How to identify the signs of countertransference in therapy

The professional relationship between a mental health therapist and a client can be crucial to mental healthcare. Finding a thorough, unbiased provider that can abide by the ethical code of the American Psychological Association can be essential. However, in some cases, a therapist's personal experiences, opinions, or feelings might affect the objectivity of their advice and guidance. This situation is known as countertransference.

Countertransference in therapy occurs when a therapist unknowingly impacts the client through their emotional responses to what is being discussed. While an emotional response may not be unhealthy in every case, it can be detrimental to the overall therapeutic relationship if it isn't addressed and appropriately managed. Understanding the difference between transference and countertransference can help you know how to act if you encounter it.

What is the difference between transference and countertransference?

Transference was originally conceptualized by Sigmund Freud and refers to the act of ‘transferring’ emotions and experiences from patient to therapist. Transference may help a therapist’s work by deepening their understanding of their client, but it can also be challenging. In the above example, if the therapist realizes that the client is directing anger toward them that arises out of their relationship with family, they may target their strategy that day on understanding the underlying difficulties in the client's family dynamic. However, if transference becomes severe or harms the therapeutic alliance, it may not be conducive to treatment.  

Countertransference differs from transference because it is done by the therapist instead of the client under a unique power dynamic. However, countertransference is also often unconscious or unintended. A therapist is trained to provide ethical care, which can mean keeping their opinions and biases out of sessions, regardless of the types of therapy they provide. However, if their bias or emotional responses are unknowingly made known to the client, it can cause challenges in the treatment process.

How does countertransference function?

In some situations, therapists may allow their past experiences and feelings to influence how they provide care, which is known as countertransference. It occurs when a therapist’s reaction involves directing their emotions toward the client.

An example of countertransference is when a therapist thinks their client has a similar personality to someone from their personal life, and in response to that thought, they treat them like they might treat the person they know. There are four types of countertransference that may occur in contemporary psychiatric treatment methods like therapy. These four types include the following:

• Subjective: occurs when a therapist’s personal experiences cause an emotional reaction to their client.

• Objective: refers to the emotions a therapist experiences as a  reaction to a client's behaviors.

• Positive: typically occurs when the therapist is overly supportive of the client. They can cross the line by trying to make the therapist-client relationship more personal and divulging more than they should.

• Negative: when the therapist is disapproving of the client. It could be that they become overly critical of them, or they try to punish or reject them.

The ethical challenges with countertransference

Although it may be challenging for a therapist to remain objective in every situation, ethical guidelines often ask that therapists not allow their personal experiences and emotions to hinder the therapeutic process. 

When personal feelings cause your therapist to provide poor care, it might negatively impact your mental well-being. A client affected by unhealthy countertransference reactions might develop an unhealthy or inappropriate relationship with the therapist, which in turn may lead them to make a major life decision based on biased guidance. For example, your therapist may transfer their feelings about relationships onto you by having an adverse reaction when you discuss your significant other. This reaction of countertransference could cause you to make a decision about your relationship that is partially based on your therapist's feelings rather than on an objective analysis of the situation. 

A therapist's job is to support you and your journey without passing judgment or letting their feelings get in the way. Therapists often have years of clinical supervision as they hone their skills and learn to avoid situations like countertransference. Many professionals are taught how to manage their emotions, so they don't affect the therapeutic relationship. However, countertransference can still happen, so knowing how to recognize it can be crucial.

Signs of therapist countertransference

When you meet with a therapist, there might be signs or indications that your therapist is experiencing countertransference. Knowing these signs may help you avoid the adverse effects of countertransference. Below are several common indicators:

• Having an excessively critical attitude toward you
• Becoming overly invested in your situation
• Providing strong judgments on situations and people in your life, independent of your own opinions
• Becoming prescriptive with advice instead of letting you arrive at decisions on your own
• Giving the impression that they want to "save" you
• Asking for details about your life that don’t seem necessary for the therapeutic process
• Becoming upset or angry about an opinion or belief that you express
• Talking about their own lives frequently
• Making sexual advances

Note that some examples of countertransference are direct violations of the APA and ACA ethical codes. If a therapist tries to partake in a friendship, romance, or sexual relationship with the client, they can lose their license. If any of these non-ethical countertransference cases occur, contact your provider's state board.

Addressing countertransference

You have a few options if your therapist shows signs of countertransference. You can tell them that you're uncomfortable with the care you're receiving and explain why you feel that way. In this case, they might recognize that they were engaging in countertransference, whether they were using it as a tool for therapy or directing their emotions toward you unknowingly.

It can be hard to know how to spot countertransference and how to address it in a professional setting, but experiencing countertransference in therapy can negatively impact how you receive treatment and the relationship you have with therapy as a whole. It is often most beneficial to recognize and point out signs of countertransference.

How to move forward

In response to your concerns, your therapist may address the situation in a helpful manner and offer to alter their approach. In some cases, they might believe continuing treatment would be unethical, and they may suggest you seek a new therapist or offer you a referral to someone else. If your therapist denies countertransference, invalidates your experience, or acts unkindly, you may benefit from moving on with a new provider and ending your relationship with this therapist.

If you feel unsafe or uncomfortable discussing countertransference with your therapist, you can end the therapeutic relationship without talking to them. If you don't feel comfortable with a provider, it may negatively impact your treatment, and another provider may better offer the care you seek.

If you decide to move forward with the same therapist, consider setting firm boundaries you'd like them to respect.

How to find professional help

Suppose you decide to find a new therapist due to countertransference or any other reason. In that case, you may feel more comfortable knowing that any new provider is a licensed, professional with experience across therapy types. Consider doing some research before choosing which therapist or one on one practice to work with. You can start by asking for recommendations from friends and checking reviews online to get a feel for the experiences others have had with a particular therapist.

Finding what may be considered a good therapist could be easier if you look for a professional with several years of experience and a large clientele. Experienced therapists like these may be better able to avoid countertransference or similar issues. However, most therapists have training, supervision, and licensing, and newer therapists may offer a modern and fresh perspective on mental healthcare.

You can check a provider's credentials by going to the website of the licensing board of the state they operate in. Look for what licensure they hold and when they obtained it. If they're new to the profession, you may want to find out who is supervising them and learn about that therapist as well. You can also investigate the therapist's experience, as finding a specialist in your care area can be beneficial.  

Other factors you may want to consider include cost, location, and availability. If applicable, you can start by checking with your health insurance company to find out if they have any coverage for mental health treatment. If they do, look for an in-network provider.  

If you don't have mental health coverage through health insurance or don't have health insurance at all, you can ask a provider if they offer sliding-scale pricing. This option can make treatment more affordable by lowering session costs based on income. You may also look for a therapist whose schedule works with your own and whose office is near you.

Therapy options

An increasingly large body of research points to online therapy as an effective method of fostering a positive client-therapist relationship. A 2021 study suggests that therapy delivered virtually is "no less efficacious" than therapy provided in person, and a growing body of research indicates the same. Another study reports that participants said they felt safer and less judged in the context of video therapy.

If you want to work with a qualified, find a therapist who is a qualified and experienced mental health professional, consider utilizing an online therapy platform like BetterHelp. All BetterHelp therapists have at least a master's degree or doctorate in their field, a minimum of three years and 1,000 hours of experience, and proper licensure. If you'd like to change therapists through this platform, you can do so easily for any reason. A solid bond with a qualified therapist can provide you with support as you work through mental health concerns or other life challenges.