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Journal of Contemporary Psychotherapy, Vol. 32, No. 1, Spring 2002 (°

C 2002)

Playing With Fire: Countertransference

and Clinical Epistemology
Jeffrey A. Hayes

This article explores both theoretical and practical concepts related to the ther-
apist’s use of the self in psychotherapy. Particular emphasis is placed on the
potential clinical value of countertransference. It is argued that awareness and
resolution of personal issues are required for therapists to draw profitably from
their own experiences in working with clients. Specific steps in translating the con-
cept of the wounded healer into clinical practice are offered, along with examples
from the author’s own practice.
KEY WORDS: countertransference; wounded healer; therapist factors; psychotherapy relationship.

Paul Jordan Smith (1995) recounts the story of a group of physicians who
are arguing about the most important organ in the human body. They take turns
presenting claims for the supremacy of the brain, stomach, heart, and lungs. A
rabbi overhears their discussion and declares, “You are all wrong. There are two
vessels of the body only that are important but you have no knowledge of them.”
When the physicians inquire as to what they are, the rabbi replies, “The channel
that runs from the ear to the soul, and the one that runs from the soul to the tongue.”
These same two channels can be, and often are, critical determinants of
psychotherapy outcome, although a vast number of therapists do not intention-
ally use them, thereby limiting or even diminishing outcome. In the following
paragraphs, I will explore both the prospective value as well as the inherent danger
in using these channels in psychotherapy, with an emphasis on how they affect the
psychotherapy relationship.
At the outset, definitional clarity is important, especially with a hackneyed
term like “soul.” In this article, I am using the word “soul” to refer specifically to
the aggregate of the individual’s personal history. In using the term in this way, it

Address correspondence to Jeff Hayes, Counseling Psychology Program, Pennsylvania State

University, 312 Cedar Building, University Park, Pennsylvania 16802; e-mail: [email protected].

93
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94 Hayes

is not my intent to trivialize or secularize the construct but rather to emphasize the
sacred nature of the individual. I recognize that the term “soul” has a collective,
as well as an individual, component (e.g., the notion that each person belongs to
a larger spiritual whole). Although this broader view of the construct is relevant
to the thoughts contained in this article, adequate consideration of these ideas is
beyond the page limitations of the present paper.

CLINICAL EPISTEMOLOGY AND THE PERSON

OF THE THERAPIST

Regardless of one’s theoretical approach to therapy, it is a general truth that

therapists’ overarching goal is to reduce human suffering. A pertinent question,
then, is what therapists know about suffering. Or perhaps a more relevant question
is “How do therapists know about human suffering?” Although a thorough treatise
on clinical epistemology is not the focus of this paper, a brief examination of
various sources of therapists’ professional knowledge may be useful nonetheless.
The origins of therapists’ knowledge may be conceptualized along a con-
tinuum ranging from the personal to the impersonal. At the impersonal end of
the continuum would be relatively public sources of knowledge, such as findings
from scientific study and philosophical reasoning that are disseminated by others,
or pronouncements made by authority figures. Knowledge obtained from these
impersonal bases can be beneficial in terms of general guidance for clinical work,
but rarely is it helpful when working with a particular client in any given moment.
Closer to the personal end of the continuum would be more private sources of
knowledge, such as one’s own clinical and life experience. The latter has been
recognized to exert considerable influence on therapy, dating back to Freud’s
(1910/1959) claim that “no psycho-analyst goes further than his own complexes
and internal resistances permit.” May (1939/1989) similarly emphasized the role
of the therapist’s well being in humanistic work: “The personal equation is all
important in counseling, as counselors can work only through themselves. It is
therefore essential that this self be an effective instrument” (p. 131). Even thera-
pists who are more cognitively and behaviorally oriented are acknowledging the
importance of the therapist’s self (e.g., Robins & Hayes, 1995; Singer, Sincoff, &
Kolligan, 1989).
Despite the importance that has been and continues to be attached to the person
of the therapist, we actually know very little about the effects of the therapist’s
life experiences on psychotherapy. For the most part, researchers have ignored
Strupp’s (1958) assertion that the therapist’s “background, attitudes, experiences,
and personality must be put under the microscope for careful scrutiny and analysis
if valid knowledge about how to treat mental illness is to be obtained” (p. 34).
Furthermore, whereas meta-analyses have demonstrated that the person of the
therapist accounts for more variability in outcome than do treatment specific factors
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Playing With Fire 95

