Robert M. Gordon,Ph.D., ABPP, LLC

The terms “transference” and “countertransference” have made their way from psychoanalytic circles into mainstream psychology. All psychologists, regardless of their theoretical orientations, are now responsible for managing the transference and countertransference. However, these terms may not be well understood by non-analytic therapists. In fact, analysts still debate the meaning of them.

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Transference is better understood. Freud saw transference, as a distorted perception of an individual based on one’s past significant relationships. Patients might have love, hate, and erotic feelings for the therapist as a repetition of unresolved unconscious conflicts. Freud believed that transference was necessary for the treatment process, and working through the transference was an important source of personal growth. Freud viewed countertransference as the therapist’s inappropriate reaction to the patient. It was based in the therapist’s own resistance to the treatment and the enactment of personal needs.

In 1882, Freud’s friend Josef Breuer told him of an interesting case of hysteria. Breuer explained to young Freud that Anna O.’s symptoms would disappear after she recalled a forgotten unpleasant event associated with her symptom. Freud suspected that hysteria was psychological in origin, and this case of Anna O. seemed to prove it. Anna O. called the process her “talking cure,” and thus began psychotherapy.

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Just when Breuer called the cased closed and a success, Anna O. announced to Breuer that she was pregnant (hysterically) with his child. Breuer abruptly stopped his treatment of Anna O., and dropped the whole business of psychology, and went on a second honeymoon with his wife. We might consider his abandonment of Anna O. the first recorded countertransference reaction to a patient’s transference.

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Freud went on to develop his ideas about unconscious conflicts causing psychological symptoms and resolving them by analyzing the transference. But the therapeutic relationship had to be safe for the unconscious to reveal its secrets and for working through the conflicts. Freud developed strict ground rules for analysts to stay in a professional role and to keep the therapy on track.

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Realizing that the patient’s aggression and sexuality would exert great pressures on the therapist, Freud advocated psychoanalysis for the analyst. Not only can countertransference lead the therapist to inappropriate personal gratification, but also keep the therapist from seeing and working deeply with the patient’s unconscious material.

Freud’s first known reference to countertransference was in 1909 in a letter to Jung. Freud tactfully warned Jung about becoming involved with a patient. Perhaps Freud diplomatically coined the term “countertransference.” Some theorists now consider the term confusing, and would more accurately simply say, “the therapist’s transference.” Freud later met with Jung’s patient, Sabina Spielrein. She was distressed over having become involved with Jung. Thus the term countertransference was born out of necessity.

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In Hungary, Ferenczi wrote in 1919 that sharing countertransference with the patient could be a good thing, since the patient needed an emotionally reactive therapist. Ferenczi was more concerned about the therapist’s defenses against the countertransference. He feared that though the therapist might be technically correct, the unemotional therapist could freeze-out the patient. Ferenczi was concerned about a too clinical atmosphere that did not promote emotional development. 

To this day the debate over the concept of countertransference continues, between Freud’s original view that countertransference is a resistance to treatment and inappropriate, and Ferenczi’s opinion that countertransference is part of the therapist’s natural emotional reaction that is necessary for a corrective emotional experience.

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In the 1940s Winnicott agreed with Ferenczi’s view and wrote that some countertransference reactions are not from the therapist’s pathology, but arise naturally in response to the patient. Winnicott argued that the therapist’s expression of countertransference was often necessary. He noted that between the therapist and patient was a third area of transitional space where play occurred. Just as children need imaginary play for mastery, adults use emotions in the playful area of transitional space between the therapist and the patient.

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In the 1950s Bion wrote that the therapist and patient were like the mother and her infant, the container and the contained. For Bion, the infant needed not just a dutiful mother, but also one who could become disturbed in reaction to the infant’s disturbance. The mother’s ability to contain and digest the disturbance was reintrojected by the child and became a source of inner soothing.

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Certainly patients both consciously and unconsciously detect the therapist’s personality and issues, and react to them. The transference and countertransference matrix is part of the emotional environment that defines what may be one of the most important aspects of treatment, the emotional fit between the therapist and the patient. More recent analytic theorists such as Kohut emphasize the real relationship between the therapist and the patient, and the importance of the therapist’s empathy for the patient. Yet Kohut, as most analysts today, view countertransference as often unempathic and disruptive.

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By, the 1990s some analysts such as Renik, felt that the term “countertransference” had no meaning since the analyst’s personality is so infused in the treatment and is ever present. Renik argued that the analyst’s subjectivity should be expressed and discussed in the open.

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I believe that once countertransference became defined as the therapist’s subjectivity and all the emotional reactions to the patient, it lost its precise meaning. I feel that countertransference should retain its original meaning, and only refer to the therapist’s inappropriate reactions to the patient. This should not be confused with the therapist’s affective attunement and appropriate emotional reactions. Counter (towards the patient) transference (not reality based) is not from empathy.

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Countertransference can help in understanding the patient. The therapist’s anger, affection, concern, and humor can all be appropriate emotional reactions. But how is a therapist to know when these emotions are constructive for the treatment?

Freud’s original ground rules have been for the most part incorporated into our ethical code. Our knowledge of appropriate ethical behavior and self-reflection should help most therapists to know to suppress and sublimate countertransference reactions. But since countertransference comes from unconscious needs and conflicts, we all need at times consultation, supervision, or psychotherapy.