Transference/counter-transference: can a therapist be saved, can his patient recover?

I am sure I have never experienced any textbook transference issues. I do believe my relationship with my therapist that spanned nearly 19 years wasnt appropriate in the sense that we were acting more like friends and knew things about each others' families that only friends would know. I had long ago came to a point of relative stability and was really dealing with life's issues which occasionally had small fires I needed help putting out. And I was very lucky. I met him fresh out of grad and business school working at an agency that also assisted people with sliding scale payments.

But each time he moved offices It was always in my area and ins network. He eventually became well known with his own practice in bougie towns. He is also in AA and has been sober 20 years. He was integral to my sobriety because he would meet me at certain meetings-I joined his homegroup. We parted ways after I had a couple of years sobriety because years of therapy that turned into "scheduled hanging out" and sobriety put me in a place of real safety and contentment. Anyway:

For "fun" Ive always been interested in the mechanics of mental health treatment, I will often have discussions with friends and family who work in various mental health, human services fields and healthcare industries.

One therapist acknowleged to me that he felt he has experienced countertransference more than he thought he would and what he considers the "standard" for dealing with that happening doesnt always apply, work, relate, or work for him

I want to also note that not all therapists and other mental health workers are well-at least not well enough to be doing their jobs objectively.

I dont know if others agree but I sometimes heard "only a crazy person can treat crazy" And I have seen a disproportionate amount of unhealthy or emotionally immature/inappropriate "professionals" when looking for doctors for my family. My son was first evaluated for ADHD and a "midline issue" at age three. He is 25 now and starting law school. You do the math but I'm talking 22 years of laymans experience- not county myself and others I have had to help.

I am just sharing that because I do not want people to feel I am anti-therapy or just some fool who read a little on webmd and thinks she is an expert. I feel very informed but I am no professional or expert.

My feelings about Transference:

If it is coming from the therapist (counter transferrence) I believe it should be talked about openly in session ASAP in order to determine if the patient feels that way, if the I feel like if the patient has transference feelings and the therapist does too on his end. I feel like that relationship should be paused and then ended. I dont see how two people who are in an emotionally jumbled relationship be expected to work on themselves and the patient with both having the same problem. I expect to have someone say that they "have a cousin who knows a guy that was a therapist, and he had feelings for his 22 year old patient he worked it out with her and she is a patient.

If transference is coming from the client it needs to be addressed asap and the entire therapist/client relationship should be re-evaluated to see how this can move forward while not contaminating the work or disturbing the process.
In particular it should be addressed with certain things in mind:

Does the client have a long term history with this type of attraction/inappropriate fixation with other people either in a personal friendship/family relationship or romantically.

Those two things make a difference. A long term history of emeshed, obssesive, and inappropriate relationships with friends and family are a lot different than a client who has these issues with their own romantic life and creates an exstensive fake relationship that is deep and one sided .Romantic and sexual feelings are strong and intoxicating and can easily support a client who wants to live in a fantasy.

if a person gets infatuated or feels romantic with their therapists it is important to see the pattern and IMO set a plan in place immediately establishing an end date and a "step down/out" plan between the therapist and client so that the therapist is owning the responsibility of preventing further harm, preventing any possibility of impropriety.

The therapist HAS to own it to change it. The client cant and more importantly wont change it- it fills whatever void they are filling and they should be considered impaired or almost incapable and unqualified to do anything THEY are the patients that have conditions that make them almost "numb " to perceiving harm and near impossible.

More importantly it is ETHICAL sets a good example, and it will ultimately spare the patient pain.

I believe in identifying the issue(transference).
I believe in prepping for the long hard conversation- ending therapy with him by knowing what treatment facility has beds open if it gets bad, Having the new therapist present and completely willing to offer help. What PHP or IOP's are full/available just in case. I would have a list of local services if your patient needs more supportive help. Its a shame you cant slowly weave yourself into her orbit even perhaps observing her routine. Decide ahead of time what you will allow. Hugs? Or do you never want physical contact.? Therapists debate the validity/effectiveness of hugging or patting patients vs never allowing any physical contact in order to establish a boundary that can never be crossed. A therapist must remain calm and neutral to make sure that the discussion is direct, equal and without shame. Remember you are still the therapist while making an exit plan without triggering any more tears, and setting up some of her services. If she ends needing some hospitalized care you will have to do the referal for her.

