What Is Countertransference?: An Attempted Explanation

[This post was edited on 3/1/2016 because I forgot to insert reference information for the article I cited.]

Last February I wrote about the difference between two interesting but often confusing concepts: projection and transference. You can read my take on those concepts here. This February I'm writing about a real humdinger called ‘countertransference.’ Quite a mouthful, right? Based on the reading I've done over the past couple weeks, it seems that even the professionals vary in how they define this complex concept. Of course, that might just be because I lack proper academic perspective. Whatever the case, this is my attempt to explain what I (think I) have learned about countertransference.

One way to understand countertransference is to remember its number. What does that mean? In the post I mentioned above, I approached projection and transference the same way. There is a minimum of 2 people involved in projection, 3 people in transference. In countertransference, you most likely will have at least 4 people involved. The picture below illustrates this. There are 2 active participants (Me and Therapist) and 2 inactive and absent participants (My past person and Therapist's past person).

Just like with plain old transference, countertransference is a subconscious mind trick that takes a person from the past and brings them into the present. In a clinical context, it is the counselor who exhibits countertransference behavior in reaction to the client's transference behavior. How about a hypothetical example? Let's say that during one of my appointments my therapist says something to me that triggers a strong reaction and all of a sudden my mind causes me to see my therapist as my dad. So I am no longer talking to my therapist in the here and now. I am talking to/yelling at my dad in the there and then—that's transference. In response to my transference behavior, my therapist's mind is triggered and all of a sudden instead of seeing me, her client, she sees her child who is in need of a proper scolding. This is countertransference. [Important aside and personal note: My therapist has never scolded me as if I were her child. I work with an incredibly talented and professional counselor who does a great job of regulating her own emotional state despite my frequent emotion dysregulation. End personal note.] You can probably see where this initial exchange could snowball into an ugly mess instead of a productive therapy session. Good thing this is merely hypothetical!

A great way to visualize transference and countertransference is by picturing a pendulum swinging back and forth. Hence the balls and strings in the picture above. One article I read about countertransference spoke of it as “the emotional pendulum effect that starts with the client’s natural transference behaviors” (Jackson, 2002). Imagine yourself taking your emotional weight from the past and letting it fly towards your therapist. If he isn't prepared to encounter transference behavior, he may react with his own emotional weight and swing it towards you.

Just like with transference, countertransference isn't always negative and isn't limited to the clinical setting. We all wear both hats on different occasions. From an everyday human being's perspective I think it is helpful to understand to some degree what countertransference is. Sometimes it is easy to forget that everyone comes with their own emotional baggage. But when we all see each other for who we really are and not so-and-so from the past, then we are able to adapt and learn and heal and grow in our current relationships and life situations.

Quoted source:
Jackson, K. C. (2002). Counselling transference / countertransference issues. ContactPoint Bulletin (Winter 2002). Retrieved from https://contactpoint.ca/2013/01/counselling-transference-countertransference-issues/

Reflecting on Inside Out

Yesterday afternoon I went to see Disney•Pixar's newest feature, Inside Out. I've been anticipating this movie's release for the past several weeks, and I was not disappointed. It's an ambitious undertaking to personify human emotions in a movie palatable and entertaining for children and adults alike. But Disney•Pixar didn't stop there. They incorporated several other mental processes into the storyline as well: Abstract thought, Dreaming, and Long-term memory, just to name a few.

Accurately and thoroughly depicting all of these processes and concepts isn't the main purpose of the film. So I'm sure there are neuropsychologists and -scientists out there who can poke holes in some of the finer points of the plot. But, in my opinion, the filmmakers did an incredible job of creating visual representations of these processes in a complex story about a complex subject: the human mind. And WOW, is it visually stunning! Ever wonder what a train of thought looks like? Ever picture different aspects of your personality? Ever imagine how big a storage facility would need to be to contain all of your memories? The human mind is an impressive structure and the Disney•Pixar team illustrates this in clever and interesting ways.

