Countertransference, phenomenology and research: Was Freud right?

Why is it if transference is when the patient/client ‘wrongly’ projects onto the therapist someone from their past, the same isn’t true for the psychological therapist’s countertransference, which seems an increasingly popular modus operandi for psychological therapists? Also to what extent can the client read the therapist’s unconscious? Previously for those singing the virtues of countertransference, it could be safeguarded because of the personal analysis of the therapist – those were the days when it was claimed one could be perfectly analysed – but even if it isn’t perfect how much ‘analysis’, if any, do today’s countertransference practitioners have?

As psychological therapists, I don’t think we can ever be sure whether anything we say is more for the client or ourselves. Yet, whether it be through growing interest in relational psychotherapy or increasing consumerism in the consulting room, there appears a greater tendency for the therapist to take centre stage and share with the client how they are making them feel, fantasise, etc, legitimising this as the work of a practitioner researcher. Previous adherence to being a blank screen seems to be waning. Yet is something important being lost? So let’s consider what’s happened to ‘countertransference’ and whether it has therapeutic merit or is more a way therapists provide something potentially harmful on the cheap (with no need for what was previously considered a proper training therapy) whilst actually deluding themselves they are the centre of their consulting room world. After all there were, and hopefully to a lesser extent still are, those therapists who seemed to really believe that everything the patient brought to the consulting room was about their analyst, so why can’t everything that comes to the registered psychological therapist’s mind be beneficially conveyed to the client?

To briefly sketch its history (with some initial thanks to Wikipedia – https://en.wikipedia.org/wiki/Countertransference): Freud first defined countertransference as ‘the result of patients’ influence on [the physician’s] unconscious feelings and ‘as a personal problem for the analyst’ (Freud, 1910) ‘warning against any countertransference lying in wait’ (Gay, 1989, p. 302) for the analyst who ‘must recognise this countertransference in himself and master it’ (Gay, 1989, p. 254).

However, following Jung’s (1976) Wounded Healer, ‘it is his own hurt that gives the measure of his power to heal’, Paula Heimann (Casement, 1990) stated that the analyst’s countertransference is ‘part of the patient’s personality’. Subsequently, ‘countertransference was thus reversed from being an interference to becoming a vital source of conformation’. Yet how many psychological therapists who justify where they’ve got to with their own problematic journey using Jung to legitimise telling clients how they make them feel, think etc, carry out Jung’s essential requirement to be in analysis? Otherwise ‘the analyst really cannot let go of the patient…both fall into the same dark hole of unconsciousness’ (Jung, 1976).

Indeed, Klein was concerned that poorly analysed psychoanalysts could excuse their own emotional difficulties, however, her followers went for countertransference (Hinshelwood & Robinson, 2006, p. 151), giving rise to Hanna Segal’s Kleinian compromise ‘countertransference can be the best of servants but it is the most awful of masters’ (in Bell, 1997, p. 30).

Later in the twentieth century, there was a growing consensus that there is ‘a distinction between “personal countertransference” (which has to do with the therapist) and “diagnostic response” – that indicates something about the patient…diagnostic countertransference’ (in Casement, 1990, pp. 8 & 165). As Janet Malcolm (1988, p. 115) reports: ‘You have to distinguish between what your reactions to the patient are telling you about his psychology and what they are merely expressing about your own’.

There appears to be agreement on this latter notion of counter transference amongst many schools. Yet there may be a growing trend where not only psychodynamic counsellors use more countertransference than transference (Jacobs, 2006). In stark contrast, there is the exception of those following Lacan, where countertransference is seen as the ultimate resistance of the analyst (Quinodoz, 2005, p. 72). Lacan defines countertransference as ‘the sum of the prejudices, passions, perplexities, and even the insufficient information of the analyst’ (Bailly, 2009, p. 188).

But do we need such technical terms as ‘countertransference’ which might inevitably be at least at times too blunt an instrument? In which case what then of Freud and phenomenology? Perhaps he was more influenced than he let on, particularly having attended with Husserl Brentano’s lectures on descriptive psychology (1982). Certainly, there are some of us who find it useful to read early Freud phenomenologically. So what then of phenomenology and countertransference? Besides phenomenology I have a long-standing research interest in ‘involvement’ (Loewenthal, 2002) which has been defined as ‘the state of being complicated, tangled, obscure; causing great difficulty’ (Penguin English dictionary, 1969, p. 397). Countertransference has also been defined ‘as a therapist’s emotional entanglement with a client’ (Stefana, 2017). So what if we try to explore countertransference entanglements through Edmund Husserl’s phenomenology? We might see this in terms of an irreducible tension between the ‘I’ (of the therapist) and of the ‘not-I’ (of the client/patient) which is allowed in openness and through which meanings emerge by being open. Here the argument is that the burdens of meanings we impose on others and ourselves are lifted and truthfulness emerges in its own way (McSherry, 2017).

