Countertransference: What It Is, Types, and Why It Happens

The therapeutic relationship is just that – a relationship. While therapists do train to respond to you in certain ways, depending on the type of therapy they offer, they’re also human. The dynamic that plays out between you can therefore offer its own insight into your internal processes.

In the relationship between you and your therapist, there are lots of different dynamics at play. One is transference, when you transfer feelings and beliefs about another relationship onto your therapist. When your therapist responds, this is called countertransference.

In this article, we’ll take a deeper look at countertransference in therapy, some examples of countertransference, and how countertransference can play into your attachment dynamics.

What Is Countertransference?

Countertransference was first introduced by Freud in 1910, upon noticing that patients’ behavior elicited the therapist’s own feelings¹. Psychologists have defined countertransference as: “therapists’ reactions to patients that are based on the therapists’ unresolved conflict”.

In other words, when the therapist has their own inner challenges to work through, it can come out in the way they react to their clients. It’s not a sign of bad clinical skills or poor practice – therapists are people too, and as long as they’re aware of their reactions and able to take responsibility and work through them appropriately, countertransference is just part of the process.

Countertransference often happens because the client’s original transference elicits the response they expect.

For example, the client transfers a fear of abandonment onto the therapist, and because of this fear of abandonment, they emphasize their needs and avoid giving any indication that they’re improving. In response to this, the therapist starts to feel helpless or inadequate (this is the countertransference), and eventually they suggest that their client may do better with a different therapist – confirming their fear of abandonment.

Transference vs Countertransference

See our main article on transference for a deeper insight into transference specifically.

How Countertransference Can Perpetuate Attachment Dynamics

In the earlier example, we discussed how transference of a fear of abandonment can lead to actual abandonment, due to the effect of countertransference.

Fear of abandonment is common in insecure attachment, although it’s expressed differently in attachment anxiety compared with attachment avoidance. Attachment anxiety might elicit the given example, in which transference causes you to emphasize your needs, while attachment avoidance might manifest as shutting out your therapist until they also suggest someone else.

Other attachment-related fears could become self-fulfilling prophecies too. If we have high attachment avoidance in our therapeutic relationship, we might transfer negative judgments onto our therapist, such as that they can’t help us or aren’t as caring as we want them to be. This can lead us to withhold things and avoid working well with them, and if the therapist experiences countertransference, they might feel overwhelmed or inadequate, leading them to actually feel unable to help us.

It’s worth mentioning that some studies have questioned whether our attachment patterns really map onto transference in therapeutic relationships the same way they do in other ways in other relationships – attachment patterns do not predict transference in the way we would expect².

Types of Countertransference

An investigation of countertransference in 2005 found 8 different types¹:

• Overwhelmed/disorganized – The therapist feels anxious, mistreated, or angry about the client.
• Helpless/inadequate – The therapist feels they are failing to help the client. Sessions make them feel confused or anxious.
• Positive – The therapist treats their client as a favorite and looks forward to their sessions more than others.
• Special/overinvolved – The therapist discloses more about their personal life to this client than they usually would and goes out of their way to offer them more than other clients.
• Sexualized – The therapist finds themselves flirting or feeling attracted to the client.
• Disengaged – The therapist feels bored or annoyed in sessions with the client.
• Parental/protective – The therapist feels protective and nurturing toward their client.
• Criticized/mistreated – The therapist feels unappreciated and devalued by the client.

While the idea of your therapist seeing you in any of these ways is uncomfortable, they are trained to recognize and analyze how they feel in sessions and understand what it says about their own internal processes.

For instance, if they feel anger toward you, they will not blame you – they’ll approach the feeling with curiosity and use it to better understand you and your relationship dynamics. They will only bring up their own feelings with you if they feel it would be beneficial to your therapy.

What Are Examples of Countertransference?

One study found that the 8 different types of countertransference are associated with different personality disorder presentations³. As an example, treating patients with Borderline Personality Disorder (BPD) was moderately associated with overwhelmed/disorganized transference – here’s what that might look like in the therapy room:

Karla has been attending therapy to help with her symptoms of BPD. Karla tends to see other people in “black and white” – their actions and traits are either all good or all bad, she has very intense emotions that are difficult to control, and has a strong fear of abandonment.

Because of this, Karla sometimes reacts strongly when she feels attacked by her therapist. This sometimes happens when her therapist tries to challenge her way of thinking; Karla feels her therapist doesn’t see her point of view and might be as untrustworthy as other people who’ve let her down, triggering her fear of abandonment, and leading her to lash out in anger.

Karla’s therapist, Jane, has her own unresolved difficulties around people raising their voice at her. She starts to feel frightened and mistreated in sessions with Karla, and she feels anxious when they have a session coming up.

Noticing these feelings, Jane brings it up in her own therapy. Her therapist helps her to identify where these feelings are coming from and how to cope with them in sessions, and they talk through how this might help Karla to understand her own relationship dynamics.

The next time Karla raises her voice in a session, Jane takes a pause. She apologizes for upsetting Karla and helps her return to a calm state, then gently explores this pattern with Karla. She asks Karla what she wants the impact to be when she raises her voice. Karla thinks for a moment and says she hopes the other people will realize that they’ve hurt her.

Jane decides it’s clinically helpful and appropriate to share that the actual impact she experiences is fear. Jane and Karla reflect on whether the intended impact of Karla’s anger is always the actual impact, and how else Karla might communicate that she feels hurt.

Does Your Attachment Style Induce Specific Countertransference in Therapy?