In addition to the intriguing story and impressive visuals, the cast of actors who voiced the emotion characters was well selected. Who embodies Joy better than Amy Poehler, who formerly played perennial optimist Leslie Knope in the TV show Parks and Recreation? Who better to voice Disgust than Mindy Kaling (Kelly Kapoor, the workplace snob) and who better to voice Sadness than Phyllis Smith (Phyllis Lapin/Vance, the workplace sulk) from The Office (U.S. version)? While not as familiar with the male members of the emotion crew, I think they were equally well cast. Fear is played by Bill Hader who I know mainly from voicing the bumbling criminal Mickey in the TV show Bob's Burgers. Anger is voiced by Lewis Black, an actor I am unfamiliar with but who handles Anger quite well.

This movie made me think about how I experience my own emotions and how my emotions sometimes end up controlling my behavior. Like the human characters in the film, I sometimes have emotions behind the control panel, pushing my buttons and causing me to behave in ways that I regret later on. It also made me think about how I am not the only one who has these certain emotions. Everyone around me experiences the same emotions that I do, and their emotions probably influence their behavior in negative ways sometimes as well. That realization alone can help me have greater empathy for those who may act unpleasantly towards me or others.

There were a couple plot points that hit me pretty hard. Like the main (human) character in the film, my family also moved away from my hometown when I was in my preteen years. It was very hard. I didn't even pretend to like it. Once school started I was around complete strangers. I teared up during my speech class once when I gave a brief speech involving my hometown. I was very angry for a long time. And while Anger is perfectly valid and useful, it doesn't always make the best decisions.

Speaking of poor decisions, the worst decision the main (human) character made occurred when her emotions no longer had any influence on her. She became numb and this enabled her to take extreme action. I can relate to this in that I struggle with addiction particularly when I am numb. If I don't feel, then I don't care. And if I don't care, then I do things I wouldn't normally do and that I regret once my emotions are back online.

In my first post about Inside Out I noted the interplay between emotion and behavior. There is a third strand in this story; this strand is called memory. Sound familiar? Probably. These three strands interweave throughout the film and are tied together at the end when we realize the purpose of the most unpopular emotion character: Sadness. As it turns out, Sadness is every bit as important and valuable as the other emotions in the film. And therein lies the lesson. All of our emotions are helpful and worth experiencing, even if they aren't always fun or enjoyable. Emotions color our experiential memories and add greater meaning to our lives.

Can you think of a better reason to be Joyful?! #InsideOut is in theatres now! Get tix: http://t.co/PB12jeplmS pic.twitter.com/7YI6KaciX5

— #InsideOut (@PixarInsideOut) June 19, 2015

Transference vs. Projection: What's the Difference?

A couple months ago, I got angry at my therapist. She hadn't done anything to hurt me or offend me or provoke me. I was just mad. So I sent her an email, explaining all the “reasons” why I was angry at her. I clustered those reasons into five paragraphs, all of which started with “I'm angry because….” My therapist sent a kind email in response, thanking me for sending that email to her and assuring me that what I said made sense. When I showed up for my appointment the following week, the first thing she wanted to talk about was that email. She reiterated that the feelings I was having made sense and there was even a word for what I was experiencing. “It's called transference,” she said. Ooooooohhhhhhhh…. That thing. I've heard of that.

Transference. I think a lot of people have heard that term before. For some reason I always confuse that word with another fun psych buzzword: projection. And judging from a brief initial web surfing excursion, I think a lot of people confuse the two. To help me get a firmer grasp on what these terms mean, I read through several seemingly trustworthy web pages about psychology written by psychologists, psychiatrists, and licensed counselors. This is my understanding of transference and projection based on my reading.

