"It's Not You, It's Me" : Counter-Transference and It's Impact on The Therapeutic Relationship
“It’s Not You, It’s Me”: Counter-
Transference and It’s Impact on the
Presented by Sean Erreger, LCSW (@StuckOnSW)
For SUNY Albany CEU Program
May 20, 2016
Understand Definitions (Transference, Countertransference, and Therapeutic
How Do These Concepts Effect Practice
Some Tools to Identify Problems / Strengths within these concepts.
How does some of these tools adopts to types of practice. Including family,
groups, and even in macro practice.
…the clients resistance, the transference-feelings wishes, fears, and defenses
that influence the clients perceptions of the therapist” (Strean, 1996).
“the clients’ experience of the therapist that is shaped by his or her own
psychological structures and past, and involves displacement onto the
therapist, of feelings, attitudes and behaviors belonging rightfully to in earlier
significant relationship.” (Gelso and Hayes, 1998)
Can be positive
Office smells like a child memory
Can be negative
Office same color as the room as where the client was assaulted
How has transference effected your practice?
“We have begun to consider the ‘counter transference’ which arises in the
physician as a result of the patient’s influence on his unconscious feelings,
and have nearly come to the point of requiring the physician to recognize and
overcome this counter transference in himself… We have noticed that every
analyst’s achievement is limited by what his own complexes and resistances
permit.” (Freud ,1910/1959)
“Counter transference is the same dynamic phenomenon as transference
except it refers to those unconscious wishes and defenses, which are always
part of the perception and treatment of the client” (Strean, 1996).
Hayes (2004) argues that the notion of the unconscious slowly evolved to
include any emotional reaction by the therapist to a client’s words or actions
The “Wounded Healer”
“…For only what he can put right in himself can he hope to put right in the
patient. This, and nothing else, is the meaning of the Greek myth of the
wounded physician” (Jung, 1959)
What is “right” and “wrong” ?
How Do You Manage Counter-
Countertransference Factors Inventory (CFI-R) | (Latts, MG, 1997)
Observational Tool for Supervisors/Clinicians
Robert Hatcher (2010) defines Therapeutic Alliance as “a way of talking about
the quality of collaborative work between the patient and therapist. Asking
the critical question of a patient feeling like that they are working together
toward goals of therapy in a single session, a month, or throughout therapy
How Do You Measure This?
The Helping Alliance Questionnaire (Haq-II 1996, therapist and client version),
System for Observing Family Therapy Alliances (SOFTA-S 2006, both therapist
and client version)
Adolescent Therapeutic Alliance Scale (ATAS 1998)
1) Shared Goals
2) Subjective feelings
3) The process of therapy
4) being mindful of the potential for a rupture/impasse in the relationship.
Haq-II is asked “I believe that we have similar ideas about the nature of the
The SOFTA-S challenges the therapist to think if they are indeed “working as a
ATAS asks the observer if there was a clear stated understanding
In the Haq-II asks the following of therapist..
1. The patient feels he/she can depend on me
2. He/she feels I understand
3. The patient feels I want him/her to achieve the goals.
9. The patient likes me as a person
15. The patient and I have meaningful exchanges
The Process of Therapy
The HAQ-II asks the following of the therapist
8. The patient believes the procedures used in his or her therapy are not well suited to
4. At times the patient distrusts my judgment.
The SOFTA-S asks therapist
3. The therapy sessions are helping the client open up (share new feelings and try new
4. It is hard for me and the client to discuss together what we should work on in therapy
11. There are some topics the client just won’t discuss in therapy.
14. I lack the knowledge and skills to help this client.
Ruptures or Impasse
The Haq-II begins ask the therapist..
10. In most sessions we find a way to work on his/her problems
11. The patient believes I relate to him/her in ways that slow up the progress,
16. The patient and I sometimes have unprofitable exchanges
Observes using the ATAS are asked rate the overall level of respect between client and
therapist. They are also asked to rate the level of anxiety or discomfort with each other
Reasons For Ending Treatment Scale
(RETQ) – Garcia
Entries, Exits, and No Exits
Entries – When families enter “the system” we often take for granted their
strengths and focus on deficits… The more deficits we focus on the more
Exits – When do services end? How does this effect the relationship? What
impact to a transfer to another therapist have?
No Exits- Family’s and providers engage in a “seemingly never-ending
interaction.” The family and providers agree on a series of “unsolvable
problems” or continues to find new ones
“Not only was there a main effect of adolescent alliance on treatment
outcome, but this association was, in part, moderated by the quality of the
parent alliance. More specifically, the strength of the adolescent alliance
predicted adolescent’s abuse and dependency symptoms only when the
parent alliance was of moderate or high strength.” (Shelef et. Al. 2005)
“Notably, when adolescents saw the alliance as strong, the parents reported
the session to be relatively less valuable. The latter finding suggests that, in
judging the worth of a session, parents were closely observing their
adolescent’s reaction to what was taking place. Apparently, very strong
adolescent alliances were seen as relatively less productive by the parents”
Friedlander, Kivlighan, & Shaffer (2012).
Professional Quality of Life Scale
The ProQOL is free
A 30 item self report measure of the positive and negative aspects of caring
The ProQOL measures Compassion Satisfaction and Compassion Fatigue
Compassion Fatigue has two subscales
Available at http://www.proqol.org/ProQol_Test.html
Exhaustion Depressed by
Sean Erreger, LCSW
Facebook: Stuck On Social Work
Adolescent Therapeutic Alliance Scale (ATAS 1998) Retrieved on April, 12 2014, from
Imber-Black, Evan (1988) Familes and Larger Systems: A Family Therapist’s Guide Through The
Labyrinth New York, NY The Guilford Press
Friedlander, M. L., Kivlighan Jr, D. M., & Shaffer, K. S. (2012). Exploring actor–partner interdependence
in family therapy: Whose view (parent or adolescent) best predicts treatment progress?. Journal of
counseling psychology, 59(1), 168.
Freud, S. (1910) Future Prospects of Psychoanalytic Psychotherapy. In J. Stratchey (Ed. And Trans). The
standard of the complete psychological works of Sigmund Freud Volume 11 pp. 139-151. London
Hogarth press. Originally published in 1910.
Hayes, Jeffrey A., Charles J. Gelso, and Ann M. Hummel. "Managing countertransference."
Psychotherapy 48.1 (2011): 88.
Garcia, J. A., & Weisz, J. R. (2002). When youth mental health care stops: therapeutic
relationship problems and other reasons for ending youth outpatient treatment. Journal of
Consulting and Clinical Psychology, 70(2), 439.
Gelso, C.J, and Hayes, J.A. (1998) The psychotherapy relationship, New York, NY: Wiley
Jung, C. G. (1959). Collected Works Vol 9.
Helping Alliance Questionnaire (Haq-II, 1996) retrieved on April 2, 2014 from,
Latts, M. G. (1997). A revision and validation of the Countertransference Factors Inventory
(Doctoral dissertation, ProQuest Information & Learning).
Strean H.S. (1996) Psychoanalytic Therapy and social work treatment. In F.J Turner. Social
Work Treatment : Interlocking approaches.(4th Edition, pages 523-554) Free Press: New York
Shelef, K., Diamond, G. M., Diamond, G. S., & Liddle, H. A. (2005). Adolescent and parent
alliance and treatment outcome in multidimensional family therapy. Journal of Consulting
and Clinical Psychology, 73(4), 689.
System for Observing Family Therapy Alliances (SOFTA-s, 2006) Retrieved on October,13, 2014