Efforts to Overcome Countertransference in Pastoral Counseling Relationships

Abstract

Countertransference is considered as a negative factor that may impede counseling relations but some assume that countertransference is a normal reaction. The purpose of this article is to explore countertransference in pastoral counseling and efforts to overcome it. The author examines the concepts, approaches, and structure of countertransference. Previous research is also reviewed. Based on this review, the author elaborates some strategies that can help pastoral counselors to overcome countertransference in their counseling practice.

Keywords

Countertransference pastoral counseling overcoming efforts

Introduction

Pastoral counseling is a unique form of counseling ministry conducted to help clients to acquire a balance life as a whole person (Patton, 2002; Benner, 2003; Tan, 2004; Malureanu, 2013; Davis, 2015). Benner (2003) explains some of the main features that make it different from other counseling services, one of which is the training of the pastoral counselor. Pastoral counselors are the only professionals who have training in systematic theology, biblical studies, ethics, and church history. Therefore, pastoral counselors have to integrate those elements in their counseling practice. The failure to integrate those dimensions suggests that the pastoral counseling has lost its identity and uniqueness (Benner, 2003).

There are many challenges to effective pastoral counseling, one of which is countertransference (Brandell, 2004; Dayringer, 2010). The concept of countertransference is important in understanding and offering effective pastoral counseling (Patton, 2002). Therefore, countertransference is considered as an important aspect of pastoral counseling (Hofsess & Tracey, 2010) which requires pastoral counselors to always realize, examine, and work through it (Burwell-Pender & Halinski, 2008; Noorani & Dyer, 2017).

Literature reviews and empirical studies show that countertransference has a significant correlation with counseling outcomes (Lambert & Barley, 2002; Gelso & Hayes, 2007; Gelso & Samstag, 2008; Hayes, Gelso, & Hummel, 2011; Fuertes, Gelso, Owen, & Cheng, 2013; Gelso, 2014; Hayes, Gelso, Goldberg, & Kivlighan, 2018). Clients undergoing counseling with counselors who experience countertransference are more likely to have poor outcomes compared to clients of counselors who do not experience countertransference.

The purpose of this article is to elaborate countertransference and strategies to overcome it in pastoral counseling relationships. These strategies will hopefully contribute positively both to the development of science and to the community.

The Concept of Countertransference

The meaning of the term countertransference is understood differently and has changed over the last few years (Wiener, 2009). This term was first introduced by Sigmund Freud in 1910 when he wrote, “We have begun to consider the countertransference, 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 countertransference in himself” (Gabbard & Wilkinson, 2000; Hayes, 2004; Fauth, 2006; Schwartz, Smith, & Chopko, 2007; Hofsess & Tracey, 2010).

Malan (in Jones, 2004) describes countertransference as transference from the therapist to the patient. Countertransference reactions include emotional reactions, attitudes, and the therapist’s behavior toward the patient (Schwartz et al., 2007). Some experts view countertransference as an impeding factor that might affect the therapist’s reaction and behavior toward the patient (Little & Reich in Racker, 2002; Gelso & Hayes, 2007; Sommers-Flanagan & Sommers-Flanagan, 2015). Therapist may react in many ways that could be seen as critical, collusive, hostile, passive-aggressive, seductive, symbiotic, rigid, rejecting, or blaming (Gabbard & Wilkinson, 2000); and such reactions are associated with poor outcomes (Lambert & Barley, 2002; Hayes et al., 2011). On the other hand, being able to understand and manage these emotional responses is associated with a positive therapeutic relationship, which in turn is associated with better therapy outcomes (Hayes et al., 2011).

The concept of countertransference is useful to counselors in understanding the uniqueness of the dynamic in each counseling relationship. Modern therapists (Dass-Brailsford in Boyd-Franklin, Cleek, Wofsy, and Mundy, 2013) understand countertransference as a normal reaction and the therapist’s reflection of their personal life. According to Dass-Brailsford (in Boyd-Franklin et al., 2013), countertransference is the therapist’s reactions and feelings toward their patient in therapeutic relationships. Those feelings and reactions come from the therapist’s personal as well as professional experience which might influence their attitude and behavior toward patients. Therapists need to recognize those feelings, deal with them, or discuss them with their supervisor to prevent negative-impact countertransference (Gelso & Hayes, 2007; Boyd-Franklin et al., 2013; Noorani & Dyer, 2017).

