Psychotherapy © 2015 American Psychological Association

2015, Vol. 52, No. 1, 127–133 0033-3204/15/$12.00 http://dx.doi.org/10.1037/a0038827

Countertransference in Successful and Unsuccessful Cases

of Psychotherapy

Jeffrey A. Hayes and Dana Lea B. Nelson James Fauth

The Pennsylvania State University Antioch University

Countertransference (CT) can provide psychotherapists with important information about relationship
dynamics with clients, the therapy process, and clinical decisions. CT also can lead therapists to view
clients and sessions inaccurately, feel unduly anxious, and behave in ways that primarily meet their own
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needs at the expense of clients. In summarizing existing scholarship on CT, Fauth (2006) noted the need
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for further research on therapists’ subjective experiences of CT to enhance current understanding of this
pantheoretical construct. To this end, we interviewed 18 therapists about their experiences of CT in a
recently terminated case; half of the therapists described CT in a case they judged to be successful, and
half described a case they thought was unsuccessful. Interview questions were designed to address the
5 components of CT proposed by Hayes (1995): origins, triggers, manifestations, effects, and manage-
ment. A grounded theory analysis was conducted and a model describing therapists’ experiences of CT
in successful and unsuccessful therapy was developed. Implications for practice, training, and research
are discussed.

Keywords: countertransference, therapist effects, qualitative research

Although the concept of countertransference (CT) originated in
psychoanalytic theory, it has become a topic of interest to thera-
pists and researchers from a variety of theoretical orientations.
Owing to the psychological scars inherent to the human condition,
all therapists experience CT, though its effects may be more
pronounced in theoretical approaches that are more relational than
technical. Following decades of clinical and theoretical writings on
CT, research conducted during the past 25 years has accumulated
to the point where meta-analyses are now possible (Hayes, Gelso,
& Hummel, 2011). Research on CT is crucial because therapists’
reactions to their clients, and the management of these reactions,
can affect the process and outcome of psychotherapy, sometimes
radically so (Fauth, 2006; Gelso & Hayes, 2007; Hayes et al.,
2011). As a result, research that enhances current understanding of
CT may be valuable to improving the quality of services that
therapists provide.
A number of definitions of CT have abounded over the years,
but the one that has been used most consistently in the research
literature construes CT as therapists’ reactions to clients that are
based on therapists’ unresolved conflicts (Gelso & Hayes, 1998,
Jeffrey A. Hayes, Department of Educational Psychology, Counseling,
and Special Education, The Pennsylvania State University; Dana Lea B.
Nelson, Center for Counseling and Psychological Services, The Pennsyl-
vania State University; James Fauth, Department of Clinical Psychology,
Antioch University.
We thank Helen Coble for her assistance with data collection. This
article is dedicated to Charlie Gelso, mentor, fishing partner, role model,
and friend.
Correspondence concerning this article should be addressed to Jeffrey A.
Hayes, 307 Cedar Building, Penn State University, University Park, PA
16802. E-mail: jxh34@psu.edu
2007). This definition does not delimit CT to the therapist’s
unconscious, negative reactions to transference (Freud’s “classical
definition”), but it does distinguish reactions that originate in the
therapist’s unresolved issues (CT) from those that have other
causes, or any cause for that matter (the “totalistic definition”).
Given the restrictiveness of the classical definition and the over-
inclusiveness of the totalistic one, most research on CT has utilized
this moderate definition, as does the present study.
Most early research on CT lacked a coherent theoretical framework
to organize and integrate findings. Hayes (1995) generated such a
framework, proposing that CT can best be conceptualized as consist-
ing of five main components: origins, triggers, manifestations, effects,
and management. Origins are areas of unresolved conflict within the
therapist. Triggers are therapy-related events that provoke the thera-
pist’s unresolved conflicts. Manifestations are the therapist’s cogni-
tive, affective, behavioral, and visceral reactions to these events.
Effects are the subsequent results of these manifestations on therapy
process and outcome. Finally, management refers to the therapists’
ability to regulate their CT manifestations.
Researchers have assessed each of these five dimensions, and the
relationships among them, with mixed success. Quantitative measures
of CT origins have tended to assess fairly superficial constructs; in
contrast we believed that a qualitative approach in which the therapist
had a trusting relationship with an interviewer might yield findings
with greater depth. Previous research on CT triggers consisted largely
of analogue studies of client characteristics predicted to evoke CT
(Gelso & Hayes, 2007). When considered alone, such triggers typi-
cally failed to predict CT manifestations. Analogue studies, however,
suffer from limited external validity; qualitative research conducted in
naturalistic settings represents one possible means of overcoming this
limitation. Research on the manifestations of CT suggests that anxi-
ety, avoidance, and distorted perceptions are perhaps the most com-
mon CT reactions (Gelso & Hayes, 2007). They are by no means,