We’ve looked at how your own transference can induce countertransference, and sometimes lead to the very fears that started it, and how this could perpetuate attachment styles even in therapy. In light of this, can certain attachment styles elicit certain countertransference types?

Conceptually, we might think that attachment avoidance in therapy could lead to a helpless, disengaged, or criticized countertransference type, as you might have walls up and avoid sharing much with your therapist. On the other hand, attachment anxiety in therapy could draw a therapist into a positive, special, or parental countertransference type, as you might make more bids to form a connection with your therapist. For now, these are just ideas – does the research measure up?

What the Research Says: Attachment and Countertransference

In some ways, yes – higher romantic attachment anxiety scores for patients have been associated with higher therapists’ scores on parental/protective and special/overinvolved countertransference⁴. Higher attachment anxiety was also associated with higher overwhelmed/disorganized countertransference, as though therapists might be aware that their protective feelings over this patient are using up more energy.

Hypotheses about attachment avoidance were not supported – there were no significant relationships between attachment avoidance and countertransference types. Other studies have found that there might be two clusters of avoidant patients in therapy: one group scores highly in security and avoidance in therapeutic attachment, and forms good therapeutic alliances, while the other only scores highly in avoidance and forms poor therapeutic alliances². This is suggested as a potential reason there’s also no relationship found between attachment avoidance and transference – the two groups could be canceling each other out. The same process could be happening in countertransference.

Studies have also found that for clients with high attachment anxiety in the beginning, the amount of parental and special countertransference decreases over time⁴. This might show that the client is gaining a more secure internal working model. However, therapists show greater overwhelmed countertransference as client anxiety decreases, which researchers suggest could be the effect of long-term work with attachment anxiety rather than a direct effect of anxiety decreasing.

Is Countertransference a Problem?

Countertransference is a normal part of the therapeutic process, and as long as your therapist is able to manage it, it’s not a problem or a sign of poor therapy. Your therapist should be able to recognize countertransference and work through it in their own therapy, without involving you in the process. They should only discuss their reactions to you if they feel it’s clinically appropriate and beneficial to your progress, and they may take some time to reflect on this decision, again with their own therapist, before bringing it up.

If your therapist does cross boundaries, trust your instincts. You may choose to bring up your discomfort or set boundaries in therapy, but it’s understandable that you might not feel comfortable doing this. It’s also okay to look for a new therapist, or perhaps you’d like to find another therapist temporarily to discuss your experience with your regular therapist.

Discomfort is expected in therapy, since we’re reflecting on things that we find difficult to face on our own. Further, the inherent power dynamic in a therapy room means that you might assume that your therapist knows best, and brush off anything that doesn’t sit right. It isn’t easy to disentangle normal discomfort from crossed boundaries in therapy, so trusting your gut and confiding in others can be helpful.

Conclusion

Countertransference is a natural part of the therapeutic relationship, and it’s nothing to worry about as long as your therapist is able to deal with it. You shouldn’t worry about the effect you’re having on your therapist – your therapy is a space for you to work through your difficulties with their support.

Countertransference demonstrates how our attachment dynamics can be repeated, even in therapy. We can transfer the attachment experiences and assumptions we’ve had with others onto our therapist, and act in ways that induce a type of countertransference that aligns with our expectations.

However, there are hopeful findings that continuing in therapy decreases this countertransference, which might indicate that clients become more secure over time.

If you’re interested in exploring building attachment security, take a look at our courses and workbooks. While these don’t replace therapy, they can be a useful tool alongside your therapy journey.

FAQs

How is countertransference different from bias?

Countertransference is a reaction to transference, while bias is a quick judgement based on traits or characteristics. Both can be unconscious, but therapists should be able to recognize and manage both. Countertransference can also be used to understand your own relationship dynamics and the feelings you elicit in others, while a therapist’s bias does not say anything about you and your relationships.

How do I tell if my therapist has countertransference?

Focusing on countertransference might distract you from your own progress in therapy; whether or not your therapist is experiencing countertransference shouldn’t impact your experience, as your therapist should be able to manage it appropriately. They might decide to bring it up with you if they feel it’s clinically relevant.

Instead of focusing on whether it’s countertransference, focus on whether your boundaries are being crossed: is something about your therapist’s behavior not sitting right? Does your sense of discomfort go beyond what might be expected in therapy? Is your gut telling you something’s off? If so, you might want to think about bringing this up or trying a new therapist.

Can countertransference be positive?

Yes, countertransference can be used by your therapist to help the both of you to understand and unpack your relationship dynamics. For example, if you’re transferring an old relationship onto your therapist, their countertransference can help them to understand what might have happened in that relationship.

References

1. Betan E, Heim AK, Zittel Conklin C, Westen D. Countertransference phenomena and personality pathology in clinical practice: An empirical investigation. American Journal of Psychiatry. 2005 May 1;162(5):890-8.
2. Woodhouse SS, Schlosser LZ, Crook RE, Ligiéro DP, Gelso CJ. Client attachment to therapist: Relations to transference and client recollections of parental caregiving. Journal of Counseling Psychology. 2003 Oct;50(4):395.
3. Colli A, Tanzilli A, Dimaggio G, Lingiardi V. Patient personality and therapist response: An empirical investigation. American Journal of Psychiatry. 2014 Jan;171(1):102-8.
4. Westerling III TW, Drinkwater R, Laws H, Stevens H, Ortega S, Goodman D, Beinashowitz J, Drill RL. Patient attachment and therapist countertransference in psychodynamic psychotherapy. Psychoanalytic Psychology. 2019 Jan;36(1):73.