 | This article is missing information about the evidence-based scientific evaluation of this phenomenon.(December 2018) |
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Countertransference, in psychotherapy, refers to a therapist's redirection of feelings towards a patient or becoming emotionally entangled with them. This concept is central to the understanding of therapeutic dynamics in psychotherapy.
Countertransference (German : Gegenübertragung), [1] originally described by Sigmund Freud in 1910, refers to a therapist's unconscious feelings influenced by their patient. Freud recognized this as an ongoing challenge for therapists, stating the need for therapists to be aware and in control of these feelings. [2] While Freud mainly saw countertransference as a personal issue for the therapist, his private correspondence indicates a deeper interest and understanding of its complexities. [3] [4] This concept broadened to include unconscious reactions, by the unconscious mind, shaped by the therapist's own history, which could impede objectivity and limit therapeutic effectiveness. For example, a therapist might unconsciously want a patient to succeed due to personal connections, leading to a biased approach in therapy. [5] [6] [7] [8]
The psychoanalytic community widely acknowledged the risks associated with countertransference. Carl Jung, Eric Berne, and Jacques Lacan, among others, highlighted its potential to complicate the therapeutic relationship. [9] [10] This understanding encompassed not only the therapist's unconscious responses rooted in their personal history but also their unconscious hostile or erotic feelings towards a patient. [11]
For example, a therapist might subconsciously project their parental role onto a patient, especially if the patient is reminiscent of their own children. For instance, a therapist whose children are in university might overly empathize with a patient's academic struggles. This bias, even when well-intentioned, can lead to what's termed a "countertransference cure." This occurs when therapy outcomes are driven more by the therapist's needs than the patient's, resulting in the patient conforming to the therapist's expectations. This compliance can suppress the patients authentic feelings and needs, creating a 'false self' or a facade of improvement rather than genuine progress. [11]
In another example, the therapist might transfer unresolved personal issues onto the patient. For example, a therapist who lacked attention from their father might perceive a patient's independent behavior as a form of rejection, an example of transference. This can lead to feelings of resentment towards the patient, a phenomenon known as the 'narrow perspective' of countertransference. In this scenario, the therapist's unresolved feelings cloud their professional judgment, potentially hindering the therapeutic process. [12]
In the 20th century, the perspectives of Carl Jung, Heinrich Racker, and Paula Heimann significantly enriched the understanding of countertransference in psychotherapy, each contributing unique insights into its role and impact. This period marked a shift from viewing countertransference merely as an interference to recognizing it as a critical part of the therapeutic process and a potential source of valuable insights.
Jung explored the idea that a therapist's own emotional wounds and experiences contribute to their ability to empathize with and heal their patients. He famously used the metaphor of the "wounded physician," suggesting that a therapist's personal suffering and healing journey can deepen their understanding and effectiveness in treating others. According to Jung, it is precisely the therapist's own hurt that informs and enhances their healing capabilities. This perspective implies that personal experiences, including those that are painful, can be a source of strength and insight in the therapeutic process. [13]
Racker emphasized the dangers inherent in repressing countertransference. He warned that ignoring or denying these feelings can complicate the therapy process, making it less effective. Racker believed that the unacknowledged countertransference becomes entangled in what he called "the mythology of the analytic situation," implying that it can create a false narrative or dynamic in the therapeutic relationship. His perspective suggests that acknowledging and understanding countertransference is crucial for an authentic and effective therapeutic process. [14]
Heimann highlighted that countertransference is not just a reaction originating within the therapist, but also a response to the patient's personality and behaviors. In her view, countertransference is an integral part of the therapeutic relationship and is, in part, shaped by the patient. This concept implies that the therapist's feelings and reactions are not solely personal but are also influenced by the patient's characteristics and the interaction between the two. Heimann's approach emphasizes the interactive and co-created nature of the therapeutic relationship. [15]
Together, these perspectives underscore the complexity of countertransference, highlighting its role as both a personal response and an interactive phenomenon within the therapeutic relationship. They also point to the importance of therapists' self-awareness and the need to integrate their experiences into their professional practice.
By the late 20th century, the distinction between 'personal countertransference' (related to the therapist's issues) and 'diagnostic response' (indicating something about the patient) became prominent. This era acknowledged the clinical usefulness of countertransference, underscoring the need to differentiate between reactions that provide insights into the patient's psychology and those reflecting the therapist's personal issues.
