A qualitative exploration of therapists’ countertransference reactions to clients’ aggression

This qualitative study investigated the therapist’s internal processes in the therapeutic clinical exchange in relation to client aggression. It also considered how client aggression can move from destructiveness towards constructiveness in the clinical exchange. The research responded to the need for a more sophisticated understanding of this topic, and a dearth of research in the area.
Eighteen experienced therapists were interviewed in order to gain a deeper understanding of the phenomena under investigation. A three-stage grounded theoretical model was constructed from the data, in which the stages are cyclical rather than linear and concurrent in nature. The model is constructed from the therapist’s account of their countertransferences and internal processes. It provides a relational framework that depicts the complexity of conceptualizing and working with aggression during therapy, with an emphasis on moments of transformation from using aggression in a destructive manner to a constructive one. The model illustrates three stages of the therapist’s countertransference. Level one deals with the therapist’s countertransference emerging from the therapist’s frustrated unconscious. Level two looks at the therapist’s attacking unconscious, and level three investigates the therapist’s benign unconscious. In each stage aggression is experienced differently in the countertransference and has different theoretical and clinical implications. In light of the findings, implications for both clinical work with clients as well as advancements in theoretical conceptualisations are discussed.