Today a client was putting me fast asleep. No sedative or hard drink could have done a more masterful job than this client. He had me bobbing and weaving for at least a few minutes while simultaneously I was feeling absolutely horrible that I had become that tired and was struggling so mightily to keep awake and attentive to him! What was I to do?

One term that floats around in psychotherapeutic jargon that many patients find rather mysterious and some therapists might even call obsolete is “Countertransference.” This term has been defined then redefined repeatedly over the many decades since Freud. Originally, it meant the private thoughts and feelings a therapist has while with a client that artificially restrict the ways the therapist can understand the client’s problems. These feelings need to be recognized and “removed from the treatment,” so as not to distract the therapist from properly understanding the client’s life.

Over the many decades through which psychotherapy has evolved, Countertransference has come to take on a whole new meaning. While it still does refer to the particular way a therapist thinks and feels about a client, it now is seen as a source of invaluable information and therapeutic power, rather than of distraction. While a therapist still needs to recognize the particular way they understand a client, the treatment actually benefits from the therapist learning from and even sharing their “countertransference” with their patients.

Let’s return to my session from today. After a few minutes of fatigue and near-misery, I feared my client would see that I was so tired and would stop talking, perhaps becoming upset at me or feeling lousy about himself that he was putting me to sleep. And that’s when it hit me: I was staring my countertransference directly in the face. I recalled that I had been perfectly awake in the treatment sessions just prior to his. Surely we can imagine I was growing tired as the day went on, but such a dramatic shift from one alert session to one in which I could hardly keep my chin off my chest was noteworthy. And I realized that his very flat, unemotional, slow-paced, overly deliberate presentation, devoid of eye contact was probably engineering something in the room between us. I believe he was unwittingly setting up a situation in which I was suffering and yet had to persevere; I felt wasn’t allowed to say anything fearing I would make him feel bad that he wasn’t including me or considering me very much in his narrative. And in that way he was giving me just small a taste of what he was going through in his own life: his presenting issue was his troubled marriage in which he and his wife lived separately; in fact she was already living with another man. Every week he would present another almost absurd way his wife had disgraced their marriage and disregarded both him and their daughter that lived at home with him. Why had he put up with that situation for so long?

For him, it mirrored his teenage years during which he lived without his biological father together with his mother and her new husband. She had several other children with him and would often tell my client how unwanted and “in the way” he was, not really part of the family, and yet living there. But my client did not respond by becoming a problem child, as what occurs so often. He obeyed and did well in school; he never to caused problems… He “put up with” the awful situation; he suffered in silence for all those years.

And he continues to suffer in silence with his disconnected wife. It was therefore important for him to have me sample just a little of his experience- so that I could understand better what he felt but could not say in these kinds of situations that have recurred throughout his life.

Realizing this, I woke up. I felt energized. Attempting to capture the moment, I just asked him straight out if he was used to suffering in silence. He looked at me, stunned… After a long pause, he said he always finds himself in bad situations where he has to take care of everyone, pick up the slack for those around him who shirk their responsibilities, and never say a word. This opened up a new dialogue about such situations for the remainder of the session. Presumably this will also open paths of discussion about his perceived helplessness versus his wish for stability beyond what’s in his best interests.