3.3 Countertransference

Awareness of Countertransference

Approaching one’s countertransference with curiosity and humility is essential to honoring the ACA and NAADAC code prescriptions of self-awareness (ACA, 2014; NAADAC, 2021). In addition to the previously mentioned self-awareness techniques and strategies, such as consultation and supervision, the following section presents some common manifestations of countertransference within the counseling relationship.

Though countertransference reactions vary widely in their presentation depending on factors such as client and counselor history and the content of a particular session, some common signs and reactions are essential to remain aware of in your practice. In the context of individual clients, signs can include intense feelings of dread or excitement as you approach a client’s sessions, a pattern of ending sessions early or extending them past what is typical, frequent and unjustified boundary extensions, strong hateful or loving feelings towards a particular client, as well as powerful emotional reactions in response to content shared by clients (Hayes et al., 2011; Jenks & Oka, 2021; Prasko et al., 2010). Outside of the session, you may experience more diverse reactions. You may find yourself thinking about the client excessively outside of work, fantasizing about the client, or noticing yourself speaking about the client with coworkers in an inappropriate or unprofessional manner (Prasko et al., 2022).

In addition to common signs of countertransference, there are a few everyday situations in which counselors may be at exceptionally high risk for countertransference reactions: (a) working with clients that share similar lived experiences to the counselor, (b) counselor and client value conflicts, and (c) in response to sexual and romantic advances by the client (Jenks & Oka, 2021; Prasko et al., 2010; Prasko et al., 2022). We will present specific guidelines for each of these categories below.

Client Similarity in Lived Experiences

Many counselors are drawn to the field because of a past personal experience with the consequences of mental health conditions, substance use disorders, or unmanaged emotional distress (Barnett, 2007; McBeath, 2019), often desiring to work with populations similar to themselves as a way of giving back to the community or personal healing. This lived experience helps to create empathetic, knowledgeable, and client-centered counselors. However, it can also present an ethical issue when strong emotions and personal reactions to clients begin to impair counselor objectivity. Counselors may feel compelled to guide the client toward a solution they have used personally and consequently feel upset or hopeless if they choose a different treatment. Similarly, counselors may begin to over-identify with clients due to similarities in lived experiences. When a client is perceived as a friend or kindred spirit, it can be disastrous for the counseling relationship. The counselor may unethically extend their boundaries, treat the patient as “special” relative to their other clients, or even withhold specific treatments or interpretations out of fear of losing a therapeutic relationship built around countertransference (Prasko et al., 2022). This is not to say that counselors with specific lived experiences should neglect to treat clients like them. However, diligence is warranted to ensure that countertransference is managed appropriately. Supervision is necessary if the counselor feels that a client-counselor relationship has surpassed traditional boundaries.

An activity that may prove particularly beneficial for the novice counselor is to spend time considering ways in which mental health or substance use concerns have touched their lives, any ongoing personal, social, or emotional difficulties they may be experiencing, as well as any lived experiences that have been particularly formative in their development. In doing so, the counselor can remain alert to areas in which they may require additional support in practice and begin to explore different ways of coping with countertransference that arise from client similarities.

Counselor and Client Value Conflicts

An additional area that may evoke strong feelings for the counselor occurs when the counselor and client’s core values conflict. These feelings may be further amplified if the counselor fails to recognize the situation as a value conflict or views their values as “superior” or “right” relative to the client’s. Identification and continual awareness of one’s values is a foundational step in the management of countertransference and may serve as a means of identifying areas deserving of special attention when the value or belief in question is identified as foundational or particularly polarizing for the counselor (i.e., religious values or political beliefs). A more in-depth overview of the identification, integration, and management of core values in counseling is presented in Chapter 6.

Effective Management of Countertransference

Though countertransference reactions have the potential to impact the therapeutic relationship negatively, when managed appropriately, they provide excellent opportunities for personal growth and the development of professional expertise. Given the abstract and diverse reactions of countertransference, no one-size-fits-all approach will be practical for every counselor. This being said, the following section provides methods that are generally accepted by the field to attenuate and reduce countertransference, such as supervision, bracketing, and exercises in empathy (Cooper, 2004; Hayes et al., 2011; Jenks & Oka, 2021; Prasko et al., 2010; Prasko et al., 2022).

Supervision

A continual best practice that will be repeated throughout the text is seeking supervision in the face of complex or seemingly insurmountable obstacles with clients. Within the context of the early identification and management of countertransference, supervisors play a vital role in assisting supervisees in navigating the complex unconscious and interpersonal artifacts that arise in early therapeutic practice (Prasko et al., 2010; Prasko et al., 2022). In discussing countertransference early in your career, your supervisor may use one of several approaches. Though an in-depth exploration of the process and clinical utility of these approaches is beyond the scope of this text, a brief overview to facilitate comfort with the supervisory process is provided below.

