been over a year since marymac wrote, it’d be nice to read a reply since I’m in a similar boat.
    My nice therapist seems frustrated with me. He’s offering me caring and I push him away.
    It’s like marymac says; I want so much more than his client-care.
    I was severely abused as a child. I find it hard to trust that his care is real, even if it is, it’s so LIMITED compared to what I need.
    I did not get what children emotionally crave. I grew up believing I was bad and unlovable. Now a stranger is offering me some empathy for 50 minutes a week in exchange for money.
    As soon as I leave, he’s offering the same allotment to his next customer, and he’s frustrated with ME???? Why can’t he see that this is frustrating for me?

    • Hi Wendy,
      I didn’t reply to marymac or billy because they stated their views but didn’t ask me to comment — well, maybe billy did, but I took it as rhetorical. Sometimes I feel I reply too much; I don’t need to have the last word every time.

      But since you asked… If your therapist can’t see how frustrated you are, you should let him know. This can be crucial for your treatment. A hard reality of adult life is that no one can satisfy a bottomless pit of emotional hunger from early childhood. You protect yourself, and your therapist, from your ferocious craving by pushing him away. But in doing so, you deprive yourself of the limited-but-real empathy and support that truly are available to you. As you imply, a main task of your therapy is (slowly) to learn to trust that caring is real. And also to tolerate the frustration of imperfect and limited caregivers, since that’s the only kind there are in real life.

      Working in the transference is a matter of degree. Patients with histories of severe childhood abuse need to be treated a little differently (more supportively, basically) than many other patients. Yet the idea is the same: Pay attention to what feelings are stirred up, including unfulfilled needs, frustrations, and yearnings regarding the therapist. Over time you will come to realize that your emotional needs are not a fearsome monster, but very much in keeping with the emotional needs shared by all of us.

      Oh, one final note about countertransference, since that was the topic of the original post. Your therapist’s frustration can potentially move your treatment forward. Maybe others in your life offer you caring and you push them away. Maybe you actually discourage them from caring. You might only learn this from the frustration your therapist recognizes in himself. Thanks for writing.

      • Wendy

        It’s one year since I wrote the previous post. One month ago my therapist dumped me. I spent a year pushing him away. He told me he didn’t feel “effective” and seemed personally hurt when I questioned the sincerity of his caring.
        I went in to session and told him that I had felt like leaving therapy the previous week. He immediately perked up and said, “I didn’t know you wanted to end therapy!” And he started ending it…he summed up our work, gave his general impressions of me, and told me what kind of therapy I should try next.
        I was shocked, shamed and passive and let him do this.
        My therapy ended.
        After a sleepless night, I left a message telling him I had no intention of ending therapy, but he manipulated me and my words and ended it himself.
        He didn’t reply.
        I called him and repeated this. He sounded uncharacteristically cold and told me that I was the one who said I wanted to end therapy.
        To make a long story short, he was so uncaring and distant in our phone conversations after this session that I never went back. I was traumatized by his behavior, I let him hear that on the phone and he was unmoved.
        He even told me he would see me for 3 more sessions, but not for 9 days because he had already given my regular appointment time away.
        Wow.
        I had a very stong transference with this therapist, and I am devastated.
        All that time I spent being afraid to trust his caring, I was right not to trust him.
        I so badly wanted to prove myself wrong.
        I was right. He dumped me. I will never trust another paid stranger. I feel like an idiot to have believed that a stranger with no need for me would have some kind of deep commitment and caring for me.
        I am an idiot.

        • Wendy

          Forgot to specifically ask for your feedback, Dr. Reidbord, would you mind giving some?

        • I don’t have much to add to my reply from a year ago, Wendy. In real life, caring and compassion aren’t limitless. It sounds like your therapist tried for over a year, you kept pushing him away, and he finally gave up. Maybe it was poor technique on his part to jump for the exit at the end, but I can hardly fault his hopelessness by then. How long was this going to go on?

          Long term dynamic psychotherapy should contain a patient’s mistrust, rage, and other toxic emotions for a long time. According to one theory, we therapists “pass a test” of trustworthiness when our patients defy us to stick with them, and we persevere. But therapists are people too. As I wrote above, your task in therapy is to tolerate the frustration of imperfect and limited caregivers, since that’s the only kind there are in real life. I’m sorry if the experience left you bitter and disillusioned, but I think there’s a lesson in it for you: Not that “paid strangers” don’t care, but that you actively discourage people from caring. The only one you can change is you.

        • Wendy

          Thank you for your reply (October 30, 2012), I’ve been thinking about it.
          I agree that only I change myself, and I agree that I actively discourage men (except for friendships) from caring.
          I also agree that there is only limited caring.

          I disagree that a year is sufficient time for a therapist of mine to bail on me.
          You don’t know my childhood, but based on my experience of it, I think I was short-changed to have only been granted one year to become a caring-accepting person.
          I also disagree that my therapist may have used “poor technique” in terminating my therapy.
          In my opinion, no technique was used at all.

          Thank you again for your thoughtful response.

        • Wendy

          After I wrote the above, I came across the following post from a therapy client, and it shows me that there are some therapists who will work for years with a client that ‘pushes’ them away, with excellent results:

          “When my therapist really connected to me and I felt cared for, I used to push him away.
          I did this for years, (although I seem to be past it now).
          I would want so badly for him to love me, think well of me, be proud of me…and then the minute I started to believe he felt those things, I wanted to run as far away as I could.
          I would create a rupture (unconsciously) and we’d eventually repair it, and the cycle would start again.
          So frustrating, scary, exhausting and confusing.
          It’s taken time (a lot) but things are much calmer now. My therapist can love and be proud of me and I can just take it in and let it fill me up. I really think the only way I got here was by going back over and over and over and over again no matter how scared or freaked out I was.”

  • AAK

    Hi, I have been seeing my therapist for about a year, have recovered from bulimia (after 25 years), well the major symptoms for almost 9 months, but despite dbt I feel I have no other outlets. I have encountered heavy duty transference and feel I need my therapist way to much, think about her all the time, want her to save me, want to be with her all the time until I’m better and my thoughts are healthier. I have even had erotic thoughts about her which I have managed to talk to her about even though it was highly uncomfortable. Sometimes these thoughts are so intense I feel suicidal. I really need this phase to end. I want the bulimia back,started cutting a little, desparate for some belief. Feel she is good at keeping boundaries, a little too good. In distress, feel to needy for her. Any thoughts

    • First, congratulations on your progress after 25 years of bulimia! It’s natural to have strong feelings about the person who helped. It sounds like you’re doing the right thing: hanging in there with a helpful therapist who has good boundaries, and continuing DBT (groups?) as well. You should discuss your suicidal feelings and cutting in DBT as well as with your therapist. It’s important to realize that progress in therapy is rarely linear, and not to blame yourself or declare it a failure when setbacks, uncomfortable feelings, and second thoughts occur. It’s not unusual to “want your bulimia back” from time to time. After all, it fulfilled an emotional need for you in the first place. Keep an eye on the general trend, it’s more important than the daily ups and downs.

      Intense feelings of dependency or neediness can be very uncomfortable. But I agree they are a “phase.” It’s good that you recognize them as transference, which tells me you can step back (with your “observing ego” we say) and see these feelings for what they are. You may have no other outlets now, but that will change. If you stick with this admittedly unpleasant process, I believe you will emerge stronger and more self-reliant. Thank you for writing.

  • Norm

    I found this post recently in doing some research about understanding transference better. It’s helped learn more about it and the role a therapist plays in it. I went through a very rough experience with psychodynamic therapist years ago, that still haunts me. I’ve done a lot of different therapeutic work to manage the hurt and grieve.

    I saw an attractive female therapist. She was good at being empathetic, non-judging, and attuned to me during our time. I saw her both in individual and group therapy. It wasn’t till about a year after I started when i first noticed the transference. She seemed a little distant and depressed in our group sessions. We asked her about it and she said she was going through something big but wouldn’t disclose it. When she finally did disclose she said it was because she felt not telling us would be crazy making for us. She announced she had gotten divorced. It took me by surprise. I think her husband had left her.

