Transference and Countertransference With Disability
A note about terminology: transference describes feelings from earlier relationships becoming active in a current one. Countertransference describes the therapist’s own emotional reactions to the client. Both are genuinely useful concepts. Both become dangerous, specifically around disability, the moment either one is used to explain away something real.
TRANSFERENCE, PLAINLY: something happening between therapist and client that may connect with other relationships, past or present, worth exploring together.
WHAT IT IS NOT: “your reaction isn’t really about me.” That phrasing closes a conversation transference is supposed to open.
COUNTERTRANSFERENCE, PLAINLY: the therapist’s own feelings, treated as useful data about what’s being evoked in the room — and, just as often, data about the therapist.
THE DISABILITY QUESTION: is this old, is this happening now, or is it both — and who decides?
If you only have two minutes: a disabled client’s strong reaction to a therapist, caution, anger, withdrawal, suspicion, is not automatically transference. It might be. It might also be an accurate read of something real happening in the room, or a reasonable response grounded in a long, documented history of professional harm. The clinical skill isn’t picking one explanation quickly. It’s holding both possibilities seriously, together, and letting the client’s own account carry real weight in deciding.
The distinction that should dominate this page
Transference
Something from an earlier relationship enters the current one, shaping the reaction more than anything actually happening now.
Accurate perception
Something genuinely problematic is happening now, and the reaction is a sound read of it.
Both
A current event activates an old relational pattern — the reaction is real and current, and carries more weight than the moment alone explains.
Most clinical writing collapses straight to the first option. Disability-informed work has to hold all three open at once, and let the evidence, not the theory’s convenience, decide which fits.
When transference becomes another way of not being believed
A disabled person has often, over years, heard from professionals: “that’s not really what’s happening,” “you’re overreacting,” “the problem is psychological.” A therapist who reads a client’s caution primarily as transference, without seriously checking the present-day evidence first, repeats exactly that pattern — now dressed in psychodynamic language instead of medical language, but functionally identical.
A client becomes visibly guarded the moment her new therapist reaches for a notepad. A quick interpretive move might reach for early experiences of being observed, assessed, written about by professionals. That may well be relevant. But the therapist asks first, plainly: “what’s happening for you right now?” She answers precisely — her last three therapists took detailed notes and then, in a case review meeting, she later learned, discussed her in terms she’d never have chosen for herself.
That’s not primarily an old pattern surfacing. It’s an accurate, current-day expectation, built from repeated recent experience. The therapist puts the notepad away and asks what would actually feel safe. Only later, once trust exists, does the older material about being observed as a child become relevant too — and it does, but it was never the whole of it.
Checking the present first isn’t avoiding the past. It’s making sure the past doesn’t get used to dismiss the present.
Where the distinction actually gets tested
Around authority
Around care
Around infantilisation
| Then | Now | Possibly both |
|---|---|---|
| A parent repeatedly took over | A personal assistant makes a decision without asking | Old loss of control activated by a real, present boundary violation |
| Professionals repeatedly dismissed concerns | A new therapist disagrees | Earlier mistrust and a genuine current disagreement coexist |
| Being unable to refuse physical handling | A therapist moves the wheelchair without asking | Past bodily powerlessness meets a current boundary violation |
Sometimes it really is transference. Sometimes the person is accurately reading the present. Very often, it is both, and the work is finding out which parts belong where, together with the client, rather than deciding alone.
Interpretation should open a possibility, not close a conversation.
I have a thought about what might be happening. See whether it fits: I’m wondering whether receiving help sometimes feels like someone taking control. Does that resonate, or am I missing something?
The client retains the right to say no, that doesn’t fit, you’re misunderstanding me. That response is information, not resistance to be overcome.
Countertransference, named honestly
A feeling alone is only half the clinical picture. What matters just as much is what it quietly makes a therapist do.
Rescue
Feeling“I need to fix this.”
BehaviourOver-advising, breaking boundaries, doing too much for the client.
Pity
Feeling“This life is terrible.”
BehaviourLowering expectations, avoiding challenge the client could actually handle.
Admiration
Feeling“They’re extraordinary.”
BehaviourRewarding coping, failing to make room for exhaustion or ordinary struggle.
Protectiveness
Feeling“I’m frightened of upsetting them.”
BehaviourSoftening honest feedback, avoiding necessary friction.
Avoidance
Feeling“I don’t know how to ask about their body.”
BehaviourSteering around embodied material the client may actually need to discuss.
Helplessness
Feeling“There’s nothing I can do.”
BehaviourDisengaging from genuinely workable material, prematurely.
Distance
Feeling“I find myself becoming strangely clinical.”
BehaviourRetreating into procedure to manage the therapist’s own discomfort.
Fear
Feeling“I’m scared of saying the wrong thing.”
BehaviourExcessive caution that itself starts to feel like distance to the client.
None of these reactions automatically makes someone a bad therapist. Unnoticed reactions are what shape therapy badly. The task is noticing them, examining them, and, when appropriate, taking them to supervision rather than placing them onto the client.
- Notice the reaction, whichever direction it runs
A client’s strong feeling toward the therapist, or the therapist’s own strong feeling toward the client. - Check the present first
Is there a real, current, checkable fact that would justify this reaction on its own? - Ask, don’t assume
Offer any interpretation as a question the client can reject, not a verdict. - Hold both possibilities
Old pattern and current reality are not mutually exclusive — let both be explored. - Take the therapist’s own reaction to supervision
Rather than resolving it by acting on it, or explaining it to the client, unexamined.
Where this can help
Making both old relational patterns and present-day realities visible and workable, without either one being used to dismiss the other.
Where interpretation should stop
When a client’s documented, pattern-based mistrust of professionals is treated primarily as transference; when a therapist’s own countertransference is acted upon, or voiced to the client, without first being examined in supervision.
Transference and countertransference are foundational psychodynamic concepts with a substantial clinical and theoretical literature. Their specific application here, the three-worked-examples structure, and the feeling-to-behaviour countertransference mapping, is a Disability in Psychotherapy clinical emphasis rather than a change to the underlying theory.
Is this old, is this happening now, or is it both — and have I actually checked, or just assumed?