What Is Countertransference? Definition, Examples & How to Manage

Countertransference happens when a therapist projects their own feelings or thoughts onto a patient. While it can pose challenges, it can also enhance understanding and improve the therapeutic process.

The therapeutic relationship, a cornerstone of effective psychotherapy, is built on trust and empathy. However, sometimes because of this closeness a therapist can experience emotional responses (both conscious and unconscious) triggered by their interactions with a patient—a concept known as countertransference. These reactions might stem from the therapist’s personal history, unresolved conflicts, or the dynamics of the therapeutic relationship itself.

While countertransference can disrupt therapy if left unaddressed, it also has the potential to provide valuable insight into the therapeutic relationship when skillfully managed. However, unmanaged countertransference risks undermining this bond, shifting the focus away from the patient’s needs and breaking professional boundaries. Read on to learn how countertransference can be identified and managed in order to promote healthy therapeutic relationships. 

Historical and modern understanding of countertransference

The concept of countertransference was first introduced by Sigmund Freud in the early 20th century. Freud initially viewed it as a hindrance to therapy, believing that therapists’ emotional reactions to their patients stemmed from their own unresolved issues. He emphasized that therapists must overcome these reactions to maintain objectivity and remain effective. However, by the mid-20th century, perspectives on countertransference began to evolve. 

Specifically, Carl Rogers, a pioneer of humanistic psychology, revolutionized the understanding of countertransference and the therapist-patient relationship. Unlike Freud’s clinical approach, Rogers advocated for a therapeutic relationship grounded in genuine connection, empathy, and trust. He encouraged therapists to bring their authentic selves into the therapeutic space, arguing that emotional reactions, when properly understood and managed, were not only natural but also a valuable part of the healing process. His emphasis on empathy and “accurate empathic understanding” reframed countertransference as an opportunity to deepen insight into the patient’s inner world.

In modern psychotherapy, countertransference is seen as a dynamic and interactive phenomenon. It reflects the interplay between the therapist’s reactions and the patient’s transference, often illuminating unconscious emotional patterns or relational dynamics. Building on Rogers’ humanistic ideas, contemporary therapists view countertransference not as a flaw to be eliminated but as a natural part of the therapeutic process. When therapists remain mindful of their emotional reactions, they can use them to strengthen rapport, enhance understanding, and tailor their interventions to meet the patient’s unique needs. However, unchecked countertransference—such as excessive protectiveness, irritation, or inappropriate emotional disclosures—can disrupt the therapeutic relationship and hinder patient progress. The key lies in recognizing and reflecting on these reactions to turn them into opportunities for growth and deeper connection.

Types of countertransference

Countertransference can manifest in various ways, including:

• Over-identifying with the patient’s experiences, blurring the boundaries of the therapeutic relationship
• Sharing excessive personal stories, which can shift focus away from the patient
• Acting outside the therapeutic role, such as offering advice or becoming overly involved in the patient’s life
• Responding with undue anger, frustration, or nurturing behaviors that may distort the therapeutic balance
• Developing inappropriate emotional or romantic attachments to the patient

While some countertransference reactions—such as empathy—can enrich therapy, others require careful management to ensure the therapeutic relationship remains a safe and effective space for growth.

Examples of countertransference

Here are some examples of what countertransference can look like: 

• A therapist may feel overly protective of a patient who reminds them of a younger sibling or child, leading them to avoid addressing difficult topics out of a subconscious desire to shield the patient from distress.
• A therapist might feel irritated or impatient with a patient whose mannerisms or behavior resemble a challenging relationship from their own past, such as a critical parent or argumentative partner.
• A therapist might react with sadness or despair if a patient’s story resonates deeply with their own personal trauma, potentially clouding their objectivity and leading to over-identification with the patient’s pain.

Countertransference vs. transference

When discussing countertransference, it’s important to also understand transference, as these two phenomena are deeply connected and can influence each other. While countertransference refers to the therapist’s emotional reactions to the patient, transference occurs when a patient unconsciously projects feelings, behaviors, or relational patterns from significant past relationships onto their therapist. 

For example, a patient who had a distant parent may perceive their therapist as emotionally unavailable, even if this isn’t the case, and respond with frustration or withdrawal. Alternatively, a patient might idealize their therapist as a source of unconditional support, interacting as though the therapist were a caregiver or mentor from their past. Transference can provide the therapist with valuable insight into the patient’s inner world and relational dynamics, offering an opportunity to address unresolved emotional conflicts.

How can therapists manage countertransference?

Therapist countertransference can be addressed using several strategies to ensure it doesn’t interfere with the therapeutic process:

1. Supervision and consultation

Therapists often seek supervision or consultation with other professionals. Discussing their reactions in a supportive environment helps them identify and manage countertransference. This practice is especially crucial for therapists in training, where supervisors can point out countertransference and offer guidance on handling it effectively.

2. Personal therapy

Many therapists undergo their own therapy to address unresolved personal issues that could lead to countertransference. Through this process, they gain insight into their triggers and learn how to maintain objectivity in sessions.

3. Professional experience

Over time, therapists develop greater self-awareness and learn to recognize patterns of countertransference dynamics. Training and continued professional development help them refine their ability to manage these responses.

4. Self-Reflection

Regular self-reflection helps therapists stay attuned to their emotional responses. Journaling or mindfulness practices may assist them in identifying reactions tied to countertransference.

Carl Rogers’ approach adds a layer of intentionality to these strategies. By fostering empathy, congruence, and unconditional positive regard, therapists can navigate countertransference while maintaining the integrity of the relationship.

How can patients manage countertransference ?

Countertransference can sometimes enrich the therapeutic relationship but may also cause harm if left unchecked. If you feel your therapist is presenting negative countertransference and it is affecting your treatment here are some steps to take:

1. Start a dialogue

If you’re comfortable, share your concerns with your therapist. Honest communication can help address the issue and strengthen the relationship.

2. Find a new therapist

If problematic countertransference impacts your experience, consider finding a different therapist. Effective therapy should feel supportive, not harmful.

3. Seek a supervisor or licensing board

If the therapist’s behavior feels harmful or unprofessional, you can request to speak with their supervisor (if applicable) or report them to their state licensing board.

Remember, a therapist’s role is to foster your growth and well-being. If their countertransference creates harm, advocating for yourself is essential—you deserve care that prioritizes your needs.

How Charlie Health can help with countertransference

If you or a loved one are struggling with countertransference, Charlie Health is here to help. Charlie Health’s virtual Intensive Outpatient Program (IOP) provides more than once-weekly mental health treatment for dealing with serious mental health conditions, including countertransference. Our expert clinicians incorporate evidence-based therapies into individual counseling, family therapy, and group sessions. With treatment, managing countertransference is possible. Fill out the form below or give us a call to start healing today.