Ethical Boundaries in Balancing the Power Dynamic in the Therapeutic Relationship

The term countertransference is used in a variety of ways and for the past few days I have been thinking about using this term to refer all of the reactions the therapist experiences in the course of therapy. Is something lost in using the term so broadly?

I am reminded of Otto Fenichel’s definition of transference as “misunderstanding the present in terms of the past.” This is actually quite close to the way we usually understand transference in Cognitive Therapy (as times when the client’s responses to the therapist are based on preconceptions developed in emotionally important relationships). I realize that I usually think of countertransference in similar terms, as being a time when the therapist’s reactions are based on the therapist’s preconceptions developed in the therapist’s emotionally important relationships.

Would we gain something by drawing a clear distinction between the times when my reactions to a client are due to my “misunderstanding the client in terms of my own past”, and the times when my reactions are simply a reaction to what the client is saying and doing? My inclination would be to reserve the term countertransference for the former situation (assuming that I didn’t come up with a more cognitive-behavioral-sounding term to use).

It seems that one would handle the two situations somewhat differently. If I become aggravated with a client due to my own distortions, I need to recognize this and handle it well enough that it doesn’t disrupt therapy. However, my reactions probably reveal more about my psyche than they reveal about the client. They may turn out to be useful in therapy but they are more likely to be an impediment.

On the other hand, if my aggravation is primarily a response to the client’s words and actions and is not strongly influenced by my own distortions, then my reactions may provide some insight into how others experience the client. Our interaction may be replicating some of the interpersonal problems the client experiences in real life and thus provide us with an opportunity to understand the problems and/or intervene in the here-and-now interaction within therapy. I still need to recognize my reactions and handle them so that they do not disrupt therapy but they may also provide us with a valuable opportunity.
Donald N. Bersoff, Ethical Conflicts in Psychology

Ethical Decision Making, Therapeutic Boundaries, and Communicating Using
Online Technology and Cellular Phones

- Yonan, J., Bardick, A. D., and Willmet, J. H. (2011). Ethical Decision Making, Therapeutic Boundaries, and Communicating Using Online Technology and Cellular Phones. Canadian Journal of Counselling and Psychotherapy, 45(4). p. 307-326.

Peer-Reviewed Journal Article References:
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Kim, S., & Rutherford, A. (2015). From seduction to sexism: Feminists challenge the ethics of therapist–client sexual relations in 1970s america. History of Psychology, 18(3), 283–296.

Pizer, B. (2017). “Why can’t we be lovers?” When the price of love is loss of love: Boundary violations in a clinical context. Psychoanalytic Psychology, 34(2), 163–168. 

Summers, F. (2017). Sexual relationships between patient and therapist: Boundary violation or collapse of the therapeutic space? Psychoanalytic Psychology, 34(2), 175–181.
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Ethics CEU QUESTION 19
What is Otto Fenichel’s definition of transference(referenced in - Bersoff, Donald N., Ph.D., "Ethical Conflicts in Psychology." American Psychological Association, Washington DC, 1999.)? To select and enter your answer go to Ethics CE Test.