Origins, consequences, and management of countertransference: A case study.

Abstract

Insight into the construct of countertransference may be gained by studying the relationships among its constituents. Toward that end, a single therapy dyad was analyzed for 13 sessions. Client verbalizations predicted to trigger countertransference reactions were studied in relation to their possible consequences, and the potential mitigating role of countertransference management was explored. Results suggest that when client material touches upon a therapist’s unresolved issues, it may affect the therapist’s avoidance behavior as well as the working alliance, session impact, and the therapist’s perceptions of his or her own social influence attributes. Effective countertransference management may enhance session depth and client perceptions of the working alliance. Findings are discussed in light of implications for therapy, theory development, and future research. Since Freud’s (1910/1959) initial identification of countertransference as a pivotal factor in therapy, countertransference has been theoretically defined, dissected, and conceptualized in dozens of ways (for informative reviews, see Hayes & Gelso, 2001; Orr, 1954/1988; Wolstein, 1982). Despite the definitional controversy that has perpetually surrounded countertransference, there is widespread agreement about its clinical significance. Consistent with current theoretical and empirical literature (Gelso & Carter, 1994; Gelso & Hayes, 1998), for the purposes of this study, we defined countertransference as “those responses to the patient which, while prompted by some event within the therapy or the therapist’s real life, are primarily based on [the therapist’s] past significant relationships; basically, they gratify [the therapist’s] needs rather than the patient’s therapeutic endeavors” (Langs, 1974, p. 298). Inherent in this definition is the recognition that countertransference may be acute or chronic (Reich, 1951). Acute countertransference occurs “under specific circumstances with specific patients” (Reich, 1951, p. 26). It may be likened to “state” countertransference that arises sporadically in the therapist. Chronic countertransference, on the other hand, is more typical for a particular therapist. Such countertransference is played out frequently, almost indiscriminately, with a multitude of clients; it is akin to “trait” countertransference. Historically, it was believed that countertransference behavior was to be avoided at all costs (Freud, 1910/1959). In contemporary