Getting triggered as a counselor

The term countertransference has been discussed and debated since Sigmund Freud first argued that it was something taboo — a personal obstacle that would harm the therapeutic relationship. Today, counselors acknowledge that countertransference is inevitable. They are human and prone to having their own issues emerge, often without them even realizing it. Sessions can trigger past experiences, unresolved issues, implicit beliefs and an array of emotions. 

“There’s no way counselors can really extricate themselves and their personality from the [therapeutic] process,” says Peter Allen, a licensed professional counselor (LPC) and integrated care supervisor at Brightways Counseling Group in Madras, Oregon. “That doesn’t mean we’re always talking about ‘me’ [in session]. But it means that I’m acknowledging that I’m coming in with a lot of baggage and perceptions about things that have to be managed.”

Jessie Guest, a licensed clinical mental health counselor and supervisor in North Carolina, views countertransference through Charles Gelso and Jeffrey Hayes’ definition, which she summarizes as an “inevitable, unresolved conflict that leads to misdirected feelings toward a client that can be triggered by the content of the session [or] the client’s personality or appearance.”

Although countertransference is more widely acknowledged today, counselors, especially those early in their careers, often struggle to disclose it, Guest says, because they are either unaware of it or they fear it will make them appear incompetent to others in the profession. Having negative feelings about a client can also make counselors question themselves — both as people and professionals — because they believe that as helpers, they should always be happy and nice, adds Guest, an American Counseling Association member whose specialties include play therapy, trauma and countertransference.

When she was a new professional, Guest worked in a play therapy room with a young child who yelled, kicked and threw objects throughout the session. This behavior triggered something in Guest, who says she is not a “yeller” herself. She felt her body tense every time the child lashed out, and she could sense her anxiety increasing. She worried that the other counselors in the building would hear the child screaming and think that Guest was a “bad” counselor who didn’t know what she was doing. 

After the session ended, Guest reflected with her supervisor on what had happened and realized that her anxiety stemmed from her own discomfort with yelling and her insecurities of being a new counselor. It wasn’t really about the client.

How counselors handle their countertransference “can either be helpful or hinder the therapeutic relationship,” says Guest, who is a registered play therapist and supervisor. “We all have experiences, and people are going to poke those experiences. … But it’s our job to be aware of it and take the time to reflect on those things so it can be helpful instead of harmful for our clients.” 

Recognizing when you’re charged 

Even if counselors realize that countertransference is inevitable, it can still be challenging to recognize when it is happening in session. From her research, Guest, a clinical assistant professor of counselor education at the University of South Carolina, found that counselors who work with children with challenging behaviors often struggled with unrecognized countertransference. 

The clients’ anger and emotional outbursts frequently caused counselors to become charged and engage in unhealthy therapeutic behaviors themselves, she says. Some counselors scheduled certain clients less frequently or ended sessions early. Others would walk out of session when they became too triggered and leave the child alone. Counselors also recalled talking more flippantly with colleagues about certain challenging clients. Guest has published and presented on countertransference, including at the 2021 ACA Virtual Conference Experience. 

Debra Chatman-Finley, an LPC in private practice in Montclair, New Jersey, says she often notices her own physical reactions when she’s triggered in session with a client. Her body may tense or she may find herself squirming in her seat or tapping her foot on the floor. 

Signs such as those let the counselor know that “something is happening between you and that client other than the typical therapeutic interactions,” she says. “And that is when the onus is on the clinician to examine it because whatever that is, it’s going to come through in the form of a question, the way you phrase a question” or a nonverbal response. 

Chatman-Finley, an adjunct professor in the Silver School of Social Work at New York University, had a Black client tell her that when they mentioned they were a graduate of a prestigious university during a session with a white therapist, there was shock written all over the therapist’s face, although the therapist didn’t verbally express it. The therapist was probably well-intentioned and didn’t even realize they were responding nonverbally, Chatman-Finley adds. 