Countertransference has an inverse correlation with the outcome of counseling treatments. Some negative effects might occur when therapists show countertransference reactions. Therapist’s countertransference behavior has been found to be harmful for treatment outcomes as it affects the counseling relationship and reduces the benefits of counseling (Harbin, 2004; Gelso & Hayes, 2007). Some authors even state that countertransference behavior leads to poor outcomes (Friedman & Gelso, Hayes et al in Harbin, 2004). Gelso and Hayes (2007) found that the ability to manage contratransference correlates positively with the outcomes of counseling. Specifically, Gelso and Hayes (2001, 2007) found that when counselors have conceptualization ability, self-integration, and better anxiety management in counseling relationships, they are more likely to produce better outcomes for their clients.

Countertransference Approaches

Academics and practitioners have mixed views on countertransference. Some view countertransference as an impeding factor; some assume that countertransference is a normal reaction. Gelso (2004) and Gelso and Hayes (2007) describe four models or perspectives that might help us understand the concept of countertransference thoroughly. The four models are: the classical model, the totalistic model, the complementary model, and the relational model.

The Classical Model

This model was developed by Sigmund Freud in 1910 and was developed further by Annie Reich in 1951 (Gelso, 2004; Gelso & Hayes, 2007). The classical model views countertransference as the therapist’s reactions to patients’ transference which is rooted in unresolved therapeutic conflicts (Gelso, 2004; Gelso & Hayes, 2007).

According to the classical model, countertransference can occur in various forms and might blur the therapist’s understanding, which can eventually confuse the therapist when trying to understand their patients’ issues. Manifestations of countertransference can be affective, behavioral, somatic, or cognitive, and are seen as interfering with treatment (Hayes, et al., 2018). Countertransference is an obstacle that must be removed by solving conflicts and the therapist’s own issues. Therapists should constantly endeavor to resolve their own conflicts to overcome the vulnerability that may cause countertransference in order for psychotherapy to be conducted effectively.

The concept of countertransference in the classical view is considered too narrow to be an impeding factor in the psychotherapy process (Gelso & Hayes, 2007). Scientific and clinical studies need to be conducted in order to see countertransference reaction which is not transference. Consideration on the benefits of countertransference and the possible benefits of countertransference that may appear during therapy are noteworthy.

The Totalistic Model

The totalistic model emerged in the 1950s and was first developed by Heiman and Little, then further developed by Kernberg in 1965 (Gelso, 2004; Gelso & Hayes, 2007). This model emerged as a reaction to the narrow perception of countertransference in the classical model. The classical concept restricts countertransference only to situations in which the therapist reacts transferencially to their patients’ transference. The totalistic concept is that countertransference encompasses every emotional reaction of a therapist to a patient. Countertransference is viewed as the totality of therapists’ emotional reactions and therefore this concept views therapists’ experience and reaction as equal (Gelso, 2004; Gelso & Hayes, 2007, Hayes, et.al, 2018).

The totalistic model goes beyond the classical concept that attributes countertransference to unresolved conflicts. Countertransference is the therapist’s internal reaction which must be understood in the context of each therapeutic relationship. The totalistic model considers that all therapists’ attitudes and feelings toward patients are countertransference (Gelso & Hayes, 2007). This view justifies the existence of countertransference as something to be analyzed, comprehended and applied in therapy, and not to be avoided. In the totalistic view, countertransference is considered as something beneficial to therapy as long as therapists identify and understand all reactions and use them to understand their clients (Gelso, 2004; Gelso & Hayes, 2007; Hayes, et.al, 2018).

