The countertransference is one of the most complex and fascinating challenges in therapeutic work.
It manifests itself as a series of emotional reactions that the patient arouses in the therapist, influencing the course of therapy. Initially considered an obstacle, over time the countertransference has been re -evaluated as an essential tool for understanding the dynamics of the therapeutic relationship and its impact on treatment.
In this article, we will explore the different Types of countertransferencethe theories who analyzed the implications and how mental health professionals can recognize And manage it.
What is the countertransference?
From German GegenübertragungThe countertransference It is defined by Freud, in a letter from 1909 destined for Jung, as one counterattackwhich arises in the therapist on the patient’s influence, acting on his unconscious feelings.
Today we could talk about countertransference in psychology referring to emotions that the patient arouses in the professional inside the session.
The countertransference for Freud
To talk about the countertransference you need to make some premises. The birth of psychoanalysis is sanctioned in the early twentieth century with the publication of the book The interpretation of dreams by Sigmund Freud.
With this writing, Freud postulted the existence of a dark and profound place, the unconscious to whom people do not have free access due to a “moral censorship“. On the basis of these theories, for Freud it became essential to extract the emotion penetrated and remained in the deep and unconscious psyche, awakening its memory and reliving the emotion itself, with the aim of taking care of some psychopathologies.
Managing to do this, the hysterical symptoms would disappear, the embolus of emotion would have melted and the psyche would have resumed, together with the body, its normal functioning.
Transference and countertransfert: opportunities or limit?
During the sessions, Freud had observed that patients manifested intense feelings towards the analyst, as if there was another person in front of them. This introduced the concept of transfer.
By carefully observing the timing of these manifestations in the patient, he sensed that this happened regularly when the investigation on the past reached a more sensitive area, or of the Removed content often located in childhood (Freud, 1912b).
Subsequently, Freud noticed that even in the analyst they could arise the reactions aroused by the material that the patient presented: the countertransference. Freud believed that the source of this counterattackderived from Unconscious conflicts not resolved of the analyst. (Freud, 1912).
The countertransference: definition and evolution over time
The idea that the countertransference of the psychologist represented an obstacle in the psychoanalytic process remains substantially unchanged for a long time. The concept of “dangerous” countertransference In the relationship with the patient remains the nucleus of what Kernberg (1965) defines the “classic” conception of this event.
This conception presupposes that the patient is the object to be known and that the analyst is the neutral observer, which is why the countertransference is considered “polluting” in this distinction of roles (Albarella and Donadio, 1998).
A sincere revolution: Sandor Ferenczi
The therapeutic countertransference and, in general, the theme of the therapist’s affections and emotions, is neglected for many years, with some exceptions. One of the first to make his contribution on the topic was Sandor Ferenczi (1928), pioneer in the recognition of the positive value of the analyst’s affections and in the criticism of the myth of “analytical neutrality”.
Ferenczi proposed a new approach to therapy and the patient, attentive to the subjectivity of the analyst and early close to the debates that will subsequently characterize the intersubjective current of practice and psychoanalytic thought.
In fact, his ideas anticipated the key concepts of psychoanalysis of the second half of the twentieth century: the importance of “sincerity” and authenticity of the psychotherapist, the value of his emotions and the use of countertransference as an analysis tool.
The turning point of the 1950s and projective identification
The real turning point, however, arrives in the 1950s, with the introduction of the concept of projective identification by Melanie Klein (1946). Klein introduces the projection of the child’s good and bad parts towards the mother, creating a bridge between classical psychoanalytic theory and interpersonal.
We then pass from a purely individual and intrapsychic vision to a relational dimension.
Thanks to these new theoretical contributions, it is possible to rethink the ideal of a “detached” analyst in favor of an analytical situation conceived as one relationship between two people. What makes it therapeutic It is not the absence of feelings in the analyst, but his ability to support and process them, instead of letting them fall on the void.
The therapist therefore becomes a “participant observer” (Sullivan, 1954).
The decline of the notion of therapist as an external observer, omniscient and detached from the patient allowed aevolution of theories concerning the emotions of the professional as a preferential access channel to the patient’s world.
In this context, also the self-disclosure of the therapist can be considered a tool to strengthen the therapeutic alliance with the patient.