Sometimes clinicians understand countertransference only at its most noticeable level, such as becoming angry or teary-eyed in session, observes Allen, an ACA member. But avoidance, annoyance and impatience are other potential signs of countertransference, and those, he says, “are much harder to recognize in yourself in the moment and can easily go unnoticed … because they can be subtle and insidious.”

When counselors aren’t sure whether they are charged or triggered in session, they can use the PERMS technique, suggests Alex Castro Croy, an LPC and licensed addiction counselor in Denver. The acronym stands for checking in with one’s physical, emotional, relational, mental and spiritual self. 

Possible physical reactions include feeling fidgety or experiencing cold sweats or elevated blood pressure. Emotional states could involve feeling angry or numb. The relational domain refers to how counselors feel toward themselves and their clients; they may feel incompetent or second-guess themselves, for example. The mental domain is based on one’s thoughts, values and beliefs about oneself such as “I’m not a good therapist” or “I’m messing up.” With the spiritual domain, counselors may question their meaning or purpose; they may wonder if they are cut out to be a counselor and may contemplate leaving the field. 

Being overly supportive is yet another form of countertransference. A counselor might make exceptions for a client because they are fond of them, or they may verbalize to a colleague that they “like this client.” Should something happen along those lines, the counselor needs to explore it further, advises Castro Croy, the owner, director and lead clinician at Life Recovery Centers, a group practice with offices in the Denver metro area. What is it that they like about the client? Is it that the client reminds them of their brother, mother or best friend? The counselor needs to be mindful of this feeling, he says, and consider the ways that it could be productive and counterproductive for the client. 

Clinicians should also pay attention to their ability to remain objective with specific clients, Guest adds. Are they getting overly defensive about a client or finding themselves oversharing in session? Do they refrain from challenging a client (when needed therapeutically) because they overidentify with the client or because the client reminds them of someone who is close to them? 

Implicit biases and beliefs 

Countertransference is often an indicator of implicit beliefs, attitudes and biases, says Chatman-Finley, who teaches workshops on racism, microaggressions and racial trauma. It reveals “what’s going on with you unconsciously that may be in conflict with what you believe or think consciously and how [that] might be showing up in your clinical work,” she explains.

All clinicians have beliefs and biases, and those can enter the therapeutic relationship without clinicians realizing it. For example, as a Black woman, Chatman-Finley believes in Black people getting their education, but she thought she could separate this personal belief from the needs of her clients. Her strong unconscious beliefs surfaced, however, when she was working with a Black mother who wasn’t interested in attending college. Chatman-Finley recalls her body tensing up when the client mentioned this, and her therapeutic questions became skewed in the direction of the client attending college. 

She thought she was being supportive and helpful. School wasn’t a priority for the client at the time, however, so the client perceived the questions as judgmental. Chatman-Finley didn’t recognize the countertransference at first, so it negatively affected her work and caused a rupture in the therapeutic relationship to the point that the client stopped showing up for sessions. 

Chatman-Finley told her supervisor that she was struggling with this particular client and couldn’t figure out why. She assumed it was because the client just wasn’t ready to do the work. But her supervisor challenged Chatman-Finley to examine her own role and responsibility for the rupture: What was she focused on in treatment? What questions was she asking the client? What happened in session right before the client stopped coming? Although this line of questioning was uncomfortable for Chatman-Finley, it forced her to reflect on how her own beliefs and internalized thoughts on race and education were sneaking into session in subtle ways. 

Chatman-Finley reached out to the client and scheduled another session where she admitted that her own beliefs about education had gotten in the way of the work that the client needed and wanted to do. 

One strategy Chatman-Finley and Allen find helpful in identifying potential bias and countertransference is to ask themselves whether they would do the same thing with a different client. “If the answer is no,” Allen says, “then you’re probably in the terrain of unrecognized countertransference.” 

He offers an example: In couples therapy, the counselor learns that the woman had an affair, and the clinician feels judgmental. In the next session, a different couple comes in, but this time the man has been unfaithful, and the clinician thinks, “Well, he must have been lonely.”  

