PROBLEMS

IN THERAPY
UNIT IV

1 TRANSFERENCE AND COUNTER TRANSFERENCE

2 GOALS SETTING ISSUES

3 RESISTANCE FOR TREATMENT

4 CAUSES FOR THE INADEQUATE TREATMENT ADHERENCE

5 LACK OF THERAPEUTIC ALLIANCE.

6 MANAGEMENT OF RESISTANCE.
 01 Client experience Client defensiveness 06

02 Therapist challenges Challenges Resistance

07
faced in Therapy

03 Fidelity adherence Unrealistic Expectations 08

Financial or Time Constraints 09

04 Client withdrawal

Counter-
05 transferential
Lack of Progress
reactions 10
 Challenges faced by Indian’s when seeking
Therapy

Stigma Around Mental Lack of Limited High

Health Awareness Accessibility Cost

Preference for Alternative Healing Gender

Language and Cultural Family Dynamics and
Practices Norms
Barriers Pressure

Systemic
Lack of Trust in
Challenges
Therapists
 TRANSFERNCE

• Sigmund Freud’s psychoanalytic practice in the

1890s.
Freud believed
that

childhood internal
experiences conflicts

Foundation for one’s development and

personality
 TRANSFERNCE

Historically the term “transference” refers to the feelings, fantasies, beliefs, assumptions and experiences unconsciously
displaced on the therapist that originate in the patients’ past relationships.
 Example of
Transference
• If a patient’s mother was extremely judgmental to her as a child, and
the therapist makes an observation that the patient perceives as
judgmental, the patient might express that and even lash out at the
therapist. This response could be interpreted as her applying to her
therapist the same feelings that she felt toward her mother.

• A client says, "You must be disappointed in me for not doing my

homework," projecting feelings they associate with their parents.

• "You always listen to me, just like my ex used to," and starts viewing the
therapist in a romantic light.

• They might say, "I hope I didn’t disappoint you," and go out of their way
to gain their boss’s praise.
 Types of Transference
Positive
Transference
• Involves feelings of admiration, affection, or trust.
• The individual transfers positive emotions they felt for someone (e.g., a parent, mentor, or
friend) onto another person, such as a therapist or authority figure.
• Example: A client views their therapist as a comforting parental figure and feels safe and
supported during sessions.

Negative
• Transference
Involves feelings of anger, frustration, mistrust, or resentment.
• These emotions are projected onto someone in the present, often based on
unresolved conflicts from past relationships.
• Example: A client gets irritated with their therapist and accuses them of being
controlling, mirroring their feelings toward a strict parent.
 Types of Transference
Erotic or Sexualized
Transference
• Involves romantic or sexual feelings directed toward a person, such as a therapist, even when
the context does not justify such emotions.
• Often stems from unmet emotional needs or unresolved relationships.
• Example: A client develops romantic feelings for their therapist and interprets their
professional care as personal affection.

Parental
• TheTransference
individual perceives another person as a parental figure and responds
with dependency, defiance, or admiration, mirroring their relationship with a
parent.
• Example: A student seeks approval from their teacher as they would from a
parent, striving for praise and fearing criticism.
 Types of Transference
Sibling
Transference
• The client projects feelings associated with siblings onto the therapist.
Characteristics:
• Rivalry, jealousy, or camaraderie.
• Seeking approval or competing for attention.
• Example: A client might feel jealous if they believe the therapist is more attentive to other
clients.
Resistance
• TheTransference
client unconsciously resists the therapeutic process by transferring
distrust or avoidance onto the therapist.
Characteristics:
• Withholding information or avoiding emotional topics.
• Feeling the therapist does not understand them.
• Example: A client avoids discussing certain topics, saying, “You wouldn’t get it
you’re just like everyone else.”
 Types of Transference
Idealizing
• Transference
The therapist is viewed as an all knowing or perfect figure.
Characteristics:
• Expecting the therapist to have all the answers.
• Placing the therapist on a pedestal.
• Example: A client might say, “I trust everything you say; you always know what’s right.”

Resistance
• TheTransference
client unconsciously resists the therapeutic process by transferring
distrust or avoidance onto the therapist.
Characteristics:
• Withholding information or avoiding emotional topics.
• Feeling the therapist does not understand them.
• Example: A client avoids discussing certain topics, saying, “You wouldn’t get it
you’re just like everyone else.”
 Types of Transference
Dependency
• Transference
The client becomes overly reliant on the therapist for emotional support.
Characteristics:
• Seeking constant reassurance.
• Fearing abandonment if sessions end.
• Example: A client feels anxious between sessions and says, “I don’t know what I’d do without
you.”

Displaced
• TheTransference
client redirects feelings about someone in their past onto the therapist.
Characteristics:
• The emotions may not align with the therapist's role but stem from
unresolved relationships.
• Example: A client reacts angrily toward the therapist because they resemble a
critical teacher from their past.
 HOW DO DEAL WITH TRANSFERENCE
IN THERAPY?

1 2 3 4
HAVE BE BE OPEN TO FEEDBACK. DON’T TAKE THINGS PERSONALLY
EMPATHY EMPATHIC

5 BE CONNECTED WITH YOUR PATIENT

6 7 8

DEVELOP PROVIDE HELP IDENTIFY

A PSYCHOLOGICAL TRANSFERENCES
THERAPEUTI SAFETY
C
ALLIANCE
IF THE PATIENT HAD A PREVIOUS
THERAPIST.
The Questions that you can
ask them

• “What went well and what did not go well in your past therapy
relationship?”
• “How would you like your past therapy to have been different?”
• “When you felt disappointed and misunderstood, were you able to share
that feeling with your therapist?”
• “In what ways would you like your relationship with me to be like your
experience with your last therapist?”
• “What are some of your worries about what you might experience in your
treatment with me?
 HOW TO RECOGNIZE AND ADDRESS
TRANSFERENCE

UNDERSTAND
AWARENESS STEP BACK IDENTIFY
THE
FEELINGS
MEANING:
The therapist
The therapist The
The therapist
therapist works to
first notices a avoids identifies uncover the
shift in the
reacting what the significance of
client’s
emotionally client is the client’s
emotions or emotions and
and looks at feeling or
behavior, which expressing how they relate
the situation
might indicate (e.g., anger, to past
objectively.
transference. fear, experiences.
sadness).
 Challenges with Transference
Client Resistance:
DISMISSIN DENIAL BLAMING FEAR OF
G THE THE CHANGE
Clients
ISSUE Some THERAPIST
Clients Some
may feel clients may insist clients
therapy may their resist
focuses deny feelings taking
too much having about the responsibil
on the any therapist ity for
therapist- reaction are solely their
client s to the based on feelings or
relationsh therapis the fear losing
ip rather t, even therapist’s their
than if these actions, familiar
 THERAPIST RESISTANCE

Avoiding Intense Overemphasizing the

Emotions Past
Therapists may avoid addressing A therapist may focus too much
strong feelings in the room on the client’s history and
because it feels uncomfortable neglect the current dynamics in
or challenging. the therapy room.

Premature Misinterpreting
Analysis: Reactions:
It’s essential for therapists to
Forcing the client to
distinguish between realistic
accept their feelings as client reactions (e.g., being
projections too early can upset the session started late)
harm trust and slow and those rooted in
progress. transference.
 Encourage clients to
Best Stay curious express their
perceptions, even if
and non-
these involve criticism
Practices defensive. of the therapist.

for Avoid Explore client

assuming all
Therapists client
emotions
gently and at
reactions are
transferentia
their pace.
\
l
Example in Initial
A client with a Triage
history of a critical parent might
Ticket unconsciously
Closure view
the therapist
Reviewastheoverly
ticket to judgmental. They might behave defensively
Practice determine its priority and
Update the ticket status
or passively
assign it toward
to the the therapist. Instead ofresolution
to reflect the denying this
or service completion.
perspective, the therapist invites the client to discuss their feelings.
appropriate support
team or individual.
Over time, this helps the client understand how their past
influences their present and work toward healthier relationships.
 COUNTERTRANSFERNCE

• Therapist's emotional reactions, thoughts, or behaviors toward a

Initial Triage
client. Ticket Closure
• Reactions may be conscious or unconscious and are influenced
Review the ticket to by the therapist's own personal history, unresolved
Update the ticket status
determine its priority and
issues, or emotional state. assign it to the
to reflect the resolution
or service completion.
• Strong emotional feeling towards the client appropriate support
team or individual.
 ORGIN OF
COUNTERTRANSFERENCE

We are almost always brought by our patients to some personal problem of our own, and we
need to discover where our weakness lies in order to maintain our authority and
understanding.” – Freud
• Freud saw countertransference as an obstacle to therapy, stemming from the analyst's unresolved emotional
Initial Triage
Ticket Closure
issues. Review the ticket to
Update the ticket status
• It was first defined by Sigmund Freud in 1910. in the paper “The Future Prospects of Psychoanalytic
determine its priority and Therapy “
to reflect the resolution
assign it to the
or service completion.
appropriate support
team or individual.
 ORGIN OF
COUNTERTRANSFERENCE
Shift in Perspective
(1950s):
• Paula Heimann and Heinrich Racker expanded the understanding of countertransference.

