Using Countertransference to Deepen the Therapeutic Alliance

By Daniel Scrafford
PACT Level 3 Therapist

In my early professional years, I was asking the question: How can I treat, or cure, or change this person? Now I would phrase the question in this way: How can I provide a relationship which this person may use for his own personal growth?

— Carl R. Rogers

Carl Rogers’ quote describes how he saw the therapeutic alliance in individual therapy. A therapist needs to develop an alliance with clients to ensure a successful outcome in therapy (Stubbe, 2019). Rogers’ brilliance is reflected in his theory, his techniques, and his ability to emotionally resonate with the client. In relationship therapy, the therapeutic alliance is made up of several facets. Both partners must believe the therapist is competent, the therapist is an expert in addressing their problem area, and the therapist has the capacity to empathize and resonate with the client’s emotional field. 

This paper will explore how therapists can use their own reactions and feelings toward the clients to deepen the therapeutic alliance and will focus on one aspect of the therapeutic alliance, countertransference. Complicating matters in couple therapy, the therapist is not making the alliance solely with individuals but with the system. In PACT, the couple is viewed as a system, and problems within the system are seen in the interactional patterns, dynamics, and context of the system, not within the individual.

Countertransference refers to the therapist’s reactions and feelings toward the clients. In the past, traditional psychoanalysts saw countertransference as negative and contaminating the neutral stance of the therapist. Many current relational models of psychotherapy now acknowledge countertransference as vital to comprehend the intrapsychic and interpersonal dynamics of the client (Solomon, 1997).  I will also share several of my own experience with couples and show how my use of countertransference as a tool deepens the therapeutic alliance.

Unpacking the Important Dynamics

Solomon addresses the usefulness of countertransference as emotionally understanding the client, even when classical psychoanalysts would indicate that the therapist’s feelings are contaminating the treatment. She states, “Questions arise concerning the difference between countertransference reactions based upon the therapist’s pathological reactions and those derived from the ‘healthier’ counter identification with the patient’s projective identification. Answers to questions such as these make arbitrary distinctions where there should be none.” (Solomon, 1997). 

She believes empathy requires the totality of the responses and feelings of the therapist. Without a full range of emotions within the therapist, many important dynamics will be missed and the alliance will be weakened. As do many schools of thoughts, I believe that our reactions and feelings toward our clients allow us to understand and emotionally resonate with our clients.

Emotional resonance is both a method of gathering needed information regarding the couple as well as a way to communicate compassion and empathy (Solomon, 1997). The ability to attune to the system evenhandedly, being attuned to the individual issues while pointing out the commonalities they have as a couple (going down the middle) is critical for successful treatment. PACT’s focus on attachment theory, informs the couple and the therapist how well each client’s parents attuned to each client’s individual needs and emotions throughout their childhood years. 

PACT provides a structure to help couples begin to see and understand each other by focusing on verbal and nonverbal language. Not only are we helping the couple see their dynamic differently, we are also helping them experience the benefit of being able to attune to each other with compassion and empathy.

Developing Alliances

  I share my mistakes and my growth through PACT with the hope that my experiences will help clinicians utilize their feelings to deepen their therapeutic alliances as they work with couples. First, my journey with PACT.

I remember the first time I was introduced to PACT. It offered me a blueprint to work with couples creatively, simply, and effectively. I was drawn to its clarity — that the role of the therapist is to move couples toward secure functioning. As I began to learn PACT, I knew intellectually what secure functioning meant, but by immersing myself in PACT, I soon learned what it looked like, what it felt like, and how each person in the room experienced it. The techniques of PACT, the strategies of PACT, the compassion of PACT made the experience in the room so alive. 

The learning curve was steep and exciting. I found it easier to develop an alliance with the couple with PACT rather than with the previous modalities I had used. When most couples enter therapy, they are interested in the therapist changing their partner. They operate as two individuals and seldom see that their ineffective relationship patterns are the result of the relational dynamics to which each of them have contributed. PACT’s techniques, such as cross-questioning, going down the middle, and creating containers changed the structure of my therapy sessions. All of PACT’S interventions help me ally with the couple rather than the individuals in the system.

The strength of the therapeutic alliance reflects how well the therapist and the couple connect, collaborate, and engage with each other. Research shows that a positive alliance is one of the best predictors of a positive therapeutic outcome (Dube, 2021). The work of being with the couple, not just the individual allows me to observe both the couple’s patterns and my reactions to those patterns. The structure of never seeing a member of the couple individually made sense and seemed essential. I felt that through PACT, my therapeutic alliance with couples was becoming stronger and more effective. I noticed that with interventions, I felt more curiosity and more compassion toward the couples. During PACT sessions, I felt strong emotions and found an emotional connection that I had not previously experienced with couples. 

I began to trust the feelings and reactions I had in session, and let this information guide my work in PACT sessions. When I did not have this therapeutic alliance, I reflected on what was different in me and in the couple that was not facilitating this connection. It became clearer to me that, in most of these cases, change wasn’t occurring because the therapeutic alliance was weak. I wasn’t focusing on my connection with the system. I would not be curious about my own process with the couple, and therefore I would miss out on vital information that my reactions and feelings were offering to me.

