TRANSFERENCE AND COUNTERTRANSFERENCE

C. H. PATTERSON

(Chapter 9 in Counseling and Psychotherapy: Theory and Practice. New York: Harper & Row,
1959)

As rapport is an overworked word with counselors, so is transference among psychotherapists.

Indeed, the indiscriminate use of these terms has led to their being considered to be, to some
extent at least, synonymous. In this indiscriminate use of the term, transference is applied to the
total relationship between the therapist and client. This total relationship is, however, sometimes
referred to as "analytic rapport," to distinguish it from transference.

The varied use of transference is the result of differing opinions, or disagreement, as to what it
really is. French (2, p. 73) writes that "there is a good deal of confusion as to what transference
really means." Macalpine (32), in a comprehensive discussion, states that "there are no clear-cut
definitions and many differences of opinion as to what transference is." She suggests that
"transference is not fully understood; if it were, it could be stated simply and clearly."

In this chapter it is our purpose to describe the phenomenon of transference as it has developed
in psychoanalysis, and to relate it to certain psychological concepts. Its significance in the client-
centered approach to counseling and psychotherapy will then be considered, and a discussion of
countertransference will conclude the chapter.

THE NATURE OF TRANSFERENCE

The concept of transference owes its origin to Freud. Freud first became aware of the
relationship which he later described as transference when he was using the technique of
hypnosis with his patients. A female patient, upon awakening from the hypnotic trance, threw
her arms around him (17, pp. 47-48). Freud felt this to be "a false connection" to the person of
the analyst. Later he used the term "displacement of affect" to refer to this phenomenon.

Freud defined transference in various, though essentially similar, ways. In one place (18, p.
139) he states that transferences "are new editions or facsimiles of the tendencies and phantasies
which are aroused and made conscious during the progress of the analysis, but they have this
peculiarity, which is characteristic for their species, that they replace some earlier person by the
person of the physician. To put it another way: a whole series of psychological experiences are
revived, not as belonging to the past, but as applying to the person of the physician at the present
moment." Later definitions of other psychoanalysts are similar. Nunberg (38) states that
"transference may be said to be an attempt of the patient to revive and re-enact, in the analytic
situation and in relation to the analyst, situations and phantasies of his childhood." Lagache (29)
specifies the situations of childhood as parent-child relationships in his definition: “Transference
is generally defined as a repetition in present-day life, and particularly in the relationship to the
analyst, of various emotional attitudes developed during childhood within the family and
especially towards the parents." Hoffer (24) offers a somewhat more technical definition: “The
term 'transference' refers to the fact that people when entering into any form of object-
relationships and using objects around them for instinct gratification and for protection against
anxieties (as a defense) transfer upon their objects those images which they encountered in the
course of previous infantile experiences, and experienced with pleasure or learned to avoid
(pleasure-pain principle)." Finally, French (2, p. 73) stresses the inappropriateness of the patient's
behavior, stating that “by transference we mean an irrational repetition of the stereotyped reaction
patterns which have not been adjusted to conform to the present situation."

Transference, then, is not the total relationship between the analyst and the patient. It is only a
part of it, that part which is irrational, i.e., not justified by the nature of the objective situation, or
the actual behavior or personality of the analyst. The irrational reactions of the patient are
repetitions of reactions to earlier figures, especially to parents or parent surrogates, in the
patient's life. The repetition is usually “explained” by the concept of the repetition compulsion
postulated by Freud to explain behavior not in accordance with the pleasure principle. (Lagache
(29), recognizing the lack of explanation in the repetition compulsion, suggests that it is related
to the Zeigarnik effect, or the fact that interrupted tasks are better remembered, and taken up
again more actively, than completed tasks. Similarly, unresolved infantile conflicts are reopened
in the analytic relationship.) Affects and emotions, conflicts, attitudes, wishes, fantasies, and
ideas originally directed toward earlier significant figures are displaced onto, or transferred to,
the analyst.

While there are some analysts who would prefer a broader definition of transference, most
agree with the definition just given. Most would limit transference to the irrational behavior of
the patient toward the analyst. But recently there have been a number of analysts who have
raised a question about how much of the presumed irrational behavior is actually irrational. It
has usually been held that transference reactions are not related to the analytic situation or the
analyst's behavior, but arise spontaneously within the patient. Freud (17, p. 76) wrote: "It must
not be supposed, however, that transference is created by analysis and does not occur apart from
it. Transference is merely uncovered and isolated by analysis." Again, he states (16, p. 382) that
". . . we do not believe that the situation in the cure justifies the genesis of such feelings."
Ferenczi, Sandor, Rado, and others of the classical or orthodox analysts accepted this point of
view. Alexander (1, p. 46) states that transference behavior occurs "without the analyst's giving
any provocation."

The analyst has traditionally been considered as a mirror, a neutral, objective, anonymous
figure. In the last few years, however, it has become recognized that this conception of the
analyst cannot be maintained. Macalpine (32) was among the first to point this out. She regards
the transference as being induced from outside the patient, by the analytic situation and the
analyst's behavior. She notes that Freud himself once stated that the analyst “must recognize that
the patient's falling in love is induced by the analytic situation," though he never elaborated or
followed up this statement.
 Macalpine (32) specifies the elements of the analytic situation which create an infantile setting
and a threat to the patient to which the patient adapts by regression to an infantile state, which is
the transference. These features include: (1) the curtailment of the object world, by the use of the
couch, which limits vision, even leads to closing of the eyes, and requires an infantile posture; (2)
the constancy of the environment, which fosters fantasy; (3) the fixed routine which is
reminiscent of infantile care; (4) the lack of response from the analyst, which is a repetition of
infantile situations; (5) the interpretations on an infantile level; (6) the reduction of ego function
to a state intermediate between waking and sleeping; (7) the diminished personal responsibility in
the analytic sessions; (8) the elements of magic, infantile in nature, in the patient-physician
relationship; (9) the liberation of fantasy from conscious control in free association; (10) the
authority of the analyst inherent in the situation; (11) the disillusionment of the patient's
expectation that he will be dependent on and loved by the analyst, leading to regression; (12) the
inability to select and guide thoughts, a facet of infantile frustration; (13) the frustration of every
gratification by the analyst, leading to regression; (14) the resulting divorce from the reality
principle, and regression to the pleasure principle. These conditions cannot help but produce
regression to an infantile state. As Spitz (53) puts it, the patient is forced into the position of a
child. Waelder (56) points out that the patient is in the position of a child coming for help, and
that by exposing the most intimate aspects of his life he is put "in the position of the child that is
nude in the presence of adults" (see also Schmideberg [51]).

