When and how does Transference link to Harm in Therapy?

It can be argued that transference and countertransference are ubiquitous phenomena in the therapeutic relationship, and much of the time the multi-layered relational responses that occur for both therapist and client either do not dominate the therapeutic work or become a fertile and productive means of gaining relational understanding and effecting therapeutic growth. In my work as a therapist, my understanding of the feelings and interactions which transpire between myself and a client play a crucial role in how I make sense of the therapeutic process and my client’s way of being in the world.

I believe wholeheartedly that transference and countertransference can hold great value in the therapeutic process (from my experiences as a client as much as anything else) so  how do I understand the significant prevalence of transference being cited as a cause of harm in books, articles, internet forums and in blogs, most frequently cited first-hand by the people who have experienced harm in therapy?

Often, when people experience difficulties in their feelings towards their therapist, they Google it. That’s what I did, and it’s also how I make sense of the fact my blog posts on transference, countertransference, and particularly, erotic transference receive more worldwide hits than any of my other posts.  When clients type ‘feelings towards my therapist’ into Google, they receive access to thousands upon thousands of resources and online discussions on transference. They will probably read that it’s important to talk to their therapist about how they are feeling, and those who feel able to, might attend their next session ready to tell their therapist about their understanding of transference and desire to talk about it. What happens next can vary widely.

In her 2016 article for Therapy Today, Dawn Devereux writes “The risk of AIT [adverse idealising transference] can also be reduced by responding appropriately when clients bring up transference concerns, as AIT is much more likely to occur if the first indications are ignored.”.

I would posit that the transference is far more likely to have a long-term adverse effect (distinct from here-and-now discomfort) if the therapist shows discomfort, rejection or denial towards the client’s feelings. Devereux continues “We have observed that therapists whose clients develop AIT are unlikely to discuss transference, and are dismissive or hostile when clients suggest it. Clients also describe therapists becoming irritated, defensive and rejecting in response to discussion about the adverse effects on the client’s life.”.

What is happening for therapists here? It is tempting to say “What terrible therapists; how dare they respond in such a way to a client!” however I think the uncomfortable truth is that any therapist could be vulnerable to responding in a hurtful way to their client and when we ‘other’ the harmful response, we avoid the necessary self-reflection for safe and ethical practice. I really want to take a look at why therapists might respond in this way and how the risks of such a harmful (and potentially retraumatising) response can be reduced.

I have experienced some mixed responses from therapists about my interest in harm in therapy, and I sometimes wonder when I receive confrontational correspondence whether this might relate in part to a reluctance on the therapist’s part to acknowledge their own potentiality to do harm (in fact I recall that this sense was once freely admitted to me). When I hear of therapists’ dismissive or rejecting responses to a discussion of transference, I wonder whether a similar avoidance occurs. It’s almost as though we can, as therapists, bask in our sense of doing good, yet have trouble reconciling ourselves with the inevitable shadow of our virtue. So how can we manage that response as therapists? I would argue that the only way we can reconcile this shadow, is by facing it head-on. I often retweet Carl Jung quotes, because he professes it so boldly and so unequivocally: “People will do anything, no matter how absurd, in order to avoid facing their own soul.”. If we find ourselves shaming and invalidating our clients in order to avoid facing our own soul, we do ourselves, our profession, and crucially, our clients, a terrible disservice.

Hostility as a response to idealising transference is an interesting one; it seems counter-intuitive to meet positive feelings in an ill-disposed manner, particularly as therapists. It seems to me that the therapist who acts with hostility (and quite possibly those who act with defensiveness and rejection too) are likely to be chin-deep in countertransference without the first idea about it. After all, I think it unlikely that any therapist would say it’s okay to act in a hostile and rejecting way to a client expressing such feelings, so if it’s happening, something may well be occurring for the therapist outside of awareness.

My supervisor said to me recently “Awareness is key, and always in the service of the client”. With that in mind, I would say, awareness, reflection, robust scrutiny, and a crucial container for all of these processes: supervision, each have a role to play in managing our own responses to our clients’ feelings in a way that reduces the risk of adverse effects when transference and countertransference emerge in the therapy room.

