Reflection
What is Countertransference?
Countertransference is, broadly, everything the therapist experiences, thinks or feels in the room.
The narrower textbook definition confines it to the therapist’s reaction to the patient’s transference. In practice the wider definition is more useful, because the material that turns out to matter often arrives without any obvious connection to what the patient has just said.
It is not a lapse in professionalism. It is information, and frequently the earliest information available about what this person does to people.
How do you know the feeling is not simply yours?
This is the whole technical problem, and there is a straightforward answer to it.
Before a session I take ten or fifteen minutes. I breathe, and I do an emotional check on where I am. Not to clear myself out, which is not possible, but to know the reading before the patient arrives.
So suppose I go in relaxed. Or suppose I go in annoyed about something from earlier in the day: that is fine, as long as I know it. Then halfway through the session I notice I am sad.
I did not bring that sadness. It was not there twenty minutes ago. So at minimum it belongs to the interaction between us, and quite possibly it belongs to the patient and is arriving in me because they cannot yet feel it themselves.
That is countertransference, and the only reason I can identify it is that I took the reading beforehand.
A therapist who walks in without knowing their own state has no way to tell their weather from the patient’s. Everything gets attributed to the person in the chair, or nothing does.
What it looks like: the Thai restaurant
A long time ago I worked with a woman, a mother, who was strikingly beautiful.
Every time I saw her I found myself thinking about a Thai restaurant. Not during the session especially. Around it. The image kept arriving, and I went to the restaurant once, then twice.
It seemed to have nothing to do with anything. I took it to supervision anyway, which is what you do with material that seems to have nothing to do with anything.
My supervisor asked whether anything came to mind about her. I said: yes, every time I think about her I think about a Thai restaurant.
He asked: how was it?
I said the food was too hot. I could not taste it.
That was the key.
Her beauty was so hot that nobody could taste her. People were stopped at the surface, and never got as far as the person underneath. That was the thing she was living inside, and I had been handed it in the form of a restaurant.
Identifying details in this account have been changed.
Why the restaurant matters
Two things worth drawing out of that.
The countertransference arrived as an image, not as a feeling. Not sadness, not irritation. A restaurant. If I had been screening only for emotions I would have discarded it as irrelevant, which is exactly what it looked like.
And I could not decode it alone. I had the image for weeks. It took a supervisor asking one ordinary question, how was it, to open it. That is not a failure of my clinical ability. It is the structural reason supervision exists.
There is more on that, and on what a therapist does in the moment they realise they have missed something, in the article on transference.
The forms it takes
The usual distinction is between two kinds.
Concordant countertransference, where you find yourself feeling what the patient feels. They cannot reach their own grief, and you are inexplicably sad. They are frightened and cannot say so, and you notice unease you cannot account for.
Complementary countertransference, where you find yourself feeling what somebody in their history felt, or being drawn into that person’s role. You become impatient in the way their father was impatient. You want to rescue them in the way their mother did. This is the one that does damage when it is not seen, because you can enact an entire relationship without ever deciding to.
Beyond both, there is everything that is simply yours: tiredness, a difficult morning, your own history meeting theirs. That does not stop being countertransference. It stops being information about the patient, which is a different question, and the baseline reading is how you tell them apart.
When it goes wrong
The damage is rarely dramatic. It looks like an ungenerous interpretation, an observation delivered a fraction too sharply, a correction that carries more edge than it needed to.
A patient who was treated badly will, sooner or later, invite the therapist into the role of the person who treated them badly. Accepting that invitation without noticing is the most common way psychotherapy harms people, and it is why the three possible responses to it are worth understanding properly. I have set them out in the transference article.
The failure is never having countertransference. Everybody has it. The failure is not noticing it, and letting it run the room.
What it is ultimately for
The way I see my job, I am a co-storyteller.
What the patient and I are making together is a story, and it is built from three things: what I see, the story the patient brings from their past, and how I feel about them in the room.
That third ingredient is the countertransference, and it is why none of this is a technical curiosity. Without it the story is built from two ingredients instead of three, and it will be a thinner story.
There is nothing right or wrong about the story we arrive at. The test is whether it works. A good one builds a narrative room large enough to hold them, or a narrative bridge from the place where they are stuck towards a future they could not previously see.
You cannot build either of those out of theory alone. Some of the material has to come from what happens to you while you sit there.
If you are in distress, Samaritans is free on 116 123, day or night. In an emergency call 999 or go to A&E.
This page is for information and does not replace assessment, supervision or treatment.