“That’s evidence that the counselor is off,” Allen says. “If I’m seeing the same situation in drastically different ways in different clients, that’s a sign” of countertransference.

It’s not the client, it’s me 

Chatman-Finley recalls learning in graduate school that the client’s issues were the only thing present in the room, so if something felt uncomfortable, it probably had to do with the client, not her. But later when she started seeing clients, she learned that this wasn’t true. Her own thoughts, feelings and beliefs could also enter the session and affect the therapeutic relationship. 

It’s easy for clinicians to slip into assuming that the negative energy in the room or the therapeutic rupture is because of the client, Chatman-Finley says. Counselors can find themselves thinking, “I guess that client is just not ready to do the work,” when in reality, she explains, it may have been something the clinician said or did in session that is the true source of the problem.

Allen acknowledges falling into this type of thinking when he was working with a client who had posttraumatic stress disorder. The client wasn’t applying the skills and concepts they were practicing in session. Instead, the client continued to show up and recount stories that depicted him as the hero, so Allen found himself getting annoyed and dreading sessions with the client. This frustration and annoyance spilled into the way that Allen phrased his clinical notes, writing, for example, that “the client refuses to practice interventions at home” rather than “the client displays difficulty in practicing interventions at home.” Despite the subtle signs of countertransference, Allen still thought his annoyance was being driven by the client’s lack of motivation. 

In discussing the client with his clinical consultation group, Allen eventually realized that he was annoyed with himself, not the client. His annoyance came from anxiety related to his own internal pressure to “heal” the client and his insecurities about not being competent as a counselor. His colleagues also helped him realize that the client was making progress in his own way: He trusted Allen and continued to show up for sessions.

To help counselors determine if the problem lies with them or with their client, Castro Croy recommends that they do a “chicken check-in” — a story that originates from his work helping a man who was employed in a grocery store deli. An older couple would regularly visit the store at lunchtime and ask for free samples, a distraction that led the employee to burn the chicken he was cooking on multiple occasions. The third time that he burned the chicken, he yelled and cursed at the couple, and they filed a complaint. 

Castro Croy worked with the client to put his frustrations in context: Had he lost his job because he burned the chicken? Had the grocery store reduced his work hours? Had his employer docked his pay? To all three questions, the client answered “no.” 

“Then, it’s not your chicken,” Castro Croy told him, meaning that it wasn’t worth him getting dysregulated over a chicken that didn’t belong to him. (Castro Croy discusses this story and the intersection of the professional and human selves in more detail during his recent TEDxCherryCreek talk.)

Castro Croy, an adjunct professor in the Department of Human Services at Metropolitan State University of Denver, now uses the “not my chicken” story both to remind clinicians to stop and assess the situation when they feel themselves getting charged in session and to help them set personal boundaries. If it’s not their chicken, counselors can let it go, but if it is their chicken, then they can temporarily bracket it, refocus on the client and process their own feelings after session, he says. 

Managing countertransference

The moment that counselors assume they have countertransference under control is when they are most vulnerable, Allen asserts. “There are days I’m going to miss it even if I’m looking for it,” he says. “And there are days I’m going to see it coming from way off. If I know I am seeing a challenging client at 2 p.m., I need to get centered about that.” 

So, Allen continues, clinicians must constantly check in with themselves and ask self-reflective questions: Do I not realize countertransference is happening? Do I notice it but it’s not an issue? Is it affecting the decisions I am making in session? 

“Recognizing it doesn’t automatically make it good either,” Allen notes. “If you recognize it and don’t do anything about it, it can still be harmful.”

Castro Croy advises counselors to first do the PERMS check-in during session to recognize if they are feeling charged. If something is affecting them, after the session ends, they can delve deeper into the countertransference they experienced by doing what he calls a “functional analysis of self.” This involves carefully contemplating their reactions and any potential underlying reasons for the countertransference (i.e., reflecting on what’s “their chicken”). 

