Countertransference is one of the oldest concepts in psychotherapy. Freud first discussed it in 1912, and it has been the subject of many clinical papers. However, research on countertransference is still relatively new. Countertransference is the emotional response of a therapist to a patient’s thoughts, behaviors, and feelings. It is caused by an interaction between a patient’s transference (their re-enactments of old relationship patterns in the relationship with the therapist) and the therapist’s unresolved personal conflicts. Freud initially thought that countertransference was an obstacle to treatment. Still, later, he and others found that a therapist’s reactions to a patient can provide helpful information to the therapist about the patient. A meta-analysis found that management of countertransference was associated with better therapy outcomes for patients, and the effect of this association was large. However, for a therapist to use their emotional reactions (i.e., countertransference) to help them work with their patient, they must have a certain level of self-awareness. In this study, Abargil and Tishby explored how changes in therapist countertransference from the beginning to the end of therapy affected patient outcomes (symptom reduction) and whether a therapist’s self-awareness of their emotional reactions would enhance or diminish the effects of countertransference on these outcomes. The authors interviewed 41 therapists and their patients who received 16 sessions of short-term dynamic psychotherapy. The interviews were designed to understand the therapist’s countertransference and relationship patterns with their patients and assess whether the therapist was aware of their countertransference and relationship patterns. Therapists were interviewed early in therapy, at the mid-point, and end of treatment to evaluate changes in countertransference and relationship patterns with patients. Patients and therapists also completed a measure of patient symptoms change. The most frequent countertransference wishes of therapists were “to achieve,” “to be comfortable,” and “to be close and accepting” of their patients. Paradoxically, the more therapist wishes for their relationship with the patient changed, the worse their patients’ outcomes. However, this finding was driven by the therapist’s lack of awareness of their countertransference. That is, only when a therapist’s awareness was low were changes in therapist countertransference related to worsening patient symptoms at the end of treatment.
Practice Implications
The findings of this study underscore the potential of therapist self-awareness in mitigating the potential adverse effects of countertransference. Self-awareness is a powerful tool for managing the negative effects of therapist countertransference. The more therapists can understand their reactions to patients in a non-defensive way, the more they will be able to separate their own needs from their patients’ needs in providing proper interventions. This suggests that therapists can become more effective in their practice with the right tools and mindset. Peer consultations, supervision, and personal therapy may allow therapists to gain greater awareness of their wishes, reactions, and relational patterns, thereby enhancing their effectiveness as therapists.
Abargil, M., & Tishby, O. (2024). Changes in countertransference and changes in patient working alliance and outcome: An empirical study. Journal of Counseling Psychology. Advance online publication. https://dx.doi.org/10.1037/cou0000743
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