Transference and countertransference influence any human interaction, including the patient-clinician relationship.
Transference is the unconscious redirection of a patient’s feelings, attitudes, and desires, often regarding a close personal relationship earlier in their life, onto the clinician.
Countertransference is the unconscious redirection of a clinician’s feelings, attitudes, and desires about a close personal relationship onto the patient.
This phenomena is common in clinical care. It is not essentially pathologic, nor does it reflect failure on the part of the clinician or patient. Yet, if unrecognized, it can potentially lead to harmful consequences for patients and clinicians.
Transference feelings go unrecognized by many clinicians and may contribute to professional loneliness, cynicism, burnout, and depression. This issue is particularly relevant for palliative care clinicians who often care for dying patients who may evoke intense, often unexamined emotions.
Whenever a clinician experiences intense emotion during a clinical encounter, be it pleasant or unpleasant, this may signify the presence of transference and/or countertransference.
A methodical approach to self-reflection, self-monitoring, and coping can help clinicians recognize these feelings more consciously and thereby prevent harmful consequences.
1. Name the feeling: transference and countertransference are unconscious processes. Naming the associated feeling(s) enables conscious awareness and thereby more control over behaviors.
2. Normalize the feeling: feelings of anger, guilt, helplessness, and betrayal, though distressing, are common in clinical care. Acknowledging and normalizing these feelings can prevent clinicians from over-catastrophizing unwanted emotions triggered during the clinical encounter.
3. Name the behaviors triggered by the feeling: after bringing the feelings to conscious awareness, clinicians should reflect on how that emotion impacted their behavior. Doing so could lead to more adaptive responses should the unwