Journal of Counseling Psychology

2010, Vol. 57, No. 1, 52 67

2010 American Psychological Association

0022-0167/10/$12.00 DOI: 10.1037/a0018111

Countertransference as a Prototype: The Development of a Measure

Christy D. Hofsess and Terence J. G. Tracey
Arizona State University
Countertransference is a concept that is widely acknowledged, but there exists little definitional consensus,
making research in the area difficult. The authors adopted a prototype theory (E. H. Rosch, 1973a, 1973b; see
C. B. Mervis & E. Rosch, 1981, for a review) to examine this construct because it conceptually fits well with
constructs that elude explicit definition. In Study 1, 45 experienced psychologists highly agreed with the
prototypicality of 104 different examples of countertransference providing support for the presence of a
prototype. In Study 2, the usage of this prototype in a sample of 35 trainees was related to ability to perceive
countertransference in a case example drawn from the literature and positively correlated with self-reports of
their experiences of countertransference but not with their self-reported ability to manage countertransference
once it was manifest. Implications for training and research are discussed.
Keywords: prototype methodology, countertransference, cognitive assessment, counselor development

view referred to as the classical definition of countertransference

(Kernberg, 1965; Reich, 1951, 1960). Other positions emerged that
challenged this original framework and contributed to the constructs complexity; these perspectives include the totalist view
(Heimann, 1950; Little, 1951), the complementary view (Epstein
& Feiner, 1988; Racker, 1957, 1968), and the relational conception
of countertransference (e.g., L. Aron, 1996; Greenberg & Mitchell,
1983; Mitchell, 1988, 1997). Although countertransference as a
construct has its origins in psychoanalysis, it has been debated and
discussed in the literature from a range of theoretical persuasions,
including feminist (Brown, 2001), cognitive-behavioral (Ellis,
2001), family systems (Kaslow, 2001), and other orientations
(Hoyt, 2001; Mahrer, 2001). Presently, there is both agreement on
and points of contention about what countertransference is and its
role in psychotherapy (Gelso & Hayes, 2007). In general, countertransference refers to the therapists feelings, cognitions, and
behaviors that occur in response to dynamics occurring in the
counseling relationship that stem from either the therapists unresolved issues or from the maladaptive behaviors elicited by the
client (Gelso & Hayes, 2007). There is broad agreement that
therapists have reactions to clients; the lack of consensus over the
construct, as Gelso and Hayes (2007) stated, revolves around the
extent to which countertransference is rooted in unresolved conflicts and issues within the therapist or includes therapist emotional
responses that are natural reactions to what the patient is pulling
for (p. 30).
Despite the existence of differing views on the construct, countertransference is considered to be transtheoretical and is thought
to invariably occur across all therapists, regardless of their theoretical persuasion or whether they label it as such (Falender &
Shrafranske, 2004; Hayes, 2004; Manning, 2005). Recent work to
reconceptualize key aspects of countertransference according to
theory (Hayes, 1995) and research (Hayes & Gelso, 2001; Hayes
et al., 1998) provides an integrative framework for the phenomenon. Gelso and Hayes (2007) proposed five integral aspects for
understanding countertransference, including its origins, triggers,
manifestations, effects, and management. The pertinent element of
their integrative theory to this study concerns the manifestations of

The concept of countertransference is generally considered to be

important in counseling because therapists who lack knowledge of
the concept may unwittingly sabotage an otherwise successful
treatment. For example, a therapist who feels sexually attracted
toward a client and behaves seductively needs to be aware of the
possible consequences and complications for the patient and guard
against their counterproductive influence during treatment. However, hypotheses of this type are difficult to test because the
construct of countertransference has been difficult to assess (Fauth,
2006; Gelso & Hayes, 1998; Luborsky & Spence, 1971). The
definitions vary (L. Aron, 1996; Epstein & Feiner, 1988; Fauth,
2006; Freud 1910/1957; Gelso & Hayes, 1998, 2007; Greenberg &
Mitchell, 1983; Heimann, 1950; Kernberg, 1965; Little, 1951;
Mitchell, 1988, 1997; Racker, 1957, 1968; Reich, 1951, 1960),
despite the fact that it is considered a transtheoretical construct
(Hayes, 2004). Although some researchers have done an excellent
job of attempting an initial explication of the features of countertransference (e.g., Gelso & Hayes, 2007), it is still an elusive
construct to many counseling trainees. In the present article, we
provided (a) a way of operationalizing the meaning of countertransference and (b) a way of applying the operationalized meaning to research. We applied a new method for assessing experienced and novice clinicians understanding and use of the
construct of countertransference using a prototype approach.

Countertransference
Countertransference has been conceptualized by many different
perspectives since Freud (1910/1957) first defined it as an unconscious phenomenon based in the therapists unresolved issues; a

Christy D. Hofsess and Terence J. G. Tracey, Department of Counseling

Psychology, Arizona State University.
Correspondence concerning this article should be addressed to Christy
D. Hofsess, who is now at the Counseling & Health Psychology Department, Bastyr University, 14500 Juanita Drive Northeast, Kenmore, WA
98028. E-mail: chofsess@bastyr.edu
52

COUNTERTRANSFERENCE AS A PROTOTYPE

countertransference. Countertransference is considered to manifest

in therapists affectively, cognitively, and/or behaviorally (Gelso &
Hayes, 2007). Although countertransference researchers have
made significant gains in understanding this construct, there are no
measures to assess it. We posit that a prototype perspective can
help illuminate the construct of countertransference as it is used by
counselors and further to enable its assessment. A prototype approach to instrument development enables researchers to explore
individual differences in clinicians knowledge of countertransference. Our intention was to directly assess novice and expert
therapists prototypes for countertransference, an area of focus that
has never been examined in the counseling and psychotherapy
literature to date.

Prototype Theory and Methodology

A prototype is a cognitive concept that provides a way of
organizing data, in the minds of individuals or groups of people,
into the clearest case or best example of a concept (Rosch, 1973a,
1973b). One benefit of examining constructs as prototypes is that
prototypes reflect how people think and talk about a construct.
Rosch (1978), who pioneered the methodology and applied it to
understand the everyday use of natural language concepts indicated that prototypes are reflective of judgments about membership in a particular category; the clearest cases or best examples of
a construct provide a means of conceptualizing it without defining
it per se. For example, her research demonstrated that subjects
rated apples as better examples of the concept of fruit than figs
(Rosch, 1973b). The content of the prototype of fruit are examples
(also referred to as exemplars, members, instances, or cases) of
fruitapples, figs, pears, orange. These examples do not define
fruit, but the ones that were rated as better examples of fruit than
the others could be considered to represent the best exemplars of
the construct. So prototype refers to the best examples of a concept, and all examples can be examined for how well they match
the prototype. Exemplars (e.g., apples and figs) are distinguished
from features (e.g., is edible, is round, is sweet, and contains
seeds), which are characteristics of exemplars. Features are often
used to define objects logically such as in statements that fruits are
objects that are edible, round, sweet, and contain seeds. However,
many concepts are difficult to define using features. Rosch (1975)
demonstrated that people often use closeness to prototypes to
define concepts over feature similarity.
An example from the countertransference literature might help
elucidate this issue. Some behaviors, such as daydreaming about
relationships or events related to a client, or acting flirtatiously
with a client, might be endorsed by a group of psychologists as
better examples of countertransference than other behaviors such
as being on time for sessions. These examples do not define
countertransference per se, but they could be considered to be
closer to the best example of the construct than other examples.
Accordingly, the behaviors that are most strongly endorsed by
therapists as representing countertransference could be construed
of as comprising the prototype of countertransference.
However this separation of exemplars and features is not always
clear. Although the above example illustrates that some exemplars
(e.g., apples) of a concept (e.g., fruit) can be more prototypical
than others (e.g., figs), some features (e.g., is edible, is sweet,
contains seeds) of a concept can similarly be considered more