    I was in a session and she asked me how I felt about it, and I told her that I felt bad for her because I knew she was probably hurting inside. We had a very intimate eye contact during it and she teared up. I asked her why she got emotional about what I said, and she told me, “I had a big warm heart” and that she felt very touched by what I said. That without a doubt is countertransference. She owned it, and I owned my transference with her. It was painful and I often got angry because i didn’t understand or like the feelings it brought up. But we talked a lot about it and the more I spoke about it the more the bad feelings subsided. I realized I needed more intimacy in my life and I needed to open myself up more to others.

    Now for the horrible turn of events. A good friend who referred me to her was also in therapy with her. One day he went in for a session and at the end of the session pulled out a gun and threatened to kill himself. she fled and called the cops and the crisis counselors tried to talk him it out of it, but he kept telling them he wanted the therapist to come back in the room. The police think he wanted to kill her too. Several hours after trying to get him to give up, he pulled the trigger and killed himself in her office.

    My friend was very depressed and had a history of suicide threats years before this happened. His family said he had a very painful transference with her and she screwed up his therapy. I know they were just very angry at her. They told me all about it and I felt even worse because now I knew too much. I told the therapist about it and she told me not to worry about what is said about her. But she freaked out later and fired me from individual and group therapy. I was devastated. I wasn’t even allowed to go in and say goodbye to the group. There was a big hole left by it. I never felt complete, and later realized I was just collateral damage. A year later in a phone conversation we had she told me she was terrified and probably having PTSD reactions and felt she couldn’t deal with me if I became angry. She told me she felt horrible about what happened but I never really got an apology from her about it. She had to take a couple years off from doing therapy before she started back again.

    I now will only see older male therapists who have some diversity of life and business experience. I also won’t ever go back to the psychodynamic approach. It felt too controlling to me. There was too much of a power differential for me. I like to ask ?’s because I am curious by nature, but I’m respectful of people’s boundaries, and didn’t inquire about her personal life. I needed someone who was more collaborative with me on life and where I want to go with it. I just had to go through hell to fully realize it.

  • Grace

    My therapist admitted to having counter transference (in the beginning of our relationship). She admitted to having rescue fantasies about me (trauma patient). And I played into it, after building trust over two years, I was very attached to her, but then she changed the course of our entire therapy (long story short, her personal a life changed, and she changed my therapy limitations).
    She also made a personal disclosure that severed my trust in her.
    We spent a few years trying to rebuild the trust, but I felt like she would just get angry and not listen. Finally, she just ended our 8 year relationship by telling me she didn’t know how to help my get past my distrust of her.
    I’m devestated. She was the only therapist I had ever trusted and I feel like she just abs downed me. Her final words to me were, “well, life isn’t fair and you shouldn’t have blindly trusted me.”
    Ii know I had transference issues, and I own that. Ibut she never tried to work through anything p, just anger….
    And I feel more traumatized now than I did when I went to see her,
    How do I get past that? Why would she do that? I feel like I can’t trust another mhp.

    • No one can know what exactly happened in your 8 year therapy except you and your therapist. My impression from your description is that she offered upsetting information, both at the beginning about her countertransference, and also the personal disclosure later. Sometimes it’s very helpful for a therapist to share personal feelings and other material. But not always, and it always depends on how it’s done. Certainly if done the wrong way or at the wrong time it can make a patient uncomfortable, and sever trust. Working to rebuild trust is admirable, but spending “a few years” trying is a long time. By that point most patients would have stopped seeing a therapist they didn’t trust.

      By the way, I’m not sure what you mean about “playing into” her rescue fantasies: the usual approach to this type of countertransference is to try to set it aside, not play into it.

      It sounds like she ended your therapy unilaterally, i.e., that it was entirely her decision and not yours. There are sometimes good reasons for this, as when a patient breaks safety rules or refuses to pay. Therapists may also do this when it seems to be in the patient’s best interest; for example, a highly dependent patient who fails to improve in order to keep the relationship going. But again, it’s all in the delivery. “Life isn’t fair” is hardly comforting, and suggests more countertransference, possibly anger with you.

