Trasference and Countertransference in Cognitive Therapy

Transference, countertransference, and reflective practice incognitive therapycp_30 112..120

Claire CARTWRIGHT

Department of Psychology, University of Auckland, Tamaki Campus, Private Bag, Auckland, New Zealand

Key wordscognitive therapy, countertransference,

reflective practice, therapeutic relationship,

transference.

CorrespondenceClaire Cartwright, Department of Psychology,

University of Auckland, Tamaki Campus, Private

Bag 92019, Auckland, New Zealand.

Email: [email protected]

Received 23 March 2011; accepted 21 August

2011.

doi:10.1111/j.1742-9552.2011.00030.x

Abstract

Background: The concepts of transference and countertransference devel-

oped within psychodynamic paradigms. While there is an increasing interestby cognitive therapists in the therapeutic relationship, there is less discussionof the relevance of transference and countertransference. Understanding theseconcepts may be useful to cognitive therapists as part of reflective practice,especially in regard to understanding and managing countertransferenceresponses.Methods: This article briefly examines the concepts of transference from a

number of different perspectives, including social-cognitive, attachment, cog-nitive analytic therapy, and schema perspectives. Two aspects of counter-transference that are sometimes termed “subjective” and “objective” are alsoexamined. A case example is given to illustrate a cognitive conceptualisationof countertransference.Results: There is some evidence that therapists’ countertransference

responses can provide insight into clients’ experiences and patterns of relatingto others. Cognitive therapists may therefore benefit from applying psycho-dynamic perspectives of countertransference in reflective practice.Conclusions: Transference and countertransference can be understood using

cognitive perspectives. These concepts may be helpful for cognitive therapiststo consider during reflective practice in self-supervision and in clinical super-vision. It seems important that cognitive therapists do not dismiss these con-cepts because of their origins but rather investigate the potential applicationsof these concepts within cognitive frameworks.

The therapeutic relationship can be viewed as hav-ing three components—the therapeutic alliance, thetransference–countertransference relationship, and thereal or personal relationship (Gelso & Hayes, 2007;Horvath, 2000). The therapeutic relationship and espe-cially the transference–countertransference relationshipare viewed as central to therapeutic outcomes in psycho-dynamic psychotherapies (Gabbard, 2004). In cognitivetherapy, the therapeutic relationship is considered impor-tant as a necessary underpinning to the effective imple-mentation of cognitive and behavioural interventionsrather than a main focus of therapy (Gilbert & Leahy,2007). In the last decade, there has been an increasingfocus on the therapeutic relationship and the therapeuticalliance in cognitive therapy (Leahy, 2008; Safran &

Key Points

1 The concepts of transference and countertransfer-ence developed within psychodynamic traditions.These concepts, however, can be understood fromalternative perspectives.

2 Understanding the concepts of transference andcountertransference from a cognitive perspectivemay aid cognitive therapists in the processes ofreflective practice and clinical supervision.

Funding: None.Conflict of interest: None.

Clinical Psychologist 15 (2011) 112–120

© 2011 The Australian Psychological Society112

Muran, 2000). However, there is less focus on transfer-ence and countertransference, although there are excep-tions to this, as will be discussed. Given the potential forcountertransference responses to impact negatively onthe therapeutic relationship (Gelso & Hayes, 2007), itmay be important for cognitive therapists to understandand consider transference and countertransference aspart of reflective practice in self-supervision and in clini-cal supervision. This, in turn, may assist in the manage-ment of countertransference responses and therebyprotect the therapeutic relationship from what psycho-dynamic therapists refer to as countertransference enact-ments (Gabbard, 2001).

In this article, I examine the concepts of transferenceand countertransference in order to consider theirusefulness for cognitive therapists as part of reflectivepractice, both in self-supervision and clinical supervision.Two potential aspects of countertransference (“subjec-tive” and “objective”) that have been studied by somepsychodynamic therapists are discussed. These conceptsare examined from a range of different perspectives,including cognitive perspectives. A case discussion is pro-vided as an illustration of the application of these con-cepts. It is important to note, however, that this article isnot suggesting that cognitive therapists adopt a psycho-dynamic approach to treatment. Rather, it considers waysin which these concepts can be understood from cogni-tive perspectives and how they can be used to reflectupon countertransference.

