PTSD ~ Transference & Countertransference in Therapy

As the daughter of a narcissistic mother, who was seldom validated, shown empathy or only criticized and felt worthless, I began therapy and suddenly this outsider (therapist) was appreciating me as a person.  This was positive ‘transference’ in my situation.

I felt I mattered; someone thought I was worth taking the time to listen to and not disregard, nor snap back with vicious words or interrupt me.  She was validating what I had to say, and it was it was comforting not to feel like a loser or a failure finally.

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 newlyweds 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 girlfriend 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.

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