53

prototypical than others. For example, Fehr (1988) demonstrated

that people considered companionate features of love (e.g., trust,
caring, honesty, respect) more prototypical of the concept of love
than passionate features (e.g., sexual attraction, think about the
person all the time, heart rate increases) (Fehr, 2004). Because
precise membership in a concept is not necessary (Fehr, 1988),
features differ in their centralitythat is, in how important possession of this feature would be in defining an object as prototypical of the category. As such, both features and exemplars are
considered to exist on a continuum. A particular concepts boundary is often blurry; outside the prototype exists other indicators of
the concept that can be classified by the extent to which there is
correspondence or resemblance to the prototype. Prototypical instances meld into nonprototypes, and nonprototypes become nonindicators of a category (Fehr, 2004).
In fact, much of the recent research on prototypes is focused on
identifying and rating features (also referred to as characteristics,
indicators, and elements) of a concept in terms of their prototypicality, though the form of the content of a prototype depends on the
context. Horowitz and Turan (2008) summarized the extant literature on prototypes by articulating the range of forms the content
of a prototype can take from exemplars of a category (Rosch,
1975, 1978), like cocker spaniels, golden retrievers, or german shepards as examples of the category of dog, to a variety of
ways features can manifest. For example, features can be behavioral acts such as gives unwanted advice used to demonstrate
evidence for the prototype of a specific trait, such as domineering (Buss & Craik, 1983), or actual characteristics of natural
objects (Rosch, 1975), as seen in the earlier example of fruit (e.g.,
is sweet, is edible). In other cases, features can be characteristic of
the subjective experience of the concept. For example, the prototypical features of the concept lonely person were found to be
feels separate from others, and feels different, unloved and not
cared for (Horowitz, French, & Anderson, 1982). So prototype
theory has been successfully applied to both exemplars and features.
Although prototype theory applies to all knowledge structures, it
is especially promising in its applications to less easily defined but
still commonly understood concepts. An example would be people
who know something when they see it but are not able to define it
beforehand. For example, when a counseling trainee is rejecting a
client in session, (i.e., a strong indicator of countertransference;
Gelso, 2004), a supervisor might begin to think about countertransference, and the activation of this concept may bring to his or
her mind other instances that are also associated with countertransference, such as when the trainee avoided eye contact or acted
defensively in supervision. Organizing a set of examples (e.g.,
rejects a client; avoids eye contact) of a construct into a higher
order concept (i.e., countertransference) enables people, or therapists in this case, to process information efficiently. This is a major
advantage of knowledge structures (i.e., prototypes) and also demonstrates the relation between prototypes and general pattern recognition skills (Driscoll, 2000).
There are two criteria enumerated by Rosch (1973a, 1973b,
1975) that are used to determine whether a concept is prototypically organized. First, Rosch (1973a, 1973b, 1975) posited that
people must be able to make decisions about the structure and the
extent to which examples/instances are good examples of the
category. Fehrs (1988, 1993, 2004a, 2004b; Fehr & Baldwin,

54

HOFSESS AND TRACEY

1996) research confirmed this central tenet; she found that people
organize fruit into prototypes such that some fruit are regarded as
better examples than other types of fruit (e.g., apples are better
examples of fruit than olives). Fehr also articulated procedures to
test this first criterion. The typical procedure involves having a
representative sample, a group referred to as the nominators,
generate features, examples, or attributes associated with the construct (Horowitz & Turan, 2008). Again, depending on the construct, the form the content of the prototype takes may vary, so
subjects may generate features or examples of a construct. These
nominated features are then given to a sample to rate for the extent
to which each is a good indicator of that category, essentially
eliciting ratings on each features centrality or prototypicality. The
mean is obtained on each feature; these mean ratings are then
ordered from the highest rated feature to the lowest. Thus, the
prototype is derived from the ordered set of indicators for a
concept and is considered to be the standard for describing the
normative associative meaning of the concept. The prototype can
then be considered the collective wisdom of a groups thinking
about a construct and serve as a standard for evaluating an individuals knowledge about the construct.
The second criterion asserted by Rosch (1973a, 1973b, 1975) is
that the internal structure is related to cognition and information
processing with respect to the category (Fehr, 1988). To test this
criterion, participants are given information tasks that are designed
to facilitate discrimination between highly prototypical features
and features lower in prototypicality ratings. Some common
information-processing tasks used in this type of research are those
that assess participants reaction time (e.g., Fehr, 2004a; Fehr &
Russell, 1984; Fehr, Russell, & Ward, 1982; Hassebrauck, 1997;
Rosch, 1973a, 1973b) and recognition memory (e.g., Cantor &
Mischel, 1977; 1979; Fehr, This second criterion thus relates to the
validity of the prototype.
Prototype theory has been applied to a wide range of difficult to
define concepts, such as emotion (e.g., Fehr & Russell, 1984;
Fitness & Fletcher, 1993; Shaver, Murdaya, & Fraley, 2001;
Shaver, Schwartz, Kirson, & OConnor, 1987), love (e.g., A. Aron
& Westbay, 1996; Fehr, 1988, 1994; Fehr & Broughton, 2001;
Fehr & Russell, 1991; Lamm & Wiseman, 1997; Regan, Kocan, &
Whitlock, 1998; see also Fehr, 1993, for a review), anger (Russell
& Fehr, 1994), jealousy (Sharpsteen, 1993), commitment (Fehr,
1988, 1999), and most recently, respect (Frei & Shaver, 2002) and
relationship quality (Hassebrauck, 1997; Hassebrauck & Fehr,
2002). However, prototype methodology has not been applied to
examine the knowledge structure of concepts germane to psychotherapy and counseling. Given the relative lack of explicit definition and yet the almost universal endorsement of the concept, the
application of prototype methodology to the construct of countertransference seems especially well suited. It should be noted that
this methodology will not resolve the long-standing debate about
the various definitions of countertransference, nor bridge the varying theoretical perspectives on the concept. The methodology
applied in this study is thus designed to highlight some consensus
among experts and experienced psychologists in the field about
how the term countertransference is used and its manifestations.
Given the focus on manifestations of countertransference (i.e.,
actual examples of countertransference), the content of the prototype included examples of countertransference instead of features
of countertransference.

Present Focus
The present project was thus focused on applying prototype
theory to the assessment of countertransference. This involved the
examination of Roschs (1973a, 1973b) two aspects of a valid
prototype representation: (a) the feasibility of developing a prototype measure of countertransference (Study 1) and (b) whether the
internal structure of the prototype relates in a theoretically predicted way to information processing (i.e., validity assessment)(Study 2). The purpose of Study 1 was to develop a prototypebased instrument of countertransference that assesses therapists
knowledge of the prototype of countertransference and use of
prototype cues. We used a sample of experienced psychologists as
the raters of examples generated from the literature because countertransference is more an evolved, experience-based concept that
arises from professional practice and experience. The items that
this group rated form the prototype and were used to construct the
Countertransference Measure (CM), an instrument that measures
whether therapists think about the construct of countertransference
prototypically.
Although the prototype is considered to reflect the collective
wisdom or collective thinking of a group, a personal template is an
individuals private representation of a construct. A personal template is operationalized by a single persons own ratings of prototypicality (Horowitz & Turan, 2008; Turan & Horowitz, 2007).
Horowitz and Turan (2008) proposed a concept called T:P match
(persons template-prototype match), which refers to the degree of
correspondence between a persons own ratings of the features or
examples and those in the (group-generated) prototype. An individuals template may or may not match the prototype (Horowitz
& Turan, 2008; Turan & Horowitz, 2007).
Countertransference theory and research has shown that there
are a range of definitions of the construct and thus different ways
that researchers and clinicians alike think about it (L. Aron, 1996;
Epstein & Feiner, 1988; Fauth, 2006; Freud, 1910/1957; Gelso &
Hayes, 1998, 2007; Greenberg & Mitchell, 1983; Heimann, 1950;
Kernberg, 1965; Little, 1951; Mitchell, 1988, 1997; Racker, 1957,
1968; Reich, 1951, 1960). A central assumption guiding this study
is that novice or inexperienced therapists, by nature of their trainee
status, have less experience working with transference and countertransference issues (Davis, 2002; Stoltenberg, McNeill, & Crethar, 1994). Cognitive science research suggests that novices
knowledge structures are less differentiated and therefore different
than experts (Glaser & Chi, 1988). Due to their lack of experience,
novice therapists personal templates of countertransference may
be less comprehensive than experienced therapists, and their pattern recognition ability may be less developed than experts. Hence,
they may be less able to recognize and use countertransference
prototypes to recognize the presence of countertransference in
themselves or in other clinicians.
Study 2 focused on using the CM to examine the extent to which
counseling trainees usage of the prototype is related to various
countertransference indicators. The measure used an index of the
degree to which trainees templates matched the prototype created
by the experienced sample. It was expected that there would be
individual differences in novice therapists pattern recognition
skills, operationalized by their ability to discern prototypic examples of countertransference from nonprototypic examples. To establish validity on the CM, it was related to a number of salient

COUNTERTRANSFERENCE AS A PROTOTYPE

counselor development constructs, specifically, self-ratings of

countertransference management, experience with countertransference, and assessment of counseling effectiveness, as measured by
participant ratings of a counselor after reading a counseling transcript of a case of countertransference. The extent to which novices templates matched the countertransference prototype should
differentially relate to these countertransference self-ratings.