The Therapeutic Relationship andCognitive Therapy

As mentioned previously, there appears to be anincreased interest in the therapeutic relationship in cog-nitive therapy (see Gilbert & Leahy’s (2007) edition thatpresents several different cognitive approaches to thetherapeutic relationship). On the other hand, there isless interest in transference and countertransference.For example, a search of the PsycInfo database between2000 and 2011 found only 16 references combining thekeywords “cognitive therapy or cognitive behavioraltherapy” and “transference,” and 13 references combin-ing the keywords “cognitive therapy or cognitive behav-ioral therapy” with “countertransference.”

The increased interest in the therapeutic relationshipmay be due to the empirical support for the importanceof the therapeutic alliance to therapy outcomes (Leahy,2008). In their meta-analytic review of 79 studies,Martin, Garske, and Davis (2000) investigated the rela-tionship between therapeutic alliance and therapy out-comes, and concluded that the alliance is moderatelyrelated to therapy outcome (r = 0.22) regardless of

variables such as the treatment approach, the type ofoutcome measure used in the study, the type of outcomerater, the time of alliance assessment, the type of alliancerater, the type of treatment provided, or the publicationstatus of the study. Similarly, in their decade reviewof process-outcome studies, Orlinsky, Ronnestad, andWillutzski (2004) concluded that the alliance is consis-tently, though not invariably, associated with positiveoutcomes in psychotherapy and that few findings inprocess and outcome research are better documented.DeRubeis, Brotman, and Gibbons (2005) point to someinconsistent findings for the role of the alliance in cogni-tive therapy and suggest that symptom improvementmay lead to a good working alliance rather than thereverse. However, there is evidence that shows that thealliance is not the result of early improvement and thatsubsequent improvement can be traced to the alliancerather than early improvement (Wampold, 2010). Forexample, Klein et al. (2003) treated 367 chronicallydepressed clients with the cognitive-behavioural analysissystem of psychotherapy and found that the early alli-ance significantly predicted subsequent improvement indepressive symptoms after controlling for prior improve-ment and client characteristics. In contrast, neither earlylevel of the alliance nor change in symptoms predictedthe subsequent level or course of the alliance. Hence, asLeahy (2008) points out, assuring the use of effectivecognitive therapy techniques, along with a good thera-peutic alliance, may provide the optimal treatment.

In order to ensure a good therapeutic alliance, thera-pists need to be able to understand and manage theirown responses to clients (Gelso & Hayes, 2007; Safran &Muran, 2000). In this article, I argue that cognitive thera-pists may benefit by using the concepts of transferenceand countertransference in the process of reflective prac-tice in self-supervision and clinical supervision. In orderfor this to be meaningful, however, it seems important tobe able to conceptualise countertransference using cog-nitive perspectives.

The next section examines transference from a numberof perspectives. These include a social cognitive model(Miranda & Andersen, 2007), an attachment model(Bowlby, 1988), the Cognitive Analytic Therapeutic(CAT) model (Ryle, 1998), and a schema-focused model(Leahy, 2007).

Transference

Transference occurs in everyday life in interpersonal situ-ations; however, the term is generally used to denoteclients’ reactions to therapists. Greenson’s (1965) defini-tion is often used by psychodynamic theorists (Andersen& Baum, 1994). This definition refers to transference as

Transference and countertransference

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“the experiencing of feelings, drives, attitudes, fantasies,and defenses toward a person in the present, which areinappropriate to the person and are a repetition, a dis-placement of reactions originating in regard to significantpersons of early childhood” (Greenson, 1965, p. 156).This definition is situated within a psychodynamicparadigm and emphasises the unconscious, drives, anddefences. On the surface, this seems incompatible with acognitive perspective, which emphasises the here andnow, problem solving, and using rationality and behav-ioural activation (Leahy, 2008).