Transference takes place when someone transfers another person's qualities, feelings, behaviors, etc., to a different person and then reacts to the different person as if he/she were the other person. (Well said. Or not so much.) Let's try it this way. It takes at least three people to have a transference scenario. So we have three people: I/Me, Present Person, and Past Person. I used to be around Past Person a lot and she always got impatient with Me when I asked questions, so after a while I feared asking her questions because I didn't like being yelled at. Now I hang around Present Person a lot and because I anticipate her becoming impatient just like Past Person, I am afraid to ask Present Person questions for fear she will also yell at me. In a sense, transference is like looking at a person but seeing someone else. The image below depicts a specific instance of transference I experience with my therapist due to previous interactions with my dad.

So even though my therapist is not my dad, and even in my most confused of states I know she's not my dad (the fact that she's female kind of gives that away), I behave as if she is. Because I anticipate her laughing at me if I exhibit emotion around her, I avoid experiencing feelings when I am in her office. This is not the most helpful of things for a person in therapy to do, but at least now I understand that I do it for a reason.

Projection is less complex, in my humble opinion. Projection happens when a person projects their own qualities, feelings, behaviors, etc., onto another person. Whereas transference takes three people, projection only requires two: This time we have I and Other Person. I woke up on the wrong side of the bed and have been a grouchy wretch all day. After an encounter with Other Person, I walk away irritated, complaining to myself about Other Person's grouchiness. The classic example, right? You are acutely aware of the horrible qualities, behaviors, attitudes, etc., of that super-annoying person next to you, only to be informed that it is you who have the horribleness. When you look at that person, you don't see that person, you see you! Horror of all horrors! The image below depicts a possible instance of projection in therapy. [NOTE: I'm not really bitter. I just couldn't think of any of my bad qualities because I'm by myself and I have no one to project them onto right now. Clever, huh?]

To manage something effectively, I think you need a basic understanding of what it is you're trying to manage. With my basic understanding of transference and projection, I'm going to try to take note of when I am experiencing these things and learn how to see people for who they are.

Learning About Your Attachment Style

Faculty and doctoral candidates at the University of Illinois at Urbana-Champaign are conducting research on attachment, particularly adult attachment. In my amateur research on attachment theory (meaning when I googled it), I came across two websites managed by some of the university's researchers that host or link to attachment-related and personality quizzes/questionnaires: http://www.yourPersonality.net/, maintained by Associate Professor R. Chris Fraley, and http://www.personalityassessor.com, maintained by doctoral candidate Nathan W. Hudson. Researchers are using these online questionnaires for the education of the quiz-taker as well as for collecting information to further their research. (See http://www.yourPersonality.net/about.htm and http://www.personalityassessor.com/about for more specifics.) If you are at all interested in attachment theory or personality assessments, I highly recommend these websites. Both provide informative quiz results that can help you understand more about yourself and how you relate to others in the context of attachment theory. Below are summaries of a few quiz results I received.

From http://www.yourPersonality.net/:

Relationship Structures

This quiz asks questions about four significant relationships in a person's life. Results are plotted on a coordinate grid, placing the quiz-taker in one of four broad attachment categories. All of my results land unquestionably in the “dismissing” area of the graph.

Close Relationships Questionnaire [ECR-R Attachment Style Questionnaire]

This quiz asks questions about your experience in “intimate” relationships, focusing on romantic relationships. The result is plotted on a grid, similar to the results in the Relationship Structures quiz, again placing the quiz-taker in one of the four attachment categories. Not surprisingly, based on my results I have a dismissing attachment style.

From www.personalityassessor.com:

Your Attachment Network

This quiz allows you to choose four significant people in your life and asks you to identify your relationship to them. Several statements are presented and you are prompted to respond in regard to the various relationships you selected. Your results for each relationship are broken down into three general categories: 1) Usage as Attachment Figure, 2) Attachment Anxiety, and 3) Attachment Avoidance. Your attachment style is provided for each relationship as well. To top it all off, your overall levels of Attachment Anxiety and Attachment Avoidance are plotted in comparison to the results of others who have taken the quiz. Once again, my results state that I exhibit a dismissing attachment style. My overall anxiety and avoidance ratings appear below.