Study 1
Method
Participants. Forty-five psychologists with at least 10 years
experience as a clinical supervisor and 10 years in practice as a
licensed psychologist were the sample who rated the prototypicality of the 104 items on the CM. The sample included 25 (55.5%)
men and 20 (44.5%) women with a mean age of 51, ranging from
38 to 68 years old. Thirty-nine (88.6%) respondents identified as
White/Caucasian, three (6.6%) as Latina/o/Hispanic, one (2.2%) as
Asian American, and one (2.2%) as biracial. The mean years of
experience as a clinical supervisor was 19.29, ranging from 10 to
40 years. The mean years experience as a practicing, licensed
psychologist was 18.49, with a range from 10 to 40 years. In terms
of their education/degree, 26 (57.7%) endorsed earning a doctorate
degree in counseling psychology, 10 (22.2%) earned a doctorate
degree in clinical psychology, three (6.6%) listed earning a doctorate degree, but with no specific field, two (4.4%) earned an
doctor of education, one (2.2%) earned a doctor of psychology in
clinical psychology, and one (2.2%) earned a doctorate degree in
counseling/clinical/school psychology. Two (4.4%) endorsed
other as a degree. In terms of theoretical orientation, 11 respondents (24.4%) endorsed interpersonal as their primary theoretical
orientation, eight (17.7%) endorsed psychodynamic, five (11.1%)
endorsed cognitive-behavioral, five (11.1%) endorsed integrative,
five (11.1%) endorsed eclectic, three (6.6%) endorsed family systems, one (2.2%) endorsed humanistic, one (2.2%) endorsed gestalt, and six (13.3%) endorsed other.
Measures. The measures used are outlined below.
The CM. Roschs (1973a, 1973b, 1975) methodology was
used as a basis for generating items for and creating the CM. A list
of examples (i.e., cognitive, affective, behavioral) that therapists
regard as cues or manifestations of countertransference was generated by sampling the extant literature on countertransference and
consulting a small group of experienced clinicians in supervisory
roles. This process resulted in the generation of a broad range of
examples of the manifestations of countertransference. These examples were then converted to items for use in the development of
this measure.
Literature consultation. Writings of experts in the field were
consulted in lieu of finding a sample of expert nominators for
several reasons. It was believed that the literature would accurately
reflect the most current thinking about the construct and would
yield a more comprehensive list of exemplars, rather than relying
on a sampling technique in which there was no guarantee that
writers and experts from all perspectives would readily respond.
First, all relevant articles and books on and available measures of
countertransference were reviewed, which included 361 published
works cited in PsycINFO from peer-reviewed journals dating back
to 1951. Many of the examples generated derive from the work of

55

Gelso and Hayes (2007), who have written extensively in this area
and whose theoretical framework categorizes countertransference
into domains, such as underinvolved behavior and overinvolved
behavior. Manifestations of countertransference from a range of
other theoretical perspectives were generated by reviewing articles
on countertransference written by authors from feminist (Brown,
2001), cognitive-behavioral (Ellis, 2001), family systems (Kaslow,
2001), and other (Hoyt, 2001; Mahrer, 2001) orientations. Anecdotal descriptions of countertransference were excluded from inclusion in the study because they were difficult to deconstruct into
particular linguistic units, and they reflected specific descriptions
of rather than general instances indicative of countertransference.
This process resulted in 66 of the final set of 104 items.
Clinical supervisors consultation. Given that the measure
was administered to counseling trainees and may be used for
counselor training purposes, we wanted to supplement the items
generated from consulting the literature to ensure that we captured
manifestations of countertransference used in clinical supervisory
practice that might not have received attention in the literature.
Nine clinical supervisors from a counseling psychology program at
a large southwestern university were recruited for participation,
and three male clinical supervisors espousing different theoretical
orientations (e.g., cognitive-behavioral, eclectic, and interpersonal)
agreed to participate. Each completed a demographic form (e.g.,
theoretical orientation, years of supervision experience) and an
open-ended questionnaire in which they were asked to write examples that are indicative of countertransference rather than focusing on descriptions of specific experiences of countertransference. The three participants generated a list of 24 indicators. The
mean years of experience as a clinical supervisor was 26.6.
Review of items. A total of 90 examples from both sampling
procedures were generated. The instances were coded according to
a procedure in which identical and highly synonymous responses
are combined (see Fehr, 1988, for details). There were a total of 15
examples that appeared highly synonymous and redundant. These
examples were removed from the final set of 90 items, which
resulted in a final set of 75 distinct examples, reflective of the rich
and complex phenomenon of countertransference.
Noncountertransferential items. We desired to have other
items that would not be as indicative of countertransference and
that would be low in prototypicality to provide information on
divergent validity and serve as a check on response styles or
respondent acquiescence, which is the tendency of respondents to
answer yes or true to all statements. So to control acquiescence in this study, unrelated and peripheral examples were generated. Creating a measure with a range of items in terms of their
prototypicality enabled both the generation of the prototype and
participant discernment of the prototype, which was essential to
assess individual differences in the availability of the prototype.
Both sets of examples (peripheral and unrelated) were generated
by four doctoral students and two professors of counseling psychology over two brainstorming sessions.
Unrelated items. First a set of examples low in prototypicality
was generated. Examples unrelated to countertransferential exemplars were related to effective therapist behavior, such as responds to a clients feelings; encourages a client to take
appropriate risks; and is prepared for supervision. A total of
14 examples reflective of effective therapist behavior but unrelated to countertransference were generated. Three were de-

56

HOFSESS AND TRACEY

leted for redundancy, and 11 were converted to items for use in

the final measure.
Peripheral items. In addition, a list of examples was generated
that could be considered peripheral examples of countertransference using the criterion that the example must reflect a possible but
not overtly obvious manifestation of countertransference. For example, examples were included that were considered to be indicative of countertransference in some circumstances. Examples of
peripheral examples include self-discloses to a client; ends a
session late or early; and questions a clients motives during the
session. A total of 22 peripheral examples were generated. Four
were deleted due to redundancy, and 18 were converted to items
for use in the CM.
Final measure. The final measure included 104 items that are
proposed to be low, moderate, and highly prototypical examples of
countertransference. These 104 items comprise the CM. Participants were asked to rate the extent to which the example was
indicative of countertransference on a scale ranging from 1 (not at
all a manifestation of countertransference) to 8 (definitely a manifestation of countertransference). Refer to Table 1 for a list of the
items on the CM.
Procedure. Clinical supervisors were recruited from multiple
professional listservs from the following organizations: the Council of Counseling Psychology Training Programs (CCPTP), American Psychological Association (APA), the counselor supervision
group of American Counseling Association (ACA), Division 29 of
APA (Psychotherapy), the Supervision and Training Section (STS)
of Division 17, the Training Directors of University Counseling
Centers, the Arizona State Psychological Association listserv, and
the National Latino Psychological Association listserv. A snowball
sampling technique was also used to recruit experienced psychologists at the individual level. Psychologists within the authors
network were asked to forward the survey link to other psychologists who fit the criteria for inclusion in the study.
The CM was made available to participants through an online
web-based survey. Participants were asked via the online survey to
first complete the demographic survey (e.g., theoretical orientation, years of supervision experience), review the list of 104
examples, and rate the extent to which they deemed each example
to be indicative of a manifestation of countertransference on an
8-point Likert-type scale as just described.
A total of 221 respondents accessed the online survey, but only
109 of the 221 completed the entire questionnaire and demographic form. Fifty percent (n 112) of the surveys were deleted
due to missing data. Demographic data from the 109 completed
surveys were reviewed according to the criteria for inclusion (e.g.,
10 years experience as a clinical supervisor and 10 years experience as a licensed psychologist) because we wanted a very expert
group to provide the prototypicality ratings. Only 41% (n 45) of
the respondents met the inclusion criteria. The remaining respondents were grouped according to years experience (e.g., less than
1 year, n 19; 1 4 years, n 18; 59 years, n 20) to examine
differences in prototype patterns across this sample.

Results
The prototypicality rating, which is the average of the participants ratings, was computed for each item on the CM. Prototypicality ratings for all 104 items ranged from 1.64 to 7.04. Table 1

lists all the items on the CM and the means and standard deviations
for the experienced psychologist sample. The table also lists the
category to which the item was assigned during instrument development, including prototype, peripheral, and unrelated.
Similar to the analyses conducted by Fehr (1988), the examples
that were considered central versus peripheral were identified as
those rated high on the list versus those rated low. To better
determine the most prototypical examples, we selected the top 10
items for closer examination.
Furthermore, we placed almost all the peripheral items and all
the low-prototypical items in the lowest rank positions. We ranked
all 29 such items at least in the bottom 40 positions, providing
discriminant validity for the scale. There were some exceptions in
which we ranked peripheral items among the 50 highest rated
items (e.g., Items 13, 33, 38, 41, and 45) and thus considered them
to be more prototypic by this sample. The criterion used to generate the peripheral items was that it may be considered to be an
example of countertransference, so the ambiguity of the peripheral
item generation process led to a range of peripheral items such that
this sample rated some of these items as more indicative of
countertransferenece than others. It appears that some of the highly
ranked peripheral items could be considered prototypic.
We computed the interrater reliability of the ratings of the 104
items using intraclass correlation coefficients (ICCs (2,k), twoway fixed items, random raters consistency evaluation). The ICC
estimates the correlation between this set of average rankings and
a second set that would be derived from a separate sample of 45
raters. The predicted correlation (i.e., between the current average
rankings and that of a hypothetical future set of raters) was very
high (ICC .97), reflecting a strong consensus among the raters
as a group regarding the examples of countertransference; this
group distinguished prototype, peripheral, and noncountertransference items on the CM. To further examine whether there was clear
consensus on the relative prototypicality among only the 75 contertransference items, we calculated the ICC on this subset. The
ICC was .94, indicating that even among the very restricted set of
countertransference items, the experts were in high agreement over
what constituted countertransference. On the basis of these results,
it could be predicted that these prototypicality ratings would be
replicated quite closely by a new group of raters. We also examined the reliability using two groups who would be most discrepant: psychodynamic experts (n 8) and cognitive-behavioral
experts (n 8). For this evaluation, ICC .94, indicating that
even among these very different experts, there was a high degree
of similarity in rating countertransference features on the CM.
The other type of ICC that is typically computed in prototype
studies is ICC (2,1), which is the average correlation between pairs
of raters; these correlations are typically predicted to be modest
(i.e., .10 .30) in prototype structures (Horowitz & Turan, 2008).
The Pearson rs computed for each pair of raters averaged .24 when
all 104 indicators were used and .17 when the 75 countertransference items were included. Thus, raters agreed modestly with each
other about the examples, so there is also variability among the
rankings of the experienced clinicians, but the means for the entire
sample were stable.
We compared the patterns in prototype endorsement across the
three other experience groups. We computed ICCs within these
groups, and the results were similar to the ratings in the experienced sample group, ranging from .93 to .98. All four groups

COUNTERTRANSFERENCE AS A PROTOTYPE

endorsed the unrelated items in the lowest ranked positions, and

the minimal fluctuations in pattern of endorsement across the
groups on the items comprising the top 10 prototypical items
appear to be due to chance. Despite concerns about sample size,
we opted to create the prototype using the most expert psychologists rankings, as these were presumed to be the most valid.
The reliability estimate computed among the top 10 examples was
ICC .86 and compared with the correlations among the lowest rated
items (ICC .74); these two estimates were outside of each others
95% confidence band, indicating significantly different values.

