Several years ago, I was supervising an intern who was clearly floundering in a very difficult therapy. The client was a classic example of a low-functioning borderline. One day, in a detailed discussion of a brief exchange in this difficult therapeutic relationship, I had an idea. As a result of that idea, my intern and I began to shift the focus of supervision – first in relation to the exchange we had been examining, and then eventually on the overall management of the case. Over the coming weeks and months, my intern’s therapy with this borderline client changed radically. In a relatively short time, the client-therapist relationship became productive and mutually gratifying, and the client began making real progress at a remarkable pace.

We then started to experiment, gradually shifting the focus of supervision about all closely supervised cases. In each instance, as my intern’s approach changed quickly and dramatically, in most instances the therapies changed just as quickly and dramatically. It turned out that renewed attention to a well-known concept in analytically oriented therapy was all that was needed, in most instances moving the process of therapy along, particularly when clients seemed especially difficult or the therapy felt ‘stuck’. Likewise, my own style of work with clients and supervisees has changed gradually since that time, and I'd like to share what I have learned with my colleagues on 4therapy.com.

The well-known concept to which I’ve been referring is countertransference, a concept familiar to most therapists. There are of course many angles on countertransference, but I offer here one (possibly unconventional) angle I’ve found to be both helpful and liberating.

Every relationship, including relationships between clients and therapists, is characterized by mutual influence. Because each person involved in the relationship both influences and is influenced by the other person and by the evolving relationship itself, it’s impossible to tell who is responsible for any given characteristic(s) of the exchange. During the time my career mostly consisted of teaching and research, I took note of this concept in a different context, and at that time used the metaphor of dance to talk about it with colleagues.

So, in short, no one can ever say for certain who is responsible for the present form of any dance, nor for the direction of its evolution--the answer must always be "both persons" and "neither person." In Yeats’ well-known words:

Oh body swayed to music, oh brightening glance,
How can we tell the dancer from the dance?

I’m suggesting that, to the extent that this perspective seems helpful, it’s apparent that we therapists may benefit by taking full responsibility for our part in the "dance" we co-create with our clients. We can carefully examine our own contribution to the present state and evolution of the relationship on a moment-by-moment basis, and in doing so monitor and consciously contribute to shaping the development of the dance over time.

As therapists, we of course always try to set the stage in therapy for a fully functional, mutually gratifying working relationship with clients. We are the professional dancers in the dances we create with clients; we are the experts on relationships. So if the relationship/dance falters or fails, we can take responsibility, as the experts in the room, for the faltering or failure. We can deeply reflect on our own roles in the dance. With sufficient self-awareness and knowledge about relationships, we ought to be able to take steps directing the dance towards increased functionality simply by focusing very closely on ourselves, that is, on our own reactions and behavior in the relationship.

In some sense, of course, this is all self-evident. Therapists always strive for a high level of self-knowledge to maintain the ideal of therapeutic neutrality, generally believed to be essential to psychotherapy. However, the present perspective is a bit different. As a full participant in the dance of the client-therapist relationship, a therapist cannot be neutral. A therapist’s reactions (subtle and not-so-subtle) to a client are shaped by the client’s behavior and by the present state of the relationship, both of which in turn having been shaped by the therapist’s behavior and some previous state of the relationship ... on and on it goes. The therapist is every bit as responsible for sustaining the dysfunctions in the relationship as is the client. Moment-to-moment self-reflection and knowledge is, from this point of view, the therapist’s only real source of understanding of the nature of the evolving therapeutic relationship.

In practical terms, what does this mean? Since starting to share this perspective more widely, I have noticed that it means different things to different therapists. I suspect that--if you’re interested in experimenting with these ideas---you will find your own way to work with this perspective with your clients.

I can however offer a concrete starting-place. If you are currently working with a client or two with whom you would feel comfortable enough to try an experiment, you might consider this. For one session (or for a portion of a session), imagine that there is virtually no actual content in the session. That is, maintain only a light awareness of the content of session (in much the same way that certain meditative traditions ask us to maintain a light awareness of our breath), and direct most of your attention internally instead. How does it feel to sit here with this client? Are you feeling engaged? Bored? Uneasy? Are you feeling confident and secure about the interaction and the relationship? Or are you feeling overconfident/cocky, or overwhelmed? Notice how these feelings change over the course of the session, and notice what’s happening in your client’s behavior, your own behavior and impulses, and the relationship as they change.

Then, begin to speculate: How much of your experience with this particular client seems constant (more or less) from client to client, and how much is unique to this particular client-therapist relationship? I would suggest that the "constants"--unless you are lucky enough to have constant feelings of engagement, authentic connection, ease--are likely to be reflections of countertransference in the classic sense, namely unresolved and/or unconscious conflicts in you, the therapist, that are triggered by the client. The rest, I suggest, may be a response primarily to your unique dance with this particular client at this stage in its evolution. And since it’s impossible to draw conclusions about the client on this basis--since we can’t tell the dancer from the dance--begin to ask yourself: What is my role in perpetuating this dance? What is my role in sustaining the dysfunction, a dysfunction that might previously have been improperly identified as the client’s problems?

If you decide to give this perspective a try and then decide to stick with it as a continuation of the experiment, after awhile you’ll probably start to notice both that the specific form and the subtler emotional tone of your own interventions change. You’ll probably start to notice that you are far less drawn in by your client’s pain and dramas, and instead spend more energy on self-reflection, focusing more on affect (especially your own affect and your perception of the affective tone of the interaction). You may even find that you are more self-revealing. You’ll also probably notice that the client eventually starts to behave differently in your sessions, and you may find that these differences – differences that primarily show up as a change in the affective quality of the relationship--are very revealing, and revealing in a very different way from your usual way of thinking about therapeutic transactions.

For many therapists, a small change in perspective like this can breathe new life into a psychotherapy practice. Of course, there is never a single perspective that can work well with all clients. But I’ve found that the "angle" on countertransference that I’ve described in this brief article can be especially useful when, like the intern with whom I first did this work, I feel bored, stuck, unproductive or floundering in a therapy. I’ve found that taking full responsibility for my own part in the dance is the most reliable means of setting up the conditions for the dance to change.