• Heimann argued that countertransference could be a valuable tool if the therapist recognized and managed it
appropriately

• Heimann argued that countertransference could be a valuable tool if the therapist recognized and managed it
appropriately

• Racker introduced the concept of complementary and concordant countertransference, focusing on how
the therapist’s reactions mirror the patient’s dynamics.
Initial Triage
 ORGIN OF
Complementary COUNTERTRANSFERENCE
Countertransference
This occurs when the therapist unconsciously takes on the role or feelings of an important figure from the patient’s life.
In essence, the therapist “complements” the patient’s internalized dynamics by stepping into a relational role.

Example:
A patient may unconsciously view the therapist as a controlling parent.
The therapist might then feel an urge to act in a controlling way, unconsciously mirroring the
role the patient has projected.

Concordant
Countertransference
This involves the therapist identifying with the patient's feelings or internal experience. Instead of adopting a relational
role, the therapist aligns emotionally with what the patient is experiencing.

Initial Triage
Example:
A patient shares feelings of helplessness.
The therapist begins to feel helpless themselves, reflecting the patient’s emotional state.
 ORGIN OF
COUNTERTRANSFERENCE
Modern perspectives on countertransference, evolving from the 1960s
onward.
• Shifted the understanding of this phenomenon from being solely a problem or therapist's weakness .

• Essential and inevitable part of the therapeutic process.

• Key contributors : Donald Winnicott and Wilfred Bion .

• Redefined the concept to focus on its relational and interactive aspects,

• Transforming countertransference into a tool for deeper therapeutic insight.

Initial Triage
 EFFECTS OF COUNTER
TRANSFERENCE R

• Distortions in the client’s perceptions .

• Mislead the treatment.
• Negative impact on the client counselor relationship and
rapport building.
• Rescuing Behavior – Therapist Overhelps, Fostering
Dependency
• Reenactment of Personal Conflicts – Past Unresolved
Initial Triage
Issues Affect Responses
GOALS SETTING ISSUES,
 GOALS SETTING ISSUES,
1.Vague or Undefined
Goals
Goals that lack clarity, specificity, or measurable outcomes.

Examples of Vague Goals in Therapy

“I just want to feel better.”

What does "better" mean?
Is it about reducing anxiety, improving self-esteem, or strengthening relationships?

“I want to stop being sad.”

Does this mean overcoming depression, managing grief, or finding more joy in life?
.
Why Do Clients Struggle with Defining
Goals?
🔸 Lack of self-awareness.
🔸 Emotional overwhelm.
🔸 Fear of commitment or failure
🔸 External pressure
Why Are Vague Goals a Problem in
Therapy?
🔹 Difficult to measure progress
Without clear goals, it’s hard to assess whether therapy is working.
🔹 Lack of direction
Sessions may become unstructured, with no clear path forward.
🔹 Frustration for both therapist and client
Clients may feel therapy isn’t helping if they don’t see tangible
improvements.
🔹 Risk of avoidance
Clients may avoid deeper issues if they don’t define what they truly
want to work on.
Therapist’s Role in Clarifying
Goals

🔹 Use open-ended questions: “What does ‘feeling

better’ mean to you?”
🔹 Help clients break down big issues into smaller,
actionable steps.
🔹 Reassess and adjust goals as therapy
progresses
🔹 Addressing Resistance & Fear of Change
🔹 Regularly Reviewing & Adjusting Goals
Examples of Turning Vague Goals into
SMART Goals
Vague Goal: “I want to feel better.”
✔ SMART Goal: “I want to reduce my anxiety levels by practicing
breathing exercises twice a day for the next month.”

Vague Goal: “I want to stop feeling sad.”

✔ SMART Goal: “I want to engage in one enjoyable activity per week
and track my mood changes over the next two months.”

Vague Goal: “I want to fix my life.”

✔ SMART Goal: “I want to improve my work-life balance by setting
boundaries at work and dedicating two evenings per week to self-
care.”