There is not space within this editorial to consider further a phenomenological approach other than to say that it has influenced my practice to the extent I consider such concepts as countertransference to have implications for the primacy of practice but not as an application (Loewenthal, 2011). What I would though like to explore here (again following McSherry, 2017) is Husserl’s (1970) view that scientific method makes us distrustful of experience whilst at the same time such method is itself simply part of a tradition (an ‘experience of truth’ for some) reflecting agreed upon concepts of normalised understanding. Husserl argued that scientific method in the field of meaning reflects sedimented ideas, which now look as if they are ‘truths’ of some kind and therefore subsume and deaden meaning and indirect experience. Husserl did not agree with the kind of transportation of mathematics onto ‘nature’ implicit to scientific method. It appears that experience tells us something important and it should not be substituted by a mathematical method or indeed any method. Isn’t this what Gadamer (1960) was writing in ‘Truth and Method’, that is to say, if you want truth you cannot have method; and, in a different way, isn’t Levinas (1969) saying something similar when arguing one can only experience very occasionally truth and justice with another?

So I have started by giving a brief outline of countertransference and how there have been differences in regard to its therapeutic usefulness. I have subsequently attempted to start to provide a Husserlian phenomenological reading of what might emerge between therapist and client. I would like to now say more following Husserl about research and experience.

I also provide clinical supervision to some London Hospitals and in the waiting area there is a sign saying ‘I am research’. Whilst I think psychotherapy is the research, I don’t think the psychotherapist is the research and this I believe to be true not only in terms of countertransference but also the growing erroneous attempt to make the psychotherapist a practitioner researcher.

As psychological therapists, can we be practitioner researchers? As mentioned I am one of those who argue that the therapy is the research. Phusis/physis is what comes out of itself, in some ways it is the natural, having external evaluation can be a form of violence and far more often than not, it is at best a red herring. As I imagine most of you may have experienced as therapists, when you are in it, it’s different. One can’t really appropriately get outside this and look in it. I think Wittgenstein said something similar (Heaton, 2014).

So what of research and countertransference? A great pioneer of psychology, William James, talked about the relationship between persons and methods ‘intermethodology’.

Countertransference might be seen primarily as ‘intermethodology’ albeit a method some psychotherapists use to interpret the client’s relationship with others. Taking then this, what of the relationship between the psychological therapist and his/her particular mode of working? What James (1912; in Loewenthal and Samuels 2014) attempted to knock on the head was the traditional belief that methods’ usage only implicates the intellect. James considered that passion, taste and practice cooperate in science and any other practical affair. This radical empiricism is in contrast to the traditional modernist belief that methods function independently of the total personalities who use them. So perhaps we might be interested in the person who is the psychological therapist and the particular method or school of psychotherapy they have chosen and what qualities in the psychological therapist it brings out that are helpful and unhelpful to the therapeutic endeavour. Further, there is the question as to what else the particular modality method allows, perhaps despite itself, to percolate through beyond its self-contained detached posturing.

We attempt to give names to what is happening, such as countertransference. But, at best, what is perhaps spoken about appears in the nooks and crannies that the particular theory can’t reach through conceptual totalising. We might therefore wonder what qualities does a method bring out in a therapist that are helpful or unhelpful to their patient/clients, and indeed themselves, and to what extend do these methods still allow something useful and magical to happen? With regard to where Freud was coming from, perhaps his warning about transference was right, or at least it needs to be tempered. I have found very important for my practice Lacan’s notion that to interpret directly the transference/countertransference could well be counterproductive as the client/patient might perceive it as persecutory. Instead, better that we will test the thought that has come to us with what our client says about his/her past and current relations, and if this repeats to interpret that rather than the relation in the consulting room.

Freud carried out his research through case studies and whilst I think we need to be critical of some of what he wrote, however beautiful, I would argue it remains the most salient way for us to carry out our research through our tradition of clinical supervision. The notion of countertransference would appear still to be a concept we should be wary of even if we have as practitioners our own personal analytic therapy, which the founders of the countertransference concept considered essential. There again, on the plus side, as Searles (2017, p. 204) has written: ‘our aim should be to remain maximally aware of our changing feelings during the analytic hour, not only because these feelings will be communicated behavioristically to the patient – via variations, no matter how subtle, in our tone, posture, and so on – but also because our feelings are our most sensitive indicators of what is going on in the interpersonal situation’. What is important here is Searles pointing out ‘It is when the patient projects, he or she strikes home’ (Young, 1992). Perhaps a more recent development of Searles approach is the work of Ferro and Civitarese (2018) on Analytic Field Theory which includes bringing together the work of Bion and Merleau-Ponty so that countertransference might be seen as more characters entering onto the therapeutic stage.

