Before I Had a Theory, I Had a Feeling:

Countertransference, Formulation, and Clinical Certainty in Relational Transactional Analysis

A Relational TA exploration of diagnosis, countertransference, ADHD, passive aggression, and how therapists create meaning under uncertainty.

A reflection on diagnosis, formulation, and the therapist's relationship with certainty.

This article began with a clinical observation. Several clients diagnosed with ADHD evoked countertransference experiences I had historically associated with passive aggressive process. Initially, I became curious about whether there was an overlap between the two. However, the deeper question proved to be something else entirely.

Drawing upon Relational Transactional Analysis, this article explores how therapists create meaning under conditions of uncertainty, and whether our formulations sometimes tell us as much about our own experience as they do about the client sitting opposite us.

Moving beyond debates about ADHD, passive aggression, and diagnosis, the article considers script, personality adaptations, re-enactment, countertransference, and the relational field. It asks a deceptively simple question:

What happens when therapists become too certain that they already know?

This piece is intended for therapists, trainees, and anyone interested in the complexities of psychotherapy, diagnosis, and relational understanding.

Written by Carl Stephens

Abstract

This paper emerged from a recurring clinical observation. Several clients who either presented with, or later received, a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) evoked countertransference experiences that I had historically associated with passive aggressive relating. Initially, I became curious about a possible relationship between ADHD and passive aggressive process. However, further reflection led me towards a different question.

Rather than asking whether a client was "really" ADHD or "really" passive aggressive, I became interested in what happened within me before I arrived at either formulation.

Drawing upon Berne's Script Theory (1972), Personality Adaptation theory (Ware, 1983; Joines & Stewart, 2002), Erskine's phenomenological enquiry (1998, 2015), and Hargaden and Sills' relational perspective (2002), this paper explores the possibility that formulation may sometimes function as a response to uncertainty within the therapist as much as an explanation of the client.

It is proposed that diagnosis, adaptation, and formulation are most useful when held as provisional hypotheses rather than conclusions. The paper argues that the therapist's task is not primarily to determine which formulation is correct, but to remain curious about the emotional and relational experiences from which formulations emerge. Particular attention is given to the possibility that formulation itself may occasionally become part of the re-enactment occurring within the relational field.

Introduction

This paper began with a clinical observation.

Over a number of years, I noticed that several clients who either presented with, or later received, a diagnosis of ADHD evoked countertransference experiences I had historically associated with passive aggressive process. I found myself feeling frustrated, ineffective, unable to influence, and at times uncertain whether the client genuinely wanted help or simply wanted to demonstrate why help would not work.

Initially, I became curious about a possible overlap between ADHD and passive aggression. The observable behaviours often appeared remarkably similar. Clients forgot appointments, struggled to follow through on agreed actions, appeared distracted, rejected suggestions, became tangential, or verbally agreed whilst behaving differently in practice.

Yet the longer I sat with these experiences, the less convinced I became that ADHD and passive aggression were the most important variables.

Instead, I found myself becoming interested in certainty itself.

How quickly do therapists arrive at explanations?

What happens when diagnosis becomes an answer?

What happens when adaptation becomes an answer?

And what happens to therapeutic enquiry when either formulation becomes too convincing?

As my reflections developed, a more fundamental question emerged. Looking back, I became aware that my formulations had not begun with theory.

They had begun with feeling.

Before I arrived at ADHD, I experienced frustration.

Before I arrived at passive aggression, I experienced a sense of being unable to influence.

Before I arrived at an explanation, I encountered a countertransference experience.

This observation led me towards the central question explored throughout this paper:

What happens when therapists mistake certainty for understanding?

Drawing upon Relational Transactional Analysis, I will argue that formulation may sometimes emerge from the therapist's struggle with uncertainty within the relational field and that, at times, formulation itself may become part of the re-enactment occurring between therapist and client.

This paper is therefore not an attempt to challenge the validity of ADHD as a diagnosis, nor to argue that passive aggression provides a better explanation for the behaviours described. Rather, it is an exploration of how therapists create meaning under conditions of uncertainty and how our theoretical explanations may occasionally tell us as much about our participation in the therapeutic field as they do about the client sitting opposite us.