Guided-Discovery

Using a guided discovery process in supervision is one of the most popular approaches across various theoretical orientations. Through this method, your supervisor will assist you in exploring any underlying factors, such as past experiences or biases, that contribute to ongoing difficulties with certain clients, with the ultimate goal of helping you spot your own countertransference. This is generally accomplished through a combination of exploratory questioning, role-playing, and reflection exercises (Prasko et al., 2022).

Cognitive Restructuring and Personal Therapy

In cases of persistently strong countertransference that has become disruptive to the therapeutic relationship, your supervisor may engage you in a process known as cognitive restructuring. The process of cognitive restructuring is derived from cognitive behavioral therapy, with goals of helping the counselor to see the problematic or counterproductive nature of particular mental sets or behaviors, leading the counselor towards positive behavioral change, and providing a greater level of self-understanding (Prasko et al., 2022).

Though cognitive restructuring in supervision draws many parallels to its use in therapy (Prasko et al., 2022), it is generally circumscribed to a counselor’s particular difficulty with a given client. Nonetheless, supervisors must be diligent in ensuring they are not inadvertently providing therapy to their supervisees. If you feel this boundary has been crossed at any point in supervision, do not hesitate to communicate your concerns with your supervisor or another appropriate authority to decide on an alternative course of action. Similar exploration can be pursued in one’s own personal therapy, which many supervisors may recommend in the face of continued struggles with countertransference.

A Note on Supervision

Establishing a solid foundation of supervisory experiences during the initial stages of work in the counseling profession is an essential step that sets the stage for a personal philosophy of self-exploration and ethical conduct later in your career. This being said, because of past stigma surrounding the discussion of countertransference (Freud, 1910; 1948; Hayes et al., 2011) as well as the reluctance of some conflict-averse counselors and supervisors to discuss sensitive topics, it is essential that prospective counseling interns appropriately vet their supervisors and advocate for themselves in the supervision process. Holding an initial discussion with a prospective supervisor to understand their approach to the supervision process and personal philosophy on both transference and countertransference is an essential first step that can help to ensure a fruitful supervisory experience at every level of practice. After beginning work with a new supervisor, it is helpful to continue this proactive approach to ensure a productive internship or pre-licensure experience with minimal surprises when it comes time for performance evaluations. We recommend candidly discussing any unresolved difficulties you may be bringing to your work with your supervisor and any patient experiences or conditions you see yourself having difficulty remaining objective in treating. Consider discussion prompts such as the following:

Bracketing

Bracketing is a cognitive skill originally popularized among researchers to set aside their preconceived notions regarding the processes and results of a given research project (Tufford & Newman, 2012). Though it has likely been used subconsciously within the counseling field for quite some time, Mick Cooper (2004) is generally credited with first describing bracketing as a strategy to increase empathy and objectivity when working with clients. This concept was further developed by Kocet and Herlihy (2014) in their work on navigating value conflicts in counseling with the notion of ethical bracketing. 

Applying this concept to navigating identified countertransference in your practice, consciously bracketing off any past experiences, beliefs, and values that you notice are impairing your objectivity and ability to counsel effectively may be beneficial. This is by no means an easy task, and it requires considerable self-exploration and practice in developing empathy to accomplish it regularly. In the following chapter on ethical decision-making in counseling, we explore strategies for effective, ethical bracketing strategies.

Empathy Exercises

The practice of empathy is considered to be one of the most effective skills in the management of harmful countertransference in counseling (Hayes et al., 2011). While a full overview of the literature on empathy development in counseling professionals is beyond this text’s scope, we present an exercise that may be used throughout your practice to offset countertransferential reactions.

Though it may seem simplistic, try to honestly and holistically put yourself in the client’s shoes. This entails more than applying a singular psychological, cultural, or values-based lens. Instead, imagine how you might feel having been shaped by the totality of the client’s past experiences within their cultural and personal worldview. Consider how factors such as prejudice, systemic oppression, or privilege may have influenced their development. If their lives have been touched by chronic health conditions, disability, or mental illness, consider the impact those factors may have on their view of the world. Then ask yourself:

When done correctly, honestly, and with an open mind, this exercise can assist you in fostering empathy for all clients. It will likely be uncomfortable and may involve questioning some of your own deeply held beliefs, convictions, and potential biases regarding how the world works. However, in doing so, you can begin to develop a deep-seated sense of humility and empathy for all clients that will have a continued impact on your practice going forward.