From this point of view, the transference is the patient's adaptation to a real situation, an
adaptation that demands regression to an infantile level. Macalpine (32) thus defines
transference as a “person's gradual adaptation by regression to the infantile analytic setting."

Transference, then, is the result of the nature of the analytic situation, and thus can be induced
or controlled by the behavior of the analyst. As Greenacre (21) states it, "The [transference]
relationship is an artificial one, arranged and maintained for the definite purpose of drawing the
neurotic reactions into sharp focus and reflecting them upon the analyst and the analytic
situation." Nevertheless, the patient contributes to the development of the transference by a
readiness and willingness to adapt to the analytic situation. He comes to the analyst for help,
thus placing himself in the hands of the analyst, accepting a dependent position. Moreover, he
regresses easily because, presumably, the origins of his conflicts lie back in the infantile
experiences.

If the transference is induced, or at least fostered, by the analytic situation, then it would appear
that it could be controlled, or even avoided, by the therapist. This is essentially the approach of
Alexander and French (2) in their brief psychoanalytic therapy. Transference, in the technical
psychoanalytic sense which has been discussed above, is not inevitable in psychotherapy, and
may be undesirable in many cases. Alexander and French agree that it is possible for a patient to
find permanent relief from symptoms by using the therapeutic relationship in a rational, realistic
way. Transference is avoided, or controlled, by decreasing the patient's dependence on the
therapist--less frequent interviews is one way which they suggest. Other ways presumably would
include dispensing with the couch, having the patient face the therapist, keeping interpretations
on a current level, abandoning the technique of free association, etc. One of the techniques of
Alexander and French is for the therapist not only to avoid being a blank screen to whom the
patient transfers attitudes and feelings, but to have the therapist take an active role, in which he
behaves toward the patient in a way opposite from the way the father, or other authority or
traumatic figure, treated him. Presumably, however, such a situation, while it may be
psychoanalytic therapy (since it is based on psychoanalytic dynamics or personality theory), is
not psychoanalysis (1, p. 161). The main work of psychoanalysis is considered to be the analysis
of the transference. Zetzel (62) suggests that in spite of differences of opinion regarding
transference, "analysis of the infantile oedipal situation in the setting of a genuine transference
neurosis is still considered a primary goal of psychoanalytic procedure. An essential difference
between analysis and other methods of therapy depends on whether or not interpretation of
transference is an integral feature of technical procedure." Transference, then, while first seen by
Freud as constituting a resistance to analysis, was also recognized as an asset in that it brought
into therapy the essential, original, and basic conflicts or neurosis. The difficulty of this analysis
of the transference accounts for the length of psychoanalysis, and for what have been called
interminable or unending analyses (2, 37). Macalpine (32 ) feels that the resolution of the
transference is not understood, and that it actually must resolve itself after analysis.

There are analysts, however, who do not accept the infantile origin of the transference
relationship (26, 28, 46, 54), or indeed that all neuroses or emotional disturbances originate in
infantile conflicts. Horney (26) is probably the most outspoken advocate of the position that
transference is not a reaction to the past, but an expression of the patient's present personality and
conflicts. Glover (20) also suggests that "the patient displaces on the analyst all he has ever
learned or forgotten throughout his mental development." It appears that Ferenczi and Rank (14)
anticipated the position of Horney. They felt that since much of the child's early experience
occurs in the preverbal period, it could not be recollected and verbalized. They therefore
proposed analysis of the existing transference without the necessity of the recollection and re-
experiencing of childhood conflicts, or the so-called lifting of infantile amnesia.

Dependence on the analyst is the result of basic anxiety, according to Horney. Interpretation in
terms of infantile patterns, she warns, has three dangers: (1) it contributes to the dependency,
since it doesn't touch the underlying anxiety, and thus counteracts the goal of therapy which is
independence; (2) the analysis as a whole may become unproductive; and (3) there may be
insufficient elaboration of the patient's actual personality structure. The purpose of analysis is
the understanding of present personality trends, not of their relationship to childhood. She raises
the interesting question if in analysis "love is a feeling which is only transferred from an infantile
object to the analyst, is it perhaps true that all love is transference, and if not, how can we
distinguish between love which is transferred and love which is not?" (26, p. 162).

Horney recognizes that the patient reacts to the therapist in terms of his own conflicts and
needs, his own personality patterns, rather than entirely in terms of the therapist's objective
personality and behavior. This, however, is not transference as it is defined by orthodox
psychoanalysis. The question which she voices raises an important point--is all transference
behavior neurotic, and if not, when is it not? This problem is perhaps related to the confusion
between the transference relationship and the transference neurosis. It is difficult to find a
distinction between them, but the terms are not always used interchangeably. Some limit the use
of transference to the transference neurosis. French gives definitions for both terms, but they
appear to be identical (2, ch.5). Irrational elements in the patient-analyst relationship are termed
neurotic, yet the transference is defined as irrational behavior. Macalpine (32) defines the
transference neurosis as the adapted, regressed condition, the end point of transference prior to its
working through. The question still remains, however, as to whether the transference
relationship is entirely an abnormal, neurotic phenomenon.

TRANSFERENCE AND GENERALIZATION

That transference is not limited to the analyst-patient relationship has been recognized by a
number of psychoanalysts. The definitions by Lagache (29) and Hoffer (24) implicitly recognize
this. Nunberg (38) specifically states that "transference occurs also in other than psychoanalytic
therapies," and further states that the transference of infantile experiences into reality and acting
them out is not limited to the transference situation, but is "a tendency to establish identity of old
and new perceptions." Greenacre (21) similarly suggests that a dependency relationship, and thus
transference, will develop in any situation where one person is seeking help from another, trained
person. Thompson (54) begins her discussion of transference with the statement: "Transference
was not created by psychoanalysis. As long as human beings have had relationships with each
other, there have probably been irrational elements in those relationships. These irrational
elements have been especially marked in the attitudes toward those upon whom a person is
dependent. Therefore, one sees it in all situations where one of the two people is in a position of
authority in relation to the other." As French (2, P. 72) reminds us, "all behavior is patterned
upon the past, is based upon experience," so that all behavior has past, or unreality, referents as
well as present, reality referents.

