What is it about?
This study explores how therapists work through difficult emotional reactions that arise during long-term therapy with people with severe personality difficulties. These reactions, known as countertransference, can include anxiety, anger, helplessness, frustration, or a strong urge to rescue the patient. They can make it harder for therapists to think clearly, understand the patient’s experience, and decide how to respond. Drawing on experienced clinicians’ accounts, the study examines how these difficulties develop within the relationship and how therapists recognize and work through them. It highlights moments when therapists become caught up in intense feelings or recurring patterns with patients, temporarily losing the perspective they usually rely on. Working through these moments involves making room to reflect, understanding what the feelings may reveal about the relationship, and recovering the ability to respond thoughtfully. Supervision offers a space to examine these experiences with another clinician and consider different ways of understanding them. The study also considers how therapists learn from mistakes and regain their footing after difficult encounters. These accounts suggest that managing emotional reactions is an ongoing part of therapeutic work. Understanding and reflecting on them may help therapists maintain a useful relationship and support patients through challenging periods in their treatment.
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Why is it important?
This study is important because therapists’ emotional reactions can influence how they understand patients and respond to them, particularly during difficult periods of treatment. Even experienced therapists can feel overwhelmed or become caught in patterns that make it harder to help. Bringing these experiences into the open may help clinicians recognize difficulties earlier and reflect on their responses. The study offers insights for training and supervision by describing how experienced therapists regain perspective and work through challenging moments. It also highlights why supporting therapists in understanding their own reactions matters for the care they provide to patients.
Perspectives
As a full-time clinician, I believe it is crucial to be aware of our own emotional and human responses to our patients. These responses can help us understand patients’ inner worlds, their ways of relating to others, and how our own experiences and vulnerabilities shape our responses. Understanding and working through these emotions is essential when helping people with severe personality difficulties. This study aims to help clinicians navigate the emotional demands of this work and use their responses thoughtfully in the service of their patients.
Dr. Juandiego Emiliano Serna-Galindo
Read the Original
This page is a summary of: Working through problematic countertransference: Senior clinicians' narratives from long‐term treatment of severe personality pathology, British Journal of Psychotherapy, September 2026, Wiley,
DOI: 10.1111/bjp.70054.
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