Countertransference – What is it?

This post, What is countertransference, was previously published on Dr. Lynn Friedman’s blog for her Johns Hopkins graduate students 

In response to the blog posting on the patient who cancels or doesn’t show up, one of you was candid enough to write to me and to tell me how frustrating you found that experience to be. You asserted that it made you feel pretty irritated, you weren’t sure how to handle your irritation and you were tempted to respond in kind.

I think this is an excellent question and I appreciated your openness and your capacity to tune into your own reactions. Our reactions to our patients are really an important guide to understanding them and to understanding ourselves. Years ago, psychoanalysts talked about, “countertransference” in a somewhat different vein than many do today. By countertransference they meant those reactions that a patient evokes in us because WE have unresolved issues & conflicts from our own childhood. Back in the day, it was presumed if we were unable to be dispassionate and objective in those situations, then, it must reflect that we were not sufficiently analyzed ourselves.

With experience, the field has evolved so that today, most psychoanalysts and psychodynamic therapists recognize that while all analysts and clinicians, even with extensive analysis, have an unresolved residual issues, a reaction to a patient’s behavior is NOT necessarily a sign of the analyst’s unresolved conflicts. Increasingly, psychoanalysts have begun to use the word, “countertransference” with a second spin. We use it to refer to our reactions to the patient. It is now understood that, of course, patients can and, in fact, will evoke an array of reactions in us and it is very important to tune into these reactions and to try to understand what feelings they evoke in us.

In fact, our reactions can tell us a great deal not only about ourselves but about our patients. It is through both of these lenses – using both meanings of countertransference that I will address aspects of lateness and the therapeutic frame in subsequent posts.