      You asked two questions. How do you get past that? Basically the same way we get past any trauma. You have to move on. Use the supports you have, find new ones (friends, another therapist who isn’t so disclosing), live your life. I wish I had magic words, but there aren’t any. Your other question, Why would she do that?, is not answerable by anyone else. We can only speculate (guess) that her own feelings, i.e., countertransference, led her to treat you harshly at the end. Take care.

  • Hannah

    Hello Steven and everyone who has posted here.

    I understand the severe pain people have experienced in the name of ‘therapy.’

    Therapists should have a disclaimer ‘I can help you so long as you have minor problems.’

    People who have been abused severely, and are starved of human care, insist on care, it is their number one need in therapy. Therapists do not like that because they don’t care a lot of the time and to deflect from this reality, they blame the client for not trusting them, or for sabotaging their progress (oncologists never have the gall to blame a cancer patient for dying despite chemo. Why do therapists get away with such behaviour?). As if people don’t want to end their mental and emotional torture!

    Every human being knows perfectly well when someone cares, and when they don’t.

    We, who have been severely abused, are so disoriented and undermined, that we often accept it as true when people insinuate that we cannot tell such a basic and simple thing!

    Transference is rubbish. It is a convenient screen behind which therapists hide their lack of care.

    Care is a genuine reaching out from the heart, of one human being, to another. Not as a ‘therapist’ (though that may be their role), but as a HUMAN BEING. If someone doesn’t care from their humanity, then they do not care.

    Real care and counterfeit care are very different. Every human being can feel the difference.

    A therapist may not care because they can’t face another person’s pain, or because they are denying their own pain, or feel compelled to protect abusers (it may be their own parents are abusers and they are in allegiance with them).

    Steven, your callous responses give therapy the bad name it has. You either have no understanding or are completely indifferent to the emotional torture people have experienced in ‘therapy.’ You should look into a career change, and stay away from hurt people, for God’s sake.

    When Billy talks of ‘buckling’ with the pain, I know exactly what he means. It is inhumane and so very unnecessary for people to be tortured like that.

    I am in solidarity with all of you on this very arduous journey.

    May you find a human being who cares for you from their heart, so that you can heal.

    Hannah

    • Hannah,

      I help those with minor problems and major ones, including people who suffered repeated sexual, physical, or emotional abuse as children. Most improve over time, finding they no longer need the brittle fake smile, dissociation, or other emotional armor they used for years. My care is genuine, from my humanity as you say, and I think it shows, but I’m not sappy sweet or huggy in my work. “Caring professional” is not a contradiction in terms, it’s an ideal to live up to. I can’t say it better than I already did (10/24/11):

      A hard reality of adult life is that no one can satisfy a bottomless pit of emotional hunger from early childhood. You protect yourself, and your therapist, from your ferocious craving by pushing him away. But in doing so, you deprive yourself of the limited-but-real empathy and support that truly are available to you. As you imply, a main task of your therapy is (slowly) to learn to trust that caring is real. And also to tolerate the frustration of imperfect and limited caregivers, since that’s the only kind there are in real life.

      In reviewing these comments, I see much pain around transference. The commenters themselves call it that, and I’ll take them at their word. The concept itself is obviously not rubbish, although it can be misused defensively to cast blame onto patients. If you re-read the comments, you’ll see that Billy suffered due to real care, not counterfeit. And Marymac chafed against time boundaries, not that the care wasn’t real within those boundaries. And Wendy’s story has more twists and turns, but ends with a quote (10/30/12) about real change in therapy. Only the anonymous commenter in April 2010 seems to share your view. On the other hand, several commenters (Delilah, Alicia, Grace, maybe Norm) suffered due to unclear or breached boundaries by their therapists. Common sense suggests this is the more traumatic mistake, to be betrayed once again. And that is why genuine caring, from one’s humanity, can and should have structure and boundaries and clarity.

      No therapist or style of therapy is right for everyone. While I’ve helped many people with abuse histories, I’ve also had a few quit early on. They said it felt too intense, or the “fit” didn’t seem right. That’s ok too, I hope they find a person and an approach they click with.

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