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Countertransference in Psychoanalysis and Psychotherapy

The complex interactions between analyst/therapist and patient

In our two prior posts, we discussed the importance of understanding the pervasive nature of unconscious mental activity and the importance of understanding how past relationships influence the nature of present relationships. In a psychodynamic therapy the relationship to the analyst or therapists promotes an accentuation of feelings of the patient towards the analyst/therapist. In this way, the therapist/analyst can understand the nature of the patient’s relationships to figures in his/her life, in the past and in the present. In this way the patient can develop more effective decisions in current relationships.

Since transference manifestations are inevitable in every relationship, it is expectable that the analyst/therapist would have feelings towards the patient based on his or her own unconscious factors. This response by the therapist/analyst is called countertransference.

In psychotherapeutic treatments of many patients counter-reactions are inevitably evoked within the clinician. As with any other person, the clinician’s experience of the patient is colored by residues from his or her own past (countertransference). That is why a clinician has to understand him or herself as much as possible. This is crucial since the clinician needs to discern, as much as possible, the degree to which his/her reactions to the patient are derived from his or her own past and how much is provoked by the patient.

Some patients can become aware of their effects on their clinicians. In order to protect themselves from painful emotions, such as powerlessness, shame, and distress that emerges in their relationship to the clinician (what is called activation of the attachment system), they may attempt to cope with those feelings by exhibiting an attitude of superiority or attempting to control the clinician. They attack the clinician and follow the motto, “A good offense is the best defense.” The provocations of the clinician and the attacks on the clinician are often a repetition of the behaviors that occur with others or those that have occurred in the past. The sooner the clinician becomes aware of his/her countertransference responses the more effectively the clinician can respond therapeutically rather than perpetuate a non-therapeutic cycle with the patient.

The greater the knowledge the clinician has about him or herself, the more effective the clinician can be in implementing a variety of therapeutic techniques with patients. By recognizing the complex interplay between patient and analyst in the sessions, the analyst helps the patient understand the nature and origin of his/her maladaptive interactions. Slowly, change can occur.

See: Regulation Focused Psychotherapy.

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