A key development was the distinction between 'personal countertransference' and 'diagnostic countertransference.' Personal countertransference involves the therapist's own emotional responses and unresolved issues. In contrast, diagnostic countertransference refers to the therapist's reactions that provide insights into the patient's psychological state. This distinction highlights the dual nature of countertransference: it can stem from the therapist's personal experiences or be a response to the patient's behavior and psychological needs. [16]
The concept of 'neurotic countertransference' (or 'illusory countertransference') was also distinguished from 'countertransference proper.' Neurotic countertransference is more about the therapist's unresolved personal issues, while countertransference proper is a more balanced and clinically useful response. This differentiation has been widely accepted across various psychoanalytic schools, though some, like followers of Jacques Lacan, view countertransference as a form of resistance, potentially the most significant resistance posed by the analyst. [17] [18] [19]
In contemporary practice, countertransference is generally seen as a phenomenon co-created by both the therapist and the patient. This view acknowledges that the patient, through transference, influences the therapist to assume roles that align with the patient's internal world. However, the therapist's personal history and personality traits also color these roles. Thus, countertransference becomes a complex interplay of both participants' psychologies.
Therapists are encouraged to use countertransference as a therapeutic tool. By reflecting on their responses and differentiating between their personal feelings and those elicited by the patient's behavior, therapists can gain valuable insights into the therapeutic dynamic. This self-awareness helps in understanding the roles being played in therapy, and the meanings behind these interpersonal interactions.
However, with this understanding comes a caution: therapists must remain vigilant about the dangers of unresolved countertransference, which can disrupt the therapeutic relationship. In modern psychotherapy, transference and countertransference are often seen as inextricably linked, creating a 'total situation' that defines the therapeutic encounter.
This evolved understanding underscores the importance of self-awareness and continuous self-reflection in therapeutic practice, ensuring that countertransference is managed effectively for the benefit of the therapeutic process. [20] [21] [22]
Contemporary understanding recognizes that most countertransference reactions are a mix of personal and diagnostic aspects, requiring careful discernment. The field now views countertransference as a jointly created phenomenon between the therapist and patient, with the patient influencing the therapist to adopt roles aligned with their internal world, colored by the therapist's personality. [23] [24] [25]
Recent research, particularly in Ireland, has explored body-centred countertransference in female trauma therapists. This phenomenon involves physical responses in therapists and has been linked to mirror neurons and automatic empathy. Researchers at NUI Galway and University College Dublin have developed a scale to measure these responses, shedding light on the somatic aspects of countertransference in therapeutic settings. [26] [27] [28] [29] [30] [31]
Psychoanalysis is a set of theories and therapeutic techniques that deal in part with the unconscious mind, and which together form a method of treatment for mental disorders. The discipline was established in the early 1890s by Sigmund Freud, whose work stemmed partly from the clinical work of Josef Breuer and others. Freud developed and refined the theory and practice of psychoanalysis until his death in 1939. In an encyclopedic article, he identified the cornerstones of psychoanalysis as "the assumption that there are unconscious mental processes, the recognition of the theory of repression and resistance, the appreciation of the importance of sexuality and of the Oedipus complex." Freud's colleagues Alfred Adler and Carl Gustav Jung developed offshoots of psychoanalysis which they called individual psychology (Adler) and analytical psychology (Jung), although Freud himself wrote a number of criticisms of them and emphatically denied that they were forms of psychoanalysis. Psychoanalysis was later developed in different directions by neo-Freudian thinkers, such as Erich Fromm, Karen Horney, and Harry Stack Sullivan.
In psychology, displacement is an unconscious defence mechanism whereby the mind substitutes either a new aim or a new object for things felt in their original form to be dangerous or unacceptable.
Transference is a phenomenon within psychotherapy in which repetitions of old feelings, attitudes, desires, or fantasies that someone displaces are subconsciously projected onto a here-and-now person. Traditionally, it had solely concerned feelings from a primary relationship during childhood.
Psychodynamic psychotherapy and psychoanalytic psychotherapy are two categories of psychological therapies. Their main purpose is revealing the unconscious content of a client's psyche in an effort to alleviate psychic tension, which is inner conflict within the mind that was created in a situation of extreme stress or emotional hardship, often in the state of distress. The terms "psychoanalytic psychotherapy" and "psychodynamic psychotherapy" are often used interchangeably, but a distinction can be made in practice: though psychodynamic psychotherapy largely relies on psychoanalytical theory, it employs substantially shorter treatment periods than traditional psychoanalytical therapies. Psychodynamic psychotherapy is evidence-based; the effectiveness of psychoanalysis and its relationship to facts is disputed.
Projective identification is a term introduced by Melanie Klein and then widely adopted in psychoanalytic psychotherapy. Projective identification may be used as a type of defense, a means of communicating, a primitive form of relationship, or a route to psychological change; used for ridding the self of unwanted parts or for controlling the other's body and mind.