Allen agrees that checking in with his physical, emotional and mental state is helpful. Throughout sessions, he’ll notice if he’s holding tension in his body or if his thoughts are distracted. When he feels triggered, he relies on the same mindfulness techniques that he often teaches his clients. For example, if a client is yelling, he continues to listen to them, but he also focuses on his own breathing. This helps him stay in the moment with the client and avoid having his own feelings affect the session.

Research supports that emotion regulation interventions such as mindfulness can be a good management strategy for dealing with countertransference when paired with psychoeducation about the client’s disorder or mental health concern, Guest notes. Her research study for her dissertation confirmed this finding. Guest created an intervention that combined psychoeducation on child communication, especially for children who have endured trauma, with a mindfulness-based practice to reduce negative countertransference for counselors working with children who exhibit externalizing behaviors such as yelling and hitting. 

The counselors in the study discussed Erik Erikson’s stages of psychosocial development, the functions of child behavior and the theoretical tenets of child-centered play therapy developed by Garry Landreth. Guest also had the counselors use the mindfulness intervention RAIN (developed by American psychologist Tara Brach): 

• Recognize the stress. (“The child kicked me, and I feel my blood pressure rising.”) 
• Allow for feelings to be expressed. (“I feel frustrated, and I’m not sure how to react.”) 
• Investigate what is happening for the counselor and the client. (“What is the worst part of this for me — the yelling or feeling insecure? What was the child trying to communicate by kicking me?”)
• Nurture with compassion for self and client. (“I’m human, and it’s OK if I don’t know what to do in this moment. The fact that the client is exhibiting this behavior with me means they are trying to show me something.”)

Guest also asked the counselors to practice breathing exercises (such as the mindful minute, during which they count their breaths before and after each session), body scans and guided meditations daily to make them less reactive in session and allow them to be controlled in how they respond to clients. 

“By doing multiple mindfulness practices, we are providing ourselves more of a space between stimulus and response. We are less reactive,” Guest says. So, she explains, instead of responding immediately to the client’s negative behavior, counselors have the space to manage and redirect their countertransference into a healthy reaction, such as considering what the child is trying to communicate by the action, rather than just ending the session quickly out of frustration. 

Taking the issue to supervision 

Successful management of countertransference involves good supervision, Chatman-Finley emphasizes. This means the supervisor normalizes countertransference as a part of the therapeutic process and challenges the supervisee to reflect on how they are feeling in session, she says. 

“Supervision can’t just be about the client,” she explains. “It has to include an examination of the therapist’s thoughts and beliefs about the client because there could be something else that’s unconsciously going on with the therapist.”

Chatman-Finley has a peer supervision group in which each member presents a case and the others in the group pose challenging questions so the counselor can consider how their own feelings, beliefs and experiences may be affecting the therapy session. Group members may ask, for example, “What is it like for you to work with that client? What are your goals in working with this client? Why did you go down that path of questioning or treatment with the client? What happens in your body while working with the client?” 

Allen notes that not all supervisors are prepared to discuss countertransference or even know how or when to bring it up. This can create problems for clinicians if they are struggling with how to manage their countertransference. If supervisors don’t handle this correctly, there is potential for them to inadvertently reinforce the message that should counselors have a reaction or feelings toward a client, it means they are bad at their job, he says. (See Allen’s Psychotherapy.net article “Countertransference: How are we doing?” for more on the social solutions to countertransference, including supervision and consultation.) 

Castro Croy is aware that counselors, especially new professionals, are sometimes hesitant to broach the issue of countertransference. So, when he notices a supervisee stumbling in the way they discuss a client or if they are overly cautious when crafting a question, he’ll prompt them by saying, “OK, what’s the question underneath that one? What are you really asking?” or “OK, now ask me that question as a human in the profession, not as a counselor.” This opens the door for them to explore and discuss those times when they feel charged in session. 