127
 128 HAYES, NELSON, AND FAUTH
however, the only types of CT reactions, and we thought that
discovery-oriented research might reveal other common manifesta-
tions of CT. We also were particularly interested to know if an
exploratory approach might suggest that CT reactions and their effects
vary as a function of the relative success of a case. The effects of CT
seem to be inversely, though modestly, related to therapy outcomes
(Hayes et al., 2011). Finally, studies of CT management have in-
volved assessing therapist characteristics, such as self-insight and
empathic ability, which are postulated to help clinicians moderate CT
reactions (Van Wagoner, Gelso, Hayes, & Diemer, 1991). The CT
management factors that have been most commonly studied to date do
not seem to help reduce CT reactions (r ⫽ ⫺.14) but they are strongly
associated with positive therapy outcomes (r ⫽ .56; Hayes et al.,
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2011). We wondered if there might be other therapist characteristics
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or behaviors that aid in the management of CT and whether they
operate differently in cases of successful and unsuccessful therapy.
We sought to explore these questions in the present study.
The aim of the present study, then, was to further the exploration
of therapists’ subjective experiences of CT, using Hayes’ (1995)
structural model as a guide. We employed a grounded theory
approach, which uses an inductive process to develop an empiri-
cally based theoretical model for a phenomenon, the details of
which will be discussed further below.
Method
Participants
Eighteen therapists in the United States were interviewed for the
study. Therapists lived in a large city on the West coast (n ⫽ 3),
a college town in the Mid-Atlantic region (n ⫽ 6), and a large city
in New York (n ⫽ 9). Ten therapists were men and 8 were women.
Their mean age was 52.0 years (range ⫽ 41– 63) and all but one
were European American; 1 therapist was African American. The
mean number of years of postdoctoral experience was 19.9
(range ⫽ 6 –30). Therapists were asked to indicate on a 1-to-5
scale the degree to which different theoretical orientations influ-
enced their work. The mean ratings were 3.65 for humanistic, 3.50
for psychodynamic, and 3.00 for cognitive– behavioral.
Procedure
Therapists in the two cities were recruited in person through
researchers’ contacts with therapists. In the college town, all
practicing psychologists listed in the telephone book were sent a
letter describing the nature of the study and inviting their partici-
pation. All interviews were conducted in person, lasted approxi-
mately an hour, and were audio-recorded. A semistructured format
with an exploratory style of interaction was used, in which open-
ended and nondirectional questions were asked to reduce the
likelihood of introducing researchers’ biases.
Prior to the interview, participating therapists were asked to
choose a client with whom they had terminated in the last year and
whose case they would be willing to discuss. Therapists were
randomly assigned to interview conditions in which they were
asked to discuss cases where they believed that therapy had been
either successful (9 therapists) or unsuccessful (9 therapists). A set
of 17 questions, designed by the researchers to elicit information
about therapists’ experiences of CT with these clients, was mailed
to participants in advance and was asked during the interview (see
the Appendix). Fifteen of the interviews were conducted by the
first and third authors; the three interviews on the West coast were
conducted by a research assistant.
Data Analysis
The analyses were performed by the three authors, two men and
a woman, all of whom were European American. Both men had
doctoral degrees in counseling psychology, had worked in aca-
demia for 13 and 22 years, respectively, had conducted research on
CT, and worked part-time in private practices. The woman was an
advanced doctoral student in clinical psychology who had com-
pleted her master’s degree. All three had experience conducting
qualitative research and were eclectic in their theoretical orienta-
tions. Each followed recommended procedures for conducting
grounded theory to raise awareness of and manage their biases,
such as documenting them in advance of data analyses and check-
ing results against preexisting beliefs and expectations by record-
ing their ideas during the data analytic process. These procedures
were thought to be especially important given that the primary
author developed the structural theory which guided the interview
questions (Hayes, 1995), he conducted some of the interviews, and
he participated in the data analysis process. The researchers needed
to be particularly cautious, therefore, of a tautological process
wherein preconceptions about CT were simply reified by the
research process. Multiple interviewers, bracketing of biases, and
multiple data analysts all were employed to increase the likelihood
that findings would yield modifications to Hayes’ (1995) theory
and new discoveries about CT.
Interviews were transcribed and analyzed using the grounded
theory method (Rennie, Phillips, & Quartaro, 1988). One re-
searcher analyzed the successful cases, one analyzed the unsuc-
cessful cases, and the third provided feedback and integrated
findings from all of the cases. After the interviews were tran-
scribed, transcripts were divided into “meaning units,” or segments
of text that contain a single idea or theme. Meaning units were then
assigned labels that remained close to the language used by the
participants. Each meaning unit was compared to every other
meaning unit, developing categories that grouped units together
according to perceived similarities. The categories were then com-
pared with one another, again looking for similarities. Similar
categories were combined, forming higher order “clusters” which
then were combined into “core categories.” This process of con-
stant comparison continued until a hierarchical model was devel-
oped, one each for the successful and unsuccessful cases. These
two models were then compared by the third researcher, who
denoted similarities and differences between them.
Results and Discussion
Because many of the interview questions were informed by
Hayes’ (1995) structural model of CT, participants’ responses
naturally followed this framework. Thus, five core categories were
established relating to the origins, triggers, manifestations, effects,
and management of CT. These core categories and their associated
clusters and illustrative categories are presented in Table 1.
 COUNTERTRANSFERENCE 129