Andersen and colleagues (Andersen & Berk, 1998;Miranda & Andersen, 2007) have investigated anddemonstrated the existence of transference in non-therapeutic situations using laboratory settings. Theyexplain transference using a social cognitive model.According to this model, transference presupposes thatmental representations of significant others exist inmemory and are triggered by relevant cues in anycontext. When a transference is triggered, the personviews the other through the lens of pre-existing repre-sentations of significant others. This model also assumesthat representations of significant others are linked withrepresentations of self, so that when a representation ofother is triggered, the corresponding representation ofself is also triggered and vice versa. These representationsof self and other are developed in relation to significantothers and lead to interpersonal patterns of relationshipsthat are superimposed onto new individuals (Andersen &Berk, 1998). The transference response that occurs isviewed as a cognitive-affective response with motiva-tional elements. Andersen and Berk argue that transfer-ence is basic to social life and therefore deeply relevantto clinical theory. While transference is seen as a normalprocess, superimposing old interpersonal patterns onrelationships in everyday life (and in therapy) can beproblematic and is linked to psychopathology.

Ryle (1998) has conceptualised transference andcountertransference according to the CAT framework.Briefly, individuals in CAT are viewed as organising theirexperience and behaviour through the developmentof “procedures” made up of self-confirming sequencesthat include cognitive processes (e.g., perception andappraisal), enactments, evaluation of consequences, andmodification or confirmation of the procedure. Indivi-duals play roles and in so doing seek out or elicit reci-procating responses from others. These reciprocatingprocedures are learnt early in life through communica-tions with caretakers (Ryle, 1998). According to Ryle,transference refers to the process by which the clientenacts a procedure that is part of the established “reper-toire of reciprocal roles” (p. 304) available to the client,and in so doing seeks a response from the therapist that

matches the role. Alternatively, the client may seek toidentify with the therapist’s role and characteristics(Ryle, 1998).

Transference has also been considered and investigatedfrom an attachment perspective (Brumbaugh & Fraley,2006). According to attachment theory (Bowlby, 1988),individuals develop mental representations of self andothers, and inner working models of relationships, basedon repeated experiences and transactions within primaryrelationships during infancy, childhood, and adoles-cence (Levy, 2005). These mental representations shapeexpectations and behaviour within interpersonal rela-tions (Levy, 2005). According to this perspective, innerworking models of relationships provide templates forthe therapeutic relationship. More recent developmentsin attachment theory over the last decade have focusedon the psychobiological findings regarding the impact ofearly emotional transactions with the primary caregiveron the maturation of brain systems involved in affect andself-regulation (Schore & Schore, 2008).

As mentioned previously, cognitive therapists gener-ally do not use the term transference or discuss transfer-ence from a cognitive perspective. Robert Leahy’s (2007;2008) work is an exception to this. Leahy (2007) arguesthat the transference relationship consists of “personaland interpersonal processes that occur between thepatient and the therapist” (p. 229). According to his per-spective, the client’s transference is based on personalschemas about the self, interpersonal schemas aboutothers, and relationship schemas, along with intrapsychicprocesses (such as repression or denial) and interpersonalstrategies (such as stonewalling or clinging). Leahy dis-cusses the ways in which client schemas manifest intherapy behaviours; for example, a client with a helplessschema is likely to seek reassurance, not have an agendato work with, call between sessions, want to prolongsessions, or be upset when the therapist takes a vacation.A narcissistic client with a schema of superiority maycome late or miss sessions, forget to pay, devalue therapyand the therapist, expect special arrangements, and feelhumiliated to have to talk about problems (see Leahy,2007).

In their cognitive approach to personality disorders, A.Beck, Freeman, and Davis (2004) also briefly commenton the importance of “transference” responses, whichthey define as the client’s emotional responses to thetherapist. They argue that it is important to explore thesereactions and bring them into the open as they “oftenprovide rich material for understanding the meaningsand beliefs behind the patient’s idiosyncratic or repeti-tious reactions” (p. 76). They also discuss the schemasand core beliefs about self and others that underlie thedifferent personality disorders and the ways in which

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these manifest within therapy. Despite noting the impor-tance of these processes, however, the reference to themis brief.

