Online psychotherapy transference and countertransference issues
For ages, the term “transference” has been associated with pathology, enmeshed boundaries, and unhealthy therapy sessions.
In reality, transference occurs within the context of relationships and represents a complex interplay of emotions, memories, and subconscious actions.
While transference is a phenomenon seen in daily life, relationships, and interactions, we will take a closer look at how it affects professional settings and examine practical ways to make it a beneficial aspect of therapy.
Before you continue, we thought you might like to download our three Positive Relationships Exercises for free. These detailed, science-based exercises will help you or your clients build healthy, life-enriching relationships.
What Are Transference & Countertransference?
Freud and Breuer (1895) originally identified and discussed transference and countertransference within a therapeutic context. These concepts were an important part of psychoanalytic treatment but have since been adopted by most forms of psychotherapy.
These concepts occur within any relationship, and the therapeutic relationship is no exception.
So what exactly are transference and countertransference?
Transference in therapy is the act of the client unknowingly transferring feelings about someone from their past onto the therapist. Freud and Breuer (1895) described transference as the deep, intense, and unconscious feelings that develop in therapeutic relationships with patients. They analyzed transference in order to account for distortions in a client’s perceptions of reality.
While Freud viewed transference as pathological, repetitive, and unreflective of the present relationship between the client and therapist (Wachtel, 2008), modern psychology has rebuffed this assessment.
Many psychological approaches recognize that the responses of a therapist can evoke reactions in the client, and the process of the interaction can be beneficial or harmful to therapy (Fuertes, Gelso, Owen, & Cheng, 2013).
Transference is multilayered and complex and happens when the brain tries to understand a current experience by examining it through the past (Makari, 1994).
There are three main categories of transference.
- Positive transference is when enjoyable aspects of past relationships are projected onto the therapist. This can allow the client to see the therapist as caring, wise, and empathetic, which is beneficial for the therapeutic process.
- Negative transference occurs when negative or hostile feelings are projected onto the therapist. While it sounds detrimental, if the therapist recognizes and acknowledges this, it can become an important topic of discussion and allow the client to examine emotional responses.
- Sexualized transference is when a client feels attracted to their therapist. This can include feelings of intimacy, sexual attraction, reverence, or romantic or sensual emotions.
A therapist can gain insight into a client’s thought patterns and behavior through transference if they can identify when it is happening and understand where it is coming from. Transference usually happens because of behavioral patterns created within a childhood relationship.
Types of transference include:
- Paternal transference
Seeing the therapist as a father figure who is powerful, wise, authoritative, and protecting. This may evoke feelings of admiration or agitation, depending on the relationship the client had with their father.
- Maternal transference
Associating the therapist with a mother figure who is seen as loving, influential, nurturing, or comforting. This type of transference can generate trust or negative feelings, depending on the relationship the client had with their mother.
- Sibling transference
Can reflect dynamics of a sibling relationship and often occurs when a parental relationship is lacking.
- Non-familial transference
Happens when clients idealize the therapist and reflect stereotypes that are influencing the client. For example, a priest is seen as holy, and a doctor is expected to cure and heal ailments.
- Sexualized transference
Occurs when a person in therapy has a sexual attraction to their therapist. Eroticized transference is an all-consuming attraction toward the therapist and can be detrimental to the therapeutic alliance and client’s progress.
Countertransference has been viewed as the therapist’s reaction to projections of the client onto the therapist. It has been defined as the redirection of a therapist’s feelings toward a patient and the emotional entanglement that can occur with a patient (Fink, 2011).
While Freud viewed countertransference as dangerous because a psychoanalyst is supposed to remain completely objective and detached, those views have since been challenged (Boyer, 1982).
Racker (1988) built the idea that the therapist’s feelings have significance and can lead to important content to be worked through with the client. His definition of countertransference is “that which arises out of the analyst’s identification of himself with the (clients) internal objects” (Racker, 1988, p. 137).
When these reactions surface, they can be dealt with and lead to a healthy therapeutic relationship.
6 Real-Life Examples
Below is a selection of examples from real life, and a few excellent videos to illustrate both transference and counter transference.