The patient will not like this at all. And it makes sense. And it will hurt the patient. And you can help with that pain by Picking a last day with the patient and writing it on the calendar because its important. Helping to make a plan with regular reminders and check in's that other patients can see.

i take so many things personal- when they are not.

Even if you end the treatment it went well you may experience some minor sadness .

I know this seems unfair and ridculous but its better to address something and move on.

Something else about counter transference: I think that if the therapist has feelings for the patient and you address it in therapy I dont think that the therapist is off the hook. I think the therapist should be required to have some therapy and emotional healing. i also think its fair to say that the therapist should have regular weekly meetings with a supervisor to discuss his cases with the supervisor and receive feedback or suggestions. The supervisor should be given enough information to be really familiar with that patient and their circumstances. i look at it as simple protocol updates.

That's it for now. it started out strong yesterday and I went 24 hours without sleep. if its not making sense i want to hear what you think.

I strongly disagree with the idea that if transference or counter-transference happens in therapy, the relationship should be terminated.

First, transference is something that is very normal, healthy people experience it all the time, as do mentally ill ones. It is a word for when somebody reminds you of someone else and your brain "confuses" the two and you might react in a way or feel something that doesn't fully make sense for the new person, since it's actually about another person. If therapy were terminated whenever this happens, therapy couldn't exist. It's something that will happen to you over and over again in your life, in all kinds of relationships. Got out of a bad romantic relationship, now you have a new partner and still feel jumpy from time to time around the new one? That's transference. Got annoyed at somebody using a certain word when you were calling them to ask about their business because that's the word your mom always used for something? Transference.

It's also not just romantic or sexual feelings, it can be joy, anger, hate, sadness... and these feelings exist on both sides, the therapist's and the client's, because they are both human beings. It is impossible for either party to not experience these things from time to time. It doesn't make the therapist a bad therapist, who needs therapy and needs regular supervision.

It also doesn't mean that the client will be better off with a different therapist because these feelings will only lead to pain and hurt. Actually, quite the contrary. How should somebody learn to deal with transference issues if as soon as it happens, they are kicked out? For me personally, this would make everything worse.

I'll talk about my own experience: for 25 years, I went through the same cycle over and over again. First, I got overwhelmed by emotions and at some point couldn't deal with them anymore. Then, I reached out to people: friends, teachers, people on the internet... and most of them tried to calm me down, but that only works for so long. But I'd need them to be there again and again, my emotional issues would get worse, because I realized that if I was doing really badly, these people would continue to be there for me. Then, I fell in love with a lot of the people who tried to help me, usually because boundaries got way too blurred, due to the whole situation being rather inappropriate. And then at some point they couldn't deal with me anymore, dropped me and I was hurt. This went so far that after some time, I'd already expect people to abandon me way before it was in their head. I was comforted by someone, that means they will leave me. Which lead me to freak out more, be even more suicidal, need even more support. Which in the end leads to them really abandoning me of course.

Now, how should I ever get over this if I can't go to my therapist and when I start getting attached say "hey, I've experienced this many times before, I absolutely know you're going to leave me any second now"? Therapy is to some extend comforting, so I will experience these feelings. If in that situation I can't talk to my therapist about it without immediately being dropped, then how should I ever be able to heal? And if it happens and I develop a crush on my T, then how should I learn that maybe having a crush on every single person that is a bit comforting is not the smartest move? Or how to deal with rejection and all the negative emotions attached to it? Even if it's romantic transference, it's just feelings. Nothing inappropriate is happening, it's two adults talking about the fact that there's some erotic feelings and how to deal with that.

As long as the emotions are not acted out, it's okay for a client to experience transference, of whatever sort, and so is it for the therapist. It might indicate that there's something in their past which maybe they should talk about with somebody else. But take again me as an example, while I will probably always feel like people might abandon me, at least I have now learned that this is just in my head and that I don't need to voice this concern immediately. And if I was a therapist, then I'd not talk to my client about how I'm scared they might not come back, even if they trigger that feeling in me. And either I as a therapist could deal with these feelings myself, or if not or if I didn't know where the feelings come from, *then* it might be a good idea to start my own therapy. But that still doesn't mean there needs to be termination. Termination would only be necessary if the therapist felt that he could not perform his role anymore and couldn't maintain his boundaries. Which would be a much larger issue, but it's not something that is inherit to transference.

