Countertransference is not a Flesh-Eating Disease – by Lawrence Rubin, PhD, ABPP

Among my varied clinical and clinically-related roles, I supervise master’s level counseling interns who are training in a variety of settings, from alternative schools to psychiatric hospitals. In our group supervision classes, we discuss a range of theoretical and applied concepts related to clinical practice. Frequently, countertransference takes center stage. Perhaps this is due to the nascency of their clinical skills, unpreparedness for or inexperience with self-reflection, lack of personal and interpersonal maturity, or all the above. In our meetings, we are never short on content for conversation or the inevitably painful role-play exercises that I inflict upon them. All in the name of their growth, of course.

With few exceptions, my counseling interns have somehow latched onto the notion that countertransference is a flesh-eating disease; proof positive of psychological frailty inevitably resulting in psychic degradation, the inability to evolve into effective clinicians, and who knows, maybe contagion. I believe that these apocalyptic notions stem in part from the origin of the study of countertransference in psychoanalysis, with its emphasis on forbidden and deeply concealed libidinal urges, unresolved parent-child conflicts and other dark intrapsychic forces ever seeking sunlight and the opportunity to wreak havoc in the therapeutic sphere.

Try as I might to dispel this notion by deploying the most powerful tools in my arsenal of empathy, they cling tightly to the fear that countertransference is the enemy within, seeking to undermine, subvert and slowly erode their fortitude and confidence. And try as I might to demonstrate the opportunities countertransference presents for self-awareness, personal and clinical growth as well as healing, they recoil at the sound of the word! Maybe, I should just call it Steve.

Two examples might help explain what I and my student-interns have been experiencing. A student-intern who was a new mother to a 9 month-old was working in an alternative high school. She was assigned, ironically enough, a seventeen-year-old student who had given birth just months before. See where I am going here? My student was angry at this young woman who had abdicated her parental responsibilities to her own mother, refused to engage in attachment-related exercises, and had become increasingly depressed and withdrawn. My student seemed, at least temporarily, incapable of empathizing because she could not fathom how someone could neglect an infant when concurrently, she was in the process of building a deep bond with her own infant. When I suggested that her negative reaction to her client was rooted in countertransference, she initially recoiled and withdrew, but with encouragement and class support, opened herself just enough to consider how she was triggered by her client. Subsequent on-site and in-class supervision helped her to reconnect with the client.

Another counseling intern had taken on a new college-age student who had experienced several years of depression, family rejection, a profound sense of hopelessness, and who had a history of rejecting therapeutic intervention. When his own clinical supervisor made specific recommendations for how to work with this client my student resisted, arguing that the supervisor was not being sufficiently empathic, had disregarded his own ideas, and he planned to speak to the client about issues that the supervisor felt were premature. My student grew increasingly angry at his supervisor, more deeply intent on doing what he thought was necessary and walling himself off from the supervisor. This was the first rupture in the relationship between this student and the supervisor whom he had previously seen as supportive. As the class supervision unfolded, I suggested to the student and the group that this particular client could be triggering something in him related to past relationships or even experiences in his own life. As with the intern mentioned above, this young man felt embarrassed and disappointed in himself that he was perhaps being influenced by countertransference. I should have called it Steve.

As the conversation unfolded, this intern volunteered that just a year before, he too had experienced a severe depressive episode and felt misunderstood by friends and family who offered suggestions that he found destructive. “If only I had been a better clinician, I would’ve seen that coming”, he lamented. Well-intentioned as he was, this posture was unrealistic, and fortunately subsequent supervision and counseling helped this particular intern to continue along his own path to healing and professional growth.


In both of these supervisory moments, the interns better understood what countertransference was and was not. If our interns are always taking universal precautions to guard against the psychological equivalent of a flesh-eating disease, then caution and defense will win out over opportunity for both personal and professional growth. Sometimes, past and present painful and/or unresolved experiences and relationships scream out from within for attention, even for debriding if you will. Only in this way can clinicians, at any point in their evolution, build healthy psychological immune systems.  

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