Table 1
Core Categories, Clusters, and Categories of CT Components

Number of
Core Category Cluster Occurrences Illustrative Categories

Origins Unresolved personal issues 6 (S) Fear of others’ dependence

5 (U) Difficulty trusting others
Unresolved professional issues 6 (S) Difficulty confronting clients
4 (U) Doubts about competence
Triggers Client resemblance to T 6 (S) Cl and T both had distant fathers
1 (U) Cl and T both need to please others
Client resemblance to others 4 (S) Cl seen by T as similar to friend
1 (U) Cl seen by T as similar to parent
Differences between Cl and T 4 (S) T perceived Cl as more attractive
0 (U)
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Client behaviors 6 (S) Cl discussed sexual escapades

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6 (U) Cl disengaged from T

Client characteristics 1 (S) T perceived Cl as attractive
6 (U) T perceived Cl as dependent
Manifestations Pleasant feelings 5 (S) Warmth, caring, compassion
7 (U) Warmth, patience, hope
Unpleasant feelings 12 (S) Anger, worry, envy, guilt
7 (U) Anger, worry, self-doubt
Cognitions 7 (S) Confusion, forgetfulness
4 (U) Confusion, misconceptualization
Behaviors 7 (S) Colluding, working too hard
4 (U) Relaxing boundaries with C
Effects Facilitating 9 (S) T paid better attention to C
2 (U) Stronger working alliance
Hindering 2 (S) C was scared by T’s disclosure
2 (U) Weaker working alliance
Management Caution/Vigilance 7 (S) About not blaming C
0 (U)
In-session reminders 6 (S) To stay calm, to be present to C
0 (U)
Out-of-session behaviors 6 (S) Took better care of self, consulted
3 (U) Reflected on treatment, consulted
Self-insight 4 (S) Kept own values in perspective
1 (U) Did not recognize reactions as CT
Note. U indicates unsuccessful cases, S indicates successful cases.