A Note on Clinical Material

The clinical material presented throughout this paper consists of fictional composites created from multiple clinical observations, supervisory reflections, and theoretical discussions. They do not represent any individual client, nor are they disguised accounts of specific therapeutic relationships.

The vignettes have been intentionally constructed to illustrate the themes explored in this paper whilst preserving client confidentiality and avoiding identification of any particular individual.

Before I Had a Theory, I Had a Feeling

Reflecting upon the clinical encounters that prompted this paper, I became aware of something that had previously escaped my attention.

My formulations did not begin with theory.

They began with feeling.

At the time, I imagined that I was moving from observation to explanation. Looking back, I am no longer convinced this was the case.

I did not first observe ADHD.

I first experienced frustration.

I did not first observe passive aggression.

I first experienced a sense of being unable to influence.

I did not first arrive at a diagnosis.

I first encountered a countertransference experience.

Only afterwards did I begin searching for a framework capable of making sense of what I was feeling.

This observation has left me wondering whether formulation sometimes emerges in the reverse order to how we imagine.

Therapists often describe a process in which observation leads to formulation. We observe patterns, generate hypotheses, and develop an understanding of the client's experience. Whilst this undoubtedly occurs, my own reflections suggest that another process may sometimes be operating alongside it.

We feel.

Then we formulate.

The explanation follows the emotional experience.

This does not invalidate diagnosis, adaptation, or formulation. Nor does it imply that such understandings are inaccurate. Rather, it raises the possibility that countertransference may play a more significant role in shaping what appears clinically obvious than therapists sometimes acknowledge.

Erskine's (1998, 2015) emphasis on phenomenological enquiry invites therapists to remain alongside lived experience before moving towards interpretation or explanation. From this perspective, the therapist's subjective experience becomes an important source of information rather than an obstacle to objectivity.

Looking back, I am struck by how quickly I sometimes moved towards explanation.

The discomfort of not understanding was often difficult to tolerate.

Frustration invited explanation.

Confusion invited explanation.

A sense of therapeutic impasse invited explanation.

Once an explanation arrived, the experience frequently became more manageable.

I felt less uncertain.

Less ineffective.

Less lost.

This leaves me wondering whether formulation occasionally serves more than one function.

On the one hand, it may deepen understanding of the client's experience.

On the other, it may help the therapist regulate the uncertainty evoked within the therapeutic encounter.

This is not a criticism of formulation.

Therapists cannot work without theory.

Rather, it is an invitation to curiosity.

When a formulation begins to feel particularly compelling, perhaps the question is not only:

"What does this explain about the client?"

but also:

"What does this help me manage within myself?"

This question feels especially important within a relational framework.

If meaning emerges within the relationship rather than residing solely within either participant, then the therapist's emotional experience cannot be assumed to sit outside the process being observed.

Before I had a theory, I had a feeling.

The remainder of this paper explores the implications of taking that observation seriously.

The Therapist's Search for Coherence

Berne (1972) proposed that individuals organise experience through life scripts that provide familiarity, predictability, and coherence. Whilst script may constrain spontaneity and autonomy, it also serves a fundamentally human function. Script offers a way of making sense of experience and creating order within an uncertain world.

Transactional Analysis has traditionally focused on how clients use script to organise their experience.

Reflecting on the observations that prompted this paper, I am left wondering whether therapists sometimes engage in a parallel process.

Faced with ambiguity, contradiction, and uncertainty within the consulting room, we seek explanations that organise experience. These explanations may take the form of diagnosis, personality adaptation, attachment theory, trauma, neurodevelopmental difference, or relational formulation.

The content differs.

The function may be remarkably similar.

In both cases uncertainty becomes organised into meaning.

This is not to suggest that formulation and script are equivalent. Nor is it to suggest that therapists are somehow acting from pathology when they formulate.

Rather, it highlights a shared human tendency to create coherence when confronted with complexity.

The clients who prompted this paper often left me feeling confused.

Different aspects of their presentation appeared contradictory.