This suggests a relationship between transference and what has been dealt with under the
concept of "transfer of training" in psychology. The similarity in terms, while perhaps purely
coincidental in their origins and development, is significant. Transference is behavior which is
affected by past experience; it is reacting in a new situation on the basis of habits learned in a
previous situation. Even the use of the terms positive and negative to apply to both transference
and transfer of training is parallel. In positive transference the patient reacts appropriately to a
helping figure, and the relationship is facilitated because of this application of past learning. In
negative transference, as in negative transfer of training, the patient reacts inappropriately to the
present reality situation using behavior learned in another, differing situation.

All adult behavior is based in part on previous learning. In a new situation, reactions are not
entirely random or trial and error in nature, but are chosen from the repertoire of learned behavior
and are more or less appropriate to the situation. The individual tends to respond as he has in the
past to similar--or better, to similarly perceived--situations. His behavior is appropriate or
inappropriate, depending on the similarity of the new situation to past ones, and on the accuracy
of perception of the individual. In other words, individuals tend to generalize from previous
learning. Transference, then, is a special case of the phenomenon of generalization. Miller (34)
has suggested this in an interesting paper.

Now it is true that generalization may be faulty; the perception of the new situation may be
false. (This situation will be discussed in the following section.) But it also happens that adequate
generalization may not occur because of the interference of persistently established behavior
reactions. Such reactions are the basis for Freud's concept of the repetition compulsion. Failure
to generalize from appropriate earlier experiences, or failure to learn to react as the present
situation demands, may be due to the persistence of inappropriate responses which have become
fixated in the individual's behavior. This is the neurotic paradox described by Mowrer (36), the
persistence of "behavior which is at one and the same time self-perpetuating and self-defeating"
(36, p. 487), a contradiction of the law of effect or the theory of reinforcement. This is not the
place to evaluate resolutions of this paradox, which led Freud to the repetition compulsion. But
the work of Maier (33) is suggestive. He found that, when forced to face an insoluble problem,
rats developed rigidly fixed patterns. And, as suggested above, and in an earlier chapter (Chap.
7), behavior is determined by the perception of the situation, rather than its “real" characteristics.
This leads to a consideration of some of the determinants of perception.

TRANSFERENCE, PERCEPTION, AND PROJECTION

The influence of needs upon perception has long been recognized in common sense psychology.
Extreme hunger and thirst lead to preoccupation with food and drink, and even to mirages, which
are false perceptions. Only recently have psychologists investigated this area, however. Among
the earliest studies were those of Sanford (49, 50) and Murphy and his students (30, 42, 52).
Since 1947 Bruner (10, 11, 41) has stimulated a great deal of work on this problem, including a
symposium published by Blake and Ramsey (6). Although there have been controversies over
some of the methods and procedures, there seems to be no doubt that personal values and needs
affect perception. ( For a recent review of this work, see Jenkin, Noel. Affective processes in
perception. Psycbol. Bull., 1957, 54:100-127.)

The mechanism by which needs and values affect perception is called projection. Projection
has been used in a number of different ways. In a technical psychoanalytic sense, projection is
the attribution, ascription, or attachment to another person of motives, desires, wishes, attitudes,
etc., which belong to, but are unacceptable to, oneself. It is thus reacting to one's own dynamic
tendencies as though they belonged to someone else, and is an unconscious, defensive process.
Projection is used in other ways, however. Several discussions of transference have employed
the term. Nunberg (38), for example, discusses transference as a projection of the image of the
father on the analyst. Zetzel likewise (62) writes that the analyst is viewed "as a substitute by
projection for the prohibiting parental figures." Greenacre (21) also uses the term. The use of
projection by these writers is not consistent with the usual psychoanalytic definition given above.
Schmideberg's (51) example of a child's fear of attack by the analyst as a projection of her own
sadism is in agreement with the definition, however. Since the sadism is not actually present in
the analyst, this is a transference reaction. But transference is, as Paulsen (40) points out, more
than projection as it is usually defined in psychoanalysis. The viewing of the analyst as the
father, or other authority figure, and endowing him with the attributes of these figures, is
displacement rather than projection.

But the term projection is frequently used in a broader sense. Freud himself defined it once as
follows:
“The projection of inner perceptions to the outside is a primitive mechanism which, for instance,
also influences our sense-perceptions, so that it normally has the greatest share in shaping our
outer world. Under conditions that have not yet been sufficiently determined even inner
perceptions of ideational and emotional processes are projected outwardly, like sense
perceptions, and are used to shape the outer world, whereas they ought to remain in the inner
world.” (The basic writings of Sigmund Freud. A. A. Brill (Ed.) New York: Random House,
1938, p. 857. Quoted in reference 3, p. 1.)

Thus broadly defined, projection would appear to include displacement, and thus transference.
It is also in this broad sense that projection has been used to apply to certain tests, such as the
TAT and Rorschach. In projective techniques, the subject responds to the test stimuli in terms of
his own perceptions as influenced by his motivations, attitudes, and drives. The meanings or
interpretations which he attributes to the stimulus are projected into it. In this sense, all
perceptions, since they are influenced by these inner factors, involve projection. The perceptions
of the therapeutic interview and of the therapist are no exceptions. What the client sees in the
therapeutic situation depends in part on the personal meanings which he projects into it.

Estes (13) states that there are two objective conditions which determine whether a personally
significant recurring experience or situation will be responded to realistically, in terms of its
objective characteristics. These are its clarity or absence of ambiguity, and its consistency. The
characteristic of ambiguity is the structured-unstructured dimension in projective tests.

Bordin (7, 8) has provided an excellent treatment of ambiguity as a dimension of

psychotherapy. He defines ambiguity as the stimulus configuration which is vague and
incomplete, and in which no clear-cut response is predetermined. Ambiguity "is that attribute of
a stimulus situation by virtue of which its demand character on different persons is different" (8,
p. 138). In the therapeutic relationship the therapist may define or structure the situation in
varying degrees. The more unstructured, or ambiguous, the situation, the more opportunity it
gives for projection by the client, or for structuring it in terms of his needs, values, and conflicts.

