An Introduction to Countertransference

An Introduction to Countertransference contains a wealth of information that will help orient novice trainees to this important topic, as well as guide experienced therapists in their own clinical work, teaching, and supervision. Dr. Cartwright's wisdom, accumulated from many years of studying and helping others learn about countertransference, is evident in this gem of a book. Dr. Cartwright neatly synthesizes theory, research, and practical applications in a highly digestible fashion. I can't imagine a therapist who would not benefit from reading this book.

This book helps the reader understand key concepts relating to transference and countertransference, providing explanation of terms from Freud’s original perspective through more modern psychodynamic views to perspectives from cognitive-behavioural therapy. This is helpful for those not well versed in psychodynamic or object relations theory. The book takes a stepwise approach from understanding terms, to their relevance for the therapeutic relationship, to a process for understanding and managing countertransference, and includes dealing with ruptures and aspects as challenging as sexual countertransference in therapy. This layering from the simple to the more complex is aided by the use of transactional analysis as a frame to guide practice. There are questions for reflection to help identify countertransference and its origin, i.e., client or self, as well as suggestions for managing it in vignettes and transcripts.

Therapists with little background in psychodynamic approaches to therapy will find this a fantastic entry into an important aspect of clinical work. For those more seasoned it will offer perspectives and processes that will complement your work. The supervisor will find the sequences of reflective questions excellent to guide the supervision process when supervisees bring their reactions to clients. This is welcomed in this era of increasingly integrative approaches to therapy where a comprehensive training in these approaches cannot be assumed. Claire’s writing style is refreshingly clear and easy to comprehend, making the reader feel resourced and encouraged. Not only this but Claire takes a compassionate approach toward plight of the clients and their unconscious dynamics and toward the therapists who get caught up in them.

Dr Cartwright has truly done the psychotherapy profession an invaluable service by writing this book as it provides a theoretical and practical guide for understanding a rich and powerful therapeutic phenomenon in such a way that is accessible to trainee therapists and therapists practicing from a wide range of therapeutic orientations. If you are a trainee therapist, therapist interested in enhancing your knowledge and/or practice around countertransference, or a person with general interest in this area, then I highly recommend you read this book.

This book will be of interest to anyone working with clients in a therapeutic or helping capacity, and perhaps in particular to those who are not used to embracing and using their own subjective responses in the work. Clinical psychologist Cartwright first provides a theoretical introduction to the concept of countertransference, from its origins in discussions between Freud and Jung, who viewed it as something of an inconvenience, through to Heimann, who argued it was a tool to be used in service of the client.

Cartwright defines countertransference as 'the emotional, cognitive, and bodily reactions of the therapist to the client or the therapy situation and context'. She goes on to explain how these reactions can affect the therapeutic process and the importance of recognising and addressing them, as well as the dangers of not being aware of them, which can lead to ruptures.

She introduces a four-step approach to working with countertransference, which although a little manualised, feels practical and grounded in client work. The steps are: becoming aware of countertransference responses, reflecting on the client's patterns in relating, developing hypotheses about the dynamic between client and therapist, and managing countertransference responses as they arise in sessions. Each step is illustrated with clinical vignettes and exercises, which although useful, occasionally felt a little simplistic.

I enjoyed the breadth of this book and the incorporation of different traditions including psychodynamic, CBT, attachment and transactional analysis. Cartwright is also mindful of the social and cultural dimensions to countertransference, for example, when clients and therapists are of different ethnic/racial backgrounds, different sexualities and genders and different socio-economic status. This is an important addition to the existing literature about countertransference responses.