I think if whenever people bring up something like romantic feelings and there would only be termination after that, this would just stigmatize the whole experience and people would not talk about it anymore, creating much deeper issues than openly talking about what's happening. Boundaries can be maintained even with such disclosures and that way people won't just hide.

Finally, I'd like to say I'd also not consider it smart for a therapist to talk about counter-transference as soon as it happens. If it affects the relationship and there are deep issues, then maybe the therapist should address it, after having discussed it already in supervision. But otherwise, if it doesn't affect the client, then why should the therapist mention anything? That just makes it about themselves. If we again imagine me as a therapist, if a client said "I'm going to take a longer vacation and never text you or write an email", and then I'd go "oh, that triggers my fears of abandonment, you know, I had many bad experiences with that and it's very difficult for me", how would that help? Even worse, how would it help if I then told them to never come back? That would neither serve my own interests, nor the client's. If I can fully just deal with it on my own, be a bit sad after the announcement but still fully concentrate on the client for the rest of the session and afterwards not think about it too much either, then why would I need to bring this up? It will only take away focus from what the client is saying and will not have any positive effect for them.

Not all feelings are transference or counter transference either. They can be genuine. Born out of the relationship. And they can facilitate amazing work if dealt with properly. Talking about it is key in my humble opinion, from both sides.

We all experience transference / counter-transference to a certain extent in relation to people in our lives. Within the therapeutic context, this is the jargon that is used.

Should it be discussed with all of these protagonists? No. Not necessarily. It might not even be the best thing to do. It could certainly do more harm than good.

I disagree that IF a T were aware they were experiencing counter-transference, then it should immediately be addressed with the client. This seems 'dangerous' and making it about the T's feelings and agenda rather than focusing on what the client is bringing in. Pretty unethical too.

What is recommended is to delve into the murkiness of the T's feelings with a supervisor. This is what these (e.g. supervisory or peer group consultations) are for.

Another point of contention is that not ALL theoretical models or approaches to psychotherapy even believe in counter-transference. So, it is unrealistic to expect Ts not versed in one model to use said model in therapy.

Same as for medical doctor or greedy lawyers who specialise in one field and don't necessarily have 'expert' knowledge in other fields. Likewise, it is unrealistic to expect a T to 'specialise' in other domains

Therapy is not a one size fits all or a 'one model for all'.

I never had a therapist even use the word "transference" during my therapy. I think I am grateful for that.

I honestly didn't even know what it was until I came to this forum - and I'm fairly sure not everyone here even agrees on the definition to start with.

I'm pretty certain transference for my therapist was not an issue. What I do realize is that I have had reactions to people in my life (not my therapists) that were definitely responses connected to my personal history. My therapists helped me recognize when my reactions were out of proportion to the current event and see the connection to my history so that I could work through that and get to a place where I don't default to that reaction. I think that is about as close to working on "transference" as we got, and again, the term was not used.

I had close relationships with my three therapists. Close, affectionate, yet very professional relationships. I have stayed friends with them for decades beyond my therapy. That's just relationship. That isn't transference. Not all connection between a therapist and a client has to be hyper-analyzed as "transference"; sometimes we just get along well and actually care without huge "issues" surrounding those relationships.

I'm not real big into the "therapy is all about the relationship between the client and the therapist" thing. That certainly has never been my experience. While I had close and positive relationships with my therapists, my therapy was about me and about my needs, issues, history; and the goal for me was to get to that place where I didn't need therapy to live a contented, emotionally stable life. I got there. And without session after session focused on the therapist/client relationship. It was rarely part of the discussion.

Everyone I will address points made when I get a chance. I’m on vacation. But I wanted to say that you have all educated me today. I’m serious. A lot for me to think about. Please accept my apologies to anyone I may have hurt, offended or invalidated

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Transference is the seed of an established, strong therapeutic relationship. The challenge is to work through the transference and process it. The subject goes back to Freud, who invented the concept of "talk therapy."