Countertransference

Countertransference^[1] is defined as redirection of a psychotherapist's feelings toward a client—or, more generally, as a therapist's emotional entanglement with a client.

Early formulations

The phenomenon was first defined by Sigmund Freud in 1910 in "The Future Prospects of Psycho-Analytic Therapy" as "a result of the patient's influence on [the physician's] unconscious feelings," but the topic was left to others to develop, as he rarely referred to it himself.^[2] When he did, it was almost invariably in terms of a 'warning against any countertransference lying in wait' for the analyst: 'every psychoanalyst...must recognize this countertransference in himself and master it'.^[3]

The potential danger of the analyst's countertransference - 'In such cases the patient represents for the analyst an object of the past on to whom past feelings and wishes are projected'^[4] - became widely accepted in psychodynamic circles, both within and without the psychoanalytic mainstream. Thus, for example, Jung warned against 'cases of counter-transference when the analyst really cannot let go of the patient...both fall into the same dark hole of unconsciousness'.^[5] Similarly Eric Berne stressed that 'Countertransference means that not only does the analyst play a role in the patient's script, but she plays a part in his...the result is the "chaotic situation" which analysts speak of'.^[6] Again, Lacan acknowledged of the analyst's 'countertransference...if he is re-animated the game will proceed without anyone knowing who is leading'.^[7]

In this sense, the term includes unconscious reactions to a patient that are determined by the psychoanalyst's own life history and unconscious content; it was later expanded to include unconscious hostile and/or erotic feelings toward a patient that interfere with objectivity and limit the therapist's effectiveness. For example, a therapist might have a strong desire for a client to get all 'A's' in university because the client reminds her of her children at that stage in life, and the anxieties that the therapist experienced during that time. Even in its most benign form, such an attitude could lead at best to 'a "countertransference cure"...achieved through compliance and a "false self" suppression of the patient's more difficult feelings'.^[8]

Another example would be a therapist who didn't receive enough attention from her father perceiving her client as being too distant and resenting him for it. In essence, this describes the transference of the treater to the patient, which is referred to as the “narrow perspective.”^[9]

The middle years

As the 20th century progressed, however, other, more positive views of countertransference began to emerge, approaching a definition of countertransference as the entire body of feelings that the therapist has toward the patient. Jung explored the importance of the therapist's reaction to the patient through the image of the wounded physician: 'it is his own hurt that gives the measure of his power to heal'.^[10] Heinrich Racker emphasised the threat that 'the repression of countertransference...is prolonged in the mythology of the analytic situation'.^[11] Paula Heimann highlighted how the 'analyst's countertransference is not only part and parcel of the analytic relationship, but it is the patient's creation, it is part of the patient's personality'.^[12] As a result, 'counter-transference was thus reversed from being an interference to becoming a potential source of vital confirmation'.^[13] The change of fortune 'was highly controversial. Melanie Klein disapproved on the grounds that poorly analyzed psycho-analysts could excuse their own emotional difficulties' thereby; but among her younger followers 'the trend within the Kleinian group was to take seriously the new view of counter-transference'^[14] - Hanna Segal warning in typically pragmatic fashion however that 'Countertransference can be the best of servants but is the most awful of masters'.^[15]

The late twentieth century paradigm

By the last third of the century, a growing consensus appeared on the importance of 'a distinction between "personal countertransference" (which has to do with the therapist) and "diagnostic response" - that indicates something about the patient...diagnostic countertransference'.^[16] A new belief had come into being that 'countertransference can be of such enormous clinical usefulness....You have to distinguish between what your reactions to the patient are telling you about his psychology and what they are merely expressing about your own'.^[17] Awareness of the distinction between ' neurotic countertransference - which...Fordham calls illusory countertransference - the personal countertransference or narrow perspective - '[and] countertransference proper '^[18] had come (despite a wide range of terminological variation) to transcend individual schools. The main exception is that for 'most psychoanalysts who follow Lacan's teaching...counter-transference is not simply one form of resistance, it is the ultimate resistance of the analyst'.^[19]

The contemporary understanding of countertransference is thus generally to regard countertransference as a “jointly created” phenomenon between the treater and the patient. The patient pressures the treater through transference into playing a role congruent with the patient’s internal world. However, the specific dimensions of that role are colored by treater’s own personality.^[20] Countertransference can be a therapeutic tool when examined by the treater to sort out who is doing what, and the meaning behind those interpersonal roles (The differentiation of the object’s interpersonal world between self and other). Nothing in the new understanding alters of course the need for continuing awareness of the dangers in the narrow perspective - of 'serious risks of unresolved countertransference difficulties being acted out within what is meant to be a therapeutic relationship';^[21] but 'from that point on, transference and counter-transference were looked upon as an inseparable couple..."total situation"'.^[22]

Twenty-first century developments

Further developments in the current century might be said to be the increased recognition that 'Most countertransference reactions are a blend of the two aspects', personal and diagnostic, which require careful disentanglement in their interaction; and the possibility that nowadays psychodynamic counsellors use countertransference much more than transference − another interesting shift in perspective over the years'.^[23] One explanation of the latter point might be that because 'in object relations therapy...the relationship is so central, "countertransference" reactions are considered key in helping the therapist to understand the transference',^[24] something appearing in 'the post-Kleinian perspective...[as] Indivisible transferencecountertransference '.^[25]

Perhaps the extreme development of the new view is 'what is known as "counter-transference self-disclosure": the analyst reveals...to the patient what he or she is feeling, so as to highlight the difference between the analyst's experience and that of the patient...In [one] opinion, this implies an entirely different view of what communication between patient and analyst is all about'^[26] - the classical late-20th century view being that it is 'not a matter of confessing to the countertransference but of recognising it and integrating it into the interpretation'.^[27]

