In this series, I dig a little deeper into the meaning of psychological terms. This week’s terms are transference and countertransference.
The concept of transference was first proposed by Sigmund Freud. In therapy, it occurs when a client unconsciously redirects feelings associated with one person, often an important figure in the earlier part of their life, onto the therapist. Transference may occur outside of therapy as well, when feelings relating to one relationship are projected onto another relationship. This could include feelings someone has experienced toward a parent being transferred onto a significant other.
Countertransference happens when the client triggers an emotional reaction in the therapist. This may be related to the therapist’s own unresolved issues.
Transference in therapy
Different theoretical perspectives take different stances towards transference. Adlerian psychotherapy frames transference as an obstacle that stands in the way of therapeutic progress. Some forms of therapy don’t address transference at all in the therapeutic model, such as cognitive behavioural therapy (CBT).; That’s not to say that it’s not possible for transference or countertransference to arise; it’s just not a part of the therapy model.
Transference plays a starring role in psychoanalysis and related therapies like psychodynamic psychotherapy. It’s seen as an important way for the therapist to gain access to the client’s unconscious mind.
Wikipedia describes the development of transference as a process by which:
… patients relive their infantile conflicts by projecting onto the analyst feelings of love, dependence and anger.
The therapist will point out and interpret any transference that arises, and this is used to identify and resolve old conflicts and problematic defense mechanisms. Interpretation of any countertransference that arises within the therapist can offer the therapist insight into elements of clients’ experiences that have gone unspoken.
Transference-focused psychotherapy is a type of psychodynamic therapy for people with borderline personality disorder. Transference helps with identifying distorted perceptions of self, others, and object representations. It’s seen as a way to gain direct access into the client’s internal world, and inconsistent perceptions of shared reality are addressed in therapy.
This wasn’t a type of therapy that I had heard of before. From what Wikipedia says, there hasn’t been much research done on it yet, but it does show some promise.
Infatuation can be one potential product of either transference or countertransference. The infatuation may be directed either from the client towards the therapist, or vice versa. Any therapist worth their professional license would recognize this early on and deal with it, either by ending the therapeutic relationship or doing their own work in therapy or supervision.
Freud also described a “transference neurosis”, which occurs when the relationship with the therapist because the most important relationship in the client’s life, and infantile feelings are directed at the therapist as a sort of parental figure. Interpretation is seen as the key therapeutic intervention.
Countertransference and BPD
Borderline personality disorder (BPD) is one of the conditions that can be particularly likely to trigger countertransference reactions on the part of the therapist or other mental health professional. Adequate supervision is important to allow therapists to work through this countertransference with peers and prevent it from interfering with the therapeutic relationship.
Supervision in a therapy context doesn’t usually mean a supervisor sitting in on a therapy session; rather, it’s an opportunity to discuss afterwards how sessions went and identify what could have been done differently or more effectively. This sort of supervision is a key element of the dialectical behaviour therapy approach.
In mental health nursing practice
In my career as a mental health nurse, I don’t think transference really came up, probably because the types of settings I’ve worked in weren’t conducive to it. I have both witnessed and experienced countertransference, though. The countertransference most often arises while working clients with BPD. I think part of this is that people with BPD tend to be highly perceptive. If the individual with BPD sees the mental health professional as being unhelpful or making things more difficult for them, the angry outbursts that can be a symptom of BPD may be targeted straight at the weaknesses the healthcare provider already feels insecure about.
Most colleagues I’ve worked with have been able to recognize this and keep it from having a negative impact on the therapeutic relationship. Unfortunately, a few didn’t keep a lid on it as much as they should have to be therapeutically effective.; My take on the matter is that countertransference at some point is inevitable to some extent for most mental health professionals, but it’s the professional’s responsibility to recognize it and deal with it so that it doesn’t become the client’s problem.
Psychoanalytic or psychodynamic therapy have never appealed to me as a way to manage my own illness, and the idea of projecting my own emotional crap onto a therapist feels kinds of icky. I’m not trying to say that it’s not a valid form of therapy; I’m sure for some people it can be very helpful, but for me, it just wasn’t a good fit.
Have transference and countertransference come into play in therapy work that you have done?