1. I have a crush on my therapist
This video provides a good description of erotic or sexual transference. This is the most dangerous form of transference and has the potential to harm the therapeutic alliance and process.
2. The Sopranos
The famous TV series The Sopranos provides us with a dramatic example of sexualized transference that would break all ethical codes of conduct for a therapy session.
3. Example of negative transference
Amanda (a 32-year-old woman) becomes furious with her therapist when he discusses assigning homework activities. She sighs loudly and states, “This is NOT what I came to therapy for. Homework? I am not in elementary school anymore!”
The therapist remains calm and states, “It sounds like you are upset about homework assignments. Tell me what you are experiencing right now.”
After exploring the emotions that surfaced, Amanda and her therapist come to realize that she was experiencing unresolved anger toward a verbally abusive authoritarian elementary school teacher.
This video was created by a therapist to demonstrate several types of transference and countertransference. The therapist plays both roles (clinician and therapist) to act out/role-play examples of how transference can transpire in a session.
5. She’s Funny That Way
In this comical clip of famous actress Jennifer Aniston pretending to be a therapist, we can see exaggerated examples of countertransference. In this case, there are no professional boundaries, ethics, or appropriate therapeutic practices taking place.
6. School counseling
Countertransference is particularly hard in school counseling settings.
According to American Counseling Association (ACA) member Matthew Armes, a high school counselor in Martinsburg, West Virginia, “all counselors went to school and have associated memories.” Armes goes on to say 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” (Notaras, 2013).
Armes initially rejected his father during the divorce but eventually repaired the relationship. He states that because so many students experience divorce, it is an issue he strongly empathizes with. It is important to set strong boundaries around this connection and empathy to effectively “let [students] know [they are] not alone and that there are ways to become a stronger person.”
Psychology Theories Behind the Concepts
Are there theories to explain these specific examples of transference? Transference and countertransference are rooted in psychodynamic theory but can also be supported by social-cognitive and attachment theories.
These theories have different approaches to examine how maladaptive behaviors develop subconsciously and outside of our control.
In psychoanalytic theory, transference occurs through a projection of feelings from the client onto the therapist, which allows the therapist to analyze the client (Freud & Breuer, 1895).
This theory sees human functioning as an interaction of drives and forces within a person and the unconscious structures of personality.
Within psychoanalytic theory, defense mechanisms are behaviors that create “safe” distance between individuals and unpleasant events, actions, thoughts, or feelings (Horacio, 2005).
Psychoanalytic theory posits that transference is a therapeutic tool critical to understanding an individual’s repressed, projected, or displaced feelings (Horacio, 2005). Healing can occur once the underlying issues are effectively exposed and addressed.
Carl Jung (1946, p. 185), a humanistic psychologist, stated that within the transference dyad, both participants experience a variety of opposites:
“In love and in psychological growth, the key to success is the ability to endure the tension of the opposites without abandoning the process, and that this tension allows one to grow and transform.”
This dynamic can be seen in the modern social-cognitive perspective, which explains how transference can occur in daily life. When individuals meet a new person who reminds them of someone from their past, they subconsciously assume that the new person has similar traits and characteristics.
The individual will treat and react to the new person with the same behaviors and tendencies they did with the original person, transferring old patterns of behavior onto a new situation.
Attachment theory is another theory that can help explain transference and countertransference. Attachment is the deep and enduring emotional bond between two people.
It is characterized by specific childhood behaviors such seeking proximity to an attachment figure when upset or threatened, and is developed in the first few years of life (Bowlby, 1969). If a child develops an unhealthy attachment style, they may later project their insecurities, anxiety, and avoidance onto the therapist.
4 Signs to Look for in Your Sessions
As mentioned, transference and countertransference are not necessarily bad for the therapeutic process.
The key to ensuring that transference remains an effective tool for therapy is for the therapist to be aware of when it is happening.
1. Unnecessarily strong (or inappropriate) emotions
When clients lash out with anger or distress in a way that seems excessive for the topic that is being discussed, it is a clear sign that transference may be taking place.
