Introduction Emotional and affective reactions to patients are a rich source of information to the experienced clinician. Over the course of their clinical experience, therapists can develop increasing.accuracy in differentiating their common and expectable emotional responses from unique reactions that often signal an important development in the therapeutic moment. Awareness of one’s breadth of emotional reactions, broadly defined as countertransference, is an important component of the psychotherapy of eating disorders. The patient’s relational patterns, developmental facets, and attachment style emerge in the context of interaction with the therapist, and the therapist’s emotional reactions to these interactions provide vital information about the patient’s life and experiences. Making use of these reactions to enhance therapeutic empathy and attunement can be challenging and fraught with risks to the treatment relationship. Yet, with the self-awareness derived from experience and self-exploration, countertransference reactions can foster important therapeutic shifts.