Origins
The primary sources of CT for therapists in this study—personal
and professional—are consistent with those found in Hayes et al.
(1998). For instance, on a personal level, therapists in both studies
identified unresolved issues from one’s family of origin and the
therapist’s need to be liked as sources of CT reactions. For exam-
ple, one therapist described himself as “never a big part of the elite
in-crowd . . . .the not-so-popular kid . . . with issues of being
attractive, issues of popularity” whose insecurity was provoked
working with a client he characterized as “the classic high school
football quarterback.” On a professional level, primary themes
related to the role of therapist found in this study had to do with the
need to feel competent or the tendency to doubt one’s ability as a
therapist, the tendency to feel overly responsible for clients’ prog-
ress or lack thereof—and therefore to feel inadequate (or, in the
words of one therapist, like a “failure”) when treatment did not
seem to be working. One therapist, speaking about his difficulty
trusting his reactions to clients, described having “unresolved
issues about my feelings of competence and confidence in myself
and willingness to listen to what’s happening inside.” Another
therapist discussed her feeling overly responsible for a client by
saying, “In terms of that rescuer/hero kind of feeling in me, she
initially really challenged me. OK, let’s do more and more and
more and more to try to get this client better.”
Triggers
Consistent with the findings of previous research (e.g., Cutler,
1958; Hayes et al., 1998; Tishby & Vered, 2011), the content of
client material was a frequent trigger for many therapists (e.g., the
client talked about sexually explicit behaviors and fantasies). Al-
though many triggers could be considered objective events (e.g.,
the client attempted suicide), others were highly influenced by
therapists’ subjective perceptions, such as perceiving clients as
similar to other people in the therapist’s life (e.g., “my biggest
countertransference with her actually was that she reminded me of
one of my closest friends and this was a little complicated”) or to
themselves. For instance, one therapist identified with her client’s
tendency to be overly accommodating:
I think I’m tuned in to issues of accommodation. That’s something
I’ve had to struggle with . . . sometimes accommodating beyond my
energy or beyond what I really should be offering . . . to somebody
else who needs me . . . . How much do you give someone, and when
do you cut them off and stop giving? . . . I thought he was similar to
 130 HAYES, NELSON, AND FAUTH
myself in that I go a very long way to try to keep people that I love
happy and promoted and I thought that he had a similar problem.
Also consistent with previous research findings (Gelso & Hayes,
2007), therapists’ CT reactions were best understood in the context
of therapy-related events (i.e., triggers) that provoked their unre-
solved issues (i.e., origins). For example, one therapist who spoke
about having unresolved issues with needing to be liked spoke
extensively about how difficult it was for her to work with a client
who was quite passive and disengaged, because the client’s dis-
engagement made her feel as though the client did not like her, and
this made her feel restricted from “being [her]self.” Another ther-
apist who spoke about unresolved issues in her relationship with
her children and her concerns about how well she had done in
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promoting her children’s individuation reacted to a client who was
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having difficulty individuating from her own mother. In this case,
the therapist became overly invested in the client’s successfully
individuating and experienced feelings of wanting to be the “good
mother” (as compared to the client’s real mother, who was the
“bad mother”). Gelso and Hayes (1998, 2007) recommend that
therapists take into account such interactions between their unre-
solved issues and the events that trigger them to understand and
manage their CT; examining origins or triggers in isolation is
probably of limited value.
Manifestations
Therapists’ affective CT reactions included a wide variety of
positive and negative feelings, both toward the client (e.g., anger,
envy) and about oneself (e.g., guilt, inadequacy). For instance, a
therapist who was attracted to her client “found him a little bit
intimidating . . . and I felt somewhat inadequate.” Another thera-
pist described feeling burdened by a client for whom the therapist
had taken too much responsibility. Therapists’ cognitive reactions
were uniformly undesirable, and they included forgetfulness, mis-
conceptualizing the client, making poor treatment decisions, and
general confusion. Some therapists spoke about how their CT led
them to overlook important information that did not fit with their
initial impressions of their clients or to make assumptions that
were later disconfirmed (e.g., “I realized that I had missed a lot of
his sadism and that what I saw as a victim, in fact, was a really
aggressive guy—and that I had been bamboozled on that”). An-
other therapist indicated “I really minimized his alcohol abuse . .
. and I don’t normally deny or miss that stuff, but I think there was
this conjunction of what my family does, always deny and mini-
mize a severe addiction when it is going on . . ..I think all of that
was so tinged with my own experiences with my brothers that it
was very hard for me to get a clear picture of him early on.” On a
behavioral level, the acting out of CT reactions took a variety of
forms, such as colluding (e.g., “Looking back at the CT stuff, I
think that there were some ways I colluded with him early on
which made a very comfortable relationship”), arguing, showing
