Counseling Today, Features

Attending to countertransference

By Stacy Notaras Murphy September 1, 2013

RailAlthough the episode took place many years ago, R. Jane Williams still gets a lump in her throat when she thinks about the nine months she spent counseling a young mother dying of breast cancer. The client’s wrenching story of her husband’s initial denial of her illness would have pained any counselor, as would the grief she expressed concerning the thought of leaving two young children behind. But Williams was particularly affected by the story because she, too, had faced breast cancer and experienced the fear of leaving her child motherless.

“It was very poignant to hear her story, and I have to say, I wasn’t sure I could work with her at first because it was so close to me and my experience,” says Williams, a member of the American Counseling Association.

After talking it over with her colleagues and in a peer supervision group, Williams decided to trust the process and her own support network. She worked with the client up until the young mother’s death. This powerful experience came to inform Williams’ work, both in private practice and as director of the pastoral counseling program at Moravian Theological Seminary in Bethlehem, Pa., where she supervises new counseling interns.

“A lot of [counselor training] programs pooh-pooh countertransference, saying it’s only Freudian and it’s just ‘your own stuff,’” Williams says. “But being aware of countertransference means you can differentiate between what you need to deal with in your own personal counseling versus what is coming up in the room that is a cue for what the client is feeling. I find it a valuable tool. It’s really important for counselors to be self-aware.”

The idea of countertransference — the counselor’s unconscious feelings that emerge as a result of working with the client — is most often attributed to Sigmund Freud, who was the first to name the phenomenon and caution other analysts to manage it within themselves. Some suggest that categorizing countertransference as part of the “psychodynamic approach” has made its understanding more difficult, particularly with the rise of other counseling styles that may not emphasize self-awareness and exploration.

In their book, What Therapists Don’t Talk About and Why, Kenneth S. Pope, Janet L. Sonne and Beverly Greene explore how certain topics become marginalized in therapy because counselors have feelings of countertransference that make the topics too uncomfortable to talk about with clients. In other words, counselors may allow their own personal experiences and histories to color the direction of treatment. The authors also note that feelings of competitiveness and embarrassment may prevent counselors from discussing these effects with their colleagues and supervisors. As a result, counselors may ignore the feelings that their clients create in them, and then model this minimization for their clients, thus providing a firsthand blueprint for avoiding tough topics and negating the impact of good counseling.

ACA members such as Tamara Suttle are trying to combat this issue by emphasizing the need for counselors to engage in their own deep, personal exploration. In her Castle Rock, Colo.-based private practice, Suttle spends about half of her time consulting with counselors and other health professionals about how to build strong businesses. Even though her own training emphasized the impact that the past can have on the present, Suttle admits that early in her career she remained “fairly clueless” about how those patterns applied to her personally. “I was so busy looking for those patterns in my clients’ lives that I often stumbled across my own history and blamed it on my clients,” she says. For example, she says, rather than recognizing her crush on a client, she misidentified it as being about his flirtatious behavior with her.

In another circumstance, Suttle found herself intimidated by an older male client with a high IQ and a tendency toward linear thinking. “In my mind, at the time, I could own part of that equation,” she says. “But I also remember attributing some of the awkwardness in our early sessions to his ‘inability to relate to people well.’ The truth is that he had done quite well professionally and personally throughout his life and had no difficulty in his personal relationships. In hindsight, that was all about me.”

Suttle’s turning point came in the early 1990s, when she attended a conference on women in psychology. She heard distinguished and well-published feminist psychologists speak openly and vulnerably about the ways their personal histories had colored their professional work, including clinical misjudgments, sexual feelings toward clients and other regrets.

“For the brand-new, wet-behind-the-ears counselor that I was, it was a practice-altering and even life-altering experience,” Suttle says. “Until that moment, I had never met one instructor, one professor or one mental health professional of any discipline [who] had spoken candidly, even once, about their own imperfect choices and how one might integrate those actions into the life of a professional counselor. Until that day, I had thought that my only choice as I imperfectly made my way into the profession was to look good, be perfect and, when all else failed, fake it.”

The therapists at the conference modeled the importance of rigorous self-awareness and self-reflection, planting the seeds in Suttle that eventually grew into a passion for helping others face similar issues in their professional lives. “It’s almost 20 years later, and I’ve never forgotten the lesson — the need for all of us to look behind us to see what might be coloring our perceptions, our choices and even our intentions. I still don’t do it perfectly, and that’s why I love talking about this,” she says. “It’s important, it matters and it’s life changing — for our clients, for ourselves and for our profession too.”

