Countertransference was a term originally used by Freud to describe a client’s influence on the analyst’s unconscious feelings. Freud believed that no psychoanalyst “goes further than his own complexes and internal resistances permit,” and for this reason, having a personal analysis as part of training was considered essential. In other words, Freud viewed countertransference as arising from unresolved and unconscious issues within the analyst. Since then, our conception of the countertransference has grown to include all of the therapist’s reactions to the client, including his or her conscious experience during the session. From this point of view, as a working therapist, your own feelings, thoughts and fantasies provide important information to further your understanding of your client. This latter view is exactly the way I think about countertransference; during sessions, I rely heavily on my internal process to help me understand the person I’m working with.
In my recent post on repression, I gave a simple example: a client who communicated a lot of pain to me during session (that is, I felt pain) but seemed not to be feeling it herself. I often have similar experiences in session, where I’m listening to someone talk; feelings will start to stir within me but my client doesn’t seem to be conscious of any particular emotion. Working this way, you have to be cautious not to assume that everything you feel comes about because of the client’s issues; you need to listen for other material that gives you a basis for believing that it’s a projection or unconscious communication. After a while working this way, you begin to trust your reactions (your countertransference in the broad sense) and feel confident about when and how to use them.
Part of that trust depends upon your comfort level with certain emotions. Remember Freud’s remarks about how unresolved complexes and resistances will limit a therapist’s effectiveness. If you’re the kind of person who has trouble bearing anger or grief, it may limit your ability to understand your client’s experience. This is especially true when dealing with certain types of depression. I’m thinking in particular of one type I discussed a while back, where unconscious and destructive rage plays a major role. Therapists who have a hard time acknowledging their own anger and aggression will struggle with this particular client because they don’t want to feel the emotions aroused by treatment. Therapists who believe they should only have kind and loving emotions toward those in their care will also have a hard time. Such therapists may often dislike the client without quite admitting it. Their interpretations may come across with an edge; or they may become much more directive and impatient because they want the client to “move on.” They may secretly dread that particular session in their day.
With this client, understanding the difference between empathy vs sympathy is crucial. For instance, a depressed client may come to session and complain about how hard or unfair life is. She may run through a list of grievances, criticize other people or implicitly blame them for what she’s going through. He may subtly communicate a demand that you “save” him from his experience. In all sorts of quietly “unsympathetic” ways, the client may ask for your sympathy and you probably won’t feel that way. Maybe you’ll instead feel a bit guilty that you don’t. This person in front of you is obviously suffering; why don’t you feel more sympathetic to his or her plight? At times like this, we may feel compelled to express sympathy in ways we don’t actually feel, and which make us sound like bad parodies of ourselves: “I hear you saying you’re in a lot of pain. I’m really sorry that you’re suffering so much.”
If, on the other hand, you rely on your countertransference in the broad sense, you’ll understand the client more deeply. Rather than expecting yourself to have sympathy, you might instead examine your own feelings and accept that you feel surprisingly annoyed or even angry with your client. For many therapists, such a recognition would be shameful. We’re mental health professionals and caretakers, after all — we’re not supposed to feel hostile toward those we care for! If you can leave yourself room to feel that way and wonder about it, you might find that it tells you something about the way your client is feeling. Of course, you have to know yourself well and feel confident that you can tell the difference between your own issues and those of your client.
Assuming you do, what might your own anger tell you? It could be many things, and you’ll need to listen carefully for clues in the material to give you more insight. Here are some possibilities I’ve seen in working with depressed clients:
1. The client is enraged and doesn’t know it. I have often found this to be the case. In the professional literature, depression has been discussed as “aggression turned inward”; along those lines, I think of some cases of depression as the result of internal raging, where the person’s mind is laid waste by the violence of his destructive feelings and fantasies. You may be resonating with that rage.
2. The client wants to control you, or is quietly demanding that you take care of him or her. For me, a feeling of irritation sometimes comes up that tells me to look for covert manipulation, often masquerading as helplessness. (I discussed this phenomenon in an earlier post.) The client who feels unable to address the extent of the internal damage may believe instead that the only viable solution is to absorb the qualities they want by controlling you. Growth by annexation, as I called it, in my discussion of the film Cracks over on my Movies blog. They want to possess the mental health and emotional capacities you represent by merging with you.
3. The client is projecting a sense of despair and impotence into you; the communications cause you to feel as if there’s nothing you can do to make things any better, that you’re helpless to help your client, you just want to put them on meds, etc. This dynamic often comes up with clients who struggle with powerful feelings of envy and jealousy, but also with those in a state of disintegration. They may feel so overwhelmed by the degree of internal damage, so full of unbearable shame that they evacuate it into you. You might also consider it a communication of the mother-infant type I discussed in my post of the development of mind and meaning.
In all of these cases, I have found that understanding the particular dynamic leads to an emotional transformation within me so that I’m able better to empathize with the client’s pain. Instead of feeling the anger or irritation, I empathize with their shame and their sense of despair about the internal destruction. As a person who has wrestled a lot with issues of rage and anger during my own analysis, I truly empathize with the pain those feelings produce. That’s quite different from feeling sympathy for what is consciously expressed.
The work then becomes about helping the client to bear those split-off emotions. It’s not easy work. Hardly anyone wants to feel rage. Few people will admit to poisonous envy. Clients can easily feel criticized when you show them the ways that they’re manipulating you. Then there’s often a long phase where the rage becomes acknowledged and explosive during session, when all that anger is now overtly directed your way. I have found this to be the case with depression in borderline personality disorder. Very hard work, to remember (in a feeling way) that you care about someone who is assaulting you. But that’s the job, as I discussed in one my earliest post — returning a kind of love in the face of hatred.