International Journal of Cognitive Therapy

, Volume 11, Issue 1, pp 80–99 | Cite as

Negative Reactions of Therapists Working with Suicidal Patients: a CBT/Mindfulness Perspective on “Countertransference”

  • Thomas E. EllisEmail author
  • Jennifer A. J. Schwartz
  • Katrina A. Rufino
Regular Article


While the construct of countertransference has been established in psychodynamic theory since its inception, it has received relatively little attention from cognitive-behavioral theorists. However, it is generally agreed that therapists’ reactions to patients powerfully influence treatment, for better or worse. Suicidal patients in particular are likely to evoke negative reactions in therapists. In this paper, we briefly review the theoretical literature on countertransference, with particular attention to suicidal patients, from standpoints of psychodynamic and cognitive-behavioral theory and research. We argue that the cognitive-behavioral perspective, together with the RAIN model proposed by mindfulness authors (Recognition, Acceptance, Investigation, and Non-Identification), opens avenues to assess, distance from, and perhaps modify cognitions that could lead to counter-therapeutic emotions and behaviors in working with suicidal patients. We conclude that, while work with suicidal patients can be challenging, cognitive-behavioral therapists can potentially improve effectiveness and enhance their own well-being by managing their reactions in a manner consistent with their theoretical orientation.


Suicide Countertransference Therapist reactions Mindfulness Acceptance Stress management 



The authors gratefully acknowledge the support of the Bernice Peltier Huber Charitable Trust and the Menninger Clinic Foundation, without whose support this work would not have been possible. We also thank two anonymous reviewers for their helpful comments on an earlier version of this paper.


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Copyright information

© International Association of Cognitive Psychotherapy 2018

Authors and Affiliations

  • Thomas E. Ellis
    • 1
    • 2
    Email author
  • Jennifer A. J. Schwartz
    • 3
  • Katrina A. Rufino
    • 4
  1. 1.The Menninger ClinicHoustonUSA
  2. 2.Department of Psychiatry and Behavioral SciencesBaylor College of MedicineHoustonUSA
  3. 3.University of ColoradoBoulderUSA
  4. 4.University of Houston, Downtown, and The Menninger ClinicHoustonUSA

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