A chance to deepen the work

Despite its negative connotations, countertransference itself is not a bad thing. Rather, it’s the ignoring of countertransference that gets counselors into trouble.

For example, the ultimate counseling taboo likely involves crossing ethical boundaries and having a sexual relationship with a client. Pope, Sonne and Greene reference the fact that though numerous books are available concerning therapist-patient sexual involvement, and while the vast majority of counselors will never engage in an inappropriate relationship with a client, there is very little research about the natural, sexual feelings that most therapists feel toward a client at various times in their careers. This creates a myth, the authors posit, that “good” therapists never have sexual feelings about their clients. This myth makes it difficult for mental health professionals to find safe places to process those feelings and may even result in a small number of therapists actually pursuing sexual relationships with clients.

Suttle and Williams each emphasize the importance of counselors recognizing the feelings that come up when working with clients, naming those feelings and finding safe outlets to consider the implications. Because Williams was able to recognize her own feelings about mortality and motherhood when working with her client who was dying, it provided her a richer sense of what the woman was experiencing and opened the door to treatment ideas she may not have uncovered any other way.

“It’s pretty terrifying when you have had a potentially life-threatening illness and someone comes to you with that disease, [but] it’s terminal for them,” Williams says. “You have the fear that it’s going to reoccur in you. I had to recognize it and make it my issue, not hers.” To do that, Williams journaled about her feelings between sessions and reread what she had written to help her set and maintain firm boundaries between herself and her client. “In sessions, I would do what I always do when I’m anxious, which is to breathe deeply, focus on her, be aware of what was coming up and trust that I could deal with it elsewhere,” she says.

Countertransference has long intrigued Matthew Armes, an ACA member working as a high school counselor in Martinsburg, W.Va. A school setting can be a hotbed of countertransference because all counselors went to school and have associated memories. Armes acknowledges that working with students who are dealing with their parents’ expectations and relationship struggles can trigger countertransference for him because his parents were divorcing just as he was starting high school.

After the divorce, Armes says, he initially rejected his father, but they eventually repaired their relationship. “Because so many students, unfortunately, experience their parents’ divorce, it’s an issue in which I can empathize with them and help them become stronger individuals,” he says. “It’s easily the biggest reason I chose to become a school counselor.”

Recently, Armes says, he most noticed the feelings he experiences when talking to a student about the absence of the student’s father. “I’ve dealt with those feelings he’s sharing with me right now, and I can … provide a sense of empathy for him to know that he’s not alone and that there are ways to become a stronger person,” he says.

The question of self-disclosure

When countertransference is recognized and dealt with outside the counseling room, it can enhance the empathy that counselors feel for clients. But in certain unique circumstances, some counselors choose to make use of their experiences more directly — by disclosing specific personal information to clients. In her consultations with counselors, Suttle notes that inappropriate self-disclosure is an early warning sign that personal issues may be unconsciously affecting the counselor. When those feelings are fully acknowledged and explored elsewhere, however, some selective self-disclosure on the part of the counselor may help certain clients to feel more comfortable and open up.

In teaching her students about the delicate issue of self-disclosure, Williams explains that whenever she feels an urgent need to reveal something about herself to a client, that usually indicates it is the worst possible time to do so. “When I’m simply considering it, and there’s no great pressure, then I think it may be appropriate,” she says. “When I feel less pressure, I know it’s more about [the client] than about me. So, I use self-disclosure at those times, but I don’t make it a general practice by any means. Most often it does help the client relax, but it needs to be titrated, and not all clients need to hear a piece of your story.”

Returning to her experience of counseling the young mother dying of breast cancer, Williams explains that she was very careful about self-disclosure because she was a cancer survivor. “I almost felt guilty for escaping what she was having to face,” Williams says. “She knew that I had breast cancer, but she didn’t know I had a daughter. I didn’t share very much of my story. Hers was so urgent and poignant that we focused on her, but I used my experience to explore what issues were there. I was less afraid because of my own experience to bring up dying and where and how to deal with her kids than I would have been had I never faced that myself.”