I don’t think this is by any means a comprehensive exploration of this huge and under-researched area, however I have tried to touch on some of the ways in which we might work to mitigate harm and engage positively with this fascinating and valuable area of the relational dynamic.

5 thoughts on “When and how does Transference link to Harm in Therapy?”

  1. It’s always so comforting to read posts of therapists who are compassionate in the face of transference. That is what initially spurred me to rush into my new therapist’s office 3 months ago and disclose my feelings in dramatic fashion, while also having the insight in hand to recognize where and who I’d felt these same pinings for from my past. I’ve run the gamut since then, and I haven’t felt that my therapist is completely comfortable with transference. I’ve found it so helpful to simply open up about my feelings, often providing it in writing, which I admit was quite salacious at one point, but they’ve begun to tell me they won’t likely read my writing anymore despite me heavily editing what I convey and always making clear it’s in regards to someone else. They had been giving me extra time when they couldn’t lower the fee, but twice they’ve retracted that suddenly where I’ve shown up and a bunch of reasons (but not any of their own feelings!) came out of their mouth. They previously replaced the time with small notes as a reassurance that I wasn’t about to be abandoned, then retracted those, too. A few weeks ago I tried to express that I had been feeling genuine connection which had been scaring me more than the transference and it was a disaster because I used the word ‘attachment’ to describe my ‘feelings’ instead and they replied, ‘attachment isn’t a feeling’ so for once I went and tried to use transference to deny my feelings, this time with regards to the real relationship between us as therapist and client; did I mention it was a DISASTER? Ugh. Now I’ve been told that their supervisor is telling them to keep the boundaries strict with me because feelings like mine are ‘difficult’. I’m feeling so hurt, and it didn’t help that when I said I hadn’t felt anything erotic for awhile in response to that they replied in a complimentative way; it just made me feel like I should hide those types of feelings if they occur again because not only am I getting the sense that punitive boundaries are being put in place, but that some emotions aren’t okay given the context.

    How would you approach this, because at this point I’m angry that my therapist seems to be back and forth and I want them to know it’s frustrating and confusing me. I get the sense that they are more uncomfortable dealing with this than even myself (as they’ve admitted this is a first for them), while they are wanting to be empathic, and yet I get the sense that their supervisor may not be the most understanding of transferential feelings themselves. I haven’t done anything to cross boundaries with my therapist, and all along I’ve come in going, “Look! Now I’m feeling this ‘towards you’, but it’s really this relationship that I’m remembering!” It’s been so enlightening and fascinating for me while simultaneously unexpected and overwhelming, but part of me wishes I’d kept it to myself because I feel like I’m getting ‘special treatment’ and not in a good way.

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  2. Hi, I’m really sorry to read about the difficulties you are having in your therapy. It is troubling to read that boundaries appear to have been extended then retracted multiple times, and this must be very confusing and distressing for you. I don’t have any specific advice for you; I think it would be wrong for me to assume to know the best way you could handle the situation, however I do want to say that your feelings are normal, okay and in reality, you should feel able to bring them to therapy without fear of being shamed, having your feelings judged, or feeling like some sort of special case who needs to be treated differently to other clients. Your therapist’s discomfort is a reflection on their limitations, and not a reflection on you. This is aimed at practitioners, but you might find it helpful to watch – this is a video of Dr Dawn Devereux, a leading practitioner in this field, discussing how transference and complex feelings in the relationship might helpfully be responded to by the therapist. http://www.theprofessionalpractitioner.net/index.php/cpd-activities/47-cpd-video-therapist-dawn-deveraux . I really hope you are able to find a positive resolution to the difficulties you have described here.

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    1. Thanks Erin. I watched the video. I have a bit of a conflict with what she says about not taking on clients who she deems highly likely to develop ‘AIT’ when she originally defines AIT as her rewording of erotic transference. Maybe I’m misunderstanding something, but that’s confusing when she then goes on to talk about how one shouldn’t just terminate therapy either if AIT develops. She didn’t say much about managing it but I do appreciate that she suggested using it collaboratively and helpfully; I agree with that because I think it can be used very therapeutically without licenses and ethics being at risk.

