3.2 Transference and Countertransference

Transference and countertransference are terms given to interpersonal phenomena in counseling that derive from psychoanalytic theory. Sigmund Freud initially identified transference as a phenomenon whereby individuals would displace romantic and sexual desires onto others, particularly the psychoanalyst, as a result of past failures to establish loving relationships. Freud believed that while transference occurred universally, it was especially strong within the therapeutic relationship and was a manifestation of client resistance that must be addressed to continue treatment (Freud, 1912; 1948). Freud spoke of countertransference somewhat differently than we do today, conceptualizing it as the impact the client has on the unconscious feelings of the analyst (Freud’s word for the role of the counselor in the time of psychoanalysis) and taking the stance that practitioners that do not directly address their countertransference should be ineligible to practice psychoanalysis (Freud, 1910; 1948). After this initial statement, Freud wrote minimally about countertransference, which has had profound implications for the field that are still felt today. Even now, countertransference is often viewed in a negative light as something to be avoided in counseling, when research has established its efficacy as a therapeutic tool in multiple domains (Hayes et al., 2011; Zanarini, 2009).

In contemporary psychotherapy, transference refers to the unconscious displacement of feelings from one person to another (Prasko et al., 2010). Within the context of the therapeutic relationship, this entails a client displacing feelings felt for others in past or present relationships towards the counselor. Though transference is particularly salient within the counseling relationship, the tendency to attribute characteristics of significant people in one’s life to others that resemble them appears to be a near-universal human phenomenon (Andersen et al., 1995).

A common manifestation of transference in the counseling relationship is illustrated in the following vignette:

Over time, the counselor might gently help the client become aware of this pattern. They might explore how her feelings toward him mirror her past relationship with her father. This exploration can lead to a deeper understanding of her current struggles in forming trusting relationships and can help her work through the unresolved issues from her past.

Countertransference is the opposite of transference. It is the displacement of the counselor’s feelings for others towards the client (Prasko et al., 2010). For example, ​​a counselor who recently went through a painful breakup is working with a client who is also navigating the end of a long-term relationship. The counselor feels unusually defensive and irritated when the client expresses anger toward their ex-partner. Without realizing it, they may discourage the client from exploring their anger, instead pushing them toward forgiveness. This reaction stems from the counselor’s unresolved feelings about their breakup, leading to countertransference, which could hinder the client’s ability to process their emotions effectively.

Freud was correct in that countertransference must be routinely identified and addressed, though it is important not to demonize this therapeutic artifact as a characteristic of an ineffective therapist. One cannot “cure” countertransference. Instead, the effective counselor approaches their countertransference with curiosity and humility to leverage its potential for therapeutic progress and personal growth, as will be explored later in this chapter.

Transference – Therapeutic Benefits

Effectively managed transference provides benefits that persist regardless of theoretical orientation. You hopefully noticed in the previous case vignette that the counselor decided to use the transference the client was demonstrating as a therapeutic tool. Transference is a natural part of the therapeutic process and, when recognized and explored, can provide valuable insights into the client’s internal world. It allows the counselor to help the client uncover unresolved issues from their past and how they might impact their current behavior and relationships (Prasko et al., 2010). Addressing transference requires the counselor to maintain a nonjudgmental and empathetic stance. The counselor must create a safe space where the client feels comfortable exploring these feelings without fear of rejection or criticism. By doing so, the counselor can help the client separate their past experiences from the present relationship and develop healthier ways of relating to others.

One need not practice psychoanalysis to derive benefit from transference, and similarly, counselors practicing from any orientation can recognize and utilize its effects. While some theoretical orientations focus almost entirely on the role of transference in psychotherapy, their discussion is beyond the scope of this text.

Diligence in the Understanding and Attribution of Transference

Before discussing how the adept counselor manages transference within their practice, it is helpful to begin with a discussion of what actually constitutes transference within the context of therapy. Although transference is common, the counseling relationship involves numerous interpersonal dynamics that may cause the client to act differently and unexpectedly. When faced with whether transference is occurring, it is always beneficial to seek supervision from one’s supervisor or consultation from a trusted colleague. As you are already part of any client-counselor relationship you choose to consult on, it may be challenging to remain objective and separate your personal feelings and experiences from a given counseling relationship to reflect objectively. Despite our best, most well-intentioned efforts, we are inherently biased, such that we view the counseling relationship through the lens of our countertransference, expectations, and worldview. Thus, having another set of eyes on one’s practice is essential to see something that might otherwise be missed.