Summary
The results of this instrument development study support the
prototype nature of countertransference. First, we constructed an
instrument that was broad in its coverage of countertransference
based on the literature and consultation with experts. This instrument was rated very similarly by a set of experienced psychologists, indicating some consensus about the examples that are most
and least characteristic of countertransference.
The agreement ratings obtained in this study on the prototypicality are similar to those obtained in other research. ICCs computed in other studies in which a prototype methodology is used to
examine concepts such as love and intimacy were similar (ICC
.97 for love and .95 for commitment) (Fehr, 1988). Correlations by
pairs of raters were lower, a result that is also consistent with the
properties of prototypes. And finally, another property of a prototype
asserted by Horowitz and Turan (2008) that was confirmed in the
study is that the highly rated items were more highly correlated than
the less prototypic items.
These results validated the first criterion necessary to claim that
countertransference exists as a prototypethat participants can
make meaningful judgments about the internal structure of a
construct by identifying the degree to which instances of the
concept are good or poor examples of it. Furthermore, the results
revealed the range of central to peripheral cues this sample of
experienced psychologists use to determine the occurrence or
manifestation of countertransference. The methodology revealed
the primary examples that experts associate with the concept.
There is considerable consistency with which psychologists rate
the examples of manifestations of countertransference on the CM.
So even though experts cannot agree on a definition of countertransference, they all know it when they see it.

Study 2
Study 1 not only demonstrated the existence of a consensual
prototype for countertransference among experienced psychologists but also demonstrated variations among individual psychologists in the match between their personal templates and the
consensual prototype. The purpose of Study 2 was to explore, in a
sample of novice therapists, whether the degree of T:P match was
related to experiences with countertransference, self-reported
awareness of and ability to manage countertransference, and ability to recognize countertransference in a transcript of a counseling
session. Study 2 was essentially a validity test of the second
criterion for a prototypethat information processing is related to
the use of the prototype.
To establish convergent validity, the CM was proposed to be
related to various countertransference indicators. One such indi-

57

cator was therapists self-report experiences with countertransference; however, there are no instruments available in the literature
to measure this, so a new student self-report measure, The Experiences with Countertransference Measure (EWCM), was created
for the purpose of this study. The measure was designed to
evaluate the frequency of countertransferential behavior in session,
the frequency of countertransference as a focus in supervision, and
the impact of countertransference on the counseling process. The
relation between therapists knowledge of countertransference and
their self-reported experiences with it was examined. There has
been no research directly examining whether knowledge affects
the self-perceived frequency of countertransference reactions in
therapists. It may be that therapists who think of the construct in a
prototypical manner would be more able to identify instances they
observe within themselves. It was predicted that there would be a
moderate positive relation between the CM and the EWCM.
To examine divergent validity, the CM was proposed to be
related to a trainees ability to manage countertransference, as
assessed by the Countertransference Factors Inventory (CFI; Van
Wagoner, Gelso, Hayes, & Diemer, 1991). Management of countertransference requires far more than simple knowledge. We
hypothesized that knowledge was a crucial first step in developing
countertransference management skills but that much more work
was involved. Although there seems to be an intuitive relation
between these two variables, research on countertransference management shows that there are many other variables beyond a
therapists knowledge of countertransference that affect a therapists ability to manage his or her countertransference, such as
skill, experience, and personality (Gelso, 2004). Due to the other
variables that influence countertransference management ability, it
was predicted that there would be low to no correlations between
the CM and the CFI subscales. Further support for this prediction
comes from the literature on social desirability (Hoyt, Warbasse, &
Chu, 2006); CFI scores may include a large amount of social
desirability variance that attenuates correlations with criterion
measures and other measures of countertransference (Hoyt et al.,
2006).
Trainees information-processing skills with respect to countertransference were proposed to be another indicator to which the
CM was related. Information-processing ability was operationalized in this study as therapists ability to detect and evaluate the
presence of countertransference in a brief counseling transcript.
Trainees read a transcript of segments of two counseling sessions
(to be described in the Method section). To assess their perceptions about the therapist in the transcripts effectiveness, the trainees completed two measures. The first was designed to evaluate
their perceptions of her ability to manage her countertransference,
assessed by their ratings on the CFI (Van Wagoner et al., 1991).
The second measure assessed trainees perceptions of the therapists countertransference behavior, including her overall countertransference behavior, her positive countertransference behavior,
and her negative countertransference behavior. These were assessed by their ratings on the Inventory of Countertransference
Behavior (ICB; Friedman & Gelso, 2000). It was predicted that
trainees whose ratings match the prototype would be better able to
discern the presence of countertransference in a counseling transcript, as reflected in higher scores on the ICB and lower scores on
the CFI.

HOFSESS AND TRACEY

58

Table 1
Means and Standard Deviations of Prototypicality Ratings on Countertransference Measure Items by Experienced Psychologists and
Initial Category of Itema
Item
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
51.
52.
53.
54.
55.
56.
57.
58.
59.
60.
61.
62.
63.

Acts flirtatious with a client.

Loves a client.
Daydreams about relationships or events related to a client.
Loses all neutrality and sides with a client.
Rejects the client in session.
Treats client in a punitive manner during session.
Expresses sexual attraction to a client.
Experiences sexual arousal with a client.
Engages in too much self-disclosure.
Expresses hostility toward or about a client.
Colludes with a client in session.
Acts in a dependent manner during a session.
Thinks about a client throughout the day.
Acts in a submissive way with the client during session.
Is overly responsible for a client.
Dreads seeing a client.
Befriends the client in session.
Feels protective of a client.
Defends client in session or in supervision.
Expresses feelings of guilt to a client.
Significant discrepancies between case notes and what actually occurred
during session.
Expresses feelings of envy to client.
Does not bring up a client in supervision.
Expresses a need to be respected, appreciated, and loved.
Acts defensive in supervision.
Expresses demands to help a client.
Avoids eye contact in session.
Rushes in to solve a clients problems.
Cherishes a client.
Departs from typical therapeutic style.
Behaves as if he or she were somewhere else during the session.
Is apathetic toward a client in session.
Feels hurts by something a client says or does in session.
Forgets important details about a session when discussing the case in
supervision.
Makes more suggestions to a client than usual.
Criticizes a client during the session.
Does not feel any caring towards a client.
Ends session early or late.
Refuses to persist at potentially useful therapeutic methods.
Feels awkward or self-conscious with a client.
Doesnt challenge a client.
Expresses anger to a client.
Experiences anger and frustration with a client.
Feels anxious about seeing a client.
Values compliments from a client.
Feels excited about seeing a client.
Does not respond to client affect.
Anticipates having negative feelings with a client.
Guards against experiencing negative feelings in session.
Spends time complaining during the session.
Acts very fond of a client.
Feels like either a great or bad therapist with a client.
Adopts an advising tone with a client.
Tries to persuade a client.
Feels inadequate with a client.
Has anxiety or feels pressure in a session with a client.
Gives idiosyncratic advice.
Misperceives the frequency with which client talked about a topic.
Talks too little and less than he or she is comfortable with.
Experiences envy, guilt, or pity with a client.
Recalls the content of a session inaccurately.
Feels buoyed by a client.
Talks about one client a lot in supervision.