At times they expressed a wish to change whilst simultaneously appearing unable, unwilling, or frightened to do so.

They sought help yet resisted influence.

They complained about outcomes whilst repeating behaviours that appeared likely to produce them.

I found these experiences difficult to hold.

The temptation to formulate was often accompanied by relief.

Once I had an explanation, the confusion seemed to diminish.

The client's behaviour became more understandable.

The therapeutic task appeared clearer.

The uncertainty reduced.

Looking back, I wonder whether this process deserves greater scrutiny.

Berne viewed script as an attempt to create predictability within an uncertain world. I am left wondering whether therapists may occasionally create explanatory narratives that function in ways not entirely dissimilar.

Faced with ambiguity, we organise.

Faced with contradiction, we explain.

Faced with uncertainty, we formulate.

Again, this is not a criticism of theory.

Without theory there can be no psychotherapy.

The question is whether our formulations remain hypotheses that support enquiry or whether they gradually become explanatory narratives that close it.

When a formulation becomes too convincing, curiosity can begin to contract.

Alternative meanings become less visible.

Contradictions become easier to overlook.

The map quietly becomes the territory.

This concern is not limited to diagnosis.

A therapist may become attached to an attachment formulation.

A trauma formulation.

A personality adaptation.

A script explanation.

Or a relational interpretation.

No theoretical framework protects us from the human desire for certainty.

Indeed, the more sophisticated the framework, the more convincing the certainty may become.

From this perspective, the challenge is not avoiding formulation.

The challenge is remaining aware of the psychological function formulation may serve for the therapist.

What uncertainty is this explanation helping me organise?

What confusion is it helping me resolve?

And what possibilities might disappear if I become too attached to it?

These questions feel particularly important within a relational approach, where meaning is understood as emerging between therapist and client rather than residing entirely within either participant.

If formulation helps create coherence, then it may tell us something not only about the client, but also about the therapist's participation in the relational field.

Personality Adaptation and the Meaning of Behaviour

One of the risks inherent in formulation is the assumption that observable behaviour transparently reveals underlying psychological meaning.

Transactional Analysis has long challenged such assumptions.

Personality Adaptation theory (Ware, 1983; Joines & Stewart, 2002) proposes that similar behaviours may emerge from markedly different adaptive organisations. What appears identical at a behavioural level may serve entirely different psychological functions.

A client who appears resistant may be protecting autonomy.

A client who appears disengaged may be defending against shame.

A client who appears oppositional may be preserving selfhood in the face of perceived intrusion or control.

A client who appears compliant may be avoiding conflict or seeking approval.

The behaviour itself tells us relatively little unless it is understood within the wider context of the individual's adaptation, history, and relational experience.

This perspective feels particularly relevant to the observations that prompted this paper.

Many of the clients who evoked experiences I associated with passive aggression displayed behaviours that could plausibly be understood in multiple ways.

Missed appointments.

Forgotten commitments.

Failure to follow through on agreed actions.

Apparent disengagement.

Resistance to influence.

At times these behaviours seemed to invite a passive aggressive interpretation.

Yet as the therapeutic work developed, alternative meanings frequently emerged.

What initially appeared as resistance sometimes revealed profound shame.

What appeared as opposition occasionally reflected fears of dependency.

What looked like avoidance sometimes emerged as confusion, overwhelm, or difficulties with self organisation.

The behaviour had not changed.

The meaning had.

This observation has left me increasingly cautious about treating behavioural descriptions as explanations.

A diagnosis may provide one way of understanding a client's difficulties.

A personality adaptation may provide another.

An attachment formulation, trauma formulation, or script formulation may provide further perspectives.

Each illuminates certain aspects of experience whilst obscuring others.

None can claim exclusive ownership of meaning.

This is not an argument for abandoning formulation.

Rather, it is an argument for humility.

Personality Adaptation theory reminds us that the same behaviour may emerge from very different internal organisations. The task of the therapist is therefore not to identify the correct explanation as quickly as possible, but to remain curious about the multiple meanings a behaviour may hold.

Viewed in this way, the question shifts.

Rather than asking:

"What is this behaviour?"

we begin asking:

"What function might this behaviour serve?"