Finally, transference could also be considered usingJudith Beck’s (1995) cognitive conceptualisation frame-work. It can be argued that her concepts of core beliefsof self and other overlap with the social cognitive andattachment concepts (discussed earlier) of representa-tions of self and other, and working models of relation-ships, as well as relationship schema. A particularviewpoint emphasised more strongly by psychodynamictheorists, and more recently in the social cognitive per-spective, is the pairing of particular self and other repre-sentations such that when one representation (self orother) is triggered, then the linked representation is alsotriggered. Extending this to Judith Beck’s approachwould guide therapists to consider not only clients’ corebeliefs about self during formulation but also the corebeliefs about others that are linked to beliefs about self;for example, self as inadequate and helpless linked withothers as judgmental, or self as inadequate and helplesslinked with other as powerful.

As can be seen, the definitions of transference dis-cussed earlier have a number of aspects in common.These include the importance of the learning that occursduring formative experiences, which leads to the devel-opment of patterns of perceiving and experiencingoneself in relation to others. These patterns can beviewed as potential templates for relationships that theclient brings to therapy and from which the clientresponds towards the therapist. A number of perspectivesemphasise the mental representations of self and otherthat underlie the individual’s relationship patterns. Thetransference response is seen as having emotional, cog-nitive, behavioural, and motivational components. Whiletransference is seen as occurring in everyday interactions,the term usually refers to clients’ responses to therapists.Finally, transference can also be understood from a cog-nitive perspective as the client’s responses to the therapistand to therapy, which are manifestations of the client’score beliefs, schemas of self and others, and relationshipschemas, developed as a result of formative experiencesin relationships with significant others.

The next section briefly discusses the evolution ofthe concept of countertransference. Some psychodynamictheorists and clinicians discuss two aspects of counter-transference that have been termed “subjective” and“objective.” Within cognitive therapy, as will be seen,there is acceptance of the notion of subjective counter-transference but no focus on what has been termed objec-tive countertransference. Hence, the empirical evidencethat supports the notion of objective countertransferencewill also be briefly examined in order to consider the value

and applicability of this concept for cognitive therapistswhen reflecting upon their own responses to clients.

Countertransference

The term countertransference is most widely used torefer to the therapist’s cognitive-affective responses tothe client (Gabbard, 2004). Freud conceptualised “coun-tertransference” as arising from the client’s influence onthe psychoanalyst’s unconscious feelings, a manifestationof the psychoanalyst’s unresolved issues, and a potentialimpediment to treatment (Storr, 1989). This conceptuali-sation dominated until the 1950s when a new “totalistic”perspective emerged in which countertransference cameto be seen as all of the therapist’s emotional reactionstowards the client (Gabbard, 2001). In a classic articlepublished in 1950, Paula Heimann suggested that theanalyst’s emotional response to the client was not simplya hindrance but an important tool in understanding theclient. She wrote that “the analyst’s immediate emotionalresponse to his patient is a significant pointer to thepatient’s unconscious processes and guides him towardsfuller understanding” of the client (p. 83). Around thesame time, Winnicott (1949) introduced the concepts of“subjective” and “objective” aspects of countertransfer-ence. The subjective aspect referred to the therapist’sresponses to the client based on the therapist’s ownpersonal issues. The objective aspect referred to thetherapist’s natural or realistic reaction to the client’s per-sonality or extreme behaviour. According to this view, aclient’s maladaptive way of relating to the therapist pro-vokes responses in the therapist that are similar to theresponses of others in the client’s life. Hence, counter-transference can be viewed as a “clinically meaningfulexperience” that can shed light on the dynamics of theclient (Betan & Westen, 2009).

Many therapists continue to use and explore theconcept of objective countertransference (e.g., Geltner,2006; Hafkenscheid, 2003; Shafranske & Falender, 2008).However, there continues to be a disagreement about theconcept of countertransference (Norcross, 2001). Accord-ing to Hayes (2004), for example, there is an agreementthat the therapist must understand the feelings elicited inhim by the client and not act impulsively on them andthat both client and therapist contribute to the counter-transference. Hayes argues that there is less agreementon the relative weight given to the client or therapistcontributions and conceptualises all countertransferenceresponses as due to the personal issues of the therapist.In contrast, some modern conceptualisations of counter-transference emphasise an intersubjective perspective inwhich countertransference is seen as “jointly created” bythe client and the therapist (Gabbard, 2001, p. 984).