Williams adds that counselors sharing their own stories with clients can be particularly useful when a client is stuck in the feeling that things will never change. “Oftentimes with grief, clients feel they will never ever feel any other way again,” she says. “I’ve experienced lots of grief in my life, so I may use self-disclosure there, in saying that ‘I can hold the hope for you when you can’t hold it, because I know there’s a future for you.’”

Barbara Barnes, an ACA member in private practice in Bothell, Wash., agrees that getting a little personal can help deepen the work of counseling. “Sometimes sharing a personal anecdote about something that I experienced … I don’t mean getting into gory or even personal details, but when someone is right on the edge [of a breakthrough], it can be a boost of confidence to hear that someone else has been there. They say, ‘Yep, she understands,’ and then they open up because they know they’re not alone and they’re not under a microscope. They’re not being judged.”

Barnes says this therapeutic use of the self is one thing that attracted her to the counseling field after beginning a career as a psychiatric nurse. In nursing school, Barnes read about Hildegard Peplau’s interpersonal relations theory, which suggests that the nurse-patient relationship is actually a partnership that holds the key to healing. When considering pursuit of a graduate counseling degree, Barnes sought an opportunity to deepen her understanding of this therapeutic use of self and selected a program that was experiential and featured a family systems perspective. “I was attracted to the idea that you are the instrument of healing,” she says. “It’s the relationship between you and the [client] that is the healing factor. It’s truly the relationship that heals because that is what is wounded — their ability to trust another person in relationship. I really found myself embracing that concept and found myself leaning in more toward my clients.”

Barnes adds, however, that a conscious process of self-reflection should take place whenever a counselor makes use of a personal story or experience in the counseling room. Barnes brings these topics up in her own therapy as well as with two supervision groups. She explains that sitting on a regular basis with people who have known her work for many years is an important part of being fully available to her own clients.

“We all know that you can get into trouble if you don’t recognize that you’re being activated [by something in the counseling room] and you get pulled into something unconsciously,” she says. “It can be very damaging to the relationship with the client.”

The role of supervision

Beyond counselors’ own experiences in therapy, most agree that the best place to acknowledge and interpret countertransference is in supervision with colleagues. But once again, the same shame and doubt that contribute to counselors burying awareness of these topics inside themselves can affect the way they approach supervision. In their book, Pope, Sonne and Greene address this issue by naming several important conditions necessary to make self-exploration possible in a group supervision setting. These include building an environment of safety and trust, encouraging active participation, nurturing respect for all group members and recognizing that there is no authoritarian right or wrong answer for most of these subjects.

When asked about bringing her concerns of working with the client who was dying to her training colleagues and peer supervision group, Williams recalls how good it felt to connect with them and feel their support. “We practice a very lonely profession,” she says. “I had realized it in my own private practice before that time and made it a practice to meet for lunch with people who were in the profession so we would be a support group for each other.” At Moravian, Williams urges her students to build careers that make room for constant supervision, noting the importance of exposing treatment choices to outside feedback.

Suttle agrees, adding that individual therapy is an excellent way for counselors to come to terms with the intersections of their personal history and professional life. She also recommends regular, ongoing consultation with mentors who have more professional experience than the counselor has, as well as joining a peer consultation or supervision group that can serve as a safe place to explore these questions, with added accountability factors.

Reading, talking and journaling about countertransference can enrich the journey, she says. “For as long as we practice counseling, we are also called to question ourselves — not just our present choices and actions, but also our personal histories and how they inform our present moments.”

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Contributing writer Stacy Notaras Murphy is a licensed professional counselor and certified Imago relationship therapist practicing in Washington, D.C. To contact her, visit stacymurphyLPC.com.

Letters to the editor: ct@counseling.org

4 Comments

  1. Laurie Omeara

    Fabulous article. I believe, as a counselor in training it is extremely important to confront our pasts and be open and honest with our current limitations. This is not to say that it is okay to minimize bias. It is my job, as a professional to educate and evaluate myself when feelings arise that are uncomfortable. The first step is acknowledgment….the second step is to be honest enough with yourself to provoke change. This is a process and takes time. I think instead of being embarrassed or trying to hide our issues, our pasts can be used as teaching, brainstorming, and self-discovery that will only improve our skills in the future.

