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Transference
In the context of treatment, transference refers to the projection of a client’s feelings for a significant person in their life onto a mental health professional. Typically, transference involves unresolved feelings and issues from childhood experiences with parents or caregivers. When Freud encountered transference in his work with clients, he realized that analyzing the transference was one of the key aspects of psychotherapy. As the transference between the client and provider occurs on an unconscious level, psychodynamic therapists use transference to expose unresolved conflicts that clients still have from their past.
Thus, the primary focus in psychodynamic psychotherapy involves both the practitioner and client identifying and acknowledging the transferential relationship and exploring its underlying meaning. Over time, this style of therapy helps clients to better distinguish between old childhood experiences and their current life experiences. Transference can be manifested toward the therapist in various forms, in rage, mistrust, parentification, codependency, a sexualized attraction, or placing the therapist in a God-like role.
Countertransference
 In contrast, countertransference is defined as redirection of a therapist’s feelings toward a client, or more generally, a therapist’s emotional reactions to a client. Psychotherapy creates circumstances in which there are often emotional reactions for both the provider and the client. When health care providers experience strong emotional reactions and focus on themselves, they may be unable to fully attend to treatment.
A therapist’s awareness of their own countertransference is nearly as essential as understanding the client’s transference. Not only does this awareness of one’s countertransference help therapists in regulating emotions in the context of the therapeutic relationship, but it also reveals relevant information regarding what the client is attempting to elicit in them. One example is a female therapist feeling a strong sexual attraction to a male client. As a clinician, she should understand this as countertransference, and assess how the client is unconsciously attempting to trigger this reaction in her. Once this dynamic has been identified, the therapist can ask the client about his feelings toward her, examine those feelings, and analyze their relationship to the client’s unconscious motivations, desires, or anxieties.
When therapists experience countertransference, even well-intentioned efforts may prove ineffective or harmful. Therefore, it is the ethical duty of therapists to manage any emotional reactions they may have toward particular clients or particular client issues.
There is always a certain level of transference and countertransference in the therapist-client relationship, as therapists have a vested interest in their role and a desire to provide valuable care. Therapists have feelings for their clients—and vice versa. These feelings can be positive or negative to the treatment process. Keep in mind that the presenting issues that elicited clients to seek professional help may predict some of the transferences that occur in treatment. In a similar way, some therapists’ countertransference can be predicted from their own personal histories. For example, a therapist struggling to cope with an unfaithful spouse may have much difficulty working with clients who are cheating on their spouses.
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Some examples of client transference include:
· A client’s anxiety and social isolation may lead the client to perceive the therapist as central to his/her life and, as such, may be one of a client’s only social contacts.
· Clients diagnosed with Borderline Personality Disorder, or clients having very difficult interpersonal relationship patterns, may shift rapidly from idealizing to devaluing others. They may perceive themselves and others as being all good or all bad. These dynamics play out with the therapist, as well.
· Clients may have such low self-esteem that they idealize therapists as perfect role models—and, as such, overly identify with them.
Examples of countertransference by the therapist include:
· Avoiding or rejecting the client
· Colluding with the client’s maladaptive relationship patterns
· Disclosing too much personal information and later is uncomfortable about revealing it
· The client reminds the therapist of someone s/he has or had strong (positive or negative) feelings about and reacts as if the client is that person
· The therapist over-identifies with the client (e.g., due to past difficulties, similar personality traits, age, gender, etc.).