Though there are no clear-cut rules for spotting transference, some common trends and behaviors that may be indicative of transference occurring include a new and unexplained stalling in therapeutic progress, abrupt changes in topic during the session, an attempt to focus the session on the counselor, new and uncharacteristically strong emotions such as idealization, anger, or disappointment, stammering, pauses, and nonverbal cues such as tapping of the hands or feet, slouching, or clenching fists (Prasko et al., 2010). When examining transference throughout counseling, positive transference, such as counselor idealization, often occurs early, while adverse transference reactions emerge later in treatment (Prasko et al., 2010).

When acknowledging these cues and pressing for transference phenomena, hesitation on the client’s part is expected in the form of dismissal or avoidance, especially as the transferred relationships can have strong emotional undertones. Nonetheless, it is beneficial to continue gently exploring the potential of transference as it may provide further insight into the client’s presentation and treatment (Prasko et al., 2010).

Power Differentials in Counseling and Status as a Counselor

Consider the power differential inherent in the counseling relationship. As a healer, the counselor is imbued with a heightened status in therapy as one who can guide the patient toward positive change in their identified areas of concern. Putting oneself in the client’s shoes and trusting someone who often begins as a stranger to help guide one’s life decisions is a humbling experience. It requires a great deal of trust, humility, and the acceptance of the problematic notion that one may not know how to address a problem through their typical support systems.

Furthermore, the counselor often has a significantly greater level of education and training (which is often made immediately apparent to the client through the convention of displaying degrees in the office and credentials behind a name), sessions are made on the counselor’s time, often at the counselor’s place of work, and the client is often expected to pay a considerable fee for their time with the counselor. All of these send the implicit message that the counselor holds power in the client-counselor relationship.

These issues become even further magnified in non-voluntary or coerced settings such as in psychiatric institutions, correctional facilities, addiction treatment, or when working with individuals otherwise court-mandated to a form of counseling. The counselor is not only conferred the previously mentioned status but is also given the power to make some of the most critical decisions in a client’s life, such as whether they return to prison, see their families and children, or are released from a psychiatric facility. Given the highly emotional nature of these issues and the magnitude of the stakes at hand for the client, behaviors such as attempting to gain the counselor’s favor or withholding negative information may become commonplace out of a genuine need for survival and control rather than as a product of transference.

All of these factors together merit the consideration that the client may be responding to the power dynamic itself or the role of the counselor rather than as a function solely of transference (Jenks & Oka, 2021). This is not to say that transference cannot occur alongside other interpersonal dynamics. In fact, it is highly likely that in most cases, as the counselor is a figure of authority, the client will transfer feelings from past experiences with significant authority figures to the counselor. However, it is vital that we not dismiss our role in this exchange as client pathology lest we stall therapeutic progress by focusing on an inconsequential issue or fail to see ways in which we can reduce disparities of power in the therapeutic relationship. Consider asking yourself the following questions when determining whether issues of power or counselor status may be affecting the client-counselor relationship:

• How do individuals from my client’s culture regard figures of authority?

• How do I regard figures of authority? Am I sending any messages in my practice that reflect how I feel authority figures should be treated?

• Can I make any changes to reduce power differentials in my practice?

• Have any parts of my client’s identity (Race, gender, sexuality, etc.) been historically disparaged by the counseling profession or “the system” as a whole?

• Is my client mandated to treatment? If I were in their shoes, would I feel pressured to act a certain way to ensure my safety and those I love?

