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Transference, Countertransference and Finding a Good Therapist

Allan Schwartz, LCSW, Ph.D. was in private practice for more than thirty years. He is a Licensed Clinical Social Worker in the states ...Read More

Some time ago I answered an E. Mail asking about being in love with a therapist. Bob wrote a comment about his therapist and some unfortunate events that evidently happened to him. The entire article and responses can be found by pressing this hot link. In that linked article, Bob discussed the topics of transference and counter transference. The present article centers on both transference and counter transference and the kind of expectations and client or patient should have about their therapist.

Transference refers to the fact that we act towards people in the present based on our experiences from the past, particularly with our parents while we were growing up. In other words, we repeat patterns of behavior in the present that we learned in the past. Transference occurs all of the time. One example is when newly weds react towards one another as though their spouse was their parent. They come to expect that the spouse will act to them as their parent once did. In psychotherapy, there are times when the patient behaves as though the therapist were the parent from the past. This transference behavior becomes tremendously important in the "talking" or psychodynamic therapies because it helps the therapist correct the misperceptions and reactions of the patient in order that the healthier behavior occurs. An example might be of a patient who was always criticized by disproved of by their parent with the result that they constantly expect the therapist to be critical and disapproving.

Counter transference refers to the fact that the psychotherapist also has feelings in reaction to the patient. The therapist’s reactions to the patient could be based on things that happened in his own past or might be in reaction to the way a patient is behaving. For example, if a patient has a transferential feeling of sexual attraction towards their therapist, the therapist might find himself having a counter transference sexual feeling towards the patient.

Anecdote of a counter transference reaction: Many years ago, when I was working with a young man with some Borderline Personality features to his personality, I became aware, during the session, of wanting to throw him out of therapy. I said nothing, as I listened to him, but was mystified by my strange kind of fantasy or thought. After carefully weighing my response, I stopped him and asked him if he had any thoughts or feelings about therapy on the way to the office. It turned out that he had a bad argument with his girl friend last night, felt like an awful person for expressing so much anger at her and, on the way to see me, had the thought and feeling that I could not possibly like him and would want to get rid of him as a patient. Wow!!! Without my saying anything about my fantasy, we explored what his anger meant to him and how it was used against him when he was a child. Whenever he was angry he was informed that he was not acceptable. It was not that his expression of anger was not acceptable to his parents but that he was not acceptable.

Ethics: It is important to remember that therapists are human beings and have thoughts and feelings just the same as the rest of the human race. However, the therapist is trained to absolutely never act upon the counter transference feelings. Under no circumstances is a therapist to act romantically or sexually towards a patient. When people come into therapy they are placing their trust with this professional mental health worker. Just the same as seeking treatment from a medical doctor or dentist, they expect to be treated with respect and dignity. The expectation of being treated with respect and dignity includes the fact that the therapy office be a completely safe place where people can learn about themselves and learn healthy new behaviors in order that they can move on with their lives.

Unfortunately, there are always a few mental healthy practitioners who lack scruples and honesty. These are people who take advantage of those who have placed their trust with them. I have heard of therapist who will actually try to convince a patient that it will help them (the patient) to have sexual relations with the therapist. When these unethical people are discovered they are investigated, lose their licenses to practice mental health and even go to jail. This holds true whether the mental health worker is a psychiatrist, psychologist or clinical social worker. All three professions are licensed and come under specific ethical rules and regulations of their profession and of the state in which they live and practice. Every state licensing board has a list of ethical rules and laws that are publicly available and can be found Online in your state.

This is why it is always important for people looking for psychotherapy to exercise the greatest of care in making a good choice.

Here are some guidelines in selecting a therapist:

1. A good starting place for selecting a therapist is taking a recommendation from a friend, family member, family doctor (Primary care physician), and from another mental health practitioner.

2. When you interview a therapist you have the right to ask their professional identity (psychiatrist, psychologist, clinical social worker). You also have the right to ask whether or not they are licensed. In most if not all states, practitioners are expected to have their licenses displayed. Never assume someone is licensed. If they are not, Beware!

3. You have every right to ask about a practitioner’s background and experience. If they do not have experience in helping people to cope with a particular mental illness or behavioral difficulty you can go elsewhere to find the right professional.

4. If any practitioner refuses to answer these types of questions then it is time to leave and seek someone else.

5. Some patients are "squeamish" about asking questions. They fear offending the therapist. You have a right to know the person you are placing your trust in. Leave if they do not want to answer the very reasonable questions in this list. It is not your job to protect the feelings of the therapist. Ask the questions you need to know about.

6. Today, many people look for therapists Online and that is OK if you are careful. One excellent place to find a licensed therapist Online is http://www.psychologytoday.com/. They carefully check each practitioner’s credentials before listing them on their site.

7. It is always possible to call the local chapter of each of the professional organizations that regulate the mental health professions. For psychiatrists, there is the American Psychiatric Association, for psychologists there is the American Psychological Association for social workers there is the National Association of Social Workers. These are places where you can check the credentials of anyone you are considering seeing as well as learning whether they have ever been convicted for unethical practices.

Summary:

In psychotherapy as in life, patients have transference feelings towards their therapist and the therapist, from time to time, may have counter transference feelings towards the patient. The idea is to teach what it all means so that you, the patient or client, can learn to live in ways that are happier and more fulfilling.

Your comments and experiences with this are encouraged.

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