Therapists talk a lot about “using countertransference”, and that phrase is rarely accompanied by specifics.
Too often, the therapist’s feelings toward the client (the countertransference) are treated as an administrative burden — something the therapist has to monitor, contain, or cautiously disclose: “I’m noticing I feel some impatience right now.” But disclosure is rarely where the real utility lies. The most potent use of countertransference happens entirely within the therapist.
Countertransference is not an intervention in itself, nor is it the therapist’s failure to maintain “unconditional positive regard.” It is real-time data about what it is like to be in a relationship with the person you are doing therapy with.
Making sense of your feelings toward a client
Suppose I have a client who is endlessly self-sacrificing, and as a result is chronically frustrated with other people for not taking care of themselves as he would. He wants them to get over whatever is holding them back, and free him from the burden of responsibility for their well-being. At the same time, he hates this angry part of himself and works hard to suppress it.
Sooner or later, he sacrifices his therapy schedule for the same external demands he resents. He misses sessions here and there, maybe even two or three in a row, and then shows up feeling exhausted, angry, and anxious.
What does the therapist catch themselves thinking?
Come on, man, I haven’t even seen you in three weeks. How did you think you were going to feel? Get it together.
It would be easy to interpret this internal reaction as a lapse in empathy. But it may actually be a moment of shared experience: maybe I’m feeling toward him something like what he feels toward others. In other words, empathy. Just unconscious empathy.
What not to say
That doesn’t mean the feeling should dictate what I say. If I don’t slow down and ask what the feeling is pulling for from me, it will be easy to unintentionally reinforce the same kind of pattern that’s already playing out:
Let’s talk about your attendance. You haven’t been making it to your therapy sessions very regularly; do you think that has anything to do with why you’re feeling so burned out?
There’s a reasonable question in there. But if I’m honest with myself, I’m not really asking it. I already have an answer, and I want him to agree with me. “Get it together” has acquired a therapeutic vocabulary.
Another likely therapist response is to “disclose the countertransference” — to tell the client my feelings.
I notice I’m feeling irritated that you aren’t following through on our agreement to meet weekly.
I might congratulate myself for “being a person in the room.” It can feel brave to say something uncomfortable and emotionally honest. But have I understood and used my irritation, or have I just found a respectable way to express it? If I haven’t worked out that distinction, I may be handing him another person’s feelings to take care of. He tells me what we both want to hear, and we move on without understanding what’s really going on.
Understanding my own feelings first
The far more interesting move is to recognize that this feeling of frustration, and desire to correct his behavior, is mirroring the very dynamic he experiences with the world.
He feels this way toward others, and he hates himself for it. Can I show him a different way, by tolerating and understanding it in myself?
So what does this feeling actually tell me?
- I have an expectation about the way he’ll allow me to help him.
- I believe there’s no good reason for him to behave otherwise.
- I’ve accepted that it is my responsibility to control his behavior.
I am no longer curious about how this relationship will play out, what competing motivations drive him to act in ways that take away his room for self-care, or what the best outcome for him will be. I think I know the answers, so I act like I know the answers, and then go to war with reality when it doesn’t align with my expectations. Just like him.
My frustration is not just some unevolved vestigial remnant of my pre-therapist self. It actually serves as my cue that I have stepped out of a therapeutic attitude and into a stubborn and controlling one.
It can also serve as my cue that I am regaining my footing: as soon as I lean into genuine inquiry, the irritation begins to dissolve. And that change in my internal state serves as a gauge of how well I’m navigating my relationship with him. Am I participating in the same type of relationship he usually tends to have with people? Or am I co-creating something entirely new and unknown?
What to say
So now I’m in a position to “use” my feelings — not just suppress, discharge, or describe them.
I know there are some unknown mental forces at work. Something makes it important for him to prioritize the expectations of others over his own. Perhaps, there are even good reasons for him to avoid the feelings that therapy brings forward. My job is to show curiosity about the way his mind is working, and impartiality about the outcome. I might say something like:
I notice something interesting going on in your therapy. I know it’s important to you because you committed yourself to it and have made sacrifices to have this for yourself every week. And at the same time, other things keep ending up feeling more important, and taking this time away from you. Do you see that too?
What I’m trying to do here is highlight the ambivalence between prioritizing self and not prioritizing self. I am not treating that as a problem and trying to fix it. In fact, I am assuming that there are good reasons for the status quo, and asking him to help me figure out what they are. Only then will we be able to discover what makes the most sense for him, in his life, with his values and priorities.