Countertransference in its lack of clarity does at least allow something alive in the psy world’s increasing attempts at scientism (Young, 1992) which seem hell bent on producing minds (of both therapist and client) with ‘no atmosphere’ (Oakeshott, 1991). For those of us who are also registered as psychologists, we might take some solace and inspiration from some of the original thoughts of Wundt and James. Wilhelm Wundt, who encouraged his doctoral student Edmund Husserl to explore phenomenology, emphasised, but still doesn’t seem to be heard, the importance of psychology marrying the empirical with the cultural/historical (Ratner, 1997). This if considered alongside William James’s radical empiricism is again rather different to the deadening empirical research methods that are currently filling our students’ time and mind with relatively little benefit to their patients/clients.

To conclude, I would agree with King and O’Brien (2011) who warn that ‘the terms “transference” and “countertransference” have developed a wide use in psychotherapy and no longer hold an exclusive association with therapies based on psychoanalysis. These terms have become so commonplace there is a real risk that therapists will gloss over the complex, and even problematic, nature of the underlying constructs. Without an appreciation of this complexity, clinical use of the terms may result in more harm than good.’

Finally however, in considering some of the dangers and virtues in the changing uses of countertransference, a bigger question emerges: If psychologists continue to ignore essential aspects of such founding fathers as Wundt and James, would the psychological therapies, if not psychology, be more appropriate as a part of the humanities rather than the social sciences? Meanwhile, for practitioners, the notion of countertransference, whilst having limitations to be continually wary of, might help bridge this gap.

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Turning to introducing the papers in this issue (20.4) of our journal: In the first paper, ‘Significance of Nature in a Clinical Setting and its Perceived Therapeutic Value from Patients´ Perspective’, Jo Benjamin Dybvik; Silja Sundsfjord; Catharina Elisabeth; Arfwedson Wang and Mary Nivison make an interesting contribution to the growing field of outdoor based therapies. Informed by phenomenology, the qualitative study investigates patients’ experiences within nature, and the impact of these experiences on their recovery. This study adds to qualitative research within adventure therapy from a European context.

‘Love in therapy: A qualitative study of how clients perceive their therapists’ emotions’ is our second paper by Maria Viou; Christina Moschakis and Androniki Nikolaou, which adds value to literature on attachment and the therapeutic alliance. Drawing on Narrative thematic analysis, the paper explores the psychological significance of the therapists’ involvement in the therapeutic process from the clients’ perspective with a particular focus on the therapists’ perceived facial expressions. The key finding, successfully delivered by this research highlights that clients’ perception of their therapist’s emotions, hold the potential to further develop the therapeutic relationship.

Our third paper, ‘Client self-image, therapist acting, and the establishment of the therapeutic Alliance in a training context’ by Caterina Pasquali; Helene Elisabeth Ybrandt and Kerstin Armelius, examines the association between client self-concept, perceptions of the therapeutic relationship, and the working alliance during the course of two treatments conducted at a psychology training clinic. A valuable piece of research that meaningfully contributes to the literature.

‘To fail psychotherapy training: Students’ and supervisors’ perspectives on the supervisory relationship’ is our fourth paper in which the authors Mattias Larsson Sköld; Magdalena Aluan; Joakim Norberg and Jan Carlsson examine the relationship between negative alliance and harmful events in supervision during psychotherapy training. Exploring both supervisee and supervisors accounts of failure within psychotherapeutic trainings, this study tackles an underside of training that is often unexplored and not represented within literature.

The final paper is entitled, ‘Evaluating Turkish University Students’ Preferences for Mental Health Therapists: A Conjoint Analysis Approach’ by Cahit Kaya; Fong Chan; Emre Umucu and Jill Bezyak. The authors use ratings-based conjoint analysis to examine attributes influencing the preference of Turkish University students for mental health service providers. An interesting study that is well executed, instructive and that highlights various problems in a complex and fast changing culture in Turkey.

From ‘fast changing culture in Turkey’ to our not quite so fast but changing cultural use of countertransference and so much ‘in the between’ – very much hope you enjoy this issue!