Exploring the Clinical Cases

The following three vignettes show how I respond to the immersion into a couple’s patterns. This immersion, with a therapeutic lens, help guide me to an effective and compassionate interventions.

Clinical Vignette #1: Blinded by the Light

The new couple enters my room for an initial session. I can feel their anxiety as they sit down next to each other in the moveable chairs. I calm myself to not react to their fears. I notice his eyes are piercing blue and his hands move nervously in his lap as he sits. She has shallow breaths, and her movements are slow and jerky. As I sit with them, I ask how I can help them. Their dramatic story begins.

 In the beginning of the session, I just observe. I notice that I am audience to an amazing story that includes overcoming childhood abuse, addiction, and incarceration. They met in rehab which they both failed at completing. They talk about a rehab program called New Dominion Rehabilitation Center, which ironically my mother founded. I immediately see my mother and lose track of them for a moment. I mistake my feelings of amazement with a deep alliance. They seem to be presenting the story of their lives like a movie. I, the viewer, find it difficult to wait for the next scene.

 I see them as honest and vulnerable with each other without taking the time to investigate whether they truly are. I am actually caught in my spell of enjoying them. After the initial session, I find myself almost drunk with delight. However, I soon realize even though I have a connection with this couple, I have merely become an outside observer to a couple who struggles in every aspect of their life. 

They have been in prison, they have lied, they have stolen, and they have let anger and isolation come between them. I have not asked them anything about what brought them here or what their goals were. I hypothesized that my reaction is part of their problem. They do well with telling their stories but continue to struggle with day-to-day living. I was in an altered state the whole time. I enjoyed the altered state and colluded with them about not dealing with their issues. I didn’t feel their pain and I was not curious about their pain. 

This self-reflection changes the arc of therapy from then on with this couple. Even though altered states feel enticing, I realize I must redirect the work toward the couple’s challenges in day-to-day living. Change doesn’t occur without pain. The focus becomes how to talk with each other, how to share and tolerate each other’s pain, and how to work out agreements about what they want to create.

This is a brief example of how becoming aware of my countertransference helps me formulate the blue print of working with couples.

Clinical Vignette #2: No Desire for Alliance

I have been working with Tom and Terri for several months. This is the second marriage for each. Tom is constantly ill and often cancels appointments because of illness. Terri has a grown daughter from her first marriage. They have both recently retired. 

Tom’s childhood has a long history of physical abuse. He has been in therapy most of his adult life.  His troubled history is a clear part of his identity, and he often uses his past to justify his actions and reactions. Terri assumed the role as parent in her family as her father was increasingly absent and her mother was bed-ridden with depression. She took care of her older sister then and still takes care of her financially, even though she is a woman in her 60’s.

 The initial session begins with Tom entering the office in the midst of having a panic attack due to the amount of traffic they encountered in the drive to my office. Terri is kind and worried. They are relieved when I offer tools to help Tom regulate his nervous system. Even though I feel an alliance, I know very little about this couple. The reason they sought marriage counseling is secondary to Tom’s panic attack.

 Treatment over the next few months becomes lifeless. I begin to lose interest in my sessions with Tom and Terri. When they are in my office, I feel like we are engaged in the routines of a tedious job. Reflecting on my emotional experience, I wonder if this says something about their unspoken marriage contract. I even wonder if this is a disorganized couple, but I do little to explore these hypothesis. 

Session after session Terri complains about not being seen, not being valued. Tom apologizes and talks about how he never felt seen or valued by his parents. Terri vacillates between empathy about his childhood and anger that he has changed the subject once again to his struggles and she still isn’t seen or heard.

I notice my energy draining out of me. I find myself with little enthusiasm when I formulate a container or when I investigate their interactions. I am also irritated with both of them, but I just ignored this irritation. Whenever I suggest something for the couple to try, Terri would say she had already tried that but agrees to cooperate. Tom is often in tears as he expresses regret that he isn’t a better partner. They frequently end each session with a statement of how much closer they feel and how much the therapy is working.

  I, on the other hand, feel that our time together was just another session. I blame myself for not wanting to connect with Tom and Terri, for not spending enough time on this couple. I hardly think about them until minutes before the session. I do not address their commitment to change. I never think to bring them up in supervision.

It became clear that I wasn’t using the countertransference as a tool, as I was focused on issues from my family of origin. Even though the couple’s dynamic and conversation were completely different from what I experienced, their sense of stickiness and hopelessness was all too familiar. I remember as a child that when these feelings would occur, I would act like nothing was wrong and withdraw just the right amount so nobody would notice, but I could still stay safe. It was exactly what I was doing with Tom and Terri. I hoped they didn’t notice that I had withdrawn from them. 

It is a joy to be hidden and a disaster not to be found.