SD

Categorya

7.04
6.87
6.82
6.76
6.44
6.42
6.33
6.33
6.29
6.22
6.22
6.20
6.04
5.93
5.93
5.89
5.67
5.64
5.60
5.60

1.46
1.52
1.03
1.30
1.53
1.69
1.65
1.65
1.84
1.29
1.36
1.63
1.71
1.72
1.63
1.71
2.06
1.69
1.40
1.76

prototype
prototype
prototype
prototype
prototype
prototype
prototype
prototype
prototype
prototype
prototype
prototype
peripheral
prototype
prototype
prototype
prototype
prototype
prototype
prototype

5.53
5.51
5.51
5.47
5.44
5.44
5.42
5.38
5.38
5.33
5.31
5.29
5.22

1.85
2.12
1.42
1.90
1.32
1.74
1.73
1.61
1.85
1.71
1.76
1.42
1.72

prototype
prototype
prototype
prototype
prototype
prototype
prototype
prototype
prototype
prototype
prototype
prototype
peripheral

5.22
5.22
5.18
5.18
5.13
5.11
5.09
5.07
5.07
5.07
5.04
4.98
4.98
4.96
4.96
4.91
4.87
4.87
4.82
4.71
4.67
4.62
4.60
4.58
4.58
4.58
4.56
4.44
4.42
4.42

1.52
1.46
1.61
1.63
1.65
2.19
2.01
1.63
1.68
1.50
1.54
1.97
1.56
1.55
2.12
1.79
2.02
1.74
1.85
1.84
1.93
1.64
1.78
1.94
1.78
1.64
2.14
1.71
1.90
2.11

prototype
prototype
prototype
prototype
peripheral
prototype
prototype
peripheral
prototype
prototype
prototype
peripheral
prototype
prototype
prototype
prototype
prototype
prototype
peripheral
prototype
prototype
prototype
prototype
prototype
prototype
prototype
prototype
prototype
peripheral
peripheral

COUNTERTRANSFERENCE AS A PROTOTYPE

59

Table 1 (continued)
Item
64.
65.
66.
67.
68.
69.
70.
71.
72.
73.
74.
75.
76.
77.
78.
79.
80.
81.
82.
83.
84.
85.
86.
87.
88.
89.
90.
91.
92.
93.
94.
95.
96.
97.
98.
99.
100.
101.
101.
103.
104.

Reflects on areas not central to a clients concerns.

Experiences boredom with effective therapeutic procedures.
Experiences boredom in session.
Feels affection for a client.
Is apologetic to the client during a session.
Expresses frustration to a client.
Neglects procedures that are less enjoyable and overemphasizes ones that
he or she finds enjoyable.
Self-discloses to a client.
Forgets important details about a clients life during a session.
Changes the topic in session.
Leans back in session with arms crossed.
Provides too much structure in session.
Is talkative in session.
Pushes a client to change.
Falls silent in session.
Frequently challenges a client.
Expresses excitement to a client.
Expresses sadness to a client.
Is differentially effective across clients.
Questions a clients motives during the session.
Expresses happiness to a client.
Rigidly adheres to a particular theory and practice of therapy.
Learns important life lessons from a client.
Often sees things from the clients point of view.
Asks a client if he or she has a significant other.
Reflects on a session with a client.
Experiences sadness with a client.
Matches a clients affect.
Responds to a clients feelings.
Agrees with the client during session.
Writes short case notes.
Recognizes his or her own negative feelings.
Encourages a client to take appropriate risks.
Is emotionally in tune with a client.
Expresses empathy for a clients loss.
Is comfortable in the presence of strong affect from a client.
Is prepared for supervision.
Feels confident working with most clients.
Is supportive.
Looks up literature related to a clients problems.
Understands the influence of culture in a clients life.

SD

Categorya

4.42
4.36
4.33
4.27
4.22
4.20

1.91
1.69
1.49
1.68
1.46
1.62

prototype
prototype
prototype
prototype
prototype
prototype

4.16
4.16
4.11
4.00
3.98
3.93
3.76
3.73
3.62
3.58
3.58
3.56
3.47
3.44
3.44
3.33
2.93
2.91
2.76
2.64
2.62
2.60
2.47
2.44
2.31
2.22
2.20
2.20
2.07
1.89
1.82
1.76
1.76
1.67
1.64

1.98
1.87
1.90
1.73
1.84
1.88
1.43
1.81
1.19
1.57
1.50
1.37
1.79
1.41
1.32
2.02
1.79
1.58
1.52
1.32
1.53
1.64
1.41
1.41
1.24
1.61
1.18
1.36
1.16
1.34
1.17
1.09
1.30
1.09
1.07

prototype
peripheral
prototype
prototype
prototype
prototype
prototype
prototype
prototype
peripheral
prototype
prototype
peripheral
peripheral
prototype
prototype
peripheral
unrelated
peripheral
unrelated
prototype
peripheral
unrelated
peripheral
peripheral
unrelated
unrelated
unrelated
unrelated
unrelated
unrelated
unrelated
peripheral
peripheral
unrelated

Category of item type refers to one of three general categories that was created during item generation, including (a) prototype, which includes all of the
items generated by consulting the literature but not specific domains such as overinvolved behavior, (b) peripheral, and (c) unrelated, reflective of effective
counselor behavior.

Method
Participants and procedure. Sample composition and procedure used in this study are outlined below.
There were two samples. The first sample was composed of a
cross-section of inexperienced student therapists enrolled in their
practicum experience for either a masters in counseling program
or a counseling psychology doctoral program at a large southwestern university. This sample completed a demographic questionnaire and read a transcript of a description of countertransference
and then rated how the countertransference was managed using the
CFI, focusing on the therapist in the transcript, and the ICB, which
focuses on the amount of countertransference demonstrated. Following this, trainees completed the CM and the CFI to assess their
personal management of countertransference and the EWCM to
assess personal experience with countertransference. This student

sample included 35 masters and doctoral students; students were

recruited from both programs to obtain variance in training and
clinical experiences. Seven (20%) were men and 28 (80%) were
women. Regarding race/ethnicity, 19 (54.3%) were White/
Caucasian, three (8.6%) were African American/Black, three
(8.6%) endorsed a category of other, one (2.9%) was Asian
American, and two (5.7%) were biracial. Seven (20%) participants
did not indicate their race/ethnicity. The mean age of the participants was 28, ranging from 22 to 57 years.
Of the 35 participants, 28 (80%) were enrolled in a masters in
counseling program, and 7 (20%) were enrolled in a doctoral
program in counseling psychology. Twenty-six (74.3%) reported
that they were currently enrolled in their first practicum experience. Two participants (5.7%) reported they had two semesters of
practica experience, including the current practicum in which they

60

HOFSESS AND TRACEY

were enrolled. Two participants (5.7%) reported they had three

semesters of practica, three participants (8.6%) reported they had
four semesters of practica, and one participant (2.9%) reported six
semesters of practica.
A second sample of 109 counselors-in-training was recruited
from classes of a counselor education and counseling psychology
program at a large southwestern university to examine group
differences (e.g., based on gender and practicum experience) on
the CM. Students completed a demographic questionnaire along
with the CM only. This sample included 25 (22.9) men and 82
(75.2%) women. Six (5.5%) participants did not identify their
gender. Sixty-one (60%) participants identified as White/
Caucasian, eight (7%) identified as biracial, five (4%) as Latino/
a/Hispanic, four (3%) as Black/African American, four (3%) as
other, three (2%) as Asian American, and one (1%) as Native
American. Twenty-four (22%) participants did not indicate their
race/ethnicity. In terms of the degree program the participants were
enrolled in, 83 (76%) checked that they were pursuing a masters
in counseling or a masters of education degree in counselor
education, 18 (16.5%) checked a doctorate degree in counseling
psychology, six (5.5%) checked other as a degree, and three
(2.7%) did not indicate any degree program. Forty-two (38.5%)
indicated that they had never had a practicum experience yet.
Thirty-one (28.4%) indicated that they were enrolled in their first
practicum experience at the time they completed the survey, and
19 (17.4%) indicated that they had completed at least one semester
of practicum. Thus, the sample consisted primarily of very inexperienced counselors.
Measures. The measures used are outlined below.
The CM. The CM is a measure of knowledge of countertransference. Student participants completed the 104-item CM derived
in Study 1. Given the interest in creating a measure of the extent
to which individuals matched the prototype of the experts, a
template matching score was created. Specifically, the top 10 and
a set of 10 of the lowest prototype items were used as representing
strong prototype features (Items 1 0) and weak prototype features
(Items 66 75), respectively. Refer to Table 1 for items noted. The
means listed for these items were viewed as the expert ratings. The
extent to which each participants ratings varied from the expert
ratings was viewed as an index of how much that individual used
the countertransference prototype. Horowitz and Turan (2008) and
Turan and Horowitz (2007) proposed two alternative indices of
template match: profile correlation and highlow difference. Profile correlation involves the correlation of the individuals scores
on the 20 items with the mean scores of the experts. The highlow
difference is based on signal detection theory and calculated by
subtracting the scores on the low prototypical items (representing
noise) from the high prototypical items (representing signal). Other
research on cognitive variables has yielded support for the high
low difference score (Paulhus & Harms, 2004; Paulhus, Harms,
Bruce, & Lysy, 2003). For the sample in this second study, these
two indices (the profile correlation and the highlow difference)
had a correlation of .93. Given the high similarity and the greater
ease of calculation of the highlow difference score, we opted for
this index of template match. (All analyses using both indices were
conducted; the profile correlation as well as the highlow difference and all results were very similar.) High CM scores represent
a greater difference in the ratings given to highly prototypical