Types of countertransference
Heinrich Racker was one of the main psychoanalysts to frame the role of the countertransference in clinical practice (1952, 1953, 1968). In particular, he classified the therapist’s countertransference in different types, on the basis of the identification that is created between professional and patient:
- Conventant countertransferencewhich of verification when the ego and the eg of the psychologist identify with those of the patient, allowing a sharing of the experience;
- complementary countertransferencewhen the psychologist identifies himself with the representations of the patient’s psyche;
- direct countertransfertin the event that the resonance of the therapist is evoked by the patient and his experience;
- indirect countertransferenceif the therapist’s reaction is evoked by a person outside the setting.
Racker also explored the Sexualized countertransfertdefining it as an inevitable part of the therapeutic process that can be used productively, integrating it as a tool for understanding the patient’s dynamics.
Living and metacuating emotions during the session
For some approaches, such as those that refer to second -order cybernetics, which pay close attention to the effect of the therapist’s interventions in the session, the emotions that resonate in therapy can be used to create a metacommunicative level.
In the latter level, the sensations experienced by the therapist within the therapeutic relationship in the here and now they can be explicit to make the patient reflect on those sensations.
There resonance It is one of the ways that the therapist has to enter and consolidate the relationship with patients. In many contemporary theories, in fact, theauthenticity The therapist becomes central so that a solid therapeutic alliance is established that allows the patient to experience a type of relationship other than all those experienced up to that moment and which somehow made him suffer.
To do this, the therapist, following the indication of Whitaker, “must deeply enter the patient and the family”, becoming part of it, but while maintaining the right distance, so as not to remain entangled in the relational dynamic in which it is immersed.
The signs of the countertransference
Recognize and understand how the countertransference manifests itself It is essential for mental health professionals, since it can have a direct impact on the effectiveness of the treatment.
How do you notice the countertransference, then? It is important to pay attention to one’s feeling and manage any critical issues that could influence the therapeutic relationship.
Some examples of countertransference e factors to be taken into consideration may be:
- intense emotions And feelings of various kinds, such as anger, frustration, attraction, or affection towards the patient. For example, a patient who tells a trauma immediately could trigger a countertransference in the therapist with traumatic experiences similar;
- fantasies or persistent thoughts not connected to therapy. For example, the therapist could find himself often thinking about the patient even outside the sessions, or could develop saving or idealization patterns;
- non -verbal behaviors And bodily: feelings of discomfort, physical tension, or even an unconscious need to increase the physical distance from the patient can emerge during a session. It could be a negative countertransference. In the same way, behaviors such as the modification of posture or the maintenance of excessive visual contact can reflect an emotional response of the professional;
- tendency to avoid or encourage certain discussions: The therapist could unconsciously avoid exploring certain issues because they generate emotional discomfort or, on the contrary, pushing excessively on certain topics due to personal involvement. This can happen, for example, when the therapist has experienced experiences similar to those of the patient and proves the need to guide the patient towards solutions that reflect their experiences;
- reactions of excessive care or detachment: In the first case, the therapist can feel a strong need to “save” the patient, overcoming the limits of professional neutrality. In the second case, the therapist could distance himself emotionally, closing himself to the involvement with the patient to avoid comparison with difficult feelings;
- dreams or unconscious thoughts: some Therapists may note that patients appear in their dreams in roles that reflect the dynamics of therapy or aspects not addressed during the sessions.
How to manage the countertransference
We have seen how the countertransference is the result of the emotions that the patient arouses in the therapist.
Likewise, the resonance They are the result of similarities in history, in childhood or family experiences that “resonate” within the therapist and that lead to one identification with the other.
Both can be used as tools by the professional to fully understand the experiences of the person who has in front and guide it in the dance between proximity and understanding, offering new points of view very distant from those of the patient.
The greatest risks of this approach could be to cultivate in ways that the patient brings, because they are too close to the therapist mode, or to interpret the stories and emotions of the other with his premises.
The psychoanalyst and psychiatrist eight Kernberg (1984), in particular in reference to the countertransfert with narcissistic patient. In these cases it is essential that the professional is well aware of his experiences so as not to alter the setting.
The antidote, as already suggested by Freud, is that of work on the professional self, also through supervision and interviewing meetings. The psychologist must make sure to enter the therapeutic relationship stripped of his premises, or at least aware of his emotions, so that any countertransference do not determine the end of therapy.
