Managing Transference and Countertransference in Patient Care and Treatment: Therapist Self-Care 

While often seen as an obstacle to be eliminated, countertransference is present in every therapeutic relationship. Additionally, your reactions to your patient can often provide valuable insight into the reactions the patient might elicit in people around them. However, it's important that you distinguish your countertransference from the patient's transference about unresolved problems. You can often do this through self-acknowledgment, supervision, and minimizing your "blind spots."

Self-reflection is integral to your role as a therapist, and, as such, it's best not to underestimate your reactions to your patients but rather address and deal with them in an honest way. The therapeutic process benefits when therapists engage in ongoing reflection about their emotional reactions and seek regular feedback from supervisors and peers.

Strategies to gain self-awareness and manage countertransference include:

• Mindfulness: As a therapist, you are subjected to your own feeling states during sessions, both emotional and physical. The more feelings you can tolerate from yourself, the more you can contain and hold your patients' unacceptable feelings. This means letting yourself feel anger, jealousy, love, sadness and other feelings that might occur in a session. Mindfulness techniques help you become more present and aware of your emotional responses. If you can allow yourself to experience and accept your feelings, you will become a more present therapist and gain tools to provide better care to your patients.
• Guided imagery: Guided imagery can help therapists gain emotion regulation and manage countertransference. This involves imagery rescripting, or addressing specific memories of past experiences associated with present problems. In the technique, a supervisor may ask you to recall an aversive experience and to rescript an imagined change in the memory of that experience. For example, a childhood memory of being bullied or rejected might be modified by imagining an older peer entering the situation and inviting the person to play.
• Role-playing: In role-playing, a supervisor might ask you to describe a specific therapy situation where you felt powerful positive or negative emotions. You then become the patient as the supervisor plays the behaviors you described, allowing you to assess how you feel and what you learned as the patient. From there, you change roles so you can understand the situation from both sides. Your supervisor will then ask you about situations where similar emotions were experienced, with whom it happened and what you felt toward that person. This allows you to come up with a way to address countertransference and replay the situations in new ways that would be beneficial in real sessions with a patient.

When handled appropriately, countertransference can help you gain insight into your reactions and understand your patient's experiences. Through supervision, self-reflection and consultation, you can use your emotional responses to enhance empathy, improve communication and strengthen the therapeutic relationship. Understanding countertransference in therapy allows you to turn potential obstacles into valuable resources for treatment.

Ultimately, the key involves being aware of your countertransference reactions, reflecting on them consciously and using them to inform your clinical work positively. This process requires ongoing attention throughout therapy sessions and regular discussion with your supervisor.

Note that if you are having trouble managing countertransference and have taken steps to mitigate it already, always put the patient first. If you feel like they could benefit, you might refer your client out to a provider who is better prepared to engage with them. This ethical consideration protects both the therapist and patient and maintains the integrity of the therapeutic process.