The Complementary Model

The complementary model was developed by Epstein and Feiner (Gelso, 2004; Gelso & Hayes, 2007). This model considers countertransference as a complement to patients’ transference. Both complementary and totalistic views consider countertransference as something unavoidable by considering the defence mechanism and the way patients relate to therapist. The signature of the complementary concept lies within the articulation of the psychological reaction between therapists and patients. Each of the reactions continuously influences internal and external reactions and lasts throughout the treatment. A patient, either consciously or unconsciously, draws a particular reaction from a therapist and the therapist is driven to respond to the reaction in a particular way that will eventually create a reaction in the patient, and so forth (Gelso, 2004; Gelso & Hayes, 2007; Hayes, et.al, 2018)).

The concept of countertransference in the complementary model is depicted properly by Racker (Gelso, 2004; Gelso & Hayes, 2007; Hayes, et.al, 2018), who is famous for his “law of talion” notion that explains that every positive transference is filled with positive countertransference, and every negative transference is filled with negative countertransference. Therefore, patients’ transference and other aspects complement therapists’ reactions. Effective therapists do not attempt to avoid those reactions, but rather make the effort to comprehend the dynamic within themselves and their patients and respond in ways that might facilitate the treatment process (Gelso, 2004; Gelso & Hayes, 2007).

The Relational Model

The relational model develops the concept of countertransference in a similar way to the complementary model, but this concept attempts to comprehend the nature of countertransference at a deeper level (Gelso, 2004; Gelso & Hayes, 2007). The relational concept stems from the object relation theory, and is often referred to as the dual-personality theory as distinct from the classical one personality psychoanalytical theory. The classical theory contends that a therapeutic process is derived from the patients’ defence mechanism and psychopathology, and an effective therapist takes the role of a neutral observer. Meanwhile, the relational theory points out that anything that happens between therapists and patients is an inseparable relationship. Therapists and patients form transference behaviors, and countertransference is also mutually created. Therefore, countertransference is a product of unavoidable interaction from the dynamic of relationship between patients and therapists. Countertransference is central to treatment and inevitable and unavoidable in every therapeutic situation (Ornstein & Ganzer, 2005).

The Structure of Countertransference

Gelso and Hayes (2007) proposed five components of countertransference which could be identified to build up a comprehensive understanding of the concept: origins, triggers, manifestations, effects, and management.

Origins

This element is proposed in order to help understand where countertransference comes from. Countertransference originates from within therapist’s unresolved conflicts and vulnerabilities (Rosenberger & Hayes, 2002; Gelso & Hayes, 2007). The roots of countertransference are found not only in the therapist’s childhood, but also in the present or the recent past.

Triggers

Triggers help us understand what happens to precipitate countertransference during a psychoanalysis session. Triggers refer to therapy events or patient qualities that bring out the therapist’s unresolved conflicts or vulnerabilities (Rosenberger & Hayes, 2002; Gelso & Hayes, 2007). As the two elements that relate and complement each other, Hayes (2004) viewed origins and triggers as the causes of countertransference.

Manifestations

This component helps the therapist to understand how countertransference shows itself. Manifestations of countertransference in therapists include affects, behaviors, or cognitions (Rosenberger & Hayes, 2002; Hayes, 2004; Jones, 2004; Gelso & Hayes, 2007). According to Gelso and Hayes (2007), the most common affective reaction to countertransference for therapists is anxiety; the manifestation of countertransference behavior can be through the therapist’s avoidance of or withdrawal from the patient; while the cognitive manifestation of countertransference can be the distortion of cognitive aspects of the patient.

Effects

Effects are related to the effect of countertransference reactions on the quality of both the treatment process and the outcomes of psychotherapy (Rosenberger & Hayes, 2002; Hayes, 2004; Gelso & Hayes, 2007). This element helps the therapist to understand how countertransference impacts on the process and outcomes of therapy. Weill (2010) states that countertransference is a universal human phenomenon that may be adaptive, maladaptive, or both adaptive and maladaptive; or, as noted by Gelso and Hayes (2007), countertransference can be for better or worse, depending on how therapists overcome it. Countertransference can damage counseling relationships if therapists cannot manage it effectively (Brandell, 2004).

