Repeatedly reviewing a code of ethics gives bodyworkers the best chance of preserving the professionalism of their client relationships when dealing with countertransference. According to the NCBTMB’s handbook, countertransference is defined as “a practitioner’s unresolved feelings and issues which are unconsciously transferred to the client”.

According to Nina McIntosh, author of The Educated Heart: Professional Guidelines for Massage Therapists, Bodyworkers and Movement Teachers, “Countertransference happens constantly. It’s not a question of ‘if,’ but rather it’s a question of when and how, and what kind of people we most easily over-react to. And once we think we’ve got our inner responses to clients figured out, someone walks through the door who turns us upside down, who makes us wonder why we feel mad, fascinated or exhausted. Working with our own transference (countertransference) is an ongoing learning process.”

While learning the technical definition of countertransference is burned in many bodyworkers’ minds, applying the definition to every day practice typically requires extra thought. By providing examples of countertransference, bodyworkers are encouraged to relate these examples to their own experiences. In addition to protecting clients from unethical behavior, recognizing a situation with the potential of countertransference will propel the therapist to address their issues outside of the client-practitioner relationship. McIntosh states, “We are human and always have unresolved issues, old wounds and insecurities. That’s the reason we have professional boundaries and framework – so that when we wander off course, we can notice it and be curious about it.

Our job is to do our best to keep our own issues from intruding into the therapeutic process.”

Countertransference Example #1

A client comes to you for a Swedish massage. In the intake interview, you discover she has advanced liver disease with abdominal ascites and cirrhosis. As a massage therapist concerned about placing too great a circulatory demand on an already compromised liver’s ability to process fluids, you describe your concerns to this client.

You propose a non-circulatory session involving acupressure, reiki and cranial-sacral therapy while awaiting her physician’s approval for a Swedish massage. Your client gets irritated and reiterates her goal for coming to see you, points out that you are not her physician, and that if she doesn’t get a Swedish massage from you, she will go elsewhere.

Her confrontation and disregard for your concern causes you to doubt your original assessment. You are flooded with old feelings of inadequacy and a fear of not making enough money that month. Conceding to the client’s request, you admit to overreacting and decide to administer a Swedish massage.

The old feelings of inadequacy and a fear of not making enough money are issues within the therapist that do not involve the client. The bodyworker is transferring these unresolved issues onto this session, and subsequently jeopardizing the health and safety of his/her client.

Countertransference Example #2

You have a long-time client who enjoys bringing in his own music to listen to during his session. During his last visit, he brought an album that holds special meaning for you; it is your favorite CD to play when being intimate with your spouse. Over the course of that session, you found yourself daydreaming of working your spouse’s muscles. For the first time in this therapeutic relationship, you became subtlety aware of your client’s arousal. After the massage, this client attests to receiving the best massage ever and vows to increase his frequency of treatments with you.

In this case, the therapist inappropriately transferred feelings of love and desire to the client. While this example does not represent transferring negative unresolved feelings, this situation must be professionally addressed to prevent its recurrence.

The intimate nature of bodywork will always deliver subtle and powerful challenges to the therapist. The relationship between client and practitioner can bring to the surface compelling fears, needs and longings for either party. Maintaining ethical conduct involves being aware of how you may experience countertransference. While not always easily accessible by the conscious mind, repeatedly ask yourself the following questions about your behaviors, feelings or intentions during your work:

  • Am I strictly focusing on the therapeutic relationship?
  • Am I involving my own issues in a treatment?
  • Is my reaction blurring any client-practitioner ethical boundary lines?
  • Could I be contributing to future problems in this therapeutic relationship?

Since massage therapists are human, countertransference is bound to occur. Dealing professionally with this occurrence is what separates ethical behavior from unethical behavior. By being aware of your intentions and understanding the basis of your behavior, a massage therapist can address and minimize countertransference. This approach is the key to preventing countertransference from jeopardizing the therapeutic relationship.

Recommended Study:

Ethics: Therapeutic Relationships

References:, Counter-transference in the Massage Profession, the, 2006., National Certification Examination Candidate Handbook, National Certification Board for Therapeutic Massage and Bodywork, January 2006.