The distinction feels subtle.

Yet clinically it may be profound.

The first question encourages classification.

The second encourages enquiry.

And it is within that space of enquiry that relational understanding becomes possible.

My Investment in Movement

As I reflected upon the frustration that emerged within these therapeutic encounters, I gradually became aware of a question that felt increasingly difficult to avoid.

Why was I so invested in movement?

The clients who prompted this paper often appeared stuck.

The same difficulties returned repeatedly.

Conversations revisited familiar territory.

Agreed actions were forgotten.

Insights did not necessarily translate into change.

At times I experienced these patterns as frustrating and perplexing.

Initially, my attention focused almost entirely upon the client.

What was preventing movement?

What was maintaining the impasse?

Why did the same difficulties continue to recur?

Over time, however, my curiosity began to shift.

I found myself wondering not only about the client's relationship with change, but also about my own.

Why was non movement so difficult for me to tolerate?

Why did I experience such urgency to understand?

Why did I become increasingly drawn towards explanations that organised my frustration?

These questions felt uncomfortable.

They required me to consider the possibility that some of my certainty emerged not solely from observation, but also from my own struggle to tolerate therapeutic uncertainty.

As therapists, we are inevitably invested in the possibility of change.

Clients seek us out because something in their lives is not working.

Training, theory, and professional identity all orient us towards facilitating movement, growth, and transformation.

Yet there are moments when this investment may become difficult to distinguish from urgency.

The client remains where they are.

The therapist wishes for movement.

The tension between these positions becomes part of the therapeutic field.

Looking back, I wonder whether some of the frustration I experienced emerged from this tension.

The more invested I became in understanding the apparent impasse, the more compelling certain explanations began to feel.

At times, formulation seemed to offer a route out of uncertainty.

If I could understand what was happening, perhaps I could influence it.

If I could name the process, perhaps movement would follow.

Yet relational theory invites a different possibility.

The therapist's desire for movement is not separate from the therapeutic encounter.

It becomes part of it.

From a Relational TA perspective, the frustration did not belong solely to the client.

Nor did it belong solely to me.

It belonged to the relationship.

My wish for movement and the client's apparent resistance, ambivalence, fear, confusion, or inability to move became organised within the relational field itself.

This perspective feels important because it shifts the focus away from locating difficulty exclusively within the client.

The question is no longer:

"Why is this client stuck?"

The question becomes:

"What is occurring between us around movement and non movement?"

Such a shift does not eliminate responsibility, agency, or psychological process.

Rather, it broadens the frame.

The therapist becomes part of what is being understood.

In this sense, my frustration ceased to be merely a reaction to the client's behaviour.

It became a source of information about the relational field.

And perhaps it was precisely this information that I was attempting to organise through formulation.

This possibility remains both unsettling and compelling.

It suggests that my certainty may have emerged not only from what I observed in the client, but also from what I found difficult to bear within myself.

Re-enactment Within the Relational Field

Hargaden and Sills (2002) describe therapeutic meaning as emerging within a co-created relational field rather than residing solely within either the client or the therapist. From this perspective, unconscious relational patterns become enacted within the therapeutic relationship and are experienced by both participants.

The significance of this idea for the present discussion is considerable.

Throughout this paper I have explored the possibility that my formulations emerged after particular countertransference experiences. Frustration, impotence, confusion, and a sense of being unable to influence frequently preceded attempts to explain what was occurring.

Initially, I understood these experiences as reactions to the client.

Relational theory invites a different possibility.

What if these experiences were not simply reactions?

What if they were communications emerging within the relational field itself?

Viewed in this way, the frustration that prompted my curiosity may not have been evidence of ADHD, passive aggression, resistance, or any other adaptation.

Instead, it may have represented a relational phenomenon occurring between us.

The focus therefore shifts.

Rather than asking:

"What diagnosis explains this client?"

we begin asking:

"What is being enacted between us?"

This movement feels significant.

The question is no longer located solely within the individual.

It becomes located within the relationship.

The frustration belongs neither entirely to the client nor entirely to the therapist.

It belongs to the field.