off, working too hard, and not working hard enough. For instance,
one therapist whose case was unsuccessful expressed she did not
work as hard to keep her client in therapy as she might have
normally. She said, “Maybe I prematurely suggested—when she
made the motions about not coming every week—I [might] have
said ‘ok’ . . . I don’t know . . . because it wasn’t very rewarding and
[it] was anxiety producing.”
It is interesting to note that therapists whose outcomes were
successful articulated more unpleasant feelings and problematic
cognitive reactions than did therapists with unsuccessful outcomes.
This raises at least two possibilities: a) therapists whose outcomes
were successful were more aware of (and willing to discuss) their
CT reactions to clients, and b) therapists whose outcomes were
successful managed their covert reactions so that they did not spill
out into CT behavior. In terms of the former, it is both plausible
and consistent with prior research that awareness of CT reactions
would be associated with better psychotherapy outcomes (Gelso &
Hayes, 2007). In terms of the latter, successful CT management
has been found to be strongly related to positive psychotherapy
outcomes (Hayes et al., 2011).
Effects
Whereas the design of this study does not permit causal infer-
ence regarding the effects of therapists’ CT, findings do provide
important information about therapists’ perceptions of such ef-
fects. Perceived effects of CT on treatment process and outcomes
included facilitating treatment by making better treatment choices,
supporting the client, strengthening the working alliance, and
coming to understand the client more deeply. For example, one
therapist whose codependency issues were similar to the client’s
remarked, “I think the facilitating part was really being able to
empathize with the sense of ‘I want to be a good person’ and ‘I
want to be helpful to this person who I love but I feel a little
trapped by the work involved’ so I think I can empathize with
that.” CT reactions also interfered with treatment through hurting
the client’s feelings, frightening the client, and weakening the
working alliance. For example, one therapist expressed that her
discomfort with her client possibly not liking her caused her to feel
restricted with the client and have more difficulty connecting with
her. Another therapist indicated that her CT caused her to become
overly invested in a particular outcome for the client, leading the
client to withhold important information for fear of disappointing
the therapist. Among the most common negative effects, therapists
spoke about ways in which CT reactions caused them to misper-
ceive their clients and thus inaccurately diagnose or conceptualize
their cases. Such misperceptions often led them to make treatment
choices that they later regretted. Several therapists also spoke
about the negative impact of their CT reactions on the working
alliance. Interestingly, both positive and negative feelings toward
the client seemed to produce such effects. For instance, a therapist
who developed strong positive feelings toward her client and
became overly invested in the client’s individuation from her own
mother came to find out that her client had withheld information
about a drug relapse for fear of disappointing the therapist.
Management
Therapists discussed a number of different strategies for man-
aging their CT reactions, seemingly with varying degrees of suc-
cess. Those therapists who indicated either that they were not
aware of their CT enough at the time to adequately manage it or
that they simply tried to contain their CT tended to view their CT
as directly related to the negative outcomes of their cases. Thera-
pists who reflected— either by themselves or with their cli-
ents— on the relational dynamics of therapy or who sought con-
 COUNTERTRANSFERENCE
sultation from colleagues tended to feel that they had more
successfully managed their CT and, when negative outcomes oc-
curred, tended to see poor outcomes as unrelated (or less related)
to their CT and more related to the limitations of their clients (e.g.,
severity of pathology, lack of “readiness” for change, antisocial
tendencies, etc.). Such findings are consistent with previous re-
search, which suggests that therapists’ awareness of their feelings
toward clients is inversely related to demonstrations of CT behav-
ior (Hayes et al., 2011).
Some therapists whose cases had unsuccessful outcomes de-
scribed simply trying to “contain” their reactions, often without
articulating how, and sometimes were unaware of their CT reac-
tions. One therapist said of her CT, “I don’t think I fully under-
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stood it until she left therapy, so I don’t remember that I did
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anything . . . I don’t think I understood it to be a problem actually
at the time . . . In hindsight I did.”
Therapists who discussed cases with successful outcomes pro-
vided much more detailed strategies about managing their CT
reactions, such as by remaining vigilant in session about their own
internal experiences; reminding themselves in session to stay calm,
objective, and attentive to clients; using their self-awareness in
session, and taking care of themselves outside of work. For exam-
ple, one therapist said that she realized, “You can’t save everybody
and it helped me kind of face some things in myself that I can’t just
think I’m going to be able to save the world here . . . . I don’t know
if this sounds weird or not but I think that once I started really
taking better care of myself it helped, I think, free me up to say
I’ve taken this client as far as I can take it.” Another therapist
remarked:
I can observe myself thinking about or framing . . . and I try
basically to be as objective as I can possibly be . . . I was able to