The psychoanalytic situation is highly ambiguous, as both Estes (13) and Bordin ((7, 8) point
out. The analytic rule of free association--"tell me everything that comes to your mind"--carries
no restrictions. The analyst is silent for long periods, giving the impression of a blank screen. In
the orthodox use of the couch, he is out of view of the patient and therefore not present as a
reality in the visual field of the patient. These conditions maximize the opportunity for
projection on the part of the patient, for the development of irrational or unrealistic perceptions--
in other words, for the development of transference. Whether the transference involves infantile
regression, or is of the type described by Horney, depends upon how the analyst structures the
situation. Where the situation is structured as one where infantile, regressed behavior is
demanded, it is inaccurate to label this behavior as purely transference, or due to projection; it is
a realistic response to the situation. The fact that the patient does regress, however, indicates the
presence of unresolved infantile conflicts. Presumably, if this is the case, patients who are
unable to adapt to an infantile relationship may not have such conflicts.
 Bordin (7, 8) lists as one of the functions of ambiguity this eliciting of the client's conflicting
feelings, and states that this is identical with the concept of transference. The eliciting of these
emotions enables the therapist to understand the client better. Finally Bordin suggests that by
being ambiguous the therapist provides a background against which the client's irrational feelings
become clear and come into awareness.

Both Estes and Bordin warn that ambiguity tends to arouse anxiety. The latter warns against
inexperienced counselors using it in extreme form. Although he feels that client-centered therapy
is less ambiguous than psychoanalysis, he claims that he has seen inexperienced counselors, in
the effort to be nondirective, become involved in intense relationships fraught with danger to the
client. While this may be possible, most beginning counselors are unable to achieve such
ambiguity, since, as Bordin also points out, an ambiguous situation is anxiety-provoking to the
therapist.

Faulty generalization, or the persistence of fixed, inappropriate behavior, may be a matter of

the "false" perception of the situation. This “false" perception arises on the basis of the
individual's values, needs, or unresolved conflicts. But it is also a function of the ambiguity of
the situation or stimulus. The motive behind these false perceptions which lead to nonadaptive
behavior are not entirely clear. These behaviors are commonly regarded as defense mechanisms.
The phenomenological point of view adopted in this book would suggest that such behavior
represents efforts toward the preservation of the self in the face of threat. Threat, it has been
suggested (Chap.7), leads to withdrawal and reduction in the variabilityof behavior. Under threat,
the individual's perceptions are more strongly influenced by his needs.

Estes advocates the avoidance of ambiguity, apparently feeling that clarity and consistency
are conducive to differentiation and accurate experience. "To the extent that the therapist and the therapeutic task
and situation are clear and consistent, to that extent the client should progressively respond to the therapist
realistically. To state the principle more generally, when a contemporary, recurrent situation is clearly and
consistently differentiated from earlier situations to which it at first gets assimilated, a perceptual conflict is
instigated. And it tends to be resolved realistically" (13). The clear differentiation of the present therapeutic
situation from the earlier infantile situation is one of the techniques used by Alexander and French (1). Ambiguity,
or transference, then, is not only unnecessary, but undesirable in psychotherapy. Estes feels that client-centered
therapy is a clear, consistent therapeutic situation.

TRANSFERENCE AND CLIENT-CENTERED THERAPY

The psychoanalytic transference does not often occur in client-centered therapy. The client-
centered therapeutic situation is such that it does not foster transference. It is less ambiguous
than psychoanalysis--the client sits up, facing the therapist; the rule of free association is not
applied; and there is perhaps less silence on the part of the therapist in the early interviews. Nor
does the client-centered relationship foster an attitude of dependence in the client. The therapist
does not assume, or imply, either by actions or words, that he is a superior or authority figure.
The whole atmosphere of the client-centered situation encourages and fosters independence in
the client, rather than dependence. Even the avoidance of interpretation contributes to this
development of independence in the client (47, pp. 214-215). Most therapies stress the need for
the therapist's understanding the client better than the client does himself, keeping at least one
step ahead of the client. Wyatt (61) relates this to transference: "Transference can only develop
when the therapist has succeeded in showing that he understands the patient more effectively
than the patient does himself." This attitude, Rogers feels (47, pp. 215-216), leads to loss of self-
confidence in the client, and to a dependent relationship.

Another factor fostering the transference is a threatening situation. Therapy in general,

including psychoanalysis, has commonly been held to be a nonthreatening situation.
Nevertheless, the analytic situation, as detailed by Macalpine (32) contains threatening elements.
She relates this threat and insecurity to the regression which is an essential of orthodox
transference. Analysis, by fostering, even forcing, regression and dependence, creates resistance
and conflict, if only regarding the dependent-independent needs of the client. And as we have
seen, ambiguity is threatening, leading to anxiety. Client-centered therapy, on the other hand, is
less threatening and more secure, with its avoidance of interpretation, less ambiguity, and
encouragement of independence rather than dependence and regression.

Transference, then, develops in a situation where the therapist is a superior, authoritative

figure, and the client is made to feel inferior and childlike. A dependence of the client on the
therapist naturally results. A threatening and insecure situation fosters regression and leads to
defensiveness (resistance), which encourages projection and misperception of the actual
situation.

Transference can and does develop to some extent in many client-centered therapy
experiences, however. It will be remembered that transference is a function of the client and the
situation. To the extent that client-centered therapy is ambiguous, transference may and does
develop. Clients may be more or less "ready" to develop a transference relationship. This
readiness is perhaps related to the nature and severity of their maladjustment or disturbance. As
Rioch (46) points out, strong, repressed feelings seek emotional discharge or expression
regardless of reality. Even in a relatively clear and unambiguous situation, the client with strong
emotional attitudes will tend to project them into the situation. A highly dependent client may be
ready, even desirous, of a transference relationship and convert the therapist into a father figure.
Rogers (47, pp. 197-217) refers to transference "attitudes" in connection with client-centered
therapy.

When transference attitudes, or a transference relationship, do develop in client-centered

therapy, what does the therapist do? The analyst, as has been indicated, analyzes and interprets
the relationship, as he does other productions of the patients. As the analyst treats transference as
he does other responses of the patient, so the client-centered therapist accepts and understands
these attitudes and feelings just as he does any other attitudes of the client (47, p. 203).