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  2. Christine Dilger

    Wonderful article! Although I am not practicing counseling in the traditional sense, I am, none-the-less, using my counseling skills in my work. Every once in a while I read articles that truly resonate with me. This is one of those articles. I work as a parole agent and have found that many of my clients share similar stories. Having my Mental health Counselor background has helped me on numerous occasions to understand what a client is dealing with. It has also given me the opportunity to pass along pearls of wisdom that have been shared with me over my years. So many people in our criminal justice system have mental health concerns that they “hide” out of shame. Typically they don’t want to admit there is “something wrong” with them. They also want to manage the symptoms on their own without medication. I often relate my sister’s diabetes to their own mental health issues. If my sister didn’t manage her diabetes with medication, she would die. Doe she enjoy having to stick herself before every meal to check her blood sugar, give herself an injection, sometimes in public restaurants or other places in public view, just to stay alive? No, but it has to be done to maintain her life. Trying to lessen the stigma of mental health concerns is an important part of helping this population return to society.

    This article has reinforced my sense that what I am feeling is normal. I do not have the advantage of supervision or a peer group where I can share these feelings. I do see a therapist on my own, and we often discuss my cases, which is a big help. Self disclosure is uncomfortable for me in this setting. My boundaries need to be very defined with this population, and I constantly have to be aware of manipulation. Countertransference and manipulation are two areas that need to be monitored. Thanks for the great article.

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  3. Dy'an Marinos

    Thank you for writing this article. I am a counselor in training graduating in the spring of 2014. Countertransference has been discussed, at length, in the classroom. However, it wasn’t until I was in internship that I was afforded the opportunity to examine the emotions that arise when working with clients dealing with something I have experienced. Similarly, the subject of self-disclosure is one covered in more than one of my courses. Again, it is when we are in practice we realize how blurred the line between sharing for the sake of developing the therapeutic relationship and over-sharing can become. Indeed, these situations are easily addressed with effective supervision; both on site and in the classroom.

    My site supervisor often challenges me to process the way I feel when working with clients. For example, I had a client around whom I would become anxious. On my own I could no explanation for this reaction. I had another client dealing with a situation I experienced several years ago. I knew the pain and uncertainty the client felt and was tempted to say as much. Excellent supervision helped me understand why I became anxious with the first client and assisted me in working to alleviate that anxiety. Together, my site supervisor and I thoroughly explored the benefits of limited self-disclosure and the potential consequences of over-sharing when working with clients whose circumstance(s) are similar to my own. Because I was able to discuss and process these issues with my supervisor, I was also able to avoid potential missteps in session.

    Regarding group supervision, I could not agree more with your assertion that creating a safe place for group members to discuss their experiences is essential. Exercises like case conceptualizations can elicit strong emotions from the presenter. Asking for advice and feedback on our work, admitting we are not sure how to proceed, and allowing the group to ask questions about our approach creates a certain amount of vulnerability. Fortunately, our courses, role plays and group work have structured a bond among the cohort. Again, effective supervision from the professor facilitated the development of trust among the group.

    Great article!

    Reply
  4. chris60

    This is an interesting article as it highlights the fact that professionals may feel obliged to appear perfect at the expense of appearing human and truly connected with their clients. As someone who experienced bad therapy I was shocked by the tendency for therapists to excuse or deny the extent of therapeutic blunders and mental illness or exploitative practice among their colleagues and then to try to attribute blame to the presenting client for the fact that one of their peers behaved seductively, abusively or exploited them and betrayed their trust. Clients present when distressed, and to focus on them as sick and troubled, and to attempt to isolate them to increase their dependency, instead of trying to build on their natural strengths does great harm. In fact, it may lead to PTSD and prevent future treatment. Few psychiatrists display the capacity to listen to their clients openly and actively, and offer the degree of trust that they in turn expect from them. Sexual abuse, verbal abuse, emotional abuse and authoritarian attitudes and behaviour were so common among psychiatrists that I began to doubt whether good help actually existed among supposed professionals. Social skills, open and honest communication, and basic respect for clients as human beings as opposed to objects to be analysed for problems, were virtually non-existent. In retrospect, I doubt whether psychiatrists – given their competitive nature, detached intellectual stance and elitist position – are capable of becoming good therapists. Most clients seek a reparative connection with another person, not a diagnosis of what is wrong with them and needs to be cure. Medicating the symptoms without eradicating the root cause of the distress does not remove the problem. Therapists need to place their clients first and not exploit them as a source of revenue, sex, power or idealised adulation. A bit of honest introspection and humility would help to stop supposedly professional people abusing or exploiting those who sought their help.

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