Explaining counter-transference in the counseling profession.

1. When inappropriate
romantic feelings for a
client threaten a
counselor’s sobriety
Ethical dilemmas involving countertransference

2. Countertransference
▪ Occurs when therapists impose their fantasies, feelings,
associations, fears, or etc. into their clients.
▪ Projections that distort the way a therapist perceives and
reacts to a patient.
▪ This is dangerous and potentially unethical because a
therapist cannot objectively assess their behaviors and
quality of care if they cannot put aside their own feelings.
▪ Can be positively treated by counselors monitoring their
feelings, and using their responses to understand clients
and themselves.
▪ Therapists must gain a self understanding, participate in
personal counseling and clinical supervision.

3. Countertransference
Therapists
fooled into
thinking they
have the
answers
Cheats clients
out of their
autonomy.
Shifts focus of
therapy to
counselor from
client.
Giving advice
Exploitation of
vulnerable
position of the
client
(Romantic)
Not veracious,
not benevolent,
unjust and
imbalanced.
(Romantic)
Can destroy the
counseling
environment
and end in a
lawsuit
Romantic
Feelings &
Social
Relationships
Too much
sympathy to
help
Identify
similarities
between client
and therapist to
expose
vulnerabilities
to
overidentifying.
Could threaten
the ability to be
objective.
Seeing yourself
in your clients
Excessive need
to please client
A loss of focus
on the client
and their need
to have progress
happen
organically.
Needing
constant
reinforcement
Perceiving the
client as needy
and dependent
and backing
away as a result.
Back away can
be maleficent
and unjust.
Rejecting a
client
Compromises
the counseling
setting by
making it too
bland.
Benign
Treatment
Caused by
counselor’s
unresolved
conflicts
Can
compromise
autonomy by
viewing clients
as infantile and
incapable of
self-
determination.
Overprotection

4. Isaac and Annalise
▪ Isaac has been a drug and alcohol counselor for 18 years. After
giving up his opioid and heroine addiction. He attended counseling,
NA, AA, and became a certified counselor.
▪ This year, the courts referred Annalise, a successful lawyer
struggling with an alcohol addiction. Annalise was a functional
alcoholic until her son died under suspicious circumstances. It took
Annalise about six months to reveal the sources of her pain and how
alcohol addiction began. During those six months, Isaac had began
having romantic feelings for Annalise.Though he consulted his own
therapist, he still believed he was the best counselor for Annalise.
▪ Isaac’s therapist, his ex-wife who was a psychotherapist could
clearly see that Isaac was experiencing distress, sleeplessness and
agitation. She knew this was because he and she had lost their own
teenage daughter about four years prior.When his daughter died,
he was having a relapse while still working as a counselor. His teen
daughter Sara found his drugs, overdosed on them, and died.

5. Isaac and Annalise
▪ Though the investigation into Sara’s death did not result in Isaac’s
prosecution, he blamed himself.
▪ Annalise’s story caused Isaac to relive the immense guilt. He tried to
kill Annalise, in a desperate attempt to take his mind off his guilt
but she ran from his office determined never to return.
▪ He tried to cope with this guilt by consulting his sponsor, but it was
too late.
▪ He ended up relapsing and using opioids again.
▪ This is an ethical issue because Isaac began experiencing romantic
feelings for Annalise the crossed boundaries early on in the
sessions. He should have sought help from his sponsor, supervisors,
or colleagues and referred Anna to a different counselor. It was
okay that he felt close to Anna, but Isaac lost his objectivity in
helping her. He was no longer able to separate his feelings from the
counseling.

6. The Six Principles
▪ Autonomy- Isaac is imposing on Anna’s autonomy because he is limiting
the help she can receive in her court ordered counseling. He is putting his
needs before hers. She has the right to determine if she wants a therapist
who has emotionally crossed boundaries with her.
▪ Nonmaleficence (doing no harm) applies to having romantic feelings. Since
Isaac’s objectivity is compromised, he is not sure that he is not causing
harm to Anna. He is viewing her outside of scope of a client and is
disregarding the vulnerability that bought her to counseling.
▪ Beneficence (helping others)- He’s not helping her by pressuring her into a
bad and imbalanced dynamic. He is no longer in the place where he can
help her and is in fact in need of rehabilitation so he can save himself.
Though he would have missed her, he should have ended the counseling
relationship before his feelings got out of control.

7. The Six Principles
▪ Justice (fair and equal treatment)- He is not treating her fairly
because he has more power than she in their relationship. He is
imposing his feelings on her and that is not fair. Not only is he
physically assaulting or harassing her, he is backing her into a corner.
▪ Fidelity- Isaac is not being true to his word because he took an oath
to do no harm but his inappropriate feelings and actions have caused
harm to his client.
▪ Veracity - Isaac should have told the truth, that he had feelings for
Anna and he should have let her have the autonomy to determine if
she wanted a different therapist.

8. Maryland Codes
▪ COMAR 10.58.03.00 is the Code of Ethics for Counselors in Maryland
▪ 10.58.03.09- Sexual misconduct is inappropriate sexual language, sexual
exploitation, harassment, behaviors and therapeutic deception.
– Consensual sexual relationships are not allowed between a client and counselor.
Isaac crossed a line when he tried to kiss Annalise. He was in violation of this code.
▪ 10.58.03.04-There is an ethical responsibility to protect clients from
physical or psychological trauma (14)
– Isaac’s actions subjected Annalise to harm. She was vulnerable and confessed her
pain to get help and make personal progress, not to elicit feelings and projections
from Isaac.This code is meant to protect the client, the counselor, and the
institution.
▪ 10.58.03.04 (B3)-To refrain from entering in a relationship that could
compromise the objectivity of the counselor or create a conflict of interest.
– His feelings and his actions created a conflict of interest and compromised his
objectivity.
– Isaac’s ex-wife being his counselor was also a conflict of interest because they were
too close. She could have struggled to stay objective and he could have struggled to
trust her.

9. ▪ Under no circumstances was it okay for Isaac to kiss Anna. He made his first
mistake when he kept seeing her even though he had inappropriate feelings
towards her.
▪ Isaac acted out and sexually harassedAnna because his own mental health is
unwell. He should have left and sought help before it reached that point.
▪ There is no shame in admitting you cannot help a patient. It is better for everyone
for you to be veracious.The counselor should report their feelings to their
counselor and try to work through the romantic feelings.
▪ If they cannot work through the feelings, they must seek the council of a supervisor
to get assistance with referring the client to another counselor.The supervisor
should advice how to proceed in a way I which they will do the least harm to add
involved, legally and psychologically.
▪ Isaac should have had a different counselor in addition to his ex-wife because that
is a conflict of interest.Though they knew each other well, it was arguable that she
could be objective and that he would trust her; after all their marriage failed and
there could still be negative feelings there.
Recommendations

10. Reflections
▪ If I began having romantic feelings for a client, I would refer them to a different
therapist, reassuring them that it is not their fault but that another counselor
can create a better and more professional environment more conducive to their
healing.
▪ I would have entered rehab the first time I relapsed instead of hiding it.
▪ The most challenging aspect would be embarrassment and fear of being
viewed as unprofessional by supervisors and colleagues. However, I would end
the problem before it ende3d in any unethical behavior, regardless of the way I
was viewed.
▪ My values would force me to uphold the law, the code of ethics, and to respect
the vulnerability of my clients.