Clients may even demonstrate inappropriate laughter surrounding issues that are not funny, which can be a signal for the therapist to intervene (Lambert, Hansen, & Finch, 2001).
The therapist can address the strong or inappropriate emotions and get at core issues.
2. Emotions directed at the therapist
An obvious sign of transference is when a client directs emotions at the therapist. For example, if a client cries and accuses the therapist of hurting their feelings for asking a probing question, it may be a sign that a parent hurt the client regarding a similar question/topic in the past.
3. Unreasonable dislike for the client
Therapists also need to be aware of countertransference, when they are projecting feelings onto a client. One of the most common signs of countertransference is disliking a client for no apparent or obvious reason (Lambert et al., 2001).
This is a good opportunity for the therapist to examine personal values, beliefs, and emotions surrounding the characteristics of the client and past relationships.
4. Becoming overly emotional or preoccupied with a client
Another red flag for countertransference is if a therapist notices that thoughts and feelings for clients are taking up a significant amount of time outside of sessions.
It is natural for therapists to think of their clients outside the therapy room, but when they are joined with strong emotions or become intrusive or obsessive thoughts, the therapist may have to refer the client to another practitioner.
5 Ways to Manage It in Therapy
Psychological, spiritual, and emotional issues can trigger the most educated and experienced therapists within the therapeutic dynamic.
Some ways to manage transference and countertransference in therapy include the following.
1. Peer support
Consult a colleague, supervisor, or clinical director when feeling an emotional trigger or response. When a session is especially challenging, it can cause a therapist to sacrifice empathy and objectivity.
Regular peer support and clinical therapy meetings can be helpful. Brickel and Associates has more information on options for finding online peer support.
2. Continual self-reflection
Explore feelings toward individual clients, and write down ways you are consciously or unconsciously reacting to them in session.
Our introspection and self-reflection article outlines practical ways to explore self-reflection.
3. Clear boundaries
Set appropriate boundaries regarding scheduling, payment, and acceptable in-session behavior. Discuss any misunderstandings of intent and emotional projection as soon as it occurs.
Practice mindfulness inside and outside of sessions to explore personal thoughts and feelings.
Gain insight into compassion fatigue, burnout, excessive stress, or an inability to do quality clinical work. Observe the space between stimulus and response, and make appropriate thoughtful reactions.
Lichtenberg, Bornstein, and Silver (1984) formulated that empathy is the foundation of human intersubjectivity, and that failing to demonstrate it is the largest impediment to treatment.
Lack of empathy can be a precursor to countertransference. When we employ empathy as practitioners, we are looking at the situation and client outside of our own view, making countertransference less likely.
Is Countertransference Bad? Ethical Considerations
Dealing with transference and countertransference is a lifelong process for therapists and clinicians.
The Social Work Dictionary defines “countertransference” as a set of conscious or unconscious emotional reactions to a client experienced by a social worker or professional, and has established specific ethical issues to consider in practice (Barker, 2014).
Just like transference, countertransference is not always bad and can be an effective tool in therapy if used properly. The ethical considerations set forth by the ACA and the Newfoundland and Labrador Association of Social Workers (2018) include:
- Professional boundaries
When experiencing countertransference, it is important to consider how professional boundaries can be impacted. Professionals need to ensure that the relationship always serves the needs of the client first.
- Conflicts of interest
Countertransference may create a conflict of interest that impedes the professional’s ability to remain unbiased or objective. Practitioners can get wrapped up in their own emotional and personal issues, which interferes with the ability to provide effective treatment and impartial judgement.
When considering self-disclosure, a professional must examine the benefits/risks and ask whose needs are being met. It is also important to think about whether the client is experiencing transference and how this influences the therapeutic relationship.
- Competence in practice
Professionals in the field of mental health should offer the highest quality service possible, and the therapeutic relationship must be terminated if countertransference affects the ability to practice competently.
Having shared experiences with a client can enhance empathy, but therapists and those in the mental health field must work through ethical considerations to inform decision making.
Self-reflection and self-awareness are some of the most powerful tools to guide ethical decisions. The following worksheets and resources can help with this.