While the terms subjective and objective countertrans-ference may be redundant in a totalistic definition ofcountertransference, it seems important to have syste-matic ways of thinking about both aspects, even if inreality the two are intertwined (Gabbard, 1997; Shafran-ske & Falender, 2008). Shafranske and Falender, forexample, in their competency-based approach to clinicalsupervision in psychology, guide supervisors to assistsupervisees to reflect on both objective and subjectivecountertransference. This article also uses these conceptsand aims to examine them from cognitive perspectives.

Before considering cognitive perspectives of counter-transference, it is important to briefly consider the evi-dence for the support of the notion of an objective (orrealistic) aspect of countertransference.

The clinical literature on objective countertransferenceis extensive, but the empirical investigation has beenrelatively limited (for an overview of the research, seeBetan, Heim, Conklin, & Westen, 2005). Some laboratoryand non-clinical studies have provided indirect evidenceto support the notion of objective countertransference(Betan et al., 2005). These studies demonstrate the effectsof an individual’s expectancies in relationships on theresponses of others (Downey, Freitas, Michaelis &Khouri, 1998). There is evidence, for example, thatdepressed individuals “desire” and “invite” negativeevaluations from others compared with non-depressedindividuals (Geisler, Josephs, & Swann, 1996) and elicitcriticism from others that matches their own self-criticism (Swann, 1997).

There have also been a number of clinical studies thathave examined countertransference responses to differ-ent client groups. Colson et al. (1986), for example,found that the responses of professional staff to clients inan inpatient unit varied systematically across clientgroups. These responses included anger towards clientsdiagnosed with personality disorder, hopelessnesstowards clients with psychotic withdrawal, and protec-tiveness towards clients with suicidal depression. Simi-larly, Brody and Farber (1996) found that depressedclients evoked mainly positive reactions in therapists;borderline clients evoked anger and irritation, and thelowest levels of empathy; and people diagnosed as“schizophrenic” evoked the most complex mix of feelingsalong with the highest perceived need to refer.

More recently, Betan et al. (2005) investigated thecountertransference responses of 181 participating clinicalpsychologists and psychiatrists to randomly selectedclients. The authors identified eight countertransferencedimensions. These included overwhelmed/disorganised,helpless/inadequate, positive, special/over-involved, sex-ualised, disengaged, parental/protective, and criticised/mistreated. These patterns of countertransference varied

across client groups in predictable ways. For example,there were significant correlations between clinicians’countertransference responses and personality disordersymptoms. Clinicians tended to respond to clients with adiagnosis of personality disorder (including antisocial,borderline, histrionic, or narcissistic) (American Psy-chiatric Association, 2000), with an overwhelmed/disorganised pattern of countertransference. Betan et al.concluded that these clients elicit what they called“average expectable countertransference responses”(p. 895). Clinicians from different orientations had similarresponse patterns to clients with different types of prob-lems, and these emerged even if therapists did not believein countertransference. The authors argue that the resultssupport the view that countertransference is useful indiagnostic understanding of clients’ dynamics and repeti-tive interpersonal patterns, thereby supporting the notionthat countertransference is potentially a valuable sourceof information about the client.

However, as stated previously, when cognitive thera-pists talk about countertransference, as they sometimesdo, they refer to the subjective form only. This focus isreflected in methods that guide cognitive therapists inself-supervision and reflective practice to consider sub-jective countertransference and the personal schemasthat underlie responses to clients (e.g., Bennett-Levy& Thwaites, 2007; Haarhoff, 2006). Similarly, Leahy(2007), one of the few cognitive therapists who use theterms transference and countertransference, deals onlywith subjective aspects of countertransference. Accordingto Leahy’s “social-cognitive model,” countertransferenceresults from the therapist’s schema or core beliefs thatunderlie the responses to client behaviours. As he states,“The therapist is similar to the patient in holding certainpersonal and interpersonal schema” (Leahy, 2007, p. 239).Examples of personal schema given by Leahy (2007)include “demanding standards” by which the therapistfeels he has to cure his clients and meet the higheststandards; “rejection sensitivity” by which the therapist isupset by conflict and therefore does not raise issues withclients if clients might be bothered; and “need of approval”by which the therapist wants to like and be liked by clients.