The client's apparent inability to move and the therapist's wish for movement become part of a shared relational process.

The client's uncertainty and the therapist's search for certainty become part of a shared relational process.

Meaning emerges not from one participant alone but from their interaction.

This perspective introduces a further possibility.

If re-enactment occurs within the relational field, might formulation itself occasionally become part of that re-enactment?

This is perhaps the most challenging idea raised by this paper.

Traditionally, formulation is understood as something the therapist does in order to understand the client.

It is assumed to sit outside the process being observed.

It describes.

It interprets.

It explains.

Yet from a relational perspective, such separation may not always be possible.

The therapist is already participating in the field.

The therapist's emotional experience emerges within the field.

The therapist's understanding emerges within the field.

Why should formulation be any different?

If this is the case, then formulation may not merely describe the enactment.

It may participate in it.

The certainty that accompanies a particular explanation may itself represent a relational response to what is being experienced between therapist and client.

The urge to diagnose, classify, explain, or conclude may not simply be an intellectual activity.

It may be an attempt to organise something emotionally difficult occurring within the field.

This possibility does not invalidate diagnosis, adaptation, or formulation.

Nor does it imply that explanations are incorrect.

Rather, it invites an additional layer of enquiry.

The question is no longer:

"Is this ADHD or passive aggression?"

The question becomes:

"What is occurring within the relational field that makes this explanation feel so compelling?"

This feels like a fundamentally relational question.

It shifts attention away from determining which explanation is correct and towards understanding why a particular explanation has emerged at this particular moment between these particular people.

The formulation itself becomes something to be explored.

Not simply because it may reveal something about the client.

But because it may reveal something about the relationship.

In this sense, the therapist's certainty ceases to be the endpoint of enquiry.

It becomes part of the enquiry itself.

Countertransference as Compass

Erskine's (1998, 2015) emphasis on phenomenological enquiry invites therapists to remain alongside experience rather than moving prematurely towards interpretation or explanation. The task is not to eliminate uncertainty but to remain in relationship with it long enough for meaning to emerge.

Viewed through this lens, countertransference becomes more than a reaction to manage.

It becomes data.

The observations that prompted this paper did not begin with diagnosis.

They began with experience.

I did not first notice ADHD.

I first noticed frustration.

I did not first notice passive aggression.

I first noticed a sense of being unable to influence.

I did not first encounter a theoretical problem.

I first encountered a relational experience.

From a relational perspective, this distinction feels important.

Countertransference may reveal something about the client.

It may reveal something about the therapist.

Most often, it reveals something about the relationship emerging between them.

This is why I have become increasingly cautious about moving too quickly from feeling to explanation.

The temptation to formulate is understandable.

Explanations organise experience.

They reduce uncertainty.

They provide coherence.

Yet if the argument presented throughout this paper has merit, then certainty may sometimes obscure as much as it reveals.

The therapist who becomes convinced they are encountering passive aggression may cease asking other questions.

The therapist who becomes convinced they are encountering ADHD may do the same.

In both instances, formulation risks becoming an endpoint rather than a beginning.

Phenomenological enquiry offers an alternative stance.

Rather than asking:

"What diagnosis explains this client?"

the therapist might ask:

"What am I being invited to experience here?"

Or perhaps:

"What is occurring within the relational field that I am attempting to understand?"

These questions do not replace diagnosis, adaptation, or formulation.

Rather, they position them differently.

Explanations become provisional.

They remain available, but are held lightly.

The emphasis shifts from certainty towards enquiry.

From classification towards relationship.

From knowing towards wondering.

Countertransference therefore becomes less a problem to solve and more a compass that may orient the therapist towards deeper understanding.

Not because it provides answers.

But because it points towards experiences that require further exploration.

In this sense, the challenge is not to eliminate formulation.

It is to ensure that formulation remains in the service of curiosity rather than replacing it.

Limitations and Humility

This paper emerges from clinical observation rather than empirical research.

No claim is being made that ADHD and passive aggressive process are causally related. Nor is it being suggested that ADHD is better understood as an adaptation, attachment pattern, script process, or relational defence.

