Today I want to talk a bit about transference.  Transference is “the phenomenon whereby we unconsciously transfer feelings and attitudes from a person or situation in the past onto a person or situation in the present.  The process is at least partially inappropriate to the present” (apt.rcpsych.org).  First identified by Freud, transference can be somewhat embarrassing or concerning from the patients perspective.  However, transference is a common place experience in therapy.  There is a sense of closeness that a patient will feel with their therapist or doctor.  The relationship is very one sided, with you, the patient, disclosing extremely personal information to someone who is often a blank slate.

The therapeutic alliance is a situation in which the clinician and patient have the same goal and  work towards that goal in a straight forward way, together.  Transference occurs when, whether consciously or unconsciously, the therapeutic alliance becomes distorted.  Transference is not necessarily a bad thing, and can often communicate a patients needs that cannot be verbally expressed.

People experience these needs in all facets of their life, and therefore, transference is not only present in therapeutic relationships, but rather is possible in any relationship a person is a part of.  For example, disliking a coworker when they have done nothing wrong to you, and then realizing that this coworker actually resembles a family member you have unresolved issues with.  Transference can involve either positive or negative emotions, and therefore you could also have warm feelings towards a coworker who makes you think of a loved family member, such as a grandmother.

The most common types of transference are paternal, maternal, sibling, and non-familial.  Paternal transference occurs when a patient looks at the clinician as a father figure, often viewing them as wise, powerful, and authoritative.  They may also feel protected, or like they can receive sound advice from this person.  Maternal transference is when the clinician is viewed as loving and influential; nurturance and comfort are expected.  Sibling transference is when peer to peer, or team-based interactions are expected.  A non-familial transference can vary greatly, from a religious leader, to a policeman.

While transference is often helpful in identifying areas to work on, it can also interrupt the therapeutic work.  One such way this can occur is an unconscious agenda on the part of the patient.  When this occurs, the clinician must consider this in the treatment plan.  Since distortion may take place in the patients understanding of an interaction, a clinician must always be aware of the possibility of transference.

It is always possible that the strong emotions a patient feels could be real and appropriate.  For example, if a patient is aware that a clinician has put extra time and effort into their treatment, they may feel a genuine gratitude and warmth toward the clinician.  On the other hand, if a clinician is often late or cuts their sessions short, it is natural that the patient would feel anger or disappointment in relation to the clinician.

Remember that clinicians are trained to deal with transference, and as the patient, it is simply your job to be honest and work with the clinician to resolve any issues you may be presenting with.  Keep an eye out for a future post in which I will explore countertransference.

Sources:

Apt.rcpsych.org/content/6/1/57

Good Therapy