As part of discussing subjective countertransference,Leahy (2007) also notes the importance of the therapist’s“emotional philosophy,” that is, the therapist’s responseto the expression of emotions. Therapists who view emo-tions as distracting or self-indulgent may communicatenegative attitudes towards clients’ emotions and emo-tional expression. Therapists who respond from theirown emotional philosophies may inadvertently modelemotional avoidance, which in turn reinforces the cli-ent’s own emotional schemas, such as “My feelings arenot important and they overwhelm others.”

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While cognitive therapists do not discuss objectiveaspects of countertransference, this notion has been con-sidered useful by some psychodynamic therapists andmay benefit cognitive therapists in the process of reflect-ing upon their countertransference responses, either inself-supervision or clinical supervision. However, it seemsimportant to have ways of conceptualising both aspects ofcountertransference from cognitive perspectives. In thenext section, Judith Beck’s (1995) concepts of core beliefsabout self and others are applied to a case discussion andused to consider countertransference.

Case Discussion—Illustration ofCognitive Conceptualisation ofSubjective and ObjectiveCountertransference

A client, Ann, 35 years old, has presented with majordepression triggered by the end of an 8-year cohabitingrelationship. Assessment reveals that Ann has sufferedfrom mild depression on and off for many years, but thishas been exacerbated in recent months. Ann is also strug-gling at work with a demanding boss and tasks that shefeels are beyond her. She presents for therapy 6 weeksbefore the therapist is due to have a 2-week holiday. Arisk assessment reveals that she is not suicidal, althoughshe is frightened by the strength of her own emotionsand the belief that she cannot cope without her partner.Ann is the youngest in her family of origin and has threeolder sisters (living overseas) who are all “strong person-alities” and “looked out for her” throughout her child-hood and adolescence. If she had any problems, “theysolved them.” Her parents, on the other hand, were“hopeless” at helping her when she was upset or havingdifficulties and were critical of her. Ann also had someexperiences of some verbal bullying at school, whenclassmates became irritated with her because she was a“crybaby,” “a sook,” and “a wuss.” Teachers also becameannoyed with Ann at times. She recalls one year whenshe was often sent to sit outside on the veranda until shehad calmed down and stopped crying. Ann reports thatshe cried a lot at school because she hated the feeling ofnot being able to do things successfully. Ann also reportsthat she cries easily at work when her boss “tells her off”for making a mistake. She says that her ex-partner alsosaid he could no longer cope with her “clinging andwhining.”

In therapy, Ann appears to respond initially in a warmand trusting manner towards the therapist, giving herfeedback by the beginning of the second session abouthow great it was to talk to her and how much better shefelt afterwards. The therapist tells Ann at the beginning ofthe sessions that she can see her but that there will be a

break of 2 weeks in sessions after the sixth session. Annhappily agrees to this, but as time goes by, she begins to“fret” about the therapist going away, says she will missher, and does not know what she will do without her.

A full conceptualisation requires further information.However, from what is provided, we can hypothesise thatAnn has core beliefs of self as being helpless or inad-equate and core beliefs of others as strong and potentiallysupportive. These beliefs about self and other may haveoriginated mainly from her relationships with her oldersisters, who appear to have taken on a caretaking rolefor Ann and perhaps inadvertently encouraged herdependence on them. However, she also appears to haverepresentations or core beliefs of others as critical andrejecting in relation to herself as helpless or inadequate.These representations may have originated in her rela-tionships with her parents, who did not assist her whenshe was distressed, and with classmates and teachers whobecame angry or critical of her when she seemed unableto cope. These core beliefs about self and other may havecontributed to her difficulties with her ex-partner andbeen reinforced by her partner’s rejection of her due toher “clinging and whining.”