items relative to low prototypical items.1 The mean CM score for

this sample was 22.80 with a standard deviation of 11.55.
To gain an indication of the reliability of this template matching
score, the CM was administered twice (1 or 2 weeks apart) to a
separate sample of counseling and counseling psychology graduate
students (n 35). The correlation was .87, indicating good stability over this time period. This assessment of reliability was
based on the sample completing the entire list of 104 items.
Because we wanted to support the use of a shorter instrument that
captured only the high and low items, we created a shorter version
of the CM, which was composed of the items used in the calculation of the highlow difference (i.e., Items 110 and Items
66 75) as well as five filler items (i.e., Items 100 104) to assess
response acquiescence. This shortened CM of 25 items was administered first to a class of graduate students in counseling (n
34). The following week, the students completed the original
104-CM form. With this alternate form, the testretest assessment
yielded a correlation of .81, demonstrating both stability and
content consistency.
The CFIForm T (CFI; Hayes, Gelso, Van Wagoner, & Diemer,
1991; Van Wagoner et al., 1991). The CFIForm T measures
therapists overall ability to manage countertransference. The measure consists of 50 items on which an evaluator assesses a therapist. It contains five subscales of therapist attributes that are
theoretically associated with the management of countertransference; Self-Insight (e.g., therapist is often aware of feelings in
him/her elicited by clients); Self-Integration (e.g., effectively
sorts out how his/her feelings relate to clients feelings); Anxiety
Management (e.g., does not become overly anxious in the presence of most client problems); Empathy (e.g., can usually identify with the clients inner experience); and Conceptualizing
Skills (e.g., can usually identify dynamics of a therapy relationship). The CFI can either be used globally, wherein evaluators
rate therapists overall behavior on each of the five attributes (e.g.,
reflects deeply on his/her feelings), or specifically, where the
focus of evaluation is on how each of the five attributes is expressed directly in therapists work with clients (e.g., reflects
deeply on how his/her feelings relate to clients feelings). Some
items on the CFI are considered direct measures of countertransference management ability because they assess the therapist as he
or she reacts during the therapy session. The item reflects deeply
on how his/her feelings relate to clients feelings is an example of
the direct item, whereas reflects deeply on his/her own feelings
is reflective of indirect items that assess the therapists experience
more generally. The five factors are purported to represent factors
correlated with countertransference management when all items on
the five subscales are taken together. However, the five factors are
thought to represent constituents of countertransference management (Gelso, Fassinger, Gomez, & Latts, 1995; Minadeo, 1993)
1

We also examined calculating the template match using the top and
bottom 20 and 30 items from the CM in addition to the top and bottom 10.
All were correlated above. 90, and the study results were very similar
regardless of using 10, 20, or 30 representative items. These results were
also similar across method (i.e., profile correlation or high-low difference
score). Given this similarity, we adopted the high-low difference score
calculated by subtracting the scores for the bottom 10 from the top 10 as
the best index given its brevity and ease of calculation.

COUNTERTRANSFERENCE AS A PROTOTYPE

when just the direct items are measured. The full measure, including both indirect and direct items, was used in this study. There is
also a self-report version of the CFI, which was selected for use in
this research.
In terms of the psychometric properties of the CFI, there has
been some initial validation of its content validity (Hayes et al.,
1991) and construct validity (Van Wagoner et al., 1991). In regards
to construct validity, the CFI has been used to differentiate excellent therapists from average therapists (Van Wagoner et al., 1991).
Research on the relation between the CFI and actual countertransference behavior within a given session shows a negative correlation in both laboratory (Gelso et al., 1995) and field (Friedman &
Gelso, 2000; Hayes, Riker, & Ingram, 1997) settings. Reliability of
the CFI has been established by high internal consistency estimates
(Minadeo, 1993; Van Wagoner et al., 1991). Internal consistency
estimates were obtained on the present sample. The overall alpha
on the total CFI score (e.g., all 50 items) items was .92. Cronbachs
alphas on the five subscales were also obtained and ranged from
.62 to .86. Means and standard deviations for the subscales are
listed in an initial descriptives table. Refer to Table 2.
The EWCM. The EWCM was created to assess the frequency
of therapists perceptions of their countertransferential experiences
in sessions with clients, their perception of the frequency of
countertransference as a focus in supervision, and their perceptions
of the impact of countertransference on their therapy process. A
deductive method of test construction was used to create the
measure in which items were selected on the basis of the detailed
description of the three components listed above. Three clinical
supervisors reviewed the items to establish content and face validity. Items of similar content, as opposed to heterogeneous items,
were generated to examine respondent individual differences. High
scores indicated greater experience with countertransference.
The measure consists of eight statements that focus on four
categories (two items per category), including the frequency of
Table 2
Means and Standard Deviations for the Dependent Measures
Measure

SD

CFI Total
CFI Self-Insight
CFI Self-Integration
CFI Empathy
CFI Conceptualizing Ability
CFI Anxiety Management
Transcript measure
CFI Self-Insight
CFI Self-Integration
CFI Empathy
CFI Conceptualizing Ability
CFI Anxiety Management
ICB positive
ICB negative
EWCM total score
EWCM seneral
EWCM supervision
EWCM impact on therapy (negative)
EWCM impact on therapy (positive)

38.84
3.98
4.04
3.83
3.74
3.85

3.34
.31
.40
.45
.44
.47

2.56
3.08
2.55
3.07
3.02
2.56
3.27
2.14
2.29
2.28
2.57
3.57

.69
.79
.50
.86
.67
1.73
2.23
.58
.60
.82
1.01
1.01

Note. CFI Countertransference Factors Inventory; ICB Inventory of

Countertransference Behavior; EWCM Experiences with Countertransference Measure.

61

countertransference experiences in sessions with clients, called the

EWCM general subscale (e.g., I have struggled with countertransference issues), frequency of countertransference issues as a focus
of supervision, called the EWCM supervision subscale (e.g., My
supervisor has brought up issues related to countertransference
with me), and negative and positive impact of countertransference
on the therapy process, referred to as the EWCM positive and
negative subscales, respectively (e.g., My issues with countertransference have had a negative/positive effect on my work with
clients). Therapists rated the items using a 6-point Likert scale
ranging from 1 (never) to 6 (always). The means and standard
deviations for each of the subscales are listed in Table 2. Internal
consistency estimates were obtained for the total score (.82) on this
measure and scores for each subscale, ranging from .74 to .82.
Assessment of countertransference from a transcript. Participants were given a case transcript, which included two brief
transcribed segments that occurred during the sixth and eighth/
final sessions between a female counselor and a female client. The
therapy was ending because the female counselor was going on
maternity leave. The transcript, which was about a page and a half,
was taken verbatim from a chapter written by Gelso (2004, pp.
243247) in which he referenced the transcript by analyzing the
therapists responses for the presence of countertransference behavior. The decision for selection of this counseling session transcript was based on several criteria. First, there was a preference
for the transcript to be taken from an example that an expert in the
field has referenced in his or her writing about the topic. There was
also a preference for the transcript to contain identifiable themes of
counseling issues (e.g., termination) but not to include exchanges
in which the therapist was obviously exhibiting countertransference (e.g., I am attracted to you) that would be easily identifiable
to the novice therapist. Lastly, there was a preference to have a
transcript that was analyzed and dissected by an expert in the field.
The excerpt extracted from Gelsos (2004) book was the one that
best met these criteria.
In his analysis, Gelso put himself in the role of the therapist and
described his reactions to the client, which involved a sense of
admiration and some wishes to rescue her and solve her problems
(Gelso, 2004). He acknowledged that his reactions could have
stemmed from both the transference she (the client) could have
been exhibiting surrounding a wish to be taken care of and also his
own issues about being a good parent and conflict about being
taken care of. His interpretation, then, may vary from another
therapist who may not struggle with similar issues or who does not
espouse a similar definition of countertransference, in this case one
in which personal conflicts are acknowledged as a contributor to
countertransference. This reveals the complexity involved in incorporating tasks that ask participants to evaluate therapist countertransference. Two measures were included to evaluate the respondents reactions to the transcript and to the therapists
effectiveness.
The CFIForm T (Hayes et al., 1991; Van Wagoner, et al.,
1991). For the purpose of the case transcription, 13 direct items
from the CFI were selected to assess counseling trainees abilities
to evaluate the case studys therapists ability to manage her
countertransference. Items were drawn from the five subscales of
the CFI: two items to assess Self-Insight, Self-Integration, Conceptualizing Skills, and Anxiety Management and five items to
assess empathy were included. In addition, four items to assess