Indeed, one of the central arguments of this paper is that such certainty may be unavailable from clinical observation alone.

The purpose of this reflection is therefore not to establish a new theory regarding ADHD, nor to challenge the validity of neurodevelopmental diagnosis.

Rather, it is to explore the therapist's relationship with explanation itself.

McWilliams (2011) cautions against treating diagnostic formulations as definitive explanations, instead describing them as tentative maps that orient understanding whilst preserving curiosity about the individual. The present paper extends that caution beyond diagnosis to adaptation, script, and formulation more broadly.

Whilst the observations described here emerged from encounters involving clients diagnosed with ADHD, the argument is not specific to ADHD.

The same questions might be asked of attachment theory, trauma theory, personality adaptation, script analysis, or indeed any explanatory framework.

Every theory illuminates certain aspects of experience whilst obscuring others.

Every formulation reveals and conceals.

The challenge is therefore not deciding which theory is correct, but remaining aware of the limitations inherent within every act of explanation.

There is also a limitation within the argument itself.

The reflections presented here emerge from my own participation in the therapeutic field and are therefore inevitably shaped by my subjectivity, theoretical orientation, and clinical interests.

This is not a weakness unique to the present paper.

From a relational perspective, it is unavoidable.

The therapist cannot stand outside the field they seek to understand.

The observations described throughout this paper may therefore reveal less about ADHD and passive aggression than they reveal about the therapist's struggle to remain curious in the face of uncertainty.

If so, this does not weaken the argument.

It may strengthen it.

Conclusion

The question that began this paper was:

"Is it ADHD or passive aggression?"

Initially, this seemed like an important clinical question.

Several clients diagnosed with ADHD evoked countertransference experiences I had historically associated with passive aggressive process. I found myself repeatedly wondering whether there was a meaningful relationship between the two.

Over time, however, I became less interested in the overlap between ADHD and passive aggression and more interested in something else.

I became interested in the process through which I arrived at those explanations.

Looking back, I am struck by the fact that my formulations did not begin with theory.

They began with feeling.

Before I had a diagnosis, I had a sense of frustration.

Before I had a formulation, I had a countertransference experience.

Before I had certainty, I was participating in a relational field.

This shift in perspective altered the question I was asking.

Rather than wondering which explanation was correct, I became curious about what was occurring within the therapeutic relationship that made particular explanations feel compelling.

From a Relational Transactional Analysis perspective, this feels significant.

If meaning emerges within a co-created relational field, then formulation cannot automatically be assumed to sit outside that field observing it objectively. At times, formulation may itself become part of the relational process it seeks to explain.

This does not diminish the value of diagnosis, adaptation, script analysis, or theory.

Nor does it suggest that therapists should abandon formulation.

Rather, it invites a different relationship with it.

Diagnosis, adaptation, and formulation may be most useful when held as tentative hypotheses rather than conclusions. They can guide enquiry without replacing it.

The challenge is not to avoid explanation.

The challenge is to hold explanation lightly enough that curiosity remains possible.

Perhaps therapists are human before they are theorists.

We seek coherence.

We organise experience.

We create meaning.

The question is not whether we formulate.

The question is whether we can continue wondering after formulation arrives.

The greatest threat to curiosity may not be ignorance.

It may be the feeling that we already know.

References

Berne, E. (1972). What do you say after you say hello? The psychology of human destiny. Grove Press.

Erskine, R. G. (1998). Theories and methods of an integrative transactional analysis. TA Press.

Erskine, R. G. (2015). Relational patterns, therapeutic presence: Concepts and practice of integrative psychotherapy. Karnac.

Hargaden, H., & Sills, C. (2002). Transactional analysis: A relational perspective. Brunner-Routledge.

Joines, V., & Stewart, I. (2002). Personality adaptations: A new guide to human understanding in psychotherapy and counselling. Lifespace Publishing.

McWilliams, N. (2011). Psychoanalytic diagnosis: Understanding personality structure in the clinical process (2nd ed.). Guilford Press.

Ware, P. (1983). Personality adaptations (doors to therapy). Transactional Analysis Journal, 13(1), 11–19.