step back and say, ‘We’re overassuming here. We’ve got to stay
where this person is and with the issues that he has that you are not
forced into here.’ That’s always running through my mind in a
parallel fashion . . . [The reactions] were there and so was my
awareness of their being there and how I was using or misusing
them at a given time.
The list of CT management strategies in Table 1 may be thought
of as a helpful set of suggestions for therapists, trainees, and
supervisors to keep in mind when CT issues are affecting a case.
They supplement the five therapist characteristics that have been
researched by Gelso and colleagues (Gelso & Hayes, 1998, 2007)
by providing possible behaviors in which therapists can engage to
effectively manage CT. Of particular potential value may be in-
session reminders to oneself (e.g., to stay calm, objective, and
present to both oneself and the client), exercising an internal
vigilance about one’s own reactions, and using one’s self-
awareness (e.g., by distinguishing the client from other people in
the therapist’s life); it is important to note that these strategies were
used only in cases that had successful outcomes.
Integration of Successful and Unsuccessful Cases:
A Grounded Theory
In successful and unsuccessful cases alike, CT was evoked when
therapists’ unresolved personal and professional issues were acti-
vated by their perceptions of client characteristics and behaviors,
manifesting through a wide range of cognitive, affective, and
behavioral mechanisms that typically led to primarily helpful
131
effects in successful cases. Successful and unsuccessful cases
differed markedly in the specificity, quality, and success of ther-
apists’ efforts to manage their CT, and the downstream effects of
CT on the case as a whole. Similar to the process of alliance
rupture and repair, in successful cases, therapists’ CT management
efforts helped them reframe, decenter, depersonalize, or otherwise
attain an enlarged perspective on the enactment taking place, and
this new understanding allowed them to make adjustments and
work more productively with their clients (Safran, Muran, Sam-
stag, & Stevens, 2001).
The results of this study not only provide additional detail to
Hayes’ (1995) model of CT but they also supplement the work of
other CT scholars. The CT manifestations reported by our partic-
ipants were consistent with common CT reactions—forgetting,
confusion, identifying with the client, and feelings of being help-
less, overwhelmed, positive, overinvolved, withdrawn, disen-
gaged, and parental—that have been identified in previous studies
by other research teams (Betan, Heim, Zittel Conklin, & Westen,
2005; Hofsess & Tracey, 2010; McClure & Hodge, 1987; Tishby
& Vered, 2011). At the same time it should be noted that none of
the participants in the current study identified bodily or somatic
CT manifestations, as has been identified and described by a team
of Irish researchers (Booth, Trimble, & Egan, 2010).
Limitations, Implications, and Recommendations for
Future Research
The inherent limitation of research based on interviews with
therapists about their CT is that therapists may not be willing or
able to share deeply personal, and perhaps unconscious, informa-
tion about themselves. Furthermore, as Rennie et al. (1988)
pointed out, an additional limitation of grounded theory research
(and qualitative research more generally) is that it tends to involve
a relatively small number of participants. What is gained in depth
is lost in breadth. Given the fact that this study explored the CT
reactions of only 18 therapists and each with only one case, these
findings are of limited generalizability to other therapists or other
cases. Nonetheless, whereas these findings are no doubt incom-
plete, their consistency with and amplification of previous research
by a variety of scholars suggests that they have touched upon some
of the major themes that tend to arise in therapists’ experiences
with their clients. Furthermore, the findings help to modify Hayes’
(1995) skeletal model of CT, particularly in the area of CT man-
agement where new, specific management strategies were identi-
fied. The more that studies of this kind are conducted (with
different types of therapists, clients, and treatment modalities), the
more comprehensive our knowledge of CT phenomena will be. It
will be especially useful for other researchers to undertake such
studies since this study suffers from the possibility of reification.
That is, the primary author was involved with the planning, data
collection, and data analysis of a study designed to augment his
own structural theory of CT. Although we believe that the find-
ings—particularly those pertaining to CT management—substan-
tially augment Hayes’ original theory, ultimately the reader must
judge how well findings met standard criteria for qualitative re-
search, including the extent to which results were coherent,
grounded in observations versus preconceptions, and replicable
(Stiles, 1997).
 132 HAYES, NELSON, AND FAUTH
Despite its limitations, the findings of this study have important
implications, both for practice and for future research on CT.
Practicing therapists may use this framework and the observations
of therapists who were part of this study to reflect on their own
experiences of CT, possible pitfalls they may be able to avoid, as
well as the success of their current management strategies. When
therapists are aware of the various cognitions and emotions listed
in Table 1, they would do well to trace their source to possible
unresolved personal or professional issues that may require atten-
tion. Likewise, trainees and supervisors may benefit from using
this framework to facilitate discussions of CT in trainees’ work
with clients and, more generally, in therapists own development.
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Appendix
Interview Questions