(Ahn & Wampold, 2001), the bulk of therapist variables that have been studied
to date are rather superficial constructs that are fairly distal to the therapy process
(Beutler, Machado, & Neufeldt, 1994).
It is also true, however, that a line of research on countertransference (CT)
has begun to emerge since 1980. Building on the pioneering studies of Fiedler
(1951), Cutler (1958), and Yulis and Kiesler (1968), researchers have started
to investigate the origins, triggers, manifestations, and management of CT (e.g.,
Fauth & Hayes, 2002; Gelso, Fassinger, Gomez, & Latts, 1995; Hayes & Gelso,
1991, 1993; Hayes, McCracken, et al., 1998; Hayes, Riker, & Ingram, 1997; Latts
& Gelso, 1995; Peabody & Gelso, 1982; Robbins & Jolkovski, 1987; Rosenberger
& Hayes, in press; see Gelso & Hayes, 1998 and Hayes & Gelso, 2001 for reviews
of this corpus of research). By and large, in these studies CT has been defined
explicitly in a manner that integrates elements of Freud’s (1910/1959) classical
definition and subsequent totalistic definitions (e.g., Fromm-Reichmann, 1950).
That is, researchers have focused on the therapist’s unresolved conflicts as the
source of CT (consistent with Freud’s classical definition) while acknowledging
that CT may be a useful source of insight into the client, treatment dynamics, or
both (in concert with the totalistic definition). Despite nominal acknowledgement
of both the vices and virtues of CT, researchers have concentrated their efforts to
date almost solely on the deleterious consequences of CT and how to avoid or man-
age them (e.g., Van Wagoner, Gelso, Hayes, & Diemer, 1991) while disregarding
the potential therapeutic value of CT.

COUNTERTRANSFERENCE AND THE WOUNDED HEALER

I would like to propose that the key to using CT therapeutically, to return to

Paul Jordan Smith, is to travel the channels from the ear to the soul and the soul to the
tongue. What do I mean by this? To understand a client’s communication, we need
a reference point. In one sense, it is impossible for us not to see the world, including
the client’s world, from our own point of view. Even when we strive to understand
the client’s frame of reference, we require an internal place from which to connect.
Spence (1982) makes this point eloquently: “Sensitive, empathic listening can
probably take place only if the words spoken by one speaker are invested with
private meanings by the other. Unless some kind of internal elaboration takes
place, the listener hears only words—we can imagine our response to a long
monologue in a completely foreign tongue—and communication fails. To listen
with understanding and involvement requires the listener to be constantly forming
hypotheses about the next word, the next sentence, the reference for a recent
pronoun, or the color of the bride’s eyes, because it is only in the midst of this kind
of activity that words take on some kind of meaning” (p. 117).
Spence’s description of the internal elaboration and hypothesis generation
that take place within the therapist hint at how the therapist might make use of the
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channels that run to and from the soul. Doing so involves the therapist intentionally
calling to mind—or at least intentionally being open to—a personal experience
that somehow relates to the client’s experience and making therapeutic use of this.
Schroeder (1925, cited in Mahrer, Boulet, & Fairweather, 1994) referred to this
process as “empathic duplication.” To be sure, empathic duplication is a dangerous
enterprise, somewhat akin to use of touch in therapy. It is a potentially powerful
practice wrought with the risk of misuse and abuse that requires judiciousness
and keen clarity about whose needs are taking precedence. Concerns about Type I
error predominate in the current professional zeitgeist, and perhaps rightly so, but
Type II errors are errors nonetheless. Just as it is a clinical mistake not to touch a
client when doing so would be appropriately comforting, reassuring, or otherwise
healing, not using the channels that run to and from the soul unnecessarily limits
the instrumentality of the therapist’s self. As therapists, it is altogether possible
to keep ourselves safe, practicing comfortably behind the shields of authority and
expertise, limiting our involvement in the client’s work and thus, in all likelihood,
our effectiveness. As Jung (1963/1989) wrote, “When important matters are at
stake, it makes all the difference whether the doctor sees himself as a part of the
drama, or cloaks himself in his authority” (p. 133).
On the other hand, when the therapist makes use of the channel that runs from
the ear to the soul, it opens up the possibility of deep empathic understanding; the
therapist’s own personal experience becomes an epistemic well from which to
draw. What does it require of the therapist to draw effectively from her own life
experience? First, the therapist must be familiar with the internal pathway from
her mind to her soul. One cannot draw therapeutically on personal experiences
without an active and ongoing interest in one’s own history.
Whatever form such introspection assumes, it ought to increase self-
awareness, including awareness of one’s wounds. Acknowledgment of the thera-
pist’s own woundedness is critically important to using the self as an instrument
of healing. Therapists who disavow their wounds run the risk of projecting onto
the client the persona of “the one who is wounded” while introjecting the persona
of “the one who heals.” In truth, both poles of the wounded healer archetype exist
within the person of the therapist and the person of the client (Whan, 1987). “There
is no essential difference between the two people engaged in a healing relationship.
Indeed, both are wounded and both are healers. It is the woundedness of the healer
which enables him or her to understand the patient and which informs the wise
and healing action” (Remen, May, Young, & Remen, 1985, p. 85). When the
therapy relationship is dichotomized into one who is wounded and one who heals,
the therapist becomes locked into a position in which her own wounds cannot be
used in service of the client, and the client’s inner healing capacities are denied
(Guggenbuhl-Craig, 1970).
Problem awareness, of course, is a necessary but insufficient condition for
using countertransference beneficially. As Nouwen (1972) succinctly put it, “Open
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Playing With Fire 97