Counselor Personality

As individuals with unique personalities, we, like our clients, can elicit characteristic response patterns from others. While there is a definite interplay between our personalities and the types of transference we may elicit (Thompson, 1945), we also impact the therapeutic relationship in characteristic ways solely as a function of our personalities. This is generally a very positive phenomenon within the field of counseling. A counselor who embodies traits such as empathy, compassion, and a warm interpersonal style can easily facilitate rapport building, client motivation for change, and a safe and comfortable counseling environment (Miller & Rollnick, 2013). This being said, aspiring counselors who have yet to explore their personal beliefs and interpersonal styles comprehensively may unintentionally contribute maladaptive ways of relating to others in the therapeutic relationship. Consider the following vignette:

You hopefully noticed that Ralph exhibits some rigid and obsessive personality traits. Some of his core beliefs are that one’s worth is determined by their accomplishments and that arriving on time is a form of showing respect for others. Though these beliefs will almost certainly cause other issues in Ralph’s work, in the case of this vignette, Ralph’s upset over his clients arriving late is negatively affecting their course of treatment, causing them to terminate early and likely harming their trust in the profession as a whole.

This example illustrates a few key lessons regarding separating the effects of one’s personality from client transference, specifically about maladaptive personality traits. Effects on clients due to personality will generally occur repeatedly across clients who exhibit different transference patterns with the counselor. Furthermore, rather than eliciting a reaction in clients insidiously or without warning, reactions to the counselor’s personality will likely be reactive, occurring in response to a particular event or pattern of events. If you find that you are eliciting reactions from your clients in this manner, it is always incredibly beneficial to seek supervision or consultation. Considering that we may be negatively impacting our clients in this way, it may feel daunting or frightening; however, the notion bears repeating that counselors are, in fact, people, too, just like our clients. Learning that we act in a way that harms others is not a sign of failure; instead, as long as we learn from our mistakes, it is one of the many ways we can continue to better ourselves as counselors.

Ethical and Professional Management of Transference

When to Address Transference

Aside from the initial uses of transference mentioned above, the clinical management and addressing of transference phenomena throughout the counseling relationship have become considerably more complex. Though occasionally necessary to resolve therapeutic impasses, the direct addressing of transference may be uncomfortable or anxiety-inducing for some clients (Safran & Muran, 2000), especially when it is done excessively or places blame exclusively on the client (Piper et al., 1991). Keeping this in mind, a degree of diligence is warranted as the counselor must determine if the knowledge gained from self-exploration and the chance of therapeutic progress outweigh any strains that may be inevitably placed on the therapeutic relationship. The primary exception to this is a class of transference-focused psychodynamic therapies that are commonly used to treat severe and persistent personality disorders. Though these theories are beyond the scope of the text, Zanarini (2009) provides an excellent introductory overview of such theories’ applicability in the treatment of Borderline Personality Disorder. The article can be found in the references section of this chapter. Furthermore, given the nature of minor transferential reactions, positive or negative, the counselor may be able to address any counterproductive effects that emerge on their own. This can be accomplished by critically examining one’s behavior, how it may elicit harmful transference reactions in the client, and making changes accordingly. Thus greatly diminishing the risks of a rupture in the therapeutic relationship.

As we move to a discussion on when and how to manage clinical transference, consider the following vignette:

As you read the following section, consider the following:

• What might be going on for Michael?

• If transference occurs, should it be addressed?

• How would you approach the topic of Michael’s recent behavior with him?

• Would you change your approach if Michael came from a culture that emphasized collectivist values and indirect communication?

Clinicians and researchers generally recommend that transference is addressed if it falls into one of these categories: (a) if it begins to cause a rift in the therapeutic relationship, (b) if it is strong or excessive (e.g., idealization of the counselor or unexplained, disruptive resentment) or (c) if the transference is romantic or sexual. (Andersen et al., 1995; Jenks & Oka, 2021; Prasko et al., 2010; Prasko et al., 2022). If transference is not directly addressed in these cases, it can begin to significantly impact client progress, leading to issues such as client dependency, stalled therapeutic progress, or even irreparable rifts in the counseling relationship (Thompson, 1945).

Given the nature of the counseling field, there is no one-size-fits-all approach to transference management. As with the methodologies we apply to the treatment of client problems, transference should be managed within the context of the particular situation that arises, the client, and their cultural lived experiences. This being said, guidelines that may prove helpful in managing transference with clients on a case-by-case basis are presented below.

