Therapist as Subject: A Review of the Empirical Countertransference Literature

More than two decades have elapsed since the last major review was published of research on countertransference (CT; Singer & Luborsky, 1977). Since that time, researchers have demonstrated renewed interest in this clinically important but empirically elusive phenomenon. In fact, a sufficient body of findings has accumulated since the last major review of CT to warrant a current review of this literature. In this article, we first briefly outline the ways in which CT has been defined since the construct was first introduced. Next, several influential studies published prior to 1977 are briefly acknowledged, followed by critical reviews of both analogue and field studies from the past two decades. Contributions of this research are summarized, and the article concludes with a discussion of themes and trends in the literature, including theoretical and methodological shortcomings, counseling implications, and suggestions for future research. Given the long-standing definitional controversy surrounding CT, clarity about our use of the term is especially important at the outset. Since Freud's initial mention of CT in 1910 (Freud, 1910/1959), definitions have generally branched into one of three directions (see Table 1). First, Freud's "classical" definition focused on the analyst's unconscious and neurotic reactions to the patient's transference (Kernberg, 1965). Second, the "totalistic" definition includes all conscious and unconscious reactions the clinician has toward the client (Heimann, 1950). The third perspective (Gelso & Carter, 1985; Gelso & Hayes, 1998; Langs, 1974), which might be labeled the "moderate" perspective, maintains that CT represents the counselor's reactions to the client that are based on the counselor's unresolved conflicts. This definition is broader than Freud's classical definition in that CT reactions are not viewed as occurring solely in response to the client's transference, nor is CT necessarily considered negative. On the other hand, the moderate definition is narrower than the totalistic definition in that it distinguishes counselor responses that are grounded in the shared reality of the counseling relationship from those originating in the counselor's unresolved issues, reserving CT for the latter. Whereas each of these definitions has been useful in broadening theoretical understanding of CT, most of the empirical research on CT, particularly in the past 20 years, has been driven by the moderate perspective. Thus, we reviewed research on CT that was in keeping with this definition. A critical review of research should ideally be framed in the context of theory that studies are designed to support or refute. However, despite nearly a century of musings and debate about CT, a comprehensive and testable theory that might help integrate, as well as stimulate, research has been absent until recently. Consequently, much of the existing research on CT has tested disparate hypotheses, and many of the findings are fragmented and difficult to synthesize in a clinically or theoretically meaningful way. Hayes (1995) developed a structural theory of CT that may serve as a useful framework for reviewing and synthesizing research on CT. Hayes argued that it is conceptually useful to categorize CT into five main components: origins, triggers, manifestations, effects, and management. CT origins are areas of unresolved conflict within the counselor. Triggers are the actual counseling events that touch upon or elicit counselors' unresolved issues. When these CT origins are triggered, counselors experience cognitive, affective, and behavioral reactions or manifestations. CT effects are the subsequent results of CT manifestations on the quality of counseling process and outcome. Finally, CT management refers to counselors' strategies for handling or coping with their CT. Before turning to our review of contemporary research on CT, it should be noted that much of this recent research has its roots in seminal contributions from the 1950s and 1960s. …