The Unseen Influencers: How Disowned Needs Shape Therapist Perception and Practice
It is easy to assume that clinical training alone safeguards us from the influence of our own relational needs. Yet the reality is more humbling.
Unless we actively cultivate awareness of our vulnerabilities, unresolved conflicts, and personal longings, they inevitably enter the treatment room and shape our way of relating. Research consistently demonstrates that countertransference does not arise only in dramatic or obvious ways; it emerges when therapists are insufficiently rigorous in monitoring their internal world. When left unexamined, these subjective pressures quietly shape perception, tone, timing, and intervention—subtly reorganizing the therapeutic field.
These patterns may appear as withdrawal or avoidance, as overattachment or overinvolvement, or as a failure to recognize essential transferential material that is central to a patient's self-organization. Without disciplined self-observation and supervision, what feels like care, neutrality, or clinical instinct can in fact be an enactment of the therapist's own unfinished business.
A therapist's unmet need for validation, for example, can lead to excessive nurturance, blurred boundaries, and eventual rupture. A therapist who feels anxious about confrontation may sidestep a patient's devaluation or grandiosity, thereby colluding with the defensive structure rather than illuminating it. There are countless overt and subtle configurations of how a therapist's subjective countertransference meets a patient's transference. It is therefore our ethical responsibility to remain engaged in ongoing self-reflection and self-confrontation through personal therapy and supervision. Only through this discipline can we approximate an unobstructed therapeutic container that allows the client a fuller encounter with themselves and with us.
All Roads Lead to Rome
After seven years in my own analysis, and three years into my training as a Gestalt psychoanalyst, during which I had already worked dozens of times in both roles, as therapist and as patient, I volunteered again to be the patient and found myself silently resolving, “I’m not going to do that thing I always do.”
This internal dialogue was an effort not to reenact my historical relational pattern with my mother: becoming overwhelmed by affect, withdrawing into shame, and then launching a defensive angry attack on the therapist. Within three minutes, I had completed the entire cycle.
I looked up at my colleague, who was serving as my therapist that evening, and saw compassion in his eyes. "Well," I said, "I guess all roads lead to Rome." He had witnessed me work as a patient year after year, and this shared recognition created a depth of seeing that was both excruciatingly vulnerable and profoundly strengthening. We laughed together as we found ourselves positioned in my impasse, aware of how the past was alive in the present. From there, the session continued with my explicit ownership of the pattern.
It wasn’t my years of analysis alone that brought me to this understanding. It was the rotation, the different therapists, different rooms, different relational configurations, and the undeniable constant running through all of it: me.
That recognition was not abstract. It was destabilizing, and through that destabilization a new organization began to take hold.
That moment marked the end of a lifelong relational cycle. Not because I had insight, but because I had experiential exposure. Month after month, in that practicum, I kept bringing the same body, the same creative adjustments, the same choreography into new relational fields. And each time, the pattern revealed itself a little more clearly.
The En Vivo Practicum: Witnessing the Pattern
Years later, I now serve as a teacher and supervisor at Gestalt Associates for Psychotherapy in Manhattan. I occupy a different vantage point—no longer as patient or therapist, but as an observer of the therapeutic dyad.
The training program includes a biweekly practicum in which one trainee works as therapist under en vivo supervision while another works as patient, exploring authentic material from their own life. Over four years, trainees rotate through these roles repeatedly. This iterative structure offers a rare and powerful opportunity to witness—and become conscious of—the repetition of implicit relational patterns with self and other.
During one training evening, I led a group where one trainee worked as therapist (we'll call him Bob) and in the following session moved into the role of patient. What emerged across these two sessions offers a vivid illustration of how a therapist's subjective relational needs shape the work—sometimes invisibly, always significantly.
Session One: The Therapist’s Pull Toward Merger
In the first session, where Bob worked as therapist, the session's theme centered on a polarity within the patient: being merged versus being differentiated. This theme became salient as the patient repeatedly expressed anxiety each time he differentiated from the therapist.
At the top of the session, the patient said: "I could burst out of my skin." The therapist responded, "I'm interested in that statement." The patient continued: "I feel it everywhere—a tingling, explosive…and now it's starting to feel less intense." The therapist replied, "I wonder what that means."
The patient said, "I've never done anything like this before," referring to the experience of working as patient in a practicum session. The therapist said, "Me neither"—and while he didn't clarify what he meant, the impact was immediate relief on the part of the patient. "I feel some warmth now. We are in this together. There's a nice quality to that—that we are in this together. Maybe this thing could hold."
The therapist then made a sweeping gesture as if gathering the patient in for an embrace and said, "I'm holding you in this experience." The patient's mouth twitched into a micro-expression of startle or disgust before responding: "I don't know you yet. I feel skeptical about you holding me…and now I feel bad saying this." The therapist replied, "I'm touched that you feel bad about saying that to me," and smiled a warm smile that seemed incongruent with the patient's expressed anxiety.
At this point, I paused the session and offered the therapist several observations and theoretical frames to support his work. I identified the polarity of merger and differentiation and invited him to heighten his attention to how the patient's physiological and relational responses were organizing around this theme. I noted the therapist's more habituated comfort with merging, contrasted with the novel emergence of differentiation in the patient. Each time the client pushed back against the therapist's implicit invitation to "be the same," fear and anxiety surfaced—resulting in a repeated interruption to contact.