Self psychology, a modern psychoanalytic theory and its clinical applications, was conceived by Heinz Kohut in Chicago in the 1960s, 70s, and 80s, and is still developing as a contemporary form of psychoanalytic treatment. In self psychology, the effort is made to understand individuals from within their subjective experience via vicarious introspection, basing interpretations on the understanding of the self as the central agency of the human psyche. Essential to understanding self psychology are the concepts of empathy, selfobject, mirroring, idealising, alter ego/twinship and the tripolar self. Though self psychology also recognizes certain drives, conflicts, and complexes present in Freudian psychodynamic theory, these are understood within a different framework. Self psychology was seen as a major break from traditional psychoanalysis and is considered the beginnings of the relational approach to psychoanalysis.
Harold Frederic Searles was one of the pioneers of psychiatric medicine specializing in psychoanalytic treatments of schizophrenia. Searles had the reputation of being a therapeutic virtuoso with difficult and borderline patients; and of being, in the words of Horacio Etchegoyen, president of the IPA, "not only a great analyst but also a sagacious observer and a creative and careful theoretician".
Resistance, in psychoanalysis, refers to the client's defence mechanisms that emerge from unconscious content coming to fruition through process. Resistance is the repression of unconscious drives from integration into conscious awareness.
Psychological resistance, also known as psychological resistance to change, is the phenomenon often encountered in clinical practice in which patients either directly or indirectly exhibit paradoxical opposing behaviors in presumably a clinically initiated push and pull of a change process. In other words, the concept of psychological resistance is that patients are likely to resist physician suggestions to change behavior or accept certain treatments regardless of whether that change will improve their condition. It impedes the development of authentic, reciprocally nurturing experiences in a clinical setting. Psychological resistance can manifest in various ways, such as denying the existence or severity of a problem, rationalizing or minimizing one's responsibility for it, rejecting or distrusting the therapist's or consultant's suggestions, withholding or distorting information, or sabotaging the treatment process. It is established that the common source of resistances and defenses is shame. This and similar negative attitudes may be the result of social stigmatization of a particular condition, such as psychological resistance towards insulin treatment of diabetes.
The therapeutic relationship refers to the relationship between a healthcare professional and a client or patient. It is the means by which a therapist and a client hope to engage with each other and effect beneficial change in the client.
Identification is a psychological process whereby the individual assimilates an aspect, property, or attribute of the other and is transformed wholly or partially by the model that other provides. It is by means of a series of identifications that the personality is constituted and specified. The roots of the concept can be found in Freud's writings. The three most prominent concepts of identification as described by Freud are: primary identification, narcissistic (secondary) identification and partial (secondary) identification.
Psychoanalytic dream interpretation is a subdivision of dream interpretation as well as a subdivision of psychoanalysis pioneered by Sigmund Freud in the early 20th century. Psychoanalytic dream interpretation is the process of explaining the meaning of the way the unconscious thoughts and emotions are processed in the mind during sleep.
Modern psychoanalysis is the term used by Hyman Spotnitz to describe the techniques he developed for the treatment of narcissistic disorders.
An auxiliary ego, also known as simply an auxiliary, is the position taken by other participants in a role-playing exercise, or psychodrama, in order to simulate particular situations for the protagonists. Additionally in psychodrama, it can also be a role of representative figures in the protagonist’s life assumed by any person between the group members on the stage, excluding the therapist. Another conceptualization describes it in psychodrama as "the representation of absentees, individuals, delusions, symbols, ideals, animals, and objects" that make the protagonist's world real and tangible.
Body-centred countertransference involves a psychotherapist's experiencing the physical state of the patient in a clinical context. Also known as somatic countertransference, it can incorporate the therapist's gut feelings, as well as changes to breathing, to heart rate and to tension in muscles.
Joseph J. Sandler was a British psychoanalyst within the Anna Freud Grouping – now the Contemporary Freudians – of the British Psychoanalytical Society; and is perhaps best known for what has been called his 'silent revolution' in re-aligning the concepts of the object relations school within the framework of ego psychology.
Robert Joseph Langs was a psychiatrist, psychotherapist, and psychoanalyst. He was the author, co-author, or editor of more than forty books on psychotherapy and human psychology. Over the course of more than fifty years, Langs developed a revised version of psychoanalytic psychotherapy, currently known as the "adaptive paradigm". This is a distinctive model of the mind, and particularly of the mind's unconscious component, significantly different from other forms of psychoanalytic and psychodynamic psychotherapy.
Paula Heimann was a German psychiatrist and psychoanalyst, who established the phenomenon of countertransference as an important tool of psychoanalytic treatment.
Negative transference is the psychoanalytic term for the transference of negative and hostile feelings, rather than positive ones, onto a therapist.
Parallel process is a phenomenon noted in clinical supervision by therapist and supervisor, whereby the therapist recreates, or parallels, the client's problems by way of relating to the supervisor. The client's transference and the therapist's countertransference thus re-appear in the mirror of the therapist/supervisor relationship.
