The Interplay of Transference and Countertransference

Therapists use their understanding of transference, countertransference, and client dynamics to identify the sources of the client’s compulsive, repetitive behaviors.

Underneath the happenings in therapy is an unconscious process. It may differ from the superficial content.

In the interaction between you and the client, the content is apparent, but the process is not always obvious. This reminds me of a story about a mother and her schizophrenic son who were eating in the hospital cafeteria. Staff overheard the mother telling her son how important it was for him to become mature and independent. Her words surprised the staff because she was cutting up his meat for him as she spoke. The content of her speech contradicted her actions, leaving the son with a mixed message.

The therapist examines the unconscious sources of resistance.

Transference and countertransference are part of the process of psychotherapy. Ralph Greenson states, “Transference refers to all the feelings the client is experiencing toward the therapist, which are displaced from figures in the past.” He adds that “some feelings are appropriate and realistic based on the actual behavior of the therapist.”

He goes on to explain, “Countertransference is based on the unconscious conflicts in the therapist’s past which make him react to the client as though the client was a significant figure in the therapist’s past” (Greenson, pp 1399–1415, 1959).

The word counter is misleading. The countertransference is not against the client’s transference.

To understand the client’s resistance to developing a more rational ego, the therapist explores the transference and the countertransference.

Psychoanalytic technique is designed to elucidate the transference and use that to understand the nature of the client’s resistance to developing a more rational ego. (Very simply put, in theory, the ego is that part of the personality that is aware of the self and tries to make realistic compromises between wishes and learned rules of behavior.)

While a nonanalytic therapist would not necessarily focus on this, understanding how transference, resistance, and countertransference work helps them understand the client.

Identifying the significant figures in a client’s past and their emotional response to them helps you understand what the client is reliving in the present. The repetition compulsion is the tendency to recreate and repeat conflictual situations to relive rather than remember the original one.

The positive transference works toward therapeutic progress. The negative transference, with its anger, mistrust, and hostility, hinders it. For example, in a negative transference, the client may see you as judgmental, like earlier significant figures, and feel reluctant to trigger your critical judgment by disclosing shortcomings.

I encourage you to read Dr. Greenson’s article to get a more precise, less simplified discussion of transference and countertransference. You might also want to read Dr. J. D. Gill’s refreshingly lucid explanations in her book Doing Psychotherapy: A Primer.

I want to look broadly at reactions or assumptions that you and a client can make about each other based not only on past figures but also on different experiences and cultural influences. Technically, that is not transference or countertransference. These reactions may be a mixture that includes or is shaped by transference/countertransference. Behavior is multi-determined. So, multiple influences, both conscious and unconscious, shape behavior.

Bret’s and Myrtle’s cases illustrate how transference and countertransference operate in therapy.

I entered my waiting room to hear the loud voice of my new client, Bret, who was chatting up my secretary. I noticed her taking in how tightly his tailored shirt and khaki slacks accentuated his build. He was dropping the names of prominent townspeople who had gone with him to see his team play in the national football championship. He took his eyes off my secretary long enough to look up and say, “Hi, Doc.” (I hate being called “Doc” almost as much as the character Doc Martin did on TV. It feels demeaning.) I could feel the muscles in my jaw tighten a bit, but I was determined to remain courteous anyway.

As he entered my office, Bret immediately remarked on the size of my desk. It was a large piece of wood that I’d had a local carpenter finish and lacquer. It rested on two short filing cabinets. Bret seemed put off by my lack of an executive-style desk. I detected a slight grimace when he had to sit down in one of my rocking chairs. He was sizing up the competition and trying to assess my status.

I was a loser.

Bret explained he was a successful business executive who, at fifty-five, had a young wife he was trying to keep happy. It was her idea that he go to therapy. She had told him he wasn’t himself, as if he was losing a step.

As I asked about symptoms, I was careful to couch my language in noncritical words, even though I’d already felt put off by Bret’s behavior. Nonetheless, he was defensive and seemed to think he needed to compete with me. He noted my college diploma and reminded me that his school had defeated mine in an important basketball game. Eventually, he seemed to realize that I was not a threat and had been pointing out some of his strengths.