In Gestalt therapy, confluence refers to a diminished differentiation between self and other, where personal boundaries become blurred. When this stance is unexamined, it can subtly shape the relational field and make differentiation feel destabilizing rather than developmental.
Our clinical aim as Gestalt therapists is flexibility: supporting clients in cultivating the capacity to join when they want to join, to merge when intimacy calls for it, and to push away or reject when differentiation is necessary. Psychological health is reflected not in a fixed position on either pole, but in the fluid movement between them.
The session resumed. The therapist offered the patient a sentence stem: "Say to me, 'We are sharing this experience together, and yet…'" The patient responded: "We are in this experience together, and yet we don't know one another, and we don't know what we are doing…I'm feeling some anxiety now. It's not that I don't think you know what you're doing." The therapist replied, "I don't know what I'm doing."
We observed again how this intervention resolved the patient's anxiety as the therapist moved back into merger. The moment of differentiation—naming the not-knowing, the separateness—quickly collapsed into sameness. The session concluded with patient and therapist rocking back and forth in slow rhythm, both repeating: "We are in this together."
Arguably, this was a meaningful session that deepened the I–Thou contact between patient and therapist and introduced enduring relational themes. It began to address the patient's implicit question: Is it safe to separate from you? However, in the spirit of examining how subjective countertransference can shape the arc of a session, we might notice that differentiation was underemphasized. The therapist might have alternated more deliberately between joining the patient and then marking their difference, with the clinical intention of developing the associated anxiety—and ultimately supporting the patient in discovering that it is safe enough to push away within the therapeutic relationship.
Session Two: The Patient, Alone, But Lonely
In the second session, Bob worked as patient. This session centered on a different but related polarity: alone versus together.
The therapist began: "It's up to you, Bob. Would you like to take some time or just jump in?" Bob responded, "I feel like I need to move." After sharing details of a recent illness and a recent breakup, he reflected: "I realized through this experience that I'm alone, but I feel really lonely—not just alone."
He continued, “The other day I was reading Arthur Schopenhauer: ‘A man can be himself only so long as he is alone; and if he does not love solitude, he will not love freedom; for it is only when he is alone that he is really free.’ I thought I understood the difference. But I think when I’m alone, I feel pretty lonely.”
He paused, looked at the therapist, and added, “But I don’t feel lonely right now with you.”
He described how his friendships had thinned since moving from another country, and how he had lost the companionship of his wife. “I’m getting so much from being with you right now. The feeling of being together is a balm for the anxiety of being alone.”
He closed his eyes. The therapist observed: "I see you closing your eyes and taking deep breaths. Are you okay?" Bob replied: "This is going to end, this time with you that I'm having right now, and it's going to be dark."
Bob's differentiation between being alone and feeling lonely highlights an existential polarity that each of us must negotiate across the lifespan. Being alone can offer an opportunity for self-reflection, self-contact, and personal growth. Existential thinkers such as Sartre and Heidegger suggest that aloneness is intrinsic to the human condition—that loneliness can catalyze anxiety while simultaneously inviting freedom and responsibility in the creation of meaning. The key distinction is that being alone can be a chosen and conscious state of presence with oneself, whereas loneliness emerges when disconnection, isolation, or a lack of belonging predominates.
But what occurs when we, as clinicians, have not sufficiently metabolized our own relationship to aloneness? What happens when we do not consciously own our need for connection and intimacy? If our personal relationships diminish or we experience loss, how might these unmet needs subtly influence our therapeutic stance?
Therapists must remain vigilant about their own relational longings so that they do not distort the therapeutic field. The capacity to acknowledge and hold these needs with awareness allows the therapist to remain grounded and attuned—rather than unconsciously recruiting the patient to soothe personal loneliness.
The Ethical Imperative of Self-Examination
As these sessions illustrate, when we are not diligent about owning and tending to our own relational needs, essential transferential material can be missed. In subtle ways, the work can begin to organize around the therapist's unexamined longings rather than the patient's developmental task.
Understanding the nuanced ways in which a therapist's personal dynamics intersect with their professional role is essential for genuine therapeutic work. This requires sustained awareness and a willingness to examine how even well-intentioned interventions may be shaped by earlier relational patterns. Disrupting entrenched dynamics demands vulnerability, patience, and support—ultimately deepening both self-awareness and clinical effectiveness.
When therapists take responsibility for their vulnerabilities, they create the conditions for patients to discover their own spontaneous impulses and to make contextual, moment-to-moment choices in service of authentic satisfaction.
What En Vivo Training Makes Possible
What made the patterns described above visible—and ultimately workable—was the structure of the training itself. The en vivo practicum, in which trainees work as both therapist and patient over the course of four years, creates the conditions for exactly this kind of seeing. You cannot hide in a case presentation what becomes unmistakable in live, witnessed relational work.
This is what distinguishes post-graduate Gestalt training from supervision models that rely primarily on case consultation. The room itself becomes the instrument.
If you're a clinician curious about what this kind of training makes possible—for your clients and for yourself—we'd welcome a conversation.
Explore GAP's training programs.
Written by Jordan Dann, MFA, LP, CIRT, SEP, faculty at the Gestalt Associates for Psychotherapy and Training in NYC. Jordan is a psychoanalyst, author, and speaker whose training in Gestalt therapy, Somatic Experiencing, and theatre has shaped her approach to helping people become more relational, self-aware, free, and expressive. She is the author of Somatic Therapy for Healing Trauma and co-author of Experiential Therapies for Treating Trauma. She is in private practice in New York City.
