267: Cohort Group Consultation and Reflective Function: Transforming Countertransference into Clinical Insight

May 22, 2026

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5 min read

In a cohort consultation group, a therapist presenting a case might feel nothing in particular, but someone else in the room will feel the anger, the shame, or the boredom that the presenter has unconsciously set aside. This is not a glitch in group process; it is the central mechanism by which clinicians can transform raw countertransference into usable clinical insight. Dr. David Puder, joined by cohort leaders Dr. Ali Rega and Dr. Jeremiah Stokes, describes how these groups function as a training ground for reflective function—the capacity to hold one's own emotional reactions in mind, wonder about their origins, and use that understanding to deepen empathy for patients rather than act out the feelings.

The Group as a Container for Disavowed Emotion

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What you'll learn

1 (00:15) **Introducing the Cohort Model and Reflective Function** - Drs. Ali Rega and Jeremiah Stokes join to discuss how cohort group consultation helps therapists understand countertransference through reflective function.
2 (06:29) **Vulnerability Without Grades** - Unlike residency, the cohort has no gatekeeping, allowing for genuine vulnerability and deeper work.
3 (09:07) **Social Veneer vs. Reflective Function** - The medical culture's strong social veneer actually lowers reflective function.
4 (10:38) **The Place of Disavowed Emotion** - The group inevitably feels whatever emotion is disavowed by a member.
5 (13:08) **Intellectualization vs. Emotional Processing** - Jumping to intellectualization keeps reflective function low; staying with the emotion is key.
6 (14:39) **Common Therapist Vulnerabilities** - The cohort normalizes common therapist personality traits and their impact on countertransference.
7 (17:58) **Facilitator Vulnerability** - Group leaders model vulnerability by acknowledging they don't have all the answers.

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Show Notes

In this episode, Dr. David Puder is joined by cohort leaders Dr. Allie Riege and Dr. Jeremiah Stokes to explore how reflective function transforms countertransference into deep clinical insight. Through their experience leading psychodynamic cohort consultation groups, they discuss the challenges therapists face with vulnerability, disavowed emotions, and the gap between theory and real-world application. The conversation dives into common therapist personality dynamics, enactments, boredom and irritability as valuable clinical data, and how group consultation helps clinicians develop greater self-awareness and empathy in their work. Drawing from Nancy McWilliams' Psychoanalytic Diagnosis and key concepts like concordant and complementary countertransference, this episode offers practical wisdom for mental health professionals seeking to improve their reflective functioning and psychodynamic case conceptualization.

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