Over time, it became more apparent that Bret had a very critical father who expected success from his son, whom he saw as an extension of himself. Bret could never please him. And now, as he got older, he was having problems pleasing his wife. His transference feelings about me involved seeing me as a critical authority figure who was an opponent he would have to compete against.

My countertransference involved my feelings about the jocks in my high school who had picked on me, an eighth-grade student council nerd who was unsuccessfully trying to keep them from smoking in the school bathroom. In my gut, I felt Bret was subtly going to bully me for not being an athlete.

Knowing I was most certainly a nerd and not a jock put my masculinity in question and played into my adolescent issues with self-worth.

So, Bret had been bullied by his father, and jocks had bullied me. In time, Bret became more accepting of himself, understood how his father’s insecurities affected their relationship, felt less compelled to always be a winner, and realized that his wife loved him for who he was. As I got to know him better, I found myself more sympathetic to his vulnerability and able to be genuinely accepting of him.

The conscious process was talking about solving Bret’s problem of not feeling like himself, but the unconscious process involved the transference/countertransference issues around bullying and self-acceptance.

You’ll be glad to know that I got over my issue with jocks. My wife is a jock who played college basketball and coached high school basketball. I won’t let her smoke in the bathroom.

Like Bert, Myrtle was defensive

Another transference and countertransference occurred when I saw Myrtle, a forty-five-year-old single woman who worked for our local veterinarian. She had unkempt hair and wore drab, loose-fitting scrubs from work. Her appearance seemed to be saying, “Not interested.”

She told me she got along better with animals than people and was having problems with her coworkers, whom she described as sneaky, two-faced bitches. She said she felt like there were two kinds of people: bad people and bad people pretending to be good.

It did not take long for me to see that Myrtle suspected I was the latter. After all, she was paying me to be nice. It was not so much that she was paranoid (thinking people were out to get her) as it was that she saw people as simply bad and uncaring.

Eventually, she could tell me that her father had abused her when she was an early adolescent and that her mother hadn’t believed her. Her transference to me was to suspect that I would eventually abuse her and discount what she told me.

My countertransference was feeling irritated, as I had with a girlfriend who questioned the intent behind everything I did. If I did something nice for her, she thought I wanted something from her or had ulterior motives.

Deirdre’s, Selma’s, and Harriet’s cases illustrate how clients unconsciously repeat behaviors to master them.

When someone sees a spotted four-legged animal coming at them quickly from three hundred yards away, they sort through profiles of animals—four-legged animals, fast-moving animals, and spotted animals—to decide if it is a leopard.

Then they become terrified and run. Their minds assume things based on experience and reading, and they react accordingly. They have benefited from what they learned in the past.

When a small child uses trial and error to learn how to pour milk, they repeat their behavior and eventually learn from the repetitions to pour milk without spilling it.

In both instances—seeing the leopard and pouring the milk—the person is consciously trying to apply what they learned in the past to deal with the present task. Sometimes, there are unconscious processes outside awareness that are factors in that behavior.

Sometimes, people unwittingly feel compelled to repeat their behavior to master an unconscious conflict. Each time they repeat the behavior, they try to benefit from what they learned the previous time.

The repetition compulsion is a friend to the investigating therapist, but not to the client’s progress. In the transference, the client recreates the most recent compulsive repetition of the earlier conflictual relationship. The therapist then uses the most recent example of the behavior to look back in time for analogous situations—earlier repetitions. The client may show similar behaviors toward other people and in different situations.

Take Deirdre, for example. Faultlessly dressed and with artful makeup, my thirtyish client told me she regularly worked out, tried to stay fit, and was sexually available to her boyfriend. Despite this, her boyfriend was constantly distant and self-absorbed. She wondered whether she had been attentive enough to his needs, yet she also felt he should reciprocate her affection.