Countertransference Management

This element helps the therapist manage countertransference effectively. Countertransference management refers to the therapist’s ability to deal with their reactions so as to minimize their negative impact on therapy and to facilitate the therapy process (Rosenberger & Hayes, 2002; Hayes, 2004; Gelso & Hayes, 2007). According to Gelso and Hayes (2007), problematic countertransference reactions are less likely to occur when therapist possesses self-insight, conceptualizing skills, empathy, self-integration, and anxiety management skills.

Studies on Countertransference

A wide range of studies have been conducted on countertransference. Greene’s research (1986), particularly that related to countertransference in counseling with elderly clients, suggests that social services and mental health institutions have to pay attention to countertransference issues, and be open to supervisors evaluating their counselling work in order to identify countertransference and age-related stereotyping. A similar survey conducted by Langsley and Yager (in Oldham, 1999) showed that most psychiatrists have the ability to identify countertransference problems and personal uniqueness, because those aspects affect their interactions with their patients.

Hunt’s (2003) research on countertransference in therapists with borderline personality disorder patients showed that most of the respondents reported positive and negative behaviors toward their patients. The most common positive countertransference behavior reported by the respondents was being supportive to their patients, while the most common negative countertransference behavior reported was being critical of patients during counseling sessions. The results indicated that countertransference behavior correlated negatively with therapists’ countertransference management skill, therapeutic alliance, and empathy, while therapists’ countertransference management skills correlated positively with therapeutic alliance. This research also supported the hypothesis that countertransference management skill correlated positively with treatment outcomes.

Harbin’s (2004) study on countertransference reaction in inter-racial contexts aimed to analyze the effect of universal-diverse orientation (UDO) and information about clients’ power on European-American therapists’ countertransference toward African-American clients. The result indicated that UDO therapists had a negative correlation toward countertransference reaction. Moreover, the result also did not correlate significantly with the main effect of information toward clients and UDO interaction, and with information about clients’ power toward countertransference reaction.

Duthiers’ (2005) study aimed to explore the relationship between countertransference awareness and management and the application of therapists’ personal therapy. The result of Duthiers' study indicated that the experience of personal therapy did not correlate with countertransference management and the duration of therapy.

Satir et al.’s (2009) study was conducted to explore therapists’ experience of countertransference reactions when working with adolescent patients with eating disorders, and to identify the variables in the therapists, patients, and therapy that related to those responses. Researchers identified six emotional reaction patterns: anger/frustration, warm/competent, aggressive/sexual, failure/incompetent, bored/anger toward parents, and overinvested/anxious. In general, the result of the study indicated that the level of therapists’ negative countertransference reactions was not high. Therapists’ countertransference reactions were often linked with therapists’ gender and functionality, and patients’ development level during treatment and personality style.

Reviews have also been conducted of the concept and empirical research on countertransference, its management, and their relationship to psychotherapy outcomes (Hayes, Gelso, & Humel, 2011; Hayes et al., 2018). The authors presented three meta-analyses on countertransference. The first meta-analysis indicated that countertransference is inversely and modestly related to psychotherapy outcomes. The second meta-analyses about the relationship between countertransference management and countertransference showed that countertransference management factors are negatively related to countertransference factors. The final meta-analysis revealed that countertransference management is moderately related to psychotherapy outcomes.

Strategies to Overcome Countertransference

The emerging question for therapists is how to overcome countertransference reactions. King and O’Brien (2011) suggested that countertransference needs to be identified and managed for effective use in counseling. Hayes (1995) explores the concept of countertransference management referring to therapists’ strategies to cope with countertransference. Therapist should regulate their countertransference because it has a more positive impact in therapy; uncontrolled countertransference has an adverse effect on therapy outcomes (Gelso 2001; Gelso & Hayes, 2007; Singger & Luborsky in Parth, Datz, Seidman, & Loffler-Statska, 2017). Therapists with the ability to manage their countertransference reactions are better equipped to facilitate deeper and more therapeutic work (Hayes, 2004).