      In some ways I relate to what she described, but in other ways I don’t. For instance, I practically wanted to describe my experience early on as ‘spiritual transference’, but months later as I traversed the gamut (pos/neg, ero/parental transference) my therapist admitted that he was confused because I don’t ask him anything, as I’m by no means obsessed with finding out about his life. I’m just very hurt that the expression of my ET has seemingly had a backlash.

      I’ve read up a lot on ET for my own understanding, and it’s often the case that school settings do not provide enough information, that supervisors can often be shaming and blaming of the therapist [which in some ways this video did the same near the end] and it just frustrates me that I might be experiencing this negative view through my own therapy. I know the things I’ve felt transferentially have been associated with previous experiences – heck, I’ve realized that’s exactly how all of my intimate relationships go – so for me it’s been very eye-opening to be able to verbalize it and recognize it within what should be the safe confines of my therapist’s office. It’s just been disappointing that – however inadvertently or under the strict guidance of a supervisor who expects the worst – their follow-up actions have been damaging. In that way, it’s not the feelings (AIT/ET) that have been damaging, it’s the mismanagement of responses to the feelings that have been damaging, however unintentionally. All along my focus has been on wanting to examine these feelings, where they came from, and what they mean – even symbolically a la Jung if you will – and to find out how to live more in the here-and-now than in the past through transference, because it was only through experiencing AIT/ET towards my therapist that I gained the awareness that what was on the surface was not the reality. I’ve realized that every time my emotions are so excessively strong that they overpower me, there’s a transferential aspect at play in all of my relationships! Which isn’t to say that what I’m experiencing presently doesn’t have a real aspect to it, but it means there’s something worth looking at in that experience to question my own intensity. I suppose if this all goes up in flames, I’ve at least gained that.

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  3. Actually, I too questioned the idea of not taking on clients who seem highly likely to develop AIT. I think if you have the experience and knowledge to manage your responses and to work with it effectively it’s really important for clients to experience their feelings being met in a therapeutic way, especially if they have had difficulties in past therapeutic relationships. Certainly that has proven true for me as a client. And I am sure I would have fallen into the category of “highly likely to develop AIT”. What you are saying about the intensity of the feelings providing clues to their historical origins resonates strongly with me. I think it’s impossible to completely unweave where here-and-now feelings end and transference/countertransference begins with regard to feelings between a therapist and client, however I think being mindful of those clues is really helpful. I often describe a process of being in your feelings whilst also bearing witness to them, and an oscillation between those different ways of being in the relationship. Of course, collaboration between therapist and client is key to this, and it’s unsurprising that the response you have received is a bigger source of pain for you then the feelings themselves. I am impressed by your own ‘inner witness’ who seems determined to gain therapeutic growth from the situation, with or without appropriate collaboration from your therapist. This is a great strength I think, and I have a hunch that you will gain learning and growth from the experiences you have with transference, whether in this therapeutic relationship or beyond.

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    1. Exactly. My therapist has become my proverbial mirror, and I’ve felt enough connection and trust with them to share that. It’s perturbed me that I feel like I don’t know if I’m coming or going with them though [I last dreamt therapy was at an airport!].

      For what it’s worth, and as over-simplified as it might seem, I have been able to continuously work myself out of one transference, and unexpectedly find myself in another one by simply asking, “Who or what situation made me feel like this before?” while recognizing 5 or so emotions/experiences within myself. It’s crazy how mirrored the experience has been with regards to something my therapist said being relative to someone from my past saying similar things, or my perception of their actions coinciding with another person’s past actions. I totally *get it* but I was hoping my therapist would then provide me with the tools to work through those associations, but that’s where I’m stuck as the complex-aspects have shown themselves through my transference, and I describe those as the ‘sticky bits’; I am of the belief that our complexes trigger transferences, in and out of a therapeutic environment. In having awareness of this happening for myself it is very much “a process of being in your feelings whilst also bearing witness to them,” as you said, but then what does one do with that? Because so-far half the relief has definitely come from expressing the transference as it is [if I ignore the fact that there seems to be a negative reaction from my therapist over time], but realigning my beliefs/interpretations of others’ motives/actions/feelings/thoughts/incentives, etc. is the complex area where I’m seeking help through therapy.

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