wounds stink and do not heal” (p. 88). The therapist must not only acknowledge
her inner conflicts but also work to resolve them. Keeping the channel as clear
of obstacles as possible allows the soul to be accessed more readily. I do not
think that complete problem resolution is either possible or essential; to help, the
therapist needs to be only a step, not a mile, ahead of the client in the healing
process. A continual willingness to work on one’s own issues simultaneously
decreases the possibility of countertransference-based reactivity with clients and
increases the pool of experiences that might be drawn upon in therapy. According
to Maeder (1989), the therapist’s decision to tend to personal wounds “leads to
a painful confrontation with his own problems and weaknesses, and ultimately
to self-knowledge. Ideally, he can overcome the difficulties; at worst, he may be
forced to resign himself to insuperable handicaps. In either case, though, the end
result is a clearer perception of his ambitions and needs and their relationship to
the task at hand. He can approach others with honesty, compassion, and humility,
knowing that he is motivated by genuine concern, not by some ulterior motive”
(p. 77).

FILLING A GAP IN AN ANCIENT LITERATURE

Though it may not be widely practiced among therapists currently, the idea of
using one’s wounds in the service of healing others is hardly new. The archetype
of the wounded healer can be traced back to the mythological character of Chiron.
Abandoned by his father, Saturn, and rejected by his mother, Philyra, who preferred
to be transformed into a tree rather than raise a creature who was half human and
half animal, Chiron was emotionally wounded from the outset. As he matured,
he became skilled in the healing arts and mentored Asclepius, the founder of
medicine, as well as Hercules, who subsequently injured Chiron accidentally with
an arrow. Chiron’s suffering was so extreme that he asked to trade places with a
mortal, Prometheus, so that Chiron might die and Prometheus be granted eternal
life (Reinhart, 1989; Snodgrass, 1994). The parallels are evident to the Christian
notion of salvation through the death of Jesus. The concept of the wounded healer
also is embodied in the ancient practice of shamanism. In a number of cultures,
shamans may be called to their roles because of some physical or emotional wound
they have suffered (Eliade, 1974). The wisdom underlying this tradition is that

in older healing practices such as shamanism, woundedness is seen not as evidence of

vulnerability but as the mark of knowledge . . . The wound validates the healer’s ability to
move “between the world’s”—the world of the well and the world of the ill, for it is in the
bridging of these world’s that the healing power lies. (Halifax, 1982, p. 84)