62

HOFSESS AND TRACEY

general therapist effectiveness (e.g., The therapist seemed to be

effective with this client; The therapist was flexible in her
approach; The therapist was responsive to the clients concerns) were included with one negatively worded item, The
therapist seemed to dismiss the clients concerns.
Internal consistency estimates for the total CFI, the five subscales, and the therapist effectiveness subscale were computed.
Cronbachs alpha for the total CFI was .83. The reliability estimates on the subscales were low to moderate, ranging from .02 to
.71. Means and standard deviations for the subscales are listed in
Table 2.
The ICB (Friedman & Gelso, 2000). The ICB is a 21-item
measure that requires respondents to rate the extent of countertransference behavior, as defined by the therapists inability to
manage or control unresolved issues so that these issues manifest
themselves during treatment. A 5-point Likert-type format is used
in which a respondent rates a therapists reaction to a client
according to the extent to which the countertransference behavior
items are present during a most recent counseling session, ranging
from 1 (to little or no extent) to 5 (to a great extent). Results from
a factor analysis on the scale identified two reliable factors labeled
Positive and Negative Countertransference. Examples of the nine
items indicative of positive countertransference include colluded
with the client; oversupported the client; and inappropriately
apologized to the client during the session. The 11 negative
countertransference items included items such as rejected the
client; was apathetic toward the client; and behaved as if she
or he were absent during the session.
The measure was created and intended for use by supervisors to
evaluate counseling trainees conducting actual therapy sessions.
The measure was used in this study to assess counseling trainees
ability to identify the presence of countertransference behavior in
a written case transcription between a therapist and a client. There
are some obvious limitations in how the measure was used in the
present study, specifically, counseling trainees rather than experienced supervisors serving as the evaluators to written stimulus
material instead of to actual counseling sessions. However, given
the context in which the vignette was createdto assess counseling trainees ability to identify countertransference behaviorthe
modifications for the present study seem justified. Moreover, this
measure is presently one of the only comprehensive behavioral
measures of countertransference supported by theoretical and empirical research.
Convergent validity has been established on the ICB; preliminary research on the ICB supports its substantive theoretical relation with other extant measures of countertransference (Friedman
& Gelso, 2000). Friedman and Gelso (2000) found a significant
negative correlation between the CFI-R and the ICB total scale, as
well as with each of the two subscales. Latts (1996) found support
for a negative correlation between the ICB total score and the two
subscales with a measure of countertransference management ability. The subscales of the ICB correlated with a one-item measure
of countertransference behavior (Hayes et al., 1997). Internal consistency estimates assessed by Cronbachs alpha on the two subscales of the ICB were both .79, and the alpha coefficient for the
total scale was .83.
Reliability estimates for this sample on the two subscales of the
ICB, negative countertransference behavior and positive countertransference behavior, were .85 and .66, respectively. The alpha

coefficient for the total scale was .87. Means and standard deviations for the subscales are listed in Table 2.

Results
The correlations of the CM template matching score with the
transference perceptions are presented in Table 3. Preliminary
convergent validity of the CM was established with significant
correlations with four of the five subscales on the EWCM. It was
predicted that there would be a moderate, positive correlation
among the CM and the subscales and overall score on the EWCM
such that trainees who thought of countertransference prototypically may be more able to identify their own experiences with it.
Trainees who have learned about the construct through their practicum experiences may show a better understanding of the construct
on the CM. This hypothesis was supported. There were several
significant positive correlations, including students reports of
countertransference in general (r .33, p .05), their overall total
score on the EWCM (r .38, p .05), students reports of the
negative impact that their countertransference has had on their
work with clients (r .39, p .05), and a significant correlation
with students reports of the positive impact that their countertransference has had on their work with clients (r .42, p .05).
Only the correlation of the CM with experience of countertransference as a focus in supervision was not significant (r .19, p
.05). Students whose individual templates of countertransference
more closely resembled the prototype established by the experienced clinicians reported greater experiences with countertransference in general and greater experiences of countertransference that
negatively and positively impacted their therapy process.
None of the correlations between the CM and the CFI total score
and subscales were significant. There is no relation between students availability or knowledge of the prototype of countertransference and their self-reports of their ability to manage their own
countertransference. This result provides some initial validation
for the divergent validity of the CM.
The next set of analyses tested the hypotheses that therapists
knowledge of the prototype of countertransference is related to
their information-processing abilities. We predicted that trainees

Table 3
Intercorrelations of the Countertransference Measure Template
Match With the Student-Rated Measures (n 35)
Scale
CFI total score
CFI Self-Insight
CFI Self-Integration
CFI Empathy
CFI Conceptualizing Ability
CFI Anxiety Management
EWCM total score
EWCM general
EWCM supervision
EWCM impact on therapy (negative)
EWCM impact on therapy (positive)

r
.10
.17
.15
.09
.07
.11
.38
.33
.19
.39
.42

Note. CFI Countertransference Factors Inventory; EWCM Experiences with Countertransference Measure.

p .05.

COUNTERTRANSFERENCE AS A PROTOTYPE

who score high on the CM may be better able to discern the

presence of countertransference in a counseling transcription, as
reflected in higher scores on the ICB (Friedman & Gelso, 2000)
and lower scores on the CFI (Hayes et al., 1991; Van Wagoner et
al., 1991). High scores on the ICB indicate the student detected the
presence of countertransference behavior from the therapist in the
transcript, and low scores on the CFI indicate students perceptions
that the therapist in the transcript had a low ability to manage her
countertransference.
Table 4 shows the correlations of the CM, the scales scores
involving the ratings of the transcript on the CFI (Hayes et al.,
1991; Van Wagoner et al., 1991) subscales, total score on the CFI,
and the subscales on the ICB (Friedman & Gelso, 2000).
There was a significant negative correlation between the CM
and the total score on the CFI (r .33, p .05) as well on the
CFI Self-Integration (r .35, p .05), Empathy (r .34, p
.05), and Anxiety Management (r .42, p .05) subscales.
Only the CFI Self-Insight (r .07, p .05) and Conceptualizing Ability (r .01, p .05) subscales yielded nonsignificant
correlations with the CM. So most of the CFI scales yielded the
hypothesized relations with the CM. There were also significant
positive correlations between the CM and the ICB positive countertransference subscale (r .34, p .05), and the total countertransference subscale on the ICB (r .36 p .05); however, the
correlation of the CM with the negative countertransference scale
(r .07, p .05) was not significant. We predicted that trainees
whose templates matched the prototype would be able to identify
the presence of countertransference, assessed by scores on the
ICB, in the transcription. There was some relation between how
students scored on the CM and how they rated the therapists
positive countertransference behavior and overall countertransference behavior in the transcription. Students whose individual templates more closely matched the prototype rated the therapist in the
transcription higher on her overall countertransference behavior
and higher on her positive countertransference behavior.
Given that the scoring index we used included as the lowest
rated items those ending at Item 75 (top 10 and then 66 75), the
official prototype of countertransference is considered to include
Items 175; Items 85 and above with a mean of 3.98 and below,
though listed in Table 1 by the initial category to which they were

63

assigned during the item generation phase, can now be considered

nonprototypic. The collection of Item 85 and above include all
categories generated during the item generation process: prototype
items, peripheral items, and unrelated items. Despite their initial
categorization and due to the results, all those items are nonprototypic.
We conducted analyses of variance (ANOVAs) on the second
sample to evaluate whether there were differences on the CMs
template match variable across gender or across levels of training
experience. We categorized therapists-in-training into three groups
according to months of practica experience; Group 1 (n 42)
reported no practicum experience, Group 2 (n 26) reported 1 4
months, equivalent of one semester of practicum, and Group 3
(n 20) reported 5 or more months. The tests for each scoring
option were not significant. We conducted an additional ANOVA
to evaluate gender differences on the CM. There were no significant results.
We conducted post hoc analyses to establish initial validity on
the EWCM. Specifically, we examined correlations between the
EWCM scales and the self-rated CFI scales. The only significant
correlations found were between the EWCM General subscale and
four of the CFI subscales. Neither EWCM Focus in Supervision
nor EWCM total subscales were correlated significantly with any
of the CFI scales. Students reports of their experiences with
countertransference in general were negatively correlated with
four of the five scales of their self-report ratings on the CFI
(Self-Insight .48, Anxiety Management .64, Empathy
.44, Conceptualizing Ability .51, and CFI total .57).
For example, as students report greater ability to manage their
anxiety, they report having fewer experiences with countertransference in general. This result makes intuitive sense because they
are based on students self-evaluations of their abilities, which may
or may not be accurate, but the relations between these measures
should be consistent. Results of the validity estimates on the
EWCM with other constructs provide some initial validation for
the measure; however, future research is needed to replicate the
results found in this study and establish a broader nomological
network of variables related to this construct. The EWCM may be
a useful measure to incorporate in future studies to assess students
perceptions of their experiences with countertransference.

Discussion
Table 4
Correlations of the Countertransference Measure Template
Match With the Student-Rated Transcription Measures:
Countertransference Factors Inventory (CFI) and Inventory of
Countertransference Behavior (ICB) (n 35)
Scale

CFI total score

CFI Self-Insight
CFI Self-Integration
CFI Empathy
CFI Conceptualizing Ability
CFI Anxiety Management
ICB total score
ICB, positive countertransference
ICB, negative countertransference

.33
.07
.35
.34
.01
.42
.36
.34
.07

p .05.

