Dissecting Transference and Countertransference

Transference and countertransference are feelings towards an individual which are brought about by past experiences and relationships. These feelings occur unconsciously and can be positive or negative in nature. Transference is often carried by the patient into the clinician-patient relationship as brought about by their history with past figures of authority in their lives. (Pearson, 2001) For example, a patient may perceive the clinician to be similar to his or her mother and as such views them as a nurturing figure whom he or she then strives hard to please.

Countertransference, in the medical setting, is brought by the clinician and is usually seen in his or her negative feelings towards the patient again as a result of previous experiences he or she had early on in life. (Pearson, 2001) The effects of those previous experiences are triggered by the clincian’s encounter with the patient. For example, a clinician might be more caring and compassionate towards a patient that reminds him or her of his or her grandparents thus invoking similar filial emotions for the patient.

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The concepts of transference and countertransference were first described by Sigmund Freud as emotions patients and doctors projected on each other, which had come from past experiences.  The two terms are used frequently in psychoanalytical literature and occur in many instances of psychoanalytic treatment. The role projection plays on both transference and countertransference was emphasized not only by Freud but also by many other members of the medical community.

Projection takes place more often in clinician-patient relationships than in other settings.

The definition of projection as a means of adaptation and communication, a form of defense mechanism by the individual, provides insight to its frequency in medical settings. (Waska, 1999) The patient faced with his or her illness and the clinician faced with the task of aiding the patient may revert to projection in order to cope with their different tasks. Therefore, transference and countertransference occur as an aftermath of the dynamics of the said projection as well as of the initial relationship between the patient and the clinician. (Waska, 1999)

In physical therapy, patient therapist relationships are important factors in the rehabilitation process.  Therapists need to be effective communicators and develop rapports with patients that facilitate trust, compliance, and comfort.  A patient who projects unconsciously past experiences into their new and present reality can create a barrier in the relationship and hinder their progress.

Transference and countertransference brought about by these projections are the most direct causes for the communication barriers – barriers that can lead to detrimental and even fatal results in the patient’s treatment. These work through mechanisms produced through positive feelings, such as a patient who sees the therapist as a nurturer figure and tries to please the therapist and therefore does not disclose functional deficits, which are not improving, and report only positive.  Negative feelings can also create a barrier in that the patient becomes hostile or resistive toward the therapist’s suggestions and plans. (Pearson, 2001)

The maladaptive effects of transference and countertransference may be lessened by a conscious effort on the part of the clinician as well as of the patient. Both must strive to understand the dynamics of their relationship. The clinician must be able to provide insights into his or her true character and thus help the patient resolve distortions brought about by transference. The clinician must also actively acknowledge the underlying needs posed by the patient’s transference as well as actively respond to his or her own projection and countertransference. (Pearson, 2001; Waska, 1999) Studies continue to explore the possibilities of using the mechanisms of transference and countertransference to make medical relationships more effective in aiding treatment.

References

Pearson, L. (2001). The clinician-patient experience: understanding transference and countertransference. Nurse Practitioner, Retrieved 06 February 2008 from http://findarticles.com/p/articles/mi_qa3958/is_200106/ai_n8996743

Waska, R. T. (1999). Projective identification, countertransference, and the struggle for understanding over acting out. Journal of Psychotherapy Practice and Research, 8, 155-161