Countertransference guilt: The therapeutic relationship: A literature review with clinical illustrations

Abstract

Guilt is an important concept in psychodynamic psychotherapy and much literature exists describing clients’ feelings of guilt and how the therapist can treat them. This dissertation explores the less published area of the therapist’s feelings of guilt, or “countertransference guilt”. Guided by personal and professional curiosity, I wished to know in what ways the therapist’s feelings of guilt affected his clinical working in the therapeutic relationship. A full and fair review of the literature available in the English language was carried out selecting all examples of literature where the therapist’s feelings of guilt appeared at least once. The literature was read, annotated and analysed according to an existing countertransference model (Marshall, 1979). Clinical vignettes from my own work further illustrated the literature. Countertransference guilt examples were distinguished according to therapist origin or client origin and grouped into the most frequent themes. An additional dimension of conscious / unconscious could not be verified as intended due to a lack of consistent description. Countertransference guilt was found to lessen therapist intentionality if unrecognised and unmanaged. Conversely the successful recognition and management of countertransference guilt was found to lead to appropriate interventions. An “Intrapersonal / Interpersonal Model of Countertransference Guilt” was created as the originally intended countertransference model proved not fully workable due to the inadequate level of description in the literature. Two additional tables succinctly list the numerous intrapersonal and interpersonal manifestations of countertransference guilt. The limitations and applications of this study are discussed, including recommendations for clinical practice and further research. In a final section I describe some aspects of how producing this dissertation has affected myself and my clinical work.