There are five factors related to countertransference management. Problematic countertransference reactions are less likely to occur when therapists possess greater self-insight, conceptualizing skills, empathy, self-integration, and anxiety management skills (Gelso, 2001; Gelso & Hayes, 2007).

Self-Insight

Self-insight refers to the extent to which therapists recognize their own feelings in working, including countertransferencial feelings (Gelso & Hayes, 2007; Perez-Rojas et al., 2017). The importance of self-understanding is clearly expressed in Freud’s comment that no therapist can advance in their careers without recognizing their own complexity. Therefore, therapists are asked to start with self-analysis, be familiar with their own internal feelings and work to manage those issues (Hayes et al., 2018). Recognizing all feelings that may affect the course of the counseling relationship is an important task for the therapist (Jones, 2004; Cabaniss, Cherry, Douglas, & Schwartz, 2011; Noorani & Dyer, 2017).

Conceptualization Ability

This ability reflects the therapists’ ability to use theory in psychotherapy and to understand the dynamic of patients in therapeutic relationships. Conceptualization ability is very helpful in raising therapists’ self-awareness and understanding the countertransference dynamic (Gelso & Hayes, 2007; Perez-Rojas et al., 2017).

Empathy

Empathy is the therapists’ ability to identify with patients and place themselves in their patients’ shoes (Gelso & Hayes, 2007; Perez-Rojas et al., 2017). Empathy helps therapists to focus on patients’ needs. Empathy is part of sensitivity to one’s own feelings, including those based on countertransference. Gelso and Hayes (2007) expressed the view that the therapist who is able to stay attuned to the patient’s feelings, experiences, and needs is less likely to put her or his own needs ahead of the patient’s.

Self-Integration

This element refers to two qualities which the therapist should have: (1) a healthy character structure, and (2) the sense of wholeness in the therapist. Therapists possessing good self-integration have very good awareness of ego boundaries (Gelso & Hayes, 2007; Perez-Rojas et al., 2017). In the counseling interaction, self-integration manifests itself as the recognition of interpersonal boundaries and the ability to differentiate the self from others (Hayes et al., 2018).

Anxiety Management Skills

Anxiety is a sign that something is going wrong. At the same time, it is important for therapists to let themselves experience anxiety, but also to have the power to control, understand and manage it so that they can continue working. Good anxiety management skills prevent therapists’ anxiety from bleeding over into their responses to patients (Gelso & Hayes, 2007; Perez-Rojas et al., 2017; Hayes et al., 2018).

Cabaniss et al. (2011) propose a three-step approach in managing countertransference. The first step is listening carefully to oneself. The therapist listens to and monitors both his or her feelings and behaviors towards the patient. The second step is reflecting. The therapist reflects on the nature of feelings and behaviors revealed by listening in order to understand if those reactions can be used to deepen the treatment. Finally, the third step is intervening. The therapist selects the most appropriate countertransference feelings to disclose to the patient, to keep to oneself, or to discuss with a supervisor.

In terms of pastoral counseling, Wicks (1985) developed numerous strategies to overcome countertransference. Those strategies include self-analysis, supervision, case-by-case countertransference analysis, consultation, and reanalysis.

Self-Analysis

Pastoral counselors need to analyze themselves continuously to identify their motivation to be in the counseling profession. Wicks (1985) underlined that pastoral counselors need to analyze their unfulfilled needs including the need to solve internal personal issues in helping others. The abandonment of such needs will not only hamper counselors in providing effective counseling, but also jeopardize their clients’ lives. The more counselors understand and purify their call through rumination on their motivation, needs, and past conflicts, the higher their chances of success in helping those they counsel. The importance of personal counseling was first put forward by Sigmund Freud (in Malikiosi-Loizos, 2013), who believed that personal counseling is at the core of effective counseling. Freud emphasized that counselors find out and obtain the ideal qualifications required for counseling through regular self-analysis. According to Freud, intense feelings for or about the client are warning signs of the therapist’s need for more personal analysis (King & O’Brien, 2011). Therapists who want to help their patients using intensive psychotherapy should first have experience in treating themselves, so that they are more familiar with the basics of their unconscious conflicts (Gabbard, 1999).