— D.W. Winnicott

With my awareness of my own contaminating reactions to the couple, I realize no one in the room is seeing each other’s true self. We are all hiding behind our defense mechanisms. I know that the therapeutic alliance has to be with each other’s true self to create movement toward secure functioning. With this couple, I am losing my ability to challenge the defenses and show compassion to the true self.

Finally, I bring this couple up in consultation and know that I need to be real with them. I have to be careful with my feelings and not project them onto the couple. I state during the next session that I find myself not wanting to address their hopelessness. I have avoided addressing some topics with them. Terri immediately gets angry with me. Ironically I feel relief.  “You have the right to be angry with me, because I wasn’t seeing you and that is what you want most in life.” 

I feel closer to her, but not to the couple. I see no reaction from Tom. I cross-question by asking Terri what she thinks Tom is feeling about what I said. Terri states, “I don’t think it matters to him.” Tom quickly affirms Terri’s guess. I immediately see Tom as a young boy who was safer when people didn’t connect with him and he didn’t connect with the people who were supposed to love him. I immediately understand why this system stirs up my feelings about my family. 

At times it is safer to be unnoticed. I realize that my reactions to this couple is a good guide. As with me, Tom doesn’t want to connect. I learn that even when the countertransference stirs up old issues for me, it can still be guiding information. My energy and my creativity immediately return during this interaction. I begin to feel the stirring of a therapeutic alliance with this couple as a more compassionate understanding of their dynamic of struggling with connection unfolds. The structure of PACT is able to help me create a container of connection as a two-person system once I deal with my own feelings of connection. 

Clinical Vignette #3: Secure Functioning

I have only worked with this couple for a few months. They came in to make sure that they are working the best way they could as a couple. Mike and Amy met in high school and dated for a brief time. They went their separate ways, each marrying other people and building a life. They found themselves in unfulfilling marriages and divorced in healthy ways. They reconnected with each other and discovered a spark between them. They lived together for two years before marrying.

  They have been married for two years when I first see them. They tell their story together, with interruptions that don’t bother either of them. Their dance is beautiful as each person remains aware of their space and that of their partner’s. Watching this in a first session, I investigate whether this is the normal way of communicating or just how they present of meeting someone new. 

In initial session, I often ask the question, “What annoys you the most about your partner?” I want to see how quickly they answer this, how careful they are, and if it is done with a laugh and somewhat of an acknowledgment that they know they are annoying also. Another investigative question that I ask is, “What is your biggest worry in your relationship?” Again, I listen to the content, but I am more focused on how they are as a couple with difficult questions.

They easily answered the annoyance question, but I see Mike’s face changed to worry as he tells Amy what he is most worried about. He lives in fear that she will wake up and find out that he isn’t good enough for her. Amy is shocked and reassures him that she is already awake and they fit perfectly together. Mike’s face is still filled with worry, and I ask Mike to tell Amy when the thought that he is not good enough entered his life. Mike opens up and shares that he has hidden this feeling most of his life because he has felt that he always disappointed his parents.

PACT therapy has many ways to help this couple, but for the purpose of this paper, I am focused on my reactions and my alliance with the couple. At the pivotal moment of Mike’s revelation, I know that the couple just needed a few interventions from me. I recognize this because they immediately look toward each other, not me, when they are being vulnerable, funny, and serious.  

Measuring Our Effectiveness

The alliance comes from trusting the couple to be a couple without interventions until they are stuck. I can transmit this trust by saying very little, and at the same time being very active with both partners. I find myself saying most of all, “What are you noticing with your partner when you said that?” 

Part of the therapeutic alliance is to know what each couple needs and to have the tools to help them get what they need.  Part of this knowledge is to be aware of my own feelings and to trust the feelings to guide me to help the couple.

We as PACT therapists measure our effectiveness with couples by their ability to improve their connection and collaboration. When I am with a couple, focusing on the therapeutic alliance and exploring the countertransference dynamics are the tools that help me engage with the couple in a more creative and productive manner. When I explore my alliance and countertransference with my PACT coach, I gain confidence in trusting my instincts. I feel more creative in my interventions. I believe that the use of countertransference diagnostically and relationally helps expand our skills working with couples. I know that it has been important to me in my learning of PACT.

REFERENCES

Dobe, K. (2021). The Therapeutic Alliance: How Your Client Relationship Impacts Outcomes. Blueprint.

Hirsch, I. (2008). Coasting in the Countertransference: Conflicts of Self Interest between Analyst and Patient. The Analytic Press.

Solomon, M.F. & Siegel, J.P. (1997). Countertransference in Couples Therapy. W.W. Norton & Company, Inc.

Stubbe, D.E. (2018).  The Therapeutic Alliance: The Fundament Element of Psychotherapy. FOCUS: The Journal of Lifelong Learning in Psychiatry, 16, 402-403. https://doi.org/10.1176/appi.focus.20180022

Webster, M., Champion, L., Stapleton, C., Cassidy, J., de Keizer, J. (2021).  Transference in Couple Work [Workshop]. Advanced Practitioner Workshop, Annandale Institute, Annandale, Australia.