Hey there,

Recently we talked about EMDR protocols for addiction treatment (DeTUR, CravEx, FSAP) and the technical pieces you need to know to work with substance use disorders.

But here's what I didn't talk about:

What can happen inside you when you're sitting across from someone in recovery. Specifically, the trust problem.

Imagine this scenario:

You're three sessions into trauma processing with a client who says they've been sober for six months. They're doing well, engaging with the protocol, reporting progress.

Then they show up late to session four, and something feels off. Their affect is flat, they're having trouble tracking the bilateral stimulation, and when you ask how they're doing, they say "fine" a little too quickly.

And suddenly you're wondering:

• Are they high right now?
• Have they been using this whole time?
• Should I have asked for a drug screen before starting EMDR?
• Am I being manipulated?

That's countertransference. And if you work with addiction long enough, it will probably show up.

Let me walk you through what I've learned about managing it.

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The Trust Bind

Here's the thing about addiction treatment that makes it uniquely challenging:

It puts you in an impossible position.

You need to trust your client enough to do deep trauma work together, as EMDR requires vulnerability, and vulnerability requires safety, and safety requires trust.

But you also know that addiction often involves lying.

Your clients may be good people with every intention of staying honest with you, but secrecy and shame are built into how addiction works. People hide their use from themselves, let alone from their therapist.

So you're stuck.

You need to trust them to do the work, but you also know that trust might be misplaced. Most therapists respond to this bind in one of two ways, and both create problems.

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Pattern One: Hypervigilance

When it comes to managing their anxiety about being lied to, some therapists become detectives.

They're constantly scanning for signs of use (i.e. looking at pupils, noting when clients seem "off," asking detailed questions about sobriety that start to feel like interrogation).

And it makes sense, too.

You don't want to do trauma processing with someone who's actively using, because it's clinically risky. Their nervous system is dysregulated, their window of tolerance is compromised, and activating trauma while they're using increases relapse risk.

But despite all your best intentions, when you become the sobriety police, your client stops being honest with you.

They learn that if they admit to a slip, you'll pull back from the work, or worse, terminate treatment. So they hide it. And now you're doing trauma processing with someone who's using and lying about it, which is exactly what you were trying to avoid.

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Pattern Two: Willful Blindness

While some therapists become hypervigilant, other therapists go the opposite direction. They take everything the client says at face value, avoid asking about substance use, and focus exclusively on the trauma work.

This also makes sense.

You want to be the therapist who believes in your client when everyone else has given up. You don't want to be another person in their life who doesn't trust them.

But that can also be an issue.

If you're not tracking their sobriety status, you can't adjust your clinical approach appropriately, which means you might:

• Push trauma processing when they need stabilization
• Install resources that get undermined by active use
• Miss warning signs that they're heading toward relapse.

Both patterns come from the same place:

You're trying to manage your own anxiety about whether you can trust what your client is telling you. But managing your anxiety by becoming either more controlling or more avoidant doesn't actually solve the trust problem.

It moves the problem underground.

So how do you work with this dynamic?

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Setting the Frame Early

So rather than trying to figure out whether you can trust this particular client with their particular addiction history, the more useful move is to name the trust dynamic as part of the treatment frame from the beginning.

Early in treatment (ideally during the preparation phase) I have a conversation that goes something like this:

"Here's something I want to talk about. Addiction involves secrecy. That's not a moral failing, it's just part of how the disorder works. You've probably hidden your use from people you care about, maybe even from yourself.

I need you to know that if you relapse during our work together, I'm not going to terminate treatment or judge you. Relapse is information. It tells us what triggers are active, what resources need strengthening, what trauma is still driving the behavior.

But I do need you to tell me when it happens, because it changes how we work together. If you're actively using, we need to focus on stabilization rather than trauma processing. If you've relapsed, we need to process that episode as a target.

The only way this treatment fails is if you're using and I don't know about it, because then I'm making clinical decisions based on incomplete information.

Can we agree that honesty about use is part of the treatment frame, even when it's hard?"

This conversation does a few things:

• It acknowledges the reality of addiction without shaming them for it.
• It clarifies what you actually need to know (sobriety status) versus what's intrusive surveillance (random drug screens, checking their phone).
• It reframes relapse as clinical information rather than treatment failure.
• It puts the responsibility for honesty back on them, where it belongs.

But even with that conversation, you may still run into situations where clients hide relapses from you. And when you find out, your countertransference will have something to say about it.