I find these websites extremely helpful in learning about and better understanding my attachment pattern/style. This awareness has helped me process a bit more of the distressing aspects in past relationships as well as understanding my struggles in present relationships. Yes, I am insecure in relationships. Yes, I use avoidance tactics to cope with distress. No, it doesn't always have to be this way.

Attachment Theory: The Basics

Attachment is a concept my therapist has discussed with me at various times in regard to my relationship with my parents. Being the amateur scholar I am, I have read a bit about attachment theory to better understand and see if aspects of it fit my past experience. Below is a conjoined summary of the following sources:

• Allen, J. G. (2005). Attachment. Coping With Trauma: Hope Through Understanding (5th ed., pp. 25–41). Arlington, VA: American Psychiatric Publishing, Inc.
• Fraley, R. C. (2010). A Brief Overview of Adult Attachment Theory and Research. Retrieved from https://internal.psychology.illinois.edu/~rcfraley/attachment.htm

Beginnings of Attachment Theory and Research: Infant Attachment Patterns

Attachment theory was developed by British psychoanalyst John Bowlby in the 1950s. Bowlby developed the theory after observing the separation of infants from their parents. He noted that it is common for infants to try very hard to prevent separation from parents, and, if separated, to try to regain proximity to the absent parents. Bowlby posited that the attachment behavioral system is a product of natural selection that developed because throughout the ages babies who stayed close to their parents, or attachment figures, had a better chance for survival. [Personal note: As a believer in God and His creation of the world and all that is in it, I disagree with Bowlby's assumption that attachment is a product of natural selection; I do, however, agree with the notion that attachment is rooted in human biology. End personal note.]

Attachment serves three basic purposes: 1) It provides a safe haven. 2) It provides a secure base. 3) It regulates physiological arousal.

1. The safe haven is a real and felt entity, providing both physical and emotional safety. It is a “place” where a child can be safe and feel safe.
2. The secure base provides a stable shelter from which a child can venture with confidence and explore the larger environment.
3. The regulation of physiological arousal a child experiences when comforted by a responsive parent promotes his ability to self-regulate and self-soothe on an emotional and physiological level.

Mary Ainsworth's famous “Strange Situation” experiment led to the categorization of relational behaviors into attachment patterns. In the Strange Situation study, 12-month-old infants were observed with mothers, when separated from mothers, and when reunited with mothers. Ainsworth found that there are three distinct attachment patterns in infants: 1) secure; 2) anxious-resistant, an insecure pattern; and 3) avoidant, another insecure pattern.

1. Secure infants are noticeably upset when separated from their mothers and readily welcome contact and comfort when reunited with their mothers.
2. Anxious-resistant infants experience high levels of distress when separated from their mothers but seem conflicted when reunited with their mothers; they seem to desire comfort but they also defiantly resist being comforted.
3. Avoidant infants do not seem very disturbed when separated from their mothers and attempt to avoid their mothers or avert their attention to other things when reunited with their mothers.

Current Attachment Research: Infant and Adult Attachment Patterns

In recent decades, researchers began to study attachment in adults, widening the scope of attachment to relationships other than the parent-child relationship. Research findings authored by Brennan, Clark, and Shaver (1998) iterate that there are two dimensions of adult attachment patterns: anxiety and avoidance. These dimensions recall aspects of Ainsworth's insecure infant attachment patterns.

Researchers have also continued to study infant attachment. Replications and descendants of Ainsworth's Strange Situation repeatedly revealed the need for a fourth category of infant attachment, so the disorganized attachment pattern was added to the three existing categories. The four infant attachment patterns have counterparts in the four adult attachment patterns.

Though there are clearly defined and widely recognized categories of attachment, attachment is, as Allen puts it, “somewhat fluid” (p. 41). Most people have multiple attachment figures throughout the course of their lives. It is possible to have different attachment patterns with different attachment figures. It is also possible for attachment patterns with one attachment figure to change over time. Though these possibilities exist, according to Fraley (2010), the factors that promote change in an individual's attachment patterns are not clearly understood and remain an important area of future research.