Ann’s response to the therapist is one that initiallycommunicates helplessness, neediness, and admirationand trust. Initially, the therapist finds herself feelingwarm towards Ann and begins to think that she cannotgo away for 2 weeks at such a crucial time, as Ann mightnot be able to cope. She begins to wonder if she shouldshorten the holiday. However, the therapist recognisesthis as a countertransference response and does not acton it. As the holiday period draws closer, the therapistfinds herself becoming irritated with Ann’s “fretting.”The “fretting” manifests as crying, rubbing her handstogether anxiously, and beginning to catastrophise aboutwhat could go wrong at work when the therapist is away.The therapist’s countertransference manifests as twingesof irritation throughout the sessions and at one point intime, an urge to say, “For God’s sake, grow up and stopwhining. It’s no wonder your partner left you!” Fortu-nately, the therapist once again recognised this as a coun-tertransference response and did not act out on the urge.

Objective Countertransference

The therapist’s responses to the client (initially support-ive and protective, and later irritated and critical) can beseen as a realistic response to the client’s relationshipstyle. The client, based on her core belief that she ishelpless, initially aims to engender the type of uncondi-tional support that she was given by her sisters, andthereby responds to the therapist from her representationof others as strong and supportive. The therapist finds



herself responding in a complementary way to the client,feeling supportive and protective, and having thoughts ofgiving up part of her holiday. As the holiday approaches,the client begins to “fret,” “whine,” wring her hands, andcatastrophise about work. At this point, the client maybe unconsciously beginning to view the therapist asrejecting or unhelpful, more similar to her parents orher ex-partner (who abandoned her to her distress).The therapist once again responds in a complementaryfashion by having fleeting feelings of irritation, and onone occasion, an urge to hit out verbally at Ann. Hence,the therapist—at least at some moments in therapy—hasresponded emotionally to Ann, as significant others have.By considering this, the therapist can understand moreabout the pattern of relationships that the client hasexperienced and now engenders.

Subjective Countertransference

It is also important that the therapist considers whethersome of her countertransference may be subjectiveand related to her own personal issues and beliefs. Forexample, a therapist with an emotional philosophy(Leahy, 2007) that values independence and feelsuncomfortable with neediness may find herself feelingirritated with the client’s distress.

As can be seen from the above, the therapist’s enact-ment of countertransference responses can have negativeconsequences for the therapy and the therapeutic rela-tionship. If the therapist changes her holiday plans, shereinforces the client’s belief in her own helplessnessand also increases the likelihood of further support andreassurance-seeking behaviour in the future. If she with-draws from the client’s neediness and distress because ofher own personal issues, she reinforces the client’s beliefsthat her emotional responses are unreasonable or over-whelming and that others are rejecting and critical. Bybeing aware of the possibilities of different aspects ofcountertransference, the therapist can consider howto respond in such a way that the client’s distress isacknowledged, and the client is assisted to cope with thechallenge ahead. Working from a cognitive perspective,the therapist may help the client challenge some of thenegative thoughts that she is having about coping whilethe therapist is away, and may work with developingsome coping strategies for this period.

Conclusions

There is an increasing interest in the therapeutic relation-ship and the therapeutic alliance in cognitive therapy.Some cognitive therapists (e.g., Leahy, 2007, 2008) andresearchers (Miranda & Andersen, 2007) have also begun

to use the terms transference and countertransferenceand to translate these into frameworks that are comple-mentary to cognitive therapy. This article has arguedthat understanding transference and countertransferencefrom within cognitive frameworks may enhance reflec-tive practice in self-supervision and clinical supervision.While some attention has been given to subjective coun-tertransference by cognitive therapists (e.g., Bennett-Levy & Thwaites, 2007; Haarhoff, 2006; Leahy, 2007),objective aspects of countertransference are not dis-cussed. However, there is some evidence to support thenotion of objective aspects of countertransference and tosuggest that therapists may benefit from understandingand reflecting on both aspects of countertransference.Given this, it seems important that cognitive therapistsdo not dismiss these concepts because of the strong asso-ciation with psychodynamic therapies, but rather inves-tigate the potential applications of these concepts withincognitive frameworks. In time, it may be desirable todevelop alternative terminology that represents theseconcepts and fits within a cognitive paradigm.

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Trasference and Countertransference in Cognitive Therapy

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