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Found Out They Lied? Here’s What to Do.

Even with that conversation, some clients will still hide relapses from you. And when you find out, you'll feel it.

Maybe they finally admit they've been using for the past month. Maybe their partner calls you because they're worried. Maybe they show up to session visibly intoxicated.

Your countertransference will be loud.

You'll feel betrayed, manipulated, foolish for believing them. You'll question everything about the treatment. You'll wonder if you should have known, if you should have pushed harder, if you're even competent to do this work.

Here's what I've learned to do in that moment:

First, notice what's happening in your body.

Where are you feeling the betrayal? What does it remind you of? (For me, it activates old patterns around disappointment and shame for substance use in my family or my own life, which has nothing to do with this client and everything to do with my own history.)

Second, separate your feelings from the clinical reality.

Yes, they lied.

No, that doesn't mean the work you've done together was worthless. It means they were struggling more than they could admit, and now you have more information about what's needed.

Third, have the repair conversation.

Such as:

"I'm noticing I'm having some feelings about finding out you were using while we were doing trauma work. I'm not ending treatment, but I do need us to talk about what happened and how we move forward."

Sometimes that conversation reveals that the client didn't feel safe telling you about the relapse because they thought you'd be disappointed or angry. That's useful information, because it means your boundaries around honesty haven't felt safe enough.

Sometimes it reveals that they were in denial about the relapse themselves and genuinely didn't think it "counted." Also useful, because it tells you denial is still active and needs to be addressed.

Modeling a reparative conversation in any therapeutic context is a good thing.

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When Your Countertransference Means You Should Refer Out

Now, having said all that, there's one more piece I need to mention. And this is probably the hardest part to acknowledge:

Sometimes your countertransference is too strong to work through in the treatment relationship (as in, you've done your own work on it, you've brought it to consultation, and it's still getting in the way of your ability to stay in your clinical role).

If you find yourself:

• Checking or wondering about their sobriety status compulsively between sessions
• Feeling personally responsible for whether they stay sober
• Getting angry or disappointed when they relapse in ways that feel parental rather than clinical
• Avoiding asking about substance use because you don't want to know the answer

You might need to refer out.

This doesn't mean you're a bad therapist. It just means you're human, and this particular client's presentation is activating something in your own history that makes it hard to maintain appropriate clinical distance.

I've referred out before, too. It’s important to remember that it really is what’s best for both you and the client.

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The Trust You Need

After working with addiction for a while, here's what I've come to understand:

The most important part of doing this work well isn't whether you trust your client to stay sober. You simply need to trust that they're telling you the truth about whether they're sober.

That's a different kind of trust, for sure. And it's built through how you respond when they do tell you the truth about a relapse.

If they admit to using and you respond with curiosity rather than disappointment, they learn it's safe to be honest. If they tell you they're struggling with cravings and you help them process that, they learn you're on their side. If they show up late and "off" and you ask directly "are you high right now?" in a tone that's concerned, they learn you can handle their reality.

And that kind of trust comes from setting a clear frame about what you need to know, responding to honesty with clinical curiosity, and doing your own work on why their sobriety feels so personally important to you.

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Final Thoughts

Countertransference in addiction work is inevitable. The trust dynamics are complicated, the relapse rates are high, and the stakes feel enormous.

But like we talked about earlier, countertransference itself isn't the issue.

However, when you don't notice it, name it, and work with it, that's when things typically start going sideways in the treatment.

If you're doing addiction work and you've never felt the pull to become the sobriety police, or the pull to avoid asking about use because you're afraid of the answer, you might not be paying attention (or you did but had really good supervision and have already mastered this).

The therapists who do this work well are the ones who notice it, get consultation on it, and use it as information about what's happening in the therapeutic relationship.

And if you need a place to bring those dynamics for consultation, that's exactly what Helicon is building for. A space where you’ll find consultants who specialize in niche areas like this to talk about the messy relational parts of EMDR work with colleagues who understand.

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Until next time,
Chris

Thanks for reading Helicon's EMDR Therapist Weekly, where we aim to provide a weekly dose of insights, tools, and opportunities for EMDR therapists; designed to support your growth, sharpen your practice, and connect you with what's next.

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Disclaimer: The information contained in this article is for informational purposes only. This is not legal or clinical advice and we make no guarantees about the outcomes or results from information shared in this document. Proceed at your own risk and discretion.

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