Frustrated and Confused… and Maybe That's OK

The last few weeks have been frustrating and confusing. The focus of my therapy sessions the past couple months has been the things I learned as a young child through my interactions with and observations of my parents and, to a lesser extent, the church community. As a child I interpreted these interactions and observations and developed some of the attitudes, beliefs, and thoughts about myself and others that influence how I view myself and others today (psychology vocab term: internal working models). My observing, interacting, and interpreting carried on into adolescence… and that's where the interpreting at least seemed to freeze in the context of a bad dating relationship.

What's frustrating and confusing about all this is that my various attitudes, beliefs, thoughts, etc., don't fit together; in a lot of ways they flat out contradict each other (psychology vocab term: cognitive dissonance). My therapist framed it this way last week:

Part of you feels that you want these things. That's the Child part, the part that says, “I want this” or “I like this” or “I don't like this.” Then there's another part of you that says you don't need those things, those things are bad. That's the Parent part. The Parent part is doing what it knows to do to protect you.

Part of my assignment for this week's session is pictured below. My therapist says the Parent part is trying to protect. I say the Parent part is being a jerk. Oddly enough, I identify myself with the Parent part and disown the Child part.

Borrowing the Parent-Adult-Child ego state concept from the Transactional Analysis school of thought helps me to understand a little better what is going on in my brain now and what's probably been going on in my brain for 20-some-odd years. It has been my (subconscious?) strategy to beat down the Child thoughts and squelch those little stirrings of humanness and vulnerability with the Parent's dismissive beliefs and attitudes.

I am still really confused about all this and that confusion is what frustrates me so much. What do we do now? How can we correct some of my thoughts, attitudes, and beliefs if those are the lenses I've been looking through as long as I can remember? Won't that change everything about me and how I interact with people? How will I know who I am? Is this even possible?

I think it is OK to feel this way because I am allowing myself to question where we are going next (anticipating movement rather than stasis) and because, for once, I am emotionally engaging in a part of my therapy.

Cognitive Restructuring: Letter to My (Baby) Self

Hey, little baby [J],

The first letter I wrote to you was really mean. [My therapist] wanted me to rewrite that letter. At first I didn't think I could do it but then some verses from the Bible popped into my head. Here they are:

“Even if my father and mother abandon me, the Lord will take care of me.” (Psalm 27:10)

A lot of the time it will sort of feel like Mom and Dad aren't really there with you. You will always have enough to eat and drink, and you will always have shoes on your feet and clothes to wear. (Don't worry. You won't always have to wear those frilly dresses.) You will get your teeth brushed, your diapers changed, your hair and body washed. Mom and Dad will make sure of all those things. But once you have 2 or 3 siblings, Mom and Dad won't really hug you or play with you. There are going to be lots of babies in your family and that will be a lot of fun. The babies will get Mom and Dad's hugs and attention. And you might not realize it for a long time, but you will get overlooked and accidentally ignored. And that won't feel good. You won't develop strong, positive attachments to either one of your parents. And a lot of times you will feel empty and alone. But you and I both need to believe that God is able to be there for you and me in ways that Mom and Dad can't be. And that is true for everyone because moms and dads aren't perfect. When you feel alone or forsaken, believe that God still wants to take care of you.

“I was placed in your care from birth. From my mother's womb you have been my God. Do not be so far away from me. Trouble is near, and there is no one to help.” (Psalm 22:10–11)

You are very blessed because your family goes to church and you hear about God. And even though you will wrestle with and question your belief in Him, you will find that God is the only real answer. Around the time you become firm in your belief, there will be a lot of scary and difficult things going on. Your family will have moved to a place where you don't know anybody, and you will not get to go to school with your friends from church. You will go to a very different school and a different church. You will no longer be taught about God by your friends' parents or your relatives or other adults you've known for a long time. You will sit by a boy in school who dies in a car accident. And you will be in a scary and sinful relationship with a boy who was also one of your first friends at your new school. You'll probably notice it then but as the years pass you'll realize it even more: You need help. But you don't know how or who to ask. These situations are too heavy to handle alone. So at night you will pray to God because that is all you can think to do. And you will pray, asking God to hear you even though you have doubted His existence, you continually sin against Him, and you have not committed yourself to following Him. And I do believe He heard you and pulled you out of the relationship you were in. When you didn't know who to go to for help, you went to God. Don't ever stop going to God for help.

