Understanding Countertransference

During a session with a high conflict couple, do you ever feel anxiety, frustration, sympathy for one partner? Do your clients trigger your sense of incompetence and insecurity? When you work with couples, they elicit feelings and thoughts are important to understand, tease out and manage. Having a countertransference reaction is not a sign of immaturity or inexperience. It’s a normal aspect of the work.

One reason why couples therapy is so challenging is that our clients project their own issues on to us, and we, in turn, have reactions to our clients that are not always based on them.

This is why it is so important for therapists to do their own family of origin work on scripts, legacies, and vulnerabilities. Understanding the roles they played or still play in their families of origin, will make them much less reactive to the inevitable breaches of the therapeutic alliance that occur in couples therapy.

Doing their own intrapsychic work about the ways in which they grew up, developed their defenses and their patterns of relationships, is as important as consultation and supervision.

Clinicians can, and do, exhibit a host of countertransferential reactions.

These can include: annoyance, rage, sorrow, frustration, sympathy, envy, pride, fear or boredom. It is the lack of attention to, and awareness of, these feelings that makes them dangerous in a clinical situation.

Without awareness, counselors tend to “act out” their countertransferential reactions. Countertransference may interfere with the therapist’s ability to understand clients and may adversely affect the therapeutic alliance.

I want to distinguish two kinds of countertransference:

Type 1. The therapist’s emotional reactions to the couple are based on the therapist’s unconscious needs, projection mechanisms, and other defenses. We bring into our interactions with our clients our characters, values, ideas about a good life, a good marriage, and good parenting. The personality, worldview, and theoretical orientation of the therapist have an enormous impact on the nature, type, and outcome of the treatment.

Type 2. A projection of the couple’s issues that the couple brings to the table onto the therapist. Sometimes, as we get to know our couples better, we can begin to understand the projected parts of one or the other member of the couple: When partner A makes us feel inadequate, blamed, or bored, this can help us understand how partner B feels in relation to partner A, among other feelings that can be revealed during the process.

When one partner makes a big deal out of something that is not a big deal for us, it could mean the client is projecting. When we lose empathy for one partner or a client makes us upset, it could be that we are reacting to something from our past: one of our parents or siblings affected us in a way that is now awakened by the interactions with our clients. Whatever the issues, we need to increase our ability to disentangle how much of our reaction and feelings come from our own life, and how much belongs to the client.

Not infrequently both kinds are taking place simultaneously. In either case, clinicians can become anxious, ignore their feelings, or be blinded by their feelings, making them impaired from doing good work.

What to do?

An ongoing effort at self-awareness, via individual therapy, couples therapy, or supervision is a must for therapists who wants to be effective in any kind of clinical work. These are even more necessary activities for anyone who wants to work with couples effectively.

• Think of your thoughts and feelings as a diagnostic tool. Your reactions and feelings have meanings in the context of the relationship with each client of the dyad. It is not a good idea to try to get rid of or ignore thoughts and feelings, whether negative or positive. If you have strong feelings, welcome them into your awareness and explore fully, because they are data about the couple and about yourself. If you can think of your feelings as data, you will become more open, more curious, and you will be able to understand its origins. .
• Your insecurities can get triggered. Think of your thoughts and feelings as your internal gyroscope. You know yourself better than anyone else. If you lose your center, your composure, your usual way of operating, it may be a signal that you need to pause and go inward, during or between sessions to understand what’s going on.
• Tolerate uncertainty and ambiguity. We don’t always know why we feel the way we feel, and we don’t always understand what’s going on. People are complex and contradictory. But uncertainty can make us uncomfortable or anxious. Tolerating uncertainty and ambiguity, and allowing the process to unfold is an important part of the process.

Lack of awareness of countertransference leads to acting out. It is not uncommon for therapists’ reactivity to lead to behavior that can border on the unethical. Abandoning clients, arguing with clients, saying bad things about clients to colleagues, are some of the signs that countertransference is playing a role. Spend some time paying attention to how you feel in your sessions with certain couples and make the effort to understanding it. You will become a better couples therapist if you do this work.