Any time you have a disproportionate response to a client or their story, you need to introspect.

Having an emotional response to what your clients tell you is normal. Sometimes it may get classified as countertransference (CT) in a way that suggests the emotion was problematic, and sometimes it is. New therapists need to know this is perilous territory and learn to manage it to maintain client wellbeing as the priority.

Problematic CT usually stems from difficult or powerful experiences growing up, which I talk about in my article on wounded healers. We all have work to do on personal growth and healing, but for now let’s just focus on recognizing when our reactions may interfere with therapy.  

Possible warning signs to watch for:

• Exceptions: any time you consider making an exception for one client, consider why you’re doing it for this person and not others

• “Whose benefit am I saying or doing this for?” If it’s to get my client or the group to take care of me, it’s not good; or to feel clever, noticed, valued, intimate, powerful, whatever (this is a healthy question to ask ourselves regularly in session)

• Self-disclosure: any use of this could be worth reflecting on, particularly excessive use

• Being or wanting to become over-involved with the client’s situation: talking to them outside of sessions, thinking about them frequently outside of work may be a concern, trying or wanting to help them outside of the scope of your role

• Koocher and Keith-Spiegel (2008) identified more areas of potential concern: “later appointment times, middle aged males often with marital problems or divorce, burnout and self-care issues, paying special attention to grooming before seeing certain clients, thinking of the person outside of session; and previous flirtatious behaviour. Other considerations include clinicians who minimize the impact of the power imbalance, are in significant life crises, view the client as ‘special,’ or may not seek supervision”

Noticing countertransference is great, and then we need to reflect on it and possibly act. These are the questions I ask myself when I notice the feelings but am unsure of their exact cause:

• Who does this person remind me of: myself or someone I have strong feelings toward?

• Am I projecting existing emotions onto this client? Does something in their story sound familiar to wounds (old or new) I’m carrying?

• Am I having a disproportionate response to this client or situation? Why?

• Did I show up to this session with as many of my needs met as possible? E.g., social, physical, intimate (the more of our needs that are met the easier it is to be there for the client in a one way supportive relationship)

• If I change one salient variable of the circumstance at a time, does this change provide insight into my response? (e.g., what if the client was: male instead of female; a couple instead of mother/daughter, older rather than young, more or less attractive, had a totally different presenting concern, different cultural background, saw them on Monday instead of Friday etc).

• When did I start to feel this way? Immediately when I met them, or once I heard a particular detail? What is it about that detail or moment?

• Feeling attracted to a client: Did I feel this way when I first met them or some time later? Would I have felt this way if they had brought up an entirely different issue? Would I feel different/acted different if the client was a different gender or less attractive? Does something about them or their way of being attend to a need of mine that’s not being met?

Noticing you feel attraction once in a while is normal and means you’re paying attention. We’re all wired for connection, and while who we find enchanting differs for each of us—periodically those people are our clients and we have to manage it. Seeking supervision in these moments is essential. Admittedly this happens for me less and less often as I age and as I continue growing as an individual.

Therapy is an intimate encounter with another person, and to be completely unaffected would be strange. 

The key is to notice and manage these thoughts and emotions in a healthy manner so you can continue to keep your client’s wellbeing as your top priority (within your professional scope, competency, and ethics). Often therapists are able to work through and sit with these feelings, but consult or refer the client elsewhere if needed. 

Irvin Yalom takes an unflinching and illuminating look at countertransference in chapter 4 of Love’s Executioner, which he titled “Fat Lady.” Thirty years later in his memoir, Yalom clarified that he exaggerated his feelings and prejudice in this chapter for clarity and education’s sake. Publishing that chapter was a vulnerable and selfless act. If you’ve ever felt guilty or like you’re a bad therapist because you had an uncharitable view of a client, read this chapter. As with most of his writing, Yalom is warm and exceptionally humanizing here.

Certain kinds of countertransference can be useful in therapy, but the above is an attempt to explore its troublesome aspects. Ideally, any time we use the information our countertransference provides, we’re purposefully choosing to because we think that in this case it promotes client wellbeing (rather than represents us acting out).

Attending to personal healing/internal work I’ve needed over the years has had a far more positive impact on my abilities as a counsellor than any coursework

Countertransference is usually gesturing toward the ‘intrapsychic’ work that we all need to do at times. Noticing patterns and exceptions is a good starting point. Be gentle and persistent with yourself as you attend to these concerns over the longterm.

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