Personal counseling aims to enhance professional development, relational competence, and the wellbeing of the counselors themselves. Personal counseling can raise counselors’ self-awareness through greater understanding which in turn leads to increased levels of empathy, warmth, and relational skills, awareness of transference and the countertransference process (Norcross, 2010). Other experts such as Grimmer and Tribe (in Orlinsky, Schofield, Schroder, & Kazantzis, 2011) argue that personal counseling can enhance the effectiveness of counseling and the counselor's wellbeing which includes several aspects related to counselors' professional development such as (a) increasing counselors' sensitivity to the needs of their client, (b) allowing counselors to master their therapeutic skills, (c) reducing counselors' stress and their emotional burden, (d) increasing counselors' understanding of their own problems, conflicts, and values.

Supervision

Supervision is the attempt to encourage and guide counselors’ development, so they can provide effective counseling (Kofler & Cosgrave, 1994). Supervision is conducted not only to support counselors’ professionalism and empower counselors to develop their counseling skills and knowledge, but also to improve the quality of counselors’ services to clients. Supervision helps counselors to recognize and discuss countertransference reactions and feelings that influence their work (Norcross, 2010; Noorani & Dyer, 2017).

Kofler & Cosgrave (1994) explained that supervisory activities help counselors reflect on how they do their work and the issues they are facing in providing services. Moreover, supervision helps counselors understand themselves better, deeply understand others, develop pastoral counseling skills, and maintain balance in counseling activities. Supervision provides an avenue to helping therapists focus on better understanding of both the client and the therapist (Gabbard & Wilkinson, 2000).

Case-by-Case Countertransference Analysis

Counselors are required to be aware of countertransference and attempt to analyze and overcome those reactions when they appear (Burwell-Pender & Halinski, 2008). Counselors need to pay attention to the following questions: what individuals say and how they cope, how I feel when I am with my client today, do my attitudes and feelings change when I face the client during the counseling session, how do I behave and feel now after my counseling meeting with past clients? (Wicks, 1985).

Consultation

Having consultation with a colleague, especially with a senior and experienced counselor, is one of the most important strategies for overcoming countertransference (Wicks, 1985). Counselors can gain new insights related to counseling cases they are facing through consultation. Consultation or presentation of a counseling case to a colleague helps counselors to get feedback which is useful for counseling practice.

Reanalysis

Counselors can use reanalysis as a strategy to identify and review all the methods and interventions they use which are not helpful. Wicks (1985) explained that when various methods and interventions are less helpful for counselors, personal counseling and consultation with a colleague are necessary. The willingness to directly engage in personal counseling without feeling embarrassed will help counselors to cope with internal conflict within themselves.

Conclusion

Various definitions and models of countertransference have been reviewed. The term countertransference is a key concept in a psychoanalytic approach. It includes emotional response, attitudes, and counselors’ behaviors toward clients. Countertransference is viewed as an impeding factor, but some consider it a normal or even beneficial reaction to counseling relationships, as long as the counsellor identifies and manages all reactions and uses them to better understand clients.

Pastoral counselors have to be aware of, examine and work through all countertransference reactions. To understand the concept of countertransference thoroughly, pastoral counselors need to comprehend the four models of countertransference: the classical model, the totalistic model, the complementary model, and the relational model.

Countertransference may affect the pastoral counselor’s attitudes and behaviors when conducting counseling. Countertransference can affect pastoral counselors during counseling sessions through the loss of empathy and respect, and the development of negative emotions toward clients. Pastoral counselors are required to continuously seek for the most appropriate and effective strategies to overcome countertransference. There are five factors that enable pastoral counselors to manage countertransference: self-understanding, self-integration, anxiety management, empathy, and conceptualization ability. Pastoral counselors who do not handle their countertransference properly are more likely to suffer from disruption that leads to therapeutic impasse.

Footnotes

Yoseph Pedhu, works in Department of Guidance and Counseling, Universitas Katolik Indonesia Atma Jaya, Indonesia Jln., Jakarta, Indonesia.

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