Deirdre’s girlfriends had warned her that he was just like her last boyfriend, whom they described as creepy and cold. They had pushed another guy on her, but she said he was just too sweet, and she didn’t feel any spark of attraction.

Her mom and dad had divorced after her mom had an affair, claiming she had finally found a man who could love her. Her dad had spent more time in the garage than with his family and seemed to care more about his Mustang than them. To no avail, Deirdre had taken an automotive class in high school, hoping they could work on the car together.

Deirdre was trying to master the unconscious conflict of getting someone unloving and distant to love her. She sought distant men to recreate the situation and master it. But she was only vaguely aware of this. The clue was that nice guys did not excite her. In the transference, she discounted any positive thing I said because I was a nice guy and not distant. She did not want acceptance from me. Deirdre wanted it from someone aloof and indifferent.

Some of the mixed feelings clients have toward therapists and the assumptions they make about them come from popular culture.

Therapists are depicted as benign but lacking common sense, sociopathic, powerful mind readers, wise but different, boundary violators, greedy, clueless, arrogant, and amazingly insightful about others but deeply flawed themselves.

In your first meeting with a client, you will orient the client to what therapy is and explain your standard procedures. That may reassure them that you don’t fit into one of those stereotypes. Don’t give in to the temptation to explain more about yourself than you need to. It may feel like you are rudely withholding part of yourself. But you are declining to show your hand for a therapeutic reason. The more concrete things the client knows about you, the more artifacts you introduce into the transference. For example, if they know you have a child, they can’t imagine that you are unable to have children.

They may already have information about you, especially if you live in a small town or if they found you through a friend or the internet. You may not avoid them seeing your wedding ring, but think twice about putting family pictures on your desk or stickers on your car.

Besides looking for a wedding ring, clients may look at what you are wearing to see if how you dress is signaling sexual interest. So, avoid wearing anything that could be perceived as sexual.

Clients have preconceived notions about therapists based on what others have told them.

Clients may have culturally based prejudices against you because of sex, gender, sexual orientation, race, relationship status, ethnicity, religion, age, appearance, and other characteristics.

When I worked at the US Public Health Service Hospital in Baltimore, my boss required us to wear our uniforms once a week. I had seen Selma, the wife of a retired army sergeant, for several Tuesdays. She had remarked about how easy it was to talk to me.

Then Selma came on a Wednesday and saw me wearing an officer’s uniform. All her feelings about officers, which had grown out of listening to her husband talk about officers for years, surfaced. Her husband had portrayed officers as snobbish know-it-alls who were clueless about how things should be run yet always found fault in the recruits. Selma suspected that I looked down on her after hearing her admit to her shortcomings. She thought I had cynically feigned my acceptance of her. She felt I had somehow tricked her into talking to an officer. Our sessions were never the same after that.

Clients may unconsciously count on you to be invulnerable, as they

counted on their parents as children.

There will be times over your career when you miss work because of illness, accidents, family illness, or a death in the family. Clients may be surprised. They may be realistically concerned and show compassion and thoughtfulness to you and your family. Let them know you are thankful.

Here is an example of how you can learn something from your client’s reactions.

Getting over an awful cold, I came to work one day feeling worn out, coughing, and frequently blowing my nose.

My appointment was with Harriet, a young woman who often came late to sessions and frequently wore something she had worn the day before and had just thrown on as she ran out the door. Scatterbrained, Harriet usually fumbled through sessions like she fumbled through life, seemingly without direction. But on this day, she was organized and goal-directed, putting together the things we had discussed in previous sessions and talking about her optimism. I wondered why there had been such a change.

Harriet had a mom who struggled with chronic depression and had difficulty being a mother. Harriet loved her mom and wished her mother could get it together to mother her better. Harriet saw I was having difficulty and had been trying to act in a way that made me feel better so I could better

mother her.

My client’s caring behavior was multi-determined. It reflected her human kindness, but her behavior also gave me insight into the mother-daughter relationship and her strong wish for a functional mother.

The first clue you might get about the transference is how you feel about the client. So, ask yourself, “What do I feel about the client?”