This handling of transference attitudes in the atmosphere of client-centered therapy appears to

lead to relatively rapid recognition by the client that their origins are within himself, rather than
in the therapist or in the therapeutic situation. That is, in a secure, nonthreatening, relatively
unambiguous or reality-oriented situation, the client is led to recognize that projection (or
displacement) is occurring. Reality, though inconsistent with the original perception, can be
accepted. Rogers gives some illustrations of this (47, pp. 201-213). In some severely disturbed
clients, where there is present a strong internal threat to the self, projection may be greater and
more persistent.

The point of view of client-centered therapy regarding transference is as follows: (1)

transference is not a necessary condition for psychotherapeutic personality change; (2) in the
client-centered approach, the orthodox psychoanalytic transference does not develop; (3)
transference attitudes do often develop, but are handled as are other attitudes expressed by the
client.

If the transference, with its regression to an infantile, dependent level, is not necessary for
therapeutic change, then does this mean that maladjustment does not originate in infancy? Or
does it rather mean that it is not necessary to uncover and analyze these origins, to recover
infantile amnesia? The latter would seem to be the more tenable position. This is the position of
Horney and other neoanalysts, who are concerned with current interpersonal relationships. If,
then, client-centered therapy and neoanalytic therapy are similar in concentrating on current
adjustment problems, how do they differ? Why is it that in one approach the transference
relationship is strong and is considered to be an essential factor, whereas in the other approach it
is not? It appears that the nature of the therapeutic situation still differs, in the same way in
which client-centered therapy differs from orthodox psychoanalysis. The analytic situation, even
in the case of the neoanalysts, appears to be one in which a dependence on the therapist is
fostered, if by no other technique than that of interpretation, even though Horney criticizes the
dependency of orthodox analysis.

Finally, then, how does client-centered therapy differ from brief psychoanalytic psychotherapy
as advocated by Alexander and French (2), where transference is not involved? In this latter
approach, transference and dependence are avoided or controlled. Nevertheless, the basic
technique is interpretation, coupled with role-taking and other activity on the part of the therapist,
which would appear to lead to the development of a dependency even if not the orthodox
transference. And the relationship is still apparently one of superiority-inferiority, with the
therapist being an authority. The total picture of brief psychoanalytic therapy is one of the
therapist keeping ahead of the client, outthinking, outwitting, and outguessing him, actively
directing and manipulating him.

As has been suggested earlier, all behavior is based on past experience, as well as being
influenced by the present situation. The client's behavior is thus a mixture of irrational, projected
elements--errors in perception and/or generalization--and of realistic reactions. The separation of
these two elements is difficult, if not impossible, even though French (2, chap. 5) insists that the
transference neurosis and reality adjusted behavior are mutually exclusive. It would appear to be
difficult for a therapist to determine whether the client's reactions are in some cases responses to
his (the therapist's) actual personality, or to projections upon the therapist. Heimann (23)
cautions that "the analyst has to consider the reciprocal fact that his own personality, no matter
how much he controls its expression, is perceived and reacted to by the patient." It is difficult for
the therapist to be aware of his own personality sufficiently well to know whether the client is
reacting to him as he is or as he is misperceived, particularly since every reaction combines the
two. Only a true mirror will give back a true reflection. The apparent error of psychoanalysis in
insisting that the transference is entirely a spontaneous reaction of the client would indicate how
easy it is to misinterpret the client's behavior. This leads us to a consideration of
countertransference.

COUNTERTRANSFERENCE

Compared to the discussion of transference, there is relatively little concerning

countertransference. Perhaps, as Racker (44) suggests, neglect has been due to the rejection by
analysts of their own problems, problems surviving the didactic analysis which Freud originated
as a result of his discovery of countertransference. The assumption was that countertransference
was not present unless the analyst was not completely analyzed; if the analyst felt he should not
have countertransference attitudes or feelings, he would suppress them. This assumption has
now given way to the recognition that countertransference is present in all analytical situations.
The development of interest in the countertransference has come perhaps as a result of the
recognition that the analyst is not, and cannot be, neutral and objective, a mirror or a screen. Nor
is the analyst, however well analyzed, free from transference reactions to the client. Racker (44)
refers to the analytic myth "that the analysis is an interaction between a sick person and a healthy
one." When the analyst ceased to be a blank screen for the patient, the patient ceased to be an
abstract problem screen to the analyst, and became the object of stronger feelings.

As transference consists of irrational reactions of the patient to the therapist, so

countertransference consists of irrational reactions of the therapist to the patient. This is included
in most definitions of the term. However, like transference, countertransference has been
variously described and defined (12, 15, 19, 31, 39, 44). As transference has been applied to all
the reactions of the patient to the analyst, so countertransference has been used to include all
reactions of the analyst to the patient. Racker (44), in a comprehensive discussion of
countertransference, accepts it as "the totality of the analyst's psychological responses to the
patient." Heimann (22) also agrees with this definition. At the other extreme, it has been limited
to "repressed elements, hitherto unanalyzed, in the analyst himself which attach to the patient in
the same way as the patient transfers to the analyst affects, etc., belonging to his parents or to the
objects of his childhood; i.e., the analyst regards the patient (temporarily and varyingly) as he
regarded his parents" (31). However, there has been less tendency to restrict countertransference
to this reaction than there has been to restrict the definition of transference. Possibly the cases in
which the analyst reacts to the patient as if the patient were his father are rare, certainly much
rarer than the reverse. This is to be expected in view of the fact that the analyst is often, if not
usually, older than the patient, and, if not older, is an authority figure because of his profession
and status, at least in the eyes of the patient. It is curious that little attention has been given to the
situation in which the analyst views the patient, irrationally, as a son.

