Describe the transference-countertransference element of the therapeutic relationship

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Describe the transference-countertransference element of the therapeutic relationship

An examination of the development of transference and counter-transference as a therapeutic tool with an exploration of the ways in which it can be defined and used in a therapeutic setting, with an overview and brief discussion of the way the concept of transference/counter-transference has been received by different schools of therapy.


This essay explores the development of transference and countertransference from their origins in Freud’s work to their current uses in different psychotherapeutic schools. The Kleinian contribution is identified as a major catalyst to re-thinking countertransference as a resource rather than simply an obstacle to treatment.

An unseemly event and a fortuitous discovery

In 1881, the physician Dr Josef Breuer began treating a severely disturbed young woman who became famous in the history of psychoanalysis as “Anna O”. She had developed a set of distressing symptoms, including severe visual disturbances, paralysing muscular spasms, paralyses of her left forearm and hand and of her legs, as well as paralysis of her neck muscles (Breuer, 1895, in Freud and Breuer 1985/2004, p. 26). Medical science could not explain these phenomena organically, save to designate them as symptoms of what was then known as “hysteria”, so Breuer took the radical step of visiting his young patient twice a day and listening carefully to her as she spoke about her troubles. He was to make a powerful discovery which deeply influenced his young assistant, Dr Sigmund Freud: whenever Anna found herself spontaneously recounting memories of traumatic events from her early history, memories she had hitherto had no simple access to through conscious introspection, her symptoms began to disappear one by one. But for the purposes of this essay, one event was to be of pivotal importance: just as Breuer was about to conclude his treatment of the young woman as a success, she declared to him that she was in love with him and was pregnant with his child. Perhaps unsurprisingly, Breuer was traumatised and withdrew from this intimate method of treatment promptly. Freud’s original biographer, Ernest Jones, reports that Breuer and Freud originally described the incident as an “untoward” event (Jones, 1953, p. 250); but where Breuer admonished himself for experimenting with an unethically intimate method which may have made him seem indiscreet to the young woman, Freud studied the phenomenon with scrupulous scientific neutrality. He, too, had experienced spontaneous outbursts of apparent love from his psychotherapeutic patients, but as Jones (1953, p. 250) observes, he was certain that such declarations had little or nothing to do with any magnetic attraction on his part. The concept of transference was born: patients, Freud argued, find themselves re-experiencing intense reactions in the psychotherapeutic relationship which were in origin connected with influential others in their childhoods (such as parents or siblings). Without being aware of doing so, patients tended to transfer their earlier relationship issues onto the person of the therapist. As Spillius, Milton, Couve and Steiner (2011) argue,

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