Body-centred countertransference

Irish psychologists at NUI Galway and University College Dublin ^[28][29] have recently begun to measure body-centred countertransference in female trauma therapists using their recently developed 'Egan and Carr Body Centred Countertransference Scale', a sixteen symptom measure. High levels of body-centred countertransference has since been found in both Irish female trauma therapists and clinical psychologists.^[30] This phenomenon is also known as 'somatic countertransference' or 'embodied countertransference' and links to mirror neurons and automatic somatic empathy for others due to the actions of these neurons have been hypothesised.^[31][32]

See also

• Transference
• Psychoanalysis
• Psychodynamic psychotherapy
• Psychotherapy
• Projective Identification
• Therapeutic relationship
• Body-centred countertransference

Bibliography

• D. W. Winnicott : 'Hate in the countertransference' in Collected Papers: through Paediatrics to Psychoanalysis (London 1958)
• Horacio Etchegoyen: The Fundamentals of Psychoanalytic Technique, Publisher: Karnac Books, 2005, ISBN 185575455X
• Margaret Little: Transference Neurosis and Transference Psychosis, Publisher: Jason Aronson; 1993, ISBN 1568210744
• Harold Searles: Countertransference and related subjects; selected papers., Publisher New York, International Universities Press, 1979, ISBN 0823610853
• K. Maroda : The Power of Countertransference: Innovation in Analytic Technique (Chichester 1991)
• D. Sedgwick, The Wounded Healer: Countertransference from a Jungian Perspective (London 1994)
• Egan, J. & Carr, A. (2005). 'Burnout in female counsellor/therapists of the NCS: Studies I,II and III. Papers presented at the 35th Annual conferenceof the psychological society of Ireland, Derry, Nov 17-20th'
• Egan, J. & Carr, A. (2008). 'Body-centred countertransference in female trauma therapists. Eisteach, 8, 22-27'.
• Booth, A., Trimble, T., & Egan, J. (2010). 'Body-centred countertransference in a sample of Irish Clinical Psychologists. The Irish Psychologist, 36, 284-289'.

Notes

1. ^ Horacio Etchegoyen: The Fundamentals of the Psychoanalytic Technique, Karnac Books ed., New Ed, 2005, ISBN 185575455X
2. ^ Laplanche, J & Pontalis, J-B. (1973) The Language of Psycho-Analysis p. 92
3. ^ Freud, quoted in Peter Gay, Freud: A life for our time(London 1989) p. 302 and p. 254
4. ^ Annie Reich, quoted in Patrick Casement, Further learning from the patient (London 1997), p. 177n
5. ^ C. G. Jung, Analytical Psychology: its Theory and Practice(London 1976) p. 159 and p. 157
6. ^ Eric Berne, What Do You Say after You Say Hello? (London 1975), p. 352
7. ^ Jacques Lacan, Ecrits: A Selection(London 1997) p. 229-230
8. ^ Patrick Casement, On Learning from the Patient (London 1990), p. 174
9. ^ Gabbard, Glen O. (1999). Countertransference Issues in Psychiatric Treatment. American Psychiatric Press. p. 1. 
10. ^ Jung quoted in Anthony Stevens, Jung (Oxford 1994) p. 110
11. ^ Heinrich Racker, Transference and Countertransference (London 1982) p. 131
12. ^ Casement, Further learning p. 12
13. ^ Robert Hinshelwood and Susan Robinson, Introducing Melanie Klein (Cambridge 2006) p. 151
14. ^ Hishelwood/Robinson
15. ^ David Bell, Reason and Passion (London 1997) p. 30
16. ^ Casement, Further learning p. 8 and p. 165
17. ^ "Aaron Green", quoted in Janet Malcolm, Psychoanalysis: the impossible profession(London 1988), p. 115
18. ^ Mario Jacoby, The Analytic Encounter (Canada 1984) p. 38
19. ^ Jean-Michel Quinodoz, Reading Freud (London 2005) p. 72
20. ^ Gabbard. p. 3. 
21. ^ Casement, Learning
22. ^ Quinodoz, Reading Freud p. 71
23. ^ Michael Jacobs, Psychodynamic Counselling in Action(London 2006), p. 146
24. ^ Jan Grant and Jim Crawley, Transference and Projection (Buckingham 2002), p. 50
25. ^ James S. Grotstein, But at the Same Time and on Another Level (London 2009) p. 38
26. ^ Quinodoz, Reading Freud p. 72
27. ^ Etchegoyen, Fundamentals p. 299
28. ^ Egan, J. & Carr, A. (2005). Burnour in female counsellor/therapists of the NCS: Studies I,II and III. Papers presented at the 35th Annual conferenceof the psychological society of Ireland, Derry, Nov 17-20th
29. ^ Egan, J. & Carr, A. (2008). Body-centred countertransference in female trauma therapists. Eisteach, 8, 22-27.
30. ^ Booth, A., Trimble, T., & Egan, J. (2010). body-centred countertransference in a sample of Irish Clinical Psychologists. The Irish Psychologist, 36, 284-289.
31. ^ Egan, J. & Carr, A. (2008). Body-centred countertransference in female trauma therapists. Eisteach, 8, 22-27
32. ^ Rothschild, B. (2006). Help for the helper: self-care strategies for managing burnout and stress. London: W. W. Norton & Company.

References

• Groves, James MD. (Date). Taking care of the hateful patient. New England Journal of Medicine, Vol. 298 No. 16