1. What was the client’s initial problem for which he or ity” of the therapy relationship and to what extent were
she sought therapy? they grounded in your own unresolved issues (i.e.,
countertransference based)?
2. What was your initial formulation of the client’s prob-
lem and how did that change over the course of therapy? 11. What happened in therapy to provoke or elicit your
countertransference reactions?
3. What was the outcome of the case? That is, how did the
client change, if at all? 12. How were those countertransference reactions related to
your own unresolved issues?
4. Please describe the working alliance at the beginning of
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

therapy and discuss how it changed over time. 13. How did you countertransference reactions facilitate or
This document is copyrighted by the American Psychological Association or one of its allied publishers.

interfere with your understanding of the client? Did this

5. In what ways was the client similar to yourself? vary during the course of therapy?

6. In what ways did the client remind you of other people 14. How did you try to manage or therapeutically use your
in your life? countertransference reactions?

7. How genuinely did you and your client relate to each 15. How frequently did you self-disclose your countertrans-
other at the outset of therapy and how did this change ference reactions to your client and what influenced
over time? your decisions about doing so?

8. How accurately do you think you and your client per-
ceived one another at the outset of therapy and how did
the accuracy of those perceptions change over time?
9. What role did transference play in the client’s percep-
tions of you and in the therapy?
16. On the whole, then, in what ways did countertransfer-
ence affect your work with this client?
17. What else might be important for me to know in under-
standing the role of countertransference in this case?

10. Please describe the various reactions that you had to this Received January 6, 2014
client (e.g., thoughts, feelings, behaviors, images, etc.). Revision received February 20, 2014
To what extent were these reactions based in the “real- Accepted February 21, 2014 䡲