Maintaining the safe and effective therapeutic relationship in the context of distrust and anger: Countertransference and complex trauma

Prior research has shown that anger is a prominent feature in the psychopathology of trauma survivors. This hostile reactivity can be difficult for clinicians, who must balance instruction or interpretation designed to teach clients appropriate ways to handle anger and judicious withholding of response to maintain the therapeutic alliance for other purposes. Unlike studies that ask therapists to report their own mistakes, this research centers on advice given by 132 interview participants who had completed long-term trauma therapies. Clients generally reported greater satisfaction with trauma clinicians who were emotionally disclosing after angry episodes and who took partial responsibility for disagreements in therapy. Outcomes and satisfaction tended to be poor if therapists were "blank screens" in the face of anger.