After you, as the counselor, have determined that the suspected transference should be addressed, approach the situation with humility and openness. It is possible that the client sees the situation differently than you, and it is essential to avoid patronizing the client by forcing them to accept your point of view. Because of this, rather than addressing the issue too directly, it may be advisable to explore it socratically, gradually asking the client their thoughts on the matter until an appropriate conclusion is reached. This should be attempted at a pace that is both comfortable for the client and sensitive to their cultural worldview.

Returning to the vignette with Michael and Colin that we discussed earlier, let us see how Colin approached the topic of transference with Michael.

In the first part of this vignette, you hopefully noticed that Michael was experiencing a transference reaction in which he was displacing the feelings of frustration and combativeness he experiences with his father to his counselor, Colin. This reaction ultimately resulted in apprehension and resignation on the part of Michael, who gradually progressed into arriving late or even intoxicated for his sessions, creating a large rift in the therapeutic relationship.

When Michael and Colin returned for another session, notice how Colin began not by telling Michael what he was experiencing but by asking him how he viewed the situation. In doing so, Colin sets a non-judgemental tone for the session. He begins modeling a means of constructively managing conflict for Michael that may also serve as a corrective recapitulation of Michael’s relationship with his father in the context of the counseling relationship (Yalom & Leszcz, 2008). Though Colin encounters some initial resistance with Michael, he provides a specific example of one of Michael’s behavioral manifestations of transference. He asks Michael to revisit what he felt in the moment, which is an effective means of briefly re-opening the transferred feelings. After doing this, Colin socratically questions Michael until he concludes that the difficult moments in counseling occurred because they reminded him of his relationship with his father. From there, Colin and Michael agreed to address similar issues.

Notice that specific use of the word transference or psycho-education regarding the topic was not present in this vignette. Instead, the counselor sought to help the client understand what was occurring in the context of his worldview and how he was actively experiencing it. However, suppose the problem persisted in this particular example, in addition to seeking supervision. In that case, the counselor may have needed to address the topic more directly and introduce the topic of transference at a level appropriate to the client’s level of psychological mindedness.

Sexual and Romantic Advances By The Client

Sexual and romantic feelings that arise within the counseling relationship present a unique and complex challenge that always constitutes a form of transference. Though perhaps not a true tabula rasa or “blank slate,” the counselor’s relative opacity and lack of self-disclosure within the counseling relationship creates a space where unconscious desires, motivations, and past experiences can be transferred from the client to the counselor. When sexual or romantic feelings arise from the client, it may be that the counselor embodies a trait the client finds attractive in others, that the counselor reminds the client of a previous romantic encounter, or that the client is re-enacting an interpersonal pattern where securing attraction from another satisfies a subconscious need such as power or belonging. Irrespective of the reason for its occurrence, when sexual or romantic transference enters the counseling relationship, it must be approached with extreme care and diligence in light of legal and ethical precedents and the potential for client harm.

Firstly, though sexual and romantic transference can be explored in counseling, it cannot be entertained. Ethics codes and most state laws expressly prohibit sexual and romantic relationships with clients except in scarce circumstances (ACA, 2014; NAADAC, 2021). This being said, it is the stance of the authors that a counselor should never enter into a sexual or romantic relationship with a past, current, or prospective client.

With regard to addressing sexual or romantic transference, it is important to maintain an empathic stance without withdrawing the unconditional positive regard present in the counseling relationship (Jenks & Oka, 2021). A concerted effort must be made to maintain boundaries, establishing the counselor as a nonsexual entity while also normalizing and validating the experience of the client (Jenks & Oka, 2021). Psychoeducational material regarding how clients perceive the novelty of the psychotherapeutic relationship may be a beneficial starting point for this discussion.

Given the delicate nature of sexual and romantic transference, supervision should always be a component of appropriate management (Jenks & Oka, 2021). This reflects sensitivity to the possibility of client harm and provides a medium for the counselor to explore how they may be contributing to ongoing transference from the client. Contemporary literature suggests that boundary extensions may serve as a contributing factor to the development of sexual or romantic transference (Jenks & Oka, 2021). Thus, exploring the circumstances that led to the development of transference may provide a beneficial opportunity for self-reflection regarding the counselor’s role in the process. Sexual and romantic transference may also contribute to countertransference in the counselor (Prasko et al., 2022), primarily when romantic or sexual relationships represent an ongoing difficulty within the counselor’s personal life.