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Countertransference (CT) as a specific aspect of the therapeutic relationship plays a crucial role in psychotherapy. It serves as a source of clinical information for initial diagnostics and is relevant over the course of the therapeutic process. Theory and research have found that some personality features in patients are significantly related to specific CT reactions in the therapists. In this interplay, the role of patients’ defense mechanisms (DM) has not been sufficiently investigated. This study aimed to explore the association between patients’ DMs and therapists’ CTs in a psychiatric inpatient sample. DMs were assessed by the Defense Style Questionnaire in 71 patients. Twelve therapists used the Therapist Response Questionnaire to rate their CT toward their patients throughout the treatment. Considering the nested data structure with therapists on Level 2 and patients on Level 1, Pearson correlations between patients’ DMs and therapists’ CTs were calculated. After Benjamini–Hochberg correction, six correlations remained significant: Patients’ DM humor was positively correlated with therapists’ positive/satisfying and sexualized CT and negatively with disengaged CT. DM acting out was positively correlated with helpless/inadequate and hostile/mistreated CT. DM splitting showed the strongest positive correlation with overwhelmed/disorganized CT and was also positively associated with special/overinvolved and hostile/mistreated CT. DM isolation was positively associated with special/overinvolved CT, and somatization was negatively associated with sexualized CT. Under careful consideration of the methodological limitations of our study, the relevance of our findings for the therapeutic relationship and process is discussed, and further research questions are pointed out.