“Listen to me, descendants of Jacob, the few people left of the nation of Israel. I've carried you since your birth. I've taken care of you from the time you were born. Even when you're old, I'll take care of you. Even when your hair turns gray, I'll support you. I made you and will continue to care for you. I'll support you and save you.” (Isa 46:3–4)

These verses are from God to His children. No matter how old you get, you will still be God's child. Even after you outgrow your cuteness and you lose your innocence, God will still pick you up and carry you. Even if you live long enough to earn gray hairs, God will still be willing and able to carry you just like your parents did when you were too young to crawl or walk or scoot on your own.

I know you don't feel these things, and neither do I, really, but we both need to believe these things. Maybe in time the feeling will match the faith. It is the faith that matters most, and that is our choice.

J

Scripture is taken from GOD'S WORD®. Copyright 1995 God's Word to the Nations. Used by permission of Baker Publishing Group. All rights reserved.

In the acknowledgment above, fair use constitutes permission. See http://bakerpublishinggroup.com/rights-permissions/permission for information on Licensing and Permissions.

Symptoms of PTSD: Avoidance (Part 3)

All quotes below are from the following Open Access sources and are solely intended for the education of the reader:

1. Norrholm, S. D., & Jovanovic, T. (2010). Tailoring therapeutic strategies for treating posttraumatic stress disorder symptom clusters. Neuropsychiatric Disease and Treatment, 6, 517–532.
2. Brousse, G., Arnaud, B., Roger, J. D., Geneste, J., Bourguet, D., Zaplana, F., … Jehel, L. 2011. Management of Traumatic Events: Influence of Emotion-Centered Coping Strategies on the Occurrence of Dissociation and Post-Traumatic Stress Disorder. Neuropsychiatric Disease and Treatment, 7, 127–133.

As described by Friedman [2006], exposure to a traumatic event … can produce a robust emotional response…, and this association can lead to PTSD avoidance symptoms…. (1)

Emotion-centered coping is an attempt to manage the emotional responses induced by the situation…. Numerous strategies belong to this category, including substance abuse, physical activity, expression of emotions, feeling of responsibility, minimization of the event, alteration, denial or avoidance of reality, hoping for a miracle, and use of the imagination. Among all these emotional behaviors, avoidance of the event seems to particularly influence evolution to PTSD, suggesting that emotion-centered strategies (avoidance, flight, denial, or self-accusation) may lead to more negative outcomes after a traumatic event…. (2)

One of the earliest theories proposed to explain avoidance behavior is Mowrer's 2-factor theory [Mowrer, 1960; Levis, 1981], which posits that escape of a fear-conditioned stimulus negatively reinforces avoidance behavior, thereby maintaining fear responses. Applied to PTSD, this theory suggests that avoidance of reminders of the trauma can maintain the disorder by preventing extinction of the original fear associations. (1)

One problem with avoidance is that it keeps you stuck. I think a lot of us construct walls of sorts to keep out the things we'd rather not see, hear, or think about. Certainly avoidance does have its place in preserving our safety and well-being, but when avoidance becomes crippling it is not healthy. And, evidently, scientific inquiry has led us to the conclusion that avoidance of (perceived) fearful things only strengthens the fear association in our brains. I don't know that there is a way to shut off the fear. But I do know that avoidance is only one way to handle it. Several other options exist. I know I have not explored those options enough. I am slowly getting there.

If you struggle with avoidance as well, please be assured that there are other methods of coping. Help is out there. We need to peek over the wall long enough to spot it.