Most discussions of countertransference clearly state, or imply, that the transference reactions
of the analyst to the patient are few and weak compared to those of the patient to the analyst.
This may be so in analysis, if not in other forms of therapy. It is perhaps to be expected, since
the analyst has been analyzed himself, and is presumably more mature, if not older, than the
patient. Berman (5) states that because of the training analysis, the attitudes and emotional
responses of the analyst will be less intense and shorter in duration than those of other persons.
 Nevertheless, the extent and significance of the emotional reactions of the analyst to the client
have been increasingly recognized, and although these reactions vary in nature, they have tended
to be included as countertransference reactions. There have been several discussions by
psychoanalysts, including those of Heimann (22), Little (31), Reich (45), Cohen (12), Gitelson
(19) and Racker (43, 44), which are of value to all therapists. Although transference appears to
constitute less of a problem in other therapies than in analysis, countertransference, broadly
defined as unwarranted or excessive attitudes or emotional reactions toward the client, is a
significant problem in all therapies. This has already been touched upon in Chapter 3, when we
discussed the influence of the therapist's needs upon the therapeutic relationship as an ethical
problem. It is not possible to deal exhaustively with the problem here, and the reader is
encouraged to consult the articles on countertransference referred to in this section.

We shall, however, give some consideration to how the therapist can recognize and deal with
his own emotional reactions in therapy. Like transference, countertransference is viewed by
analysts as being both a danger and an asset. Though it would appear to be more often a
hindrance, recently it has been viewed as a help, but its use has not been adequately described or
explored.

Since the needs which the therapist may be satisfying in the therapeutic relationship do not
usually reach awareness, how can the therapist become aware of them? Sometimes, of course,
they are accompanied by strong or clear feelings. This suggests that the therapist should examine
any strong or unusual emotions arising within himself during therapy. The development of a
strong liking for or dislike of the client should be examined. On the one hand, the therapist may
be identifying with the client, so that empathy has become sympathy. On the other hand he may
be irritated and impatient at the lack of progress of the client, which may be threatening his
concept of himself as a successful, competent therapist. Reactions of love or hate may or may
not be related to the actual personality or behavior of the client, but in any case they should be
examined.

Again, strong emotional reactions of the client should not be accepted automatically or
interpreted as transference reactions. The therapist should examine himself to see if his own
personality or behavior has aroused the reaction. Since we see what we want to see, in therapy,
as in other situations, it is too easy to attribute the client's reactions to the transference rather than
to examine them in terms of one's own personality and behavior. The therapist may be projecting
his own ideas and needs into the client's behavior. Benedek (4) points out that the client may
make valid responses to the therapist as a person, which the therapist labels as transference
because to accept them would compel him to give up his position as an impersonal agent, or
screen.

We see then that both the client's and therapist's emotional reactions must be examined in terms
of being reality responses to each other and must be understood as such for progress in therapy.
Cohen (12) suggests in this connection that "perhaps the loss of the feeling that communication is
going on is the most commonly used signal which starts the analyst on a search for what is going
wrong, a search which begins with himself. She suggests a useful definition of
countertransference for all therapists: "When, in the patient-analyst relationship, anxiety is
aroused in the analyst with the effect that communication between the two is interfered with by
some alteration in the analyst's behavior (verbal or otherwise) then countertransference is
present." She classifies anxiety-arousing situations into three categories. The first includes
situational factors, or reality events, in the analyst's life, including the need for success or
recognition as a competent therapist. Current problems or frustrations would also be included
here, as well as fears of failure, or of a psychotic break or suicide of the patient. The second
category includes unresolved neurotic problems of the therapist. The third consists of the
communication of the patient's anxiety to the therapist, by verbal or nonverbal means.

The presence of countertransference attitudes may thus be identified by anxiety to which the
therapist should be alert. Cohen's signals of anxiety are useful, and are included, slightly
reworded, here:

1. Unreasonable dislike for the client.

2. Inability to empathize with the client, who seems unreal or mechanical.
3. An overemotional reaction to the client's hostility.
4. Excessive liking for the client.
5. Discomfort with the client; dread of sessions with him.
6. Preoccupation with client's behavior trends, including fantasying about responses to the
client.
7. Difficulty in paying attention to the client, with mind wandering to personal affairs, or
drowsiness.
8. Beginning appointments late or running over the established time.
9. Getting involved in arguments with the client.
10. Defensiveness or vulnerability to the client's criticism.
11. Repeated misunderstanding of the therapist by the client, or disagreement with his responses.
12. Provoking affect in the client.
13. Over-concern about the confidential nature of his work with the client.
14. Sympathy with client regarding his treatment by others.
15. Feeling impelled to do something active for the client, such as giving advice or suggestions.
16. Appearance of the therapist in the client's dreams as himself, or the appearance of the client
in the therapist's dreams.

When the therapist recognizes the presence of excessive or unjustified emotional reactions to a
client, what should he do about it? Most discussions of countertransference regard it as
detrimental to therapy. As Alexander expresses it, "So far as the countertransference is
concerned, the prevailing view is that the analyst's own emotional reactions to the patient should
be considered as a disturbing factor. It is a kind of unavoidable impurity" (1, p. 82). The goal,
then, is to minimize this impurity. This is the purpose of the training analysis. The aim is to
attempt to approach the ideal of the analyst as a blank screen, with the analyst's personality
minimized if not eliminated, so that the patients reactions can be, as purely as possible,
transference reactions. The analyst, therefore, should be aware of his countertransference
reactions in order to control them, in the attempt to achieve objectivity and a neutral, detached
attitude, even though "this detached attitude is, of course, studied and not quite spontaneous
because even the well-analyzed therapist retains certain characteristic reactions to other persons"
(1, p. 85). But “quite often the analytic process becomes stymied on account of the
inexperienced student's lack of ability to control his spontaneous countertransference attitudes"
(1, p. 89). Alexander continues: "The analyst should attempt to replace his countertransference
reactions with attitudes which are consciously planned and adopted according to the dynamic
exigencies of the therapeutic situation" (1, p. 93). Though a completely objective attitude is
unattainable, it should be striven for, even though the result is a studied, controlled relationship
rather than a spontaneous one.

This point of view regarding the handling of countertransference attitudes has been questioned
recently, and Alexander himself recognizes the possible potential value of a different approach to
the use of countertransference. This new approach is based on the fact that actually the
countertransference cannot be controlled by the therapist. It is not easy, or perhaps possible, for
the therapist to conceal his emotional reactions from the client. The reactions are sensed by the
client. The personality of the therapist cannot be kept out of therapy by control or role-playing.