2 Helpful Worksheets for Therapists and Clients
For some helpful materials to strengthen your and your client’s understanding of transference, check out the following worksheets.
1. Awareness Transference Worksheet
This basic worksheet helps both clients and clinicians identify specific people in their life and their cognitive and emotional reactions to them. This exercise can highlight how past relationships are being transferred to the present moment.
2. Transference Exercise
This free exercise was designed to help teach clinical psychology students about transference. It can be a helpful exercise to revisit, even among seasoned clinicians.
PositivePsychology.com’s Relevant Resources
You’ll find even more resources around our blog around the topics of transference, communication boundaries, and the therapeutic relationship.
Check out some of the following free materials to get you started:
- 3-Step Mindfulness Worksheet
Mindfulness is an important tool for both therapists and clients to practice on a consistent basis. This simple but effective worksheet can bring both parties to a place of self-awareness and decrease the likelihood of unproductive transference.
- Levels of Validation
This short self-assessment helps therapists and counselors consider the level at which they typically validate the feelings and experiences of their clients, ranging from mindfully listening to radical genuineness.
- Listening Accurately Worksheet
This handout presents five simple steps to facilitate accurate listening and can be used to help establish communication norms at the beginning of a therapeutic relationship.
- Assertive Formula
This three-part worksheet lays out a formula to help you or your clients clearly and respectfully communicate when someone else’s behavior is causing a problem.
Besides these tools, these articles are excellent supplemental reading material:
A Take-Home Message
Mental health professionals practice in a very lonely world bound by confidentiality and ethical concerns. We must be simultaneously aware of the emotions and feedback clients project and the emotions and thoughts that are personally experienced.
Transference and countertransference can be a double-edged sword. They can destroy the therapeutic process or provide an avenue to healing. They can break down the therapeutic alliance or become its most effective tool.
Identifying examples of transference and countertransference is a wonderful starting point to prevent negative interference in therapy.
Self-reflection, mindfulness, empathy, and ethical boundaries are excellent tools to ensure that when transference arises in session, it is directed in a helpful and therapeutic way.
We hope you enjoyed reading this article. Don’t forget to download our three Positive Relationships Exercises for free.
- Barker, R. (2014). The social work dictionary. NASW Press.
- Bowlby, J. (1969). Attachment and loss: Volume I attachment. Basic Books.
- Boyer, L. B. (1982). Analytic experiences in work with regressed patients. Unknown publisher.
- Fink, B. (2011). The fundamentals of psychoanalytic technique: A Lacanian approach for practitioners. W. W. Norton & Co.
- Freud, S., & Breuer, J. (1895). Studies in hysteria. Penguin Books.
- Fuertes, J. N., Gelso, C., Owen, J., & Cheng, D. (2013). Real relationship, working alliance, transference/countertransference and outcome in time-limited counseling and psychotherapy. Counseling Psychology Quarterly, 26(3), 294–312.
- Horacio, E. (2005). The fundamentals of psychoanalytic technique. Karnac Books.
- Jung, C. (1946). The psychology of transference. Princeton University Press.
- Lambert, M. J., Hansen, N. B., & Finch, A. E. (2001). Patient-focused research: Using patient outcome data to enhance treatment effects. Journal of Consulting and Clinical Psychology, 69, 159–172.
- Lichtenberg, J., Bornstein, M., & Silver, D. (1984). Empathy I. Analytic Press.
- Makari, G. J. (1994). Toward an intellectual history of transference. The Psychiatric Clinics of North America, 17(3), 559–570.
- Newfoundland and Labrador Association of Social Workers. (2018). Standards of practice for social workers in Newfoundland and Labrador. Retrieved June 15, 2021, from https://nlcsw.ca/sites/default/files/inline-files/Standards_of_Practice.pdf
- Notaras, S. (2013). Attending to countertransference. Counseling Today, 9, 29–31.
- Racker, H. (1988). The meaning and uses of countertransference. In B. Wolstein (Ed.), Essential papers on countertransference. New York University Press.
- Wachtel, P. L. (2008). Relational theory and the practice of psychotherapy. Guilford Press.