Presentation given to The State University of New York at Albany School of Social Welfare Continuing Education program. May 20, 2016

1. “It’s Not You, It’s Me”: Counter-
Transference and It’s Impact on the
Therapeutic Relationship
Presented by Sean Erreger, LCSW (@StuckOnSW)
For SUNY Albany CEU Program
May 20, 2016

2. Goals
 Understand Definitions (Transference, Countertransference, and Therapeutic
Relationship)
 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.
-

3. “I invented it’s not you… it’s me!”

4. Transference
 …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)

5. Transference
 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?

6. Counter-Transference

7. Counter-Transference
 “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)

8. Counter Transference
 “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

10. 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” ?

11. How Do You Manage Counter-
Transference
 Countertransference Factors Inventory (CFI-R) | (Latts, MG, 1997)
 Observational Tool for Supervisors/Clinicians

12. CFI-R (continued)

13. CFR-I (continued)

14. Let’s Try It
 14 year old Client you are treating for ADHD but the parent starts to discuss
some “some problems about sex”

15. Therapeutic Alliance

16. Therapeutic Alliance
 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
thus far“.
 How Do You Measure This?

18. The Scales
 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)

19. Categories
 1) Shared Goals
 2) Subjective feelings
 3) The process of therapy
 4) being mindful of the potential for a rupture/impasse in the relationship.

20. Shared Goals
 Haq-II is asked “I believe that we have similar ideas about the nature of the
problem”
 The SOFTA-S challenges the therapist to think if they are indeed “working as a
team”
 ATAS asks the observer if there was a clear stated understanding

21. Subjective Feelings
 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

22. 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
her needs.
 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
things)
 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.


23. 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

24. Reasons For Ending Treatment Scale
(RETQ) – Garcia

25. Entries, Exits, and No Exits
(Imber-Black, 1988)
 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
specialists needed
 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

26. Family Therapy
 “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).

27. Professional Quality of Life Scale
(ProQOL)
 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
 Burnout
 Secondary Trauma
Available at http://www.proqol.org/ProQol_Test.html

28. Professional
Quality
of Life
Compassion
Fatigue
Compassion
Satisfaction
(ProQOL CS)
Work
Environment
Client
Environment
Personal
Environment
Traumatized
by work
Secondary
Exposure
(ProQOL STS)
Primary
Exposure
Frustration
Anger
Exhaustion Depressed by
Work
Environment
(ProQOL
Burnout)

29. Contact Info
 Sean Erreger, LCSW
 Email: stuckonsw@gmail.com
 Blog: www.StuckonSocialWork.wordpress.com
 Twitter: @stuckonsw
 Facebook: Stuck On Social Work

30. References:
Adolescent Therapeutic Alliance Scale (ATAS 1998) Retrieved on April, 12 2014, from
http://www.excellenceforchildandyouth.ca/sites/default/files/meas_attach/Adolescent_Therapeutic_Al
liance_Scale_(ATAS).pdf
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.

31. References (cont)
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.

32. References
 Helping Alliance Questionnaire (Haq-II, 1996) retrieved on April 2, 2014 from,
http://www.med.upenn.edu/cpr/documents/HAQ2QUES.pdf
 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
from http://www.softa-soatif.com/?page_id=2961