We have described two studies to clarify the construct of countertransference. In Study 1, we used prototype methodology to
expose the principal examples that experts associate with the
concept, essentially validating that there is a consensual prototype
of countertransference. So although a consensus definition of
countertransference is elusive, it is possible for experts to agree on
a prototype of it. To borrow from the vernacular: They may not
know how to define countertransference, but they know it when
they see it! We showed that these examples constitute a knowledge structure and then adapted that knowledge structure to devise
a way of assessing individual differences in the quality of the
persons knowledge of countertransference for trainees in a counseling psychology training program. In Study 2, we demonstrated
that the test enables us to predict the level of a trainees ability to
apply the knowledge to case material. Use of the prototype was
related to sensitivity to perceiving countertransference and admit-

64

HOFSESS AND TRACEY

ting to having experienced countertransference in our sample of

trainees. So the results of the two studies provide support for
Roschs (1975) two criteria for the presence of a prototype: (a)
People agree on a set of examples and (b) the examples are related
to differences in understanding and information processing. Additional support for the presence of a prototype was demonstrated by
confirming the three properties of prototypes asserted by Horowitz
and Turan (2008): There are modest correlations between pairs of
raters (less than .30), stable mean prototypicality ratings across
groups of raters, and strong correlations among the most highly
prototypical features or examples relative to the associations
among the lowest rated features or examples.
These results are promising in light of the challenges the field
has faced with establishing a unified definition amenable to clinicians and researchers from a range of theoretical orientations and
may suggest the value of exploring manifestations rather than
definitions of countertransference in theoretical, empirical, and
clinical applications. At the very least, a focus on the manifestations of countertransference does not preclude clinicians from
various orientations from then exploring underlying factors or
contributors to the countertransferential manifestation from their
unique vantage point or perspective. For example, if a supervisor
or clinician notices one of the features from the prototype in himor herself or a supervisee, such as engaging in too much selfdisclosure, then an investigation about the reasons for the behavior
could still be explored within the clinicians understanding of the
construct. For a clinician who espouses an interpersonal view of
countertransference, the focus of inquiry would then be on what
the client may be doing to elicit the disclosure. Similarly, if a
clinician adopts a more classical definition, then the focus of the
investigation may be on the personal conflicts related to extensive
disclosure.
The results in Study 2 showed that students whose personal
templates of countertransference more closely resembled the prototype reported greater experiences with countertransference as a
focus in supervision and greater experiences of countertransference negatively impacting their therapy process. Moreover, students whose personal templates closely matched the prototype also
reported having fewer experiences of countertransference positively impacting their therapy process. The causal direction of this
relationship is not clear and was not tested in the study, so only
correlational claims can be made about the relationship between
these two variables. It may be that those novice therapists from this
sample who think of countertransference prototypically are also
more familiar with its features and are thus able to recognize it
within their work, either in supervision or with clients. The fact
that they reported higher ratings on the negative impact of countertransference in their work and lower ratings on the positive
impact on their work might be related to novice therapists tendency to espouse a more classical definition, that it is a bad thing
that deleteriously impacts the therapy process. However, this result
is consistent with the fact that most research on countertransference focuses on the detrimental effects to therapy, despite recent
research calls to explore the possible therapeutic benefits (Hayes,
2004). Another explanation for these results could be that a focus
on countertransference in supervision is related to greater knowledge of the construct.
Results of the correlations between the CM and the measures
used to assess the therapist in the transcripts efficacy provided

added support of the second criterion asserted by Rosch (1973a,

1973b). Therapists-in-training whose personal templates closely
matched the prototype rated the therapist in the transcription as
having a low ability to manage her countertransference overall (as
evidenced by the correlation with the total score of the CFI) and in
the areas of self-integration, empathy, and anxiety management.
Additionally, trainees rated her as exhibiting high overall countertransference behavior and positive countertransference behavior. It
appears that the sample of novice trainees whose templates
matched the prototype thought the therapist in the transcription
was generally ineffective and exhibited countertransference behavior, particularly in the area of positive countertransference (e.g.,
oversupporting client, talking too much). Furthermore, based on
their ratings, it appears that they thought she did not manage her
countertransference well in terms of demonstrated empathy and
anxiety management within the session.
In summary, the transcript results showed that novice therapists
demonstrated pattern recognition skills with respect to the construct of countertransference, a result that contributes to the literature on the role of cognition in counselor development by specifically examining pattern recognition skills. However, further
investigation is warranted to explore the accuracy of these skills
compared with experienced psychologists. Research in other domains has revealed some salient differences between experts and
novices ability to recognize patterns (Cunning & Stewart, 1983;
DeGroot, 1965; Patel & Groen, 1991). One recommendation for a
future study would be to include experienced psychologists ratings of a therapists behavior (either through a counseling transcription, analogue study, or actual session) and then use their
ratings for a more valid index of respondents ability to recognize
countertransference.
A virture of the CM is that it is derived from a consensual
prototype that is not known to respondents. In other words, the
right answer on the CM is not obvious, which mutes the role of
social desirability motivation as a determinant of score variance.
The CM may therefore be a valid measure of countertransference
because replicable variance on this measure tends to be valid
variance. Future studies could examine the CM correlations with
the assessment of countertransference measures (e.g, CFI, ICB) to
see which measure, the CM or CFI, has greater predictive validity.

Limitations and Future Directions

There are several additional limitations of the study. With regard
to the expert sample, the generalizability of the results may be
limited. The experienced clinician sample used to generate the
prototype was limited to a group of self-selected participants
affiliated with professional organizations on staff at college counseling centers or on staff at academic training programs who
volunteered to complete the survey and thus limits generalizability
to other experienced psychologists. Although there was a small
representation of clinical psychologists (n 11), the majority of
this sample were counseling psychologists (n 26). Although
countertransference is generally considered relevant as a training
issue by both counseling and clinical psychology programs, its
historical emphasis was largely among psychoanalysts, a group
who was not adequately represented in the present sample (n 8).
Unlike the more general concepts typically examined by lay samples in prototype research such as love or commitment, coun-

COUNTERTRANSFERENCE AS A PROTOTYPE

tertransference is a concept that is unique to trained psychology

professionals. Consequently, sampling becomes a particularly essential issue.
Another limitation of the study was the sample and sample size
used to validate the CM. The sample included only 35 counseling
trainees enrolled in a practicum, thus severely restricting power
and the ability to detect effects due to the restricted range of scores.
The sample was recruited over 1 year from one masters and
doctoral program and primarily consisted of beginning-level therapists in their first practicum. Thus, generalizability to advanced
counseling students, counseling students in other programs, and
clinical psychology students is limited. As such, a possible next
step in future research would be to include a broader and more
comprehensive trainee sample inclusive of beginning and advanced counseling and clinical psychology students to allow for
comparisons within and between training groups.
Along the same line of thinking, future research in this area
could explore differences in prototypes across discrete groups of
therapists, perhaps by theoretical orientation. If there are indeed
different prototypes for different groups, then it becomes possible
to compute different divergence scores for individual templates to
then compare the predictive validity of divergence scores derived
from the different prototypes.
One contribution of this study is that it introduces a methodology for operationalizing knowledge structures salient to the counseling and psychotherapy field. The prototype methodology can be
adopted by counseling and psychotherapy researchers to develop
instruments and examine the knowledge structure of many other
related constructs. A prototype strategy for construction of personality scales has been shown to be statistically superior to other
traditional test construction strategies (e.g., empirical, factor analytic, rational); the approach also incorporates techniques that use
contemporary cognitive principles to examine how people think
about and organize cognitive categories (Broughton, 1984). The
main reason for the superiority of this method over others is that
scales composed of items high in prototypicality are better predictors than scales composed of other more traditional methods (e.g.,
rational, factor analytic, and empirical; Broughton, 1984).
The CM has many implications for training and research in
counselor development programs. In terms of a training tool, the
CM itself could be used in counseling courses or supervision as a
tool for discussion about the construct of countetransference in
general or as a framework to discuss how it gets manifested in
therapy. The tool could help focus a discussion on the actual
manifestations of countertransference rather than on the abstracted
controversy over its definition. Trainees may fall prey to being at
either extreme of the countertransference continuumthat is,
never labeling their experiences as countertransferential or always
talking about reactions in terms of countertransference. The CM
provides a concrete tool for keeping a dialogue focused on actual
behaviors and affective reactions.
Additionally, the CM could be used as an assessment of knowledge for trainees by supervisors. Identifying prototypical instances
of countertransference may be useful for supervisors currently
supervising counseling students to prime them to look for specific
behavioral or affective cues, the examples of the CM that may
indicate supervisees potential countertransference behavior. High
scores on the CM indicate close resemblance to the prototype. Low
scores may indicate that a respondent does not think about coun-

65

tertransference in the prototypical manner. Given the concerns

about the face validity of the items, if a respondent scores low on
the CM, then it could be an indication that he or she is thinking of
it idiosyncratically. In a clinical application, low scores on the CM
may serve as a signal to supervisors to further explore with their
supervisee their understanding of countertransference and effective therapist behavior in general. It could also be used as a
screeningto identify those novice therapists who may be prone
to misunderstanding counseling constructs. Introducing the prototype to trainees may also help them in identifying their own
countertransference behavior and help enhance awareness, which
Gelso (2004 ) claimed is the most important moderator of countertransference.
Additionally, supervisors-in-training who are learning about the
role of a supervisor might benefit from the knowledge of the
examples of countertransference that comprise the prototype. Being aware of the examples of the prototype, specifically, the most
prototypical cases of countertransference, could help them know
what to look for when working with trainees.
In terms of research, the CM could be incorporated into future
studies to examine the relation between knowledge, a cognitive
construct, and counseling behavior. Additionally, studies examining the development of cognition over time among counselors-intraining could incorporate the CM. The role of cognition is often
overlooked in counseling research.

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Received September 2, 2007

Revision received October 12, 2009
Accepted October 16, 2009

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