Hayes, J. A., Gelso, C. J., Goldberg, S., & Kivlighan, D. M. (2018). Countertransference management and effective psychotherapy: Meta-analytic findings. Psychotherapy, 55(4), 496-507.
This is another meta analysis from the Psychotherapy Relationship That Work series that will be published in a book by Norcross and Wampold in 2019. Psychotherapists’ unresolved personal conflicts and the cognitive, emotional, or behavioural manifestations of these conflicts in therapy are called countertransference. Countertransference can result in reactions within the therapist that negatively affect their relationship with patients and patient outcomes. Successfully managing these reactions may be an important aspect of positive outcomes in psychotherapy. The old view of countertransference, dating back to Freud, was that countertransference was detrimental to therapy, and therapists had to work to keep their personal reactions out of therapy. More contemporary views see therapist countertransference as inevitable and as providing potentially important information about the patient. In their model of countertransference management, Hayes and Gelso identified five aspects managing countertransference. 1) Origins of countertransference refer to therapists gaining an understanding of their unresolved issues from their past that can interact with patient characteristics in therapy (therapist unresolved family issues, low professional self esteem). 2) Triggers refer to specific issues within the patient that stimulate a specific unresolved issue in the therapist (the patient is competitive and the therapist has a fragile professional self esteem). 3) Manifestations refer to therapist cognitive, behavioural, or affective reactions to triggers and origins (the therapist puts the competitive client in his or her place). 4) Effects refer to the impact of countertransference manifestations on the therapy process or outcome (patient who is put in his or her place drops out or goes silent). 5) Management refers to therapists’ strategies to manage countertransference, including self awareness, self care, consultation and supervision, or personal therapy. In this series of meta analyses, Hayes and colleagues found that: (1) countertransference reactions are associated with poorer therapy outcomes (r = -.16, p = .02, 95% CI [-.30, -.03], d = -0.33, k = 14 studies, N = 973); (2) therapists’ management of countertransference reduces countertransference reactions (r = -.27, p = .001, 95% CI [-.43, -.10], d = -0.55, k = 13 studies, N = 1,065); and (3) successful countertransference management is related to better therapy outcomes (r = .39, p = .001, 95% CI [.17, .60], d = 0.84, k = 9 studies, N = 392 participants).
The research on countertransference management is still in its early stages but results are promising. Therapists’ ability to identify unresolved issues within themselves, how these issues interact with specific patient behaviors and clinical presentations, and management of therapist reactions are important to their work. The work of psychotherapy is fraught with emotional challenges and potential pitfalls for the therapist. Every therapist will experience confusing or challenging emotional reactions to a client. Better understanding and management of these reactions and their manifestations will not only lead to better patient outcomes, but also to greater therapist personal well-being and work satisfaction.