Guest recalls having a supervisor who normalized countertransference without even mentioning the term. When discussing how she felt stuck with a specific client, the supervisor simply asked her, “Do you like your client?” 

She was initially surprised by this question. Of course she liked her client! But then she let the question sink in for a few moments, and she considered whether she did actually like this client, what that even meant and why she felt the need to like all of her clients. 

“It was a great question,” she says, “because it allowed me the freedom and safety to process and accept if I was having frustrations or not.” 

Guest encourages counselors to surround themselves with colleagues who are supportive, who will challenge them, who have diverse experiences and perspectives, and who “can help [them] see any blind spots.” 

Turning countertransference into a therapeutic tool 

Although countertransference is largely discussed in terms of something to be avoided, it can have benefits for both the counselor and the client. Namely, it can provide clinicians with insight to better understand the client, Guest asserts. 

For example, she says, take a counselor who is triggered by a young female client who is often defensive and not receptive to feedback in session. The client’s behavior has caused the counselor to become tense and anxious. The client has mentioned in previous sessions that she struggles with relationships and isn’t sure why. The counselor could choose to use the countertransference as a reflective tool to examine if this experience in the counseling session is also happening outside of the session for the client, Guest says. They could say, “I’m noticing some tension, and sometimes I feel like you may not hear me. I’m curious if this happens for you in your other relationships.”

Allen has used countertransference in a similar way. He once worked with a client who dominated the conversation and rarely gave him a chance to talk. Allen was aware that his own annoyance with this type of personality could result in negative countertransference, but instead he used it as a tool to better understand the client. He said, “I’ve noticed you ask me questions, but you do not give me the space to answer them, so I’m not sure if you want me to answer them or not.” 

He followed up with a few questions to learn more about why the client felt the need to dominate the conversation: “Did you come from a family where you felt like you couldn’t get a word in? Are you uncomfortable with silence?”

Sometimes countertransference even has the potential to strengthen the therapeutic relationship. Allen was doing couples therapy shortly after his own divorce. With one particular couple, he decided to meet with them individually to see if they could identify issues they might have been hesitant to share when the other partner was in the room. In an individual session, one of the partners started to cry as she said, “I don’t think we are going to make it.” 

Allen began to tear up as well. He quickly decided to allow that moment of countertransference to come through because he thought it would be helpful to the client in that moment. His instincts proved correct. The client asked him, “Have you gone through this before?” He acknowledged that he was recently divorced, and she told him that she felt seen by him. 

“If I had locked those feelings away and been professorial and distant, it would have been very disconnecting for her,” Allen says. “But I had a spontaneous reaction, and she saw it, and it was a wonderful moment in therapy.” 

However, Allen cautions counselors to carefully consider each client and situation before showing their personal feelings in session. “It might have been the exact wrong thing to do with another client on another day,” he observes. 

The gift of countertransference 

Countertransference can also provide counselors with greater self-awareness. Castro Croy once worked with a Latino child whose father was reinforcing culturally stereotypical messages at home. The instant the child shared this information in session, Castro Croy blurted out, “Excuse me?” in an appalled tone. 

This client’s experience evoked a strong reaction in Castro Croy because he had also struggled with religious and cultural oppression from his upbringing as a child. But he quickly reminded himself, “This is not my chicken,” and proceeded to focus on the client in session. 

This brief moment of countertransference made him realize that there were still residual parts of his own childhood that he had not fully processed in therapy, and he had more work to do himself. 

“When things from the unconscious show up — whether it’s good, bad or ugly — there’s room for that in the [clinical] space,” Castro Croy affirms. Counselors don’t need to “feel scared or intimidated with the humanness that shows up in the profession,” he continues. “Countertransference is a gift because it reminds us … that we are human, that we still have work to do. So, it should not be seen as something negative but as a strength — this is an area I need to work on.”

 

****

Lindsey Phillips is the senior editor for Counseling Today. Contact her at lphillips@counseling.org.

****

Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.