Despite the long-standing nature of these ideas, and their occasional discus-
sion in the psychotherapy literature (e.g., Buie, 1981; Schafer, 1959), to the best
of my knowledge, the specific mechanisms for translating them into actual clinical
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98 Hayes

work have not been described in detail. I will attempt to provide some of the
particulars, followed by two examples from my own work with clients.
The starting place is to adopt a posture of slightly bifurcated attention, concen-
trating primarily on the client, of course, while maintaining an openness to one’s
internal experience. Sensations of almost any kind might naturally arise—visual,
auditory, visceral—and these may serve as useful associations for understanding
the client’s material more deeply. The sensation may be vague at first. I take comfort
in Sedgwick’s (1994) notion that “Countertransferences often start off muddled
and wind up, one would hope, bringing clarity” (p. 106). Alternatively, I sometimes
find that distinct images of an exact location with which I am familiar or lyrics
from a personally meaningful song will trickle into consciousness. What is their
connection to the client’s communication, including the client’s covert messages?
If I am able to find an association, and it is not uncommon that I cannot, I treat
the insight tentatively, searching for evidence that supports or refutes it until the
association itself loses meaning. I also examine the possibility that the sensation
is more indicative of boredom or defensiveness on my part than a useful source of
insight into what the client is expressing. Honesty is important to the endeavor.
When information emanating from my own experience does not arise natu-
rally, I might seek it out, especially when I am having difficulty empathizing with a
client or when I want to understand the client more deeply. How do I connect with
my client’s account of having been raped? Is there an event from my own history
that I can draw from where I encountered or felt something similar to the client? If
so, I check my arousal level to try to determine if my issues are sufficiently resolved
that I will be able to recognize important distinctions between her experience and
my own, between her emotions and mine, between her needs now and mine then.
If using this channel to my soul is in the best interest of my client and not primar-
ily an act of self-indulgence, I may allow myself to reexperience affect connected
with the event, mindful of cues about the client’s possible feelings and vigilant
about both the source and intensity of my feelings. I look to extract relevant lessons
from my own experience that might deepen my understanding of the client and
provide guidance about our work together. Again, tentativeness is the norm here;
I cannot assume that what has worked for me will work for my client. But perhaps
my own experiences can be used to facilitate the client’s healing process.
I will conclude by sharing a couple of examples to help elucidate these ideas.
One of my former clients had been trying to conceive a child for quite some time.
When she announced the good news to me that she was finally pregnant, I shared
her joy (as a father of three, this was easy to do). About six weeks later, my client
disclosed that she had miscarried. An image came to mind almost immediately of
my wife and me drinking chicken soup in bed, accompanied by a slight tension in
my chest. Years earlier we had lost a daughter after a fairly advanced pregnancy,
and one night shortly after the miscarriage, a friend brought us chicken soup. We
ate in bed and wept. That image gave me a place from which to connect to the
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Playing With Fire 99

client’s grief. Having lost Kelsey and having worked through the associated pain
and anger and disappointment, I understood the client’s range of emotions more
deeply than I would have otherwise. Without minimizing the client’s experience,
I also was able to offer her genuine hope borne out of my own experience that
helped her through her grieving.
Another client once was talking about getting pushed around by others, and
in my mind’s eye I saw Barnegat Bay from a distinct vantage point, and my body
relaxed noticeably. I searched for the association. This specific location on the
shoreline is a place where I feel at one with myself, congruent, whole. When I
am not myself, I feel anxious. I wondered if this might be how the client was
feeling, although he had not been saying so. I became more attuned to signs of
potential anxiety in the client, looking for evidence to confirm or disconfirm my
hypothesis. He did not sound anxious, but he looked tense. I floated out my obser-
vation, which he took to, and in no more than a handful of seconds, our work had
deepened. I became more empathic toward his experience of being pushed around,
and I was able to offer the prospect of greater wholeness as a goal for our work
together.

ACKNOWLEDGMENTS

I am grateful to the following individuals for their encouragement and support

while I developed the ideas contained in this article: Susan Bowers, Charlie Gelso,
Mary Margaret Hart, Janet McCracken, and Glenn Mitchell.

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