Transference and Countertransference

Transference is a psychoanalytic term where old personal feelings, attitudes, desires, or fantasies are displaced and projected onto the analyst.  Countertransference is its’ counterpart where the analyst displaces and projects old personal feelings onto the patient.  These terms are shorthand for a common experience where someone reminds you so much of another person from your past that you treat them like that person. The only difference between the two terms is which side of the fence you are sitting on, the analyst or patient, or the giver or recipient. 

The apparent reason for transference and countertransference is that we unconsciously look for patterns to help make our world more predictable.  The patterns we know are often limited, so we apply it even when it doesn’t fit. Abraham Maslow, a famous 20^th century psychologist, noted “If the only tool you have is a hammer, you tend to see every problem as a nail.” 

When you see transference it gives you insight into how the person thinks, but that doesn’t make the association true. The person is still not really someone from your past. Ordinarily, we ignore these patterns, for example, if someone likes you because you remind him of his brother, what harm is it? However, when transference or countertransference starts to interfere with relationships and actions, it has to be addressed.  

The Danger of Being Blind to Transference or Countertransference

2/12/24 Speaker of the House of Representatives Mike Johnson revealed at an NACL (National Association of Christian Lawmakers) gala that he heard directly from God in his prayers and that he was like Aaron in the Book of Exodus (Chapter 14) and needed to step forward and forge a path through the rolling sea. A path only he could see, and men could not see.   Really?

A Jesuit Catholic Priest, author and consultant to the Vatican was in attendance.  He wrote in disbelief, “A good spiritual director will tell you that insights you feel are coming from God, which are usually subtle, must be carefully tested and weighed.” 

With the Mike Johnson example, anyone who is not an avid Evangelical Christian becomes the embodiment of his thoughts and beliefs that outsiders are not to be trusted or listened to. He projects his negative feelings onto all non-evangelicals without knowing anything about them. This is an example of negative transference. It seems so real to him that he is blind to any other the possibility.

To become more reasonable, he has to see the signs that he might be wrong and try to change. If he thought about it, God has already given him a clear sign. He doesn’t even represent the beliefs of half of the Christians in America. Christians represent 63% of all Americans. Protestants represent about 40% of Christians, and Evangelicals represent about half of Protestant churches. The rest are Catholics, Anglicans, and Eastern Orthodox churces in America who who don’t agree with the Evangelical view. The second sign is egoism or self-aggrandizement. (This is not a valued Christian trait.) It seems to be the height of arrogance and conceit to compare oneself to Arron, a patron saint to Christians, or to feel he alone knows the word of God.  

How Can You See Bias When You Don’t Know It’s There 

Even though we are not conscious of transference, as the Mike Johnson example shows, there are signs when it is present. If it is a negative transference, one clearly shows negative bias, and are unable to feel empathy, or are angry or indifferent. A Brazilian group looked at how therapists described feelings they had for patients who experienced a traumatic event on a scale called the Assessment of Countertransference Scale (ACS).  The scale was a questionnaire of 23 feelings that therapists may have about patients who experienced a trauma.  The patients had disorders like depression as well as ones that typically cause a negative bias, like personality disorders, substance abuse, or somatization (physical symptoms caused by emotional distress).  Generally, the people with disorders that cause negative bias caused higher countertransference scores in therapists. The main categories of countertransference responses were less feelings of closeness, higher rejection, and more indifference. 

Awareness (insight)   

Transference and countertransference interferes with realtionships. It distorts one’s view of others and it is hard to recognize it when it is happening. Testing for transference or countertransference is a conscious process.  First we need to look for signs of transference or countertransference. An example is feeling hatred for no reason or seeming irrational to others. (Table 1 – Signs). Second, we must avoid treating others in certain ways because they remind us of someone else.  

The next blog will describe motivational interviewing as a technique on how to have meaningful conversations that might help reduce these biases.