Some analysts have stressed the use of the countertransference as a tool or instrument in
psychotherapy (e.g., 4, 12, 22, 31, 44, 58). Cohen (12) and Racker (44) suggest that
understanding the origins of countertransference attitudes may aid in understanding the client's
transference. Benedek (4) and Little (31) suggest that the countertransference be analyzed, the
latter suggesting that the analyst discuss his countertransference reactions with the client. There
is little, however, of a very specific nature regarding the actual use of countertransference as a
tool.

Of more significance, perhaps, are some reports of experiences resulting from the actual
expression of the therapist's emotions in the therapeutic situation. Weigert (58) gives an
illustration of the expression by the therapist of disappointment and anger in therapy, without the
loss of good will toward the client. Alexander (1, pp. 90-91) reports that "an inadvertent
expression of my resentment against the patient's provocative attitude had an unexpected
therapeutic result." When the patient said: "Do you deny that you dislike me and do you call it
analysis being impatient with your patient?" the therapist admitted the dislike, while pointing out
that the patient's behavior was unconsciously calculated to make him disliked. Alexander,
however, regards this as a loss of the control which is so important in psychoanalytic therapy. He
considered the favorable results in this case only an accident. Only by chance would a
spontaneous expression of a countertransference reaction be beneficial.

Weigert (58) feels that the countertransference can be used as an instrument for determining the
progress of therapy. The resolution of the countertransference permits the analyst to be
emotionally more free and spontaneous with the patient, until "The analyst is able to treat the
analysand in terms of equality."

But why should not the therapist be free and spontaneous throughout the therapy? This
attitude toward the therapist's participation in the therapeutic relationship, perhaps first suggested
by Ferenczi, but opposed by Freud, is being expressed again by the Sullivanian school of
analysts. Thompson (55) writes that "The analyst need no longer feel defensive about being
natural and spontaneous."

Warkentin (57) gives some illustrations of the introduction of the therapist's feelings, including
aggression, into therapy, stating that "on occasion it is even helpful when the therapist offers
directly his aggressive or negative as well as his positive attitude to the patient." He suggests that
"the patient may more readily accept the therapist's positive feeling, when there is no withholding
of other emotions as they are experienced by the therapist." He reports the case of a school
teacher, giving an "excellent history," to whom he said: "You are beginning to irritate me with
your empty smile and friendliness; I wish you felt free to be more honest with me." This may
seem to be inconsistent with the attitude of acceptance and a nonthreatening therapeutic
atmosphere. Possibly in extreme form it is, even though it is based on sincerity and frankness.
Warkentin appears to use the method as a technique with selected patients, and stresses that there
must be no question of the genuine acceptance of the patient, and that the statements must be an
honest expression of the therapist's emotional experiences at the time.

Possibly the control of countertransference attitudes introduces an artificial element into

therapy, contributing, as does the classical transference on the part of the client, to the length of
analysis. The control of the countertransference may be an important element in the development
of the transference, and in the establishment of an authority-dependency, superior-inferior
relationship.

Rogers (48) recently has raised a similar question regarding the participation of the therapist.
He uses the term “congruence" to cover in effect what has been considered to be freedom from
countertransference, or awareness of the therapist of his true emotional reactions. "Thus, if he is
experiencing threat and discomfort in the relationship, and is aware only of an acceptance and
understanding, then he is not congruent in the relationship, and therapy will suffer. It seems
important that he should accurately 'be himself' in the relationship, whatever the self of that
moment may be." Then he continues, "Should he also express or communicate to the client the
accurate symbolization of his own experience? The answer to this question is still in an
uncertain state. At present we would say that such feelings should be expressed, if the therapist
finds himself persistently focussed on his own feelings rather than those of the client, thus greatly
reducing or eliminating any experience of empathic understanding; or if he finds himself
experiencing some other feeling than unconditional positive regard" (48, pp. 49-43).

The therapeutic relationship is a complex one. Both therapist and client are reacting to each
other in terms of varying degrees of reality, and projection, or transference. Each is reacting to
the other in terms of perceptions and misperceptions, and to the perceptions and misperceptions
which the other has of him. It is no wonder then, that the relationship is complex, and its
analysis difficult and often confusing. It is no wonder that misunderstandings develop in the
relationship.

A necessary condition of therapeutic change is the presence of understanding, which is based

on successful communication. Anything which clears the channels of communication is
therefore desirable. The therapist must continually keep in mind the necessity for
communication and mutual understanding in deciding what he shall introduce into the
therapeutic situation in terms of his own feelings and reactions. It would appear that where the
suppression or control of these feelings impedes communication, they should be expressed in
some form. It is possible that spontaneity on the part of the therapist is an important aid in
developing and maintaining a condition of communication and understanding.

REFERENCES

1. Alexander, F. Psychoanalysis and psychotherapy. New York: Norton, 1956.

2. Alexander, F., & French, T. M. Psychoanalytic therapy. New York: Ronald, 1946.
3. Bell, J. E. Projective techniques. New York: Longmans, Green, 1948.
4. Benedek, Therese. Dynamics of the countertransference. Bull. Menninger Clin., 1953,
17:201-208.
5. Berman, L. Countertransference and attitudes of the analyst in the therapeutic process.
Psychiatry, 1949, 12:159-166.
6. Blake, R. R., & Ramsey, G. V. (Eds.) Perception: an approach to personality. New York:
Ronald, 1951.
7. Bordin, E. S. Ambiguity as a therapeutic variable. J. consult. Psychol. , 7, 1955, 19:9-15.
8. Bordin, E. S. Psychological counseling. New York: Appleton-Century-Crofts, 1955.
9. Brody, N. W. Transference and countertransference in psychotherapy. Psychoanalytic Rev.,
1955, 42:88-94.
10. Bruner, J. S., & Goodman, Cecile G. Value and need as organizing factors in perception. J.
abnorm. soc. Psychol., 1947, 42:33-44.
11. Bruner, S., & Postman, L. Emotional selectivity in perception and reaction. Personality,
1947, 16:69-77.
12. Cohen, Mabel B. Countertransference and anxiety. Psychiatry, 1952, 15:231-243.
13. Estes, S. G. Concerning the therapeutic relationship in the dynamics of cure. J. consult.
Psychol., 1948, 12:76-81.
14. Ferenczi, S., & Rank, 0. Developmental goals of psychoanalysis. The development of
psychoanalysis. New York: Nervous and Mental Disease Publishing Co., 1925.
15. Flescher, J. On different types of countertransference. Int. J. Group Psychother., 1953,
3:357-372.
16. Freud, S. A general introduction to psychoanalysis. New York: Liverright, 1935.
17. Freud, S. An autobiographical study. London: Hogarth Press, 1936.
18. Freud, S. Fragment of an analysis of a case of hysteria. In Collected papers. Vol. III.
London: Hogarth Press, 1925.
19. Gitelson, M. The emotional position of the analyst in the psychoanalytic situation. Int. J.
Psycho-Anal., 1952, 33:1-10.
20. Glover, E. Symposium on the therapeutic results of psychoanalysis. Int. J. Psycho-Anal.,
1937, 18:125-132.
21. Greenacre, Phyllis. The role of transference. J. Amer. Psychoanaltic Ass., 1954, 2:671-684.
22. Heimann, Paula. On countertransference. Int. J. Psycho-Anal., 31:81-84.
23. Heimann, Paula. Dynamics of transference interpretatations. Int. J. Psycho-Anal., 1956,
37:303-310.
24. Hoffer, W. Transference and transference neurosis. Int. J. Psycho-Anal., 1956, 37:377-379.
25. Hora, T. Beyond countertransference. Amer. J. Psychother., 1956, 10:18-23.
26. Horney, Karen. New ways in psychoanalysis. New York: Norton, 1939.
27. Ivimey, Muriel. Developments in the concept of transference. Amer. J. Psychoanal.,
1944,4:122-133.
28. Kanzer, M. Past and present in transference. J. Amer. Psychoanalytic Ass., 1953, 1:144-154.
29. Lagache, D. Some aspects of transference. Int. J. Psycho-Anal., 1953, 34:1-10.
30. Levine, R., Chein, I., & Murphy, G. The relation of intensity of a need to the amount of
perceptual distortion: a preliminary report. Psycbol., 1942, 13:283-293.
31. Little, Margaret. Countertransference and the patient's response to it. Int. J. Psycbo-Anal.,
1951, 32:32-40.
32. Macalpine, Ida. The development of the transference. Psychoanalytic Quart., 1950, 19:501-
539.
33. Maier, N. R. F. Frustration: the study of behavior without a goal. New York: McGraw-Hill,
1949.
34. Miller, N. Theory and experiment relating psychoanalytic displacement to stimulus-response
generalization. J. abnorm. soc. Psychol., 1948, 43:155-178.
35. Money-Kyrle, R. E. Normal countertransference and some of its deviations. Int. J. Psycho-
Anal., 1956, 37:360-366.
36. Mowrer, 0. H. Learning theory and personality dynamics. New York: Ronald, 1950.
37. Nacht, S. Technical remarks on the handling of the transference neurosis. Int. J. Psycbo-
Anal., 1957, 38:196-203.
38. Nunberg, H. Transference and reality. Int. J. Psycbo-Anal., 1951, 32:1-9.
39. Orr, D. W. Transference and countertransference: A historical survey. J. Amer.
Psychoanalytic Ass., 1954, 2:621-670.
40. Paulsen, Lola. Transference and projection. J. analytic Psychol., 1956, 1:203-206.
41. Postman, L., Bruner, J. S., & McGinnies, E. Personal values in perception. J. abnorm. soc.
Psycbol., 1948, 43:142-154.
42. Proshansky, H., & Murphy, G. The effects of reward and punishment on perception. J.
Psycbol., 1942, 13:295-305.
43. Racker, H. Contribution to the problem of countertransference. Int. J. Psycho-Anal., 1953,
34:313-324.
44. Racker, H. The meaning and uses of countertransference. Psycboanalytic Quart., 1957,
26:303-357.
45. Reich, Annie. On countertransference, Int. J. Psycho-Anal., 1951, 32:25-31.
46. Rioch, Janet MacK. The transference phenomenon in psychoanalytic therapy. In P. Mullahy
(Ed.) A study of interpersonal relations. New York: Hermitage, 1950.
47. Rogers, C. R. Client-centered therapy. Boston: Houghton Mifflin, 1951.
48. Rogers, C. R. A theory of therapy, personality, and interpersonal relationships, as
developed in the client-centered framework. Chicago, 1956. (Mimeographed.)
49. Sanford, R. N. The effects of abstinence from food upon imaginal processes--a preliminary
experiment. J. Psychol., 1936, 2:129-136.
50. Sanford, R. N. The effects of abstinence from food upon imaginal processes: a further
experiment, J. Psychol., 1937, 3:145-159.
51. Schmideberg, Melitta. A note on transference. Int. J. Psycho-Anal. 1953, 34:199-201.
52. Shafer, R., & Murphy, G. The role of autism in a visual figure-ground relationship. J. exp.
Psychol., 1943, 32:335-343.
53. Spitz, R. A. Transference: the analytical setting and its prototype. Int. J. Psycho-Anal.,
1956, 37:380-388.
54. Thompson, Clara. Transference as a therapeutic instrument. Psychiatry, 1945, 8:273-278.
Also in A. H. Brayfield (Ed.), Readings in modern methods of counseling. New York:
Appleton-Century-Croft, 1950.
55. Thompson, Clara. The role of the analyst's personality in therapy. Amer. J. Psychother.,
1956, 10:347-367.
56. Waelder, R. Introduction to the discussion on problems of transference. Int. J. Psycho-Anal.,
1956, 37:367-368.
57. Warkentin, J. Support through non-reassurance. Amer. J. Psychother., 1956, 10:709-715.
58. Weigert, Edith., Contribution to the problem of terminating psychoanalyses. Psychoanalytic
Quart., 1952, 21:465-480.
59. Wolstein, B. Transference: its meaning and function in psychoanalytic therapy. New York:
Grune & Stratton, 1954.
60. Wood, A. B. Transference in client-centered therapy and in psychoanalysis. J. consult.
Psychol., 1951, 15:72-75.
61. Wyatt, L. The self-experience of the psychotherapist. J. consult.Psychol., 1948, 12:83-87.
62. Zetzel, Elizabeth R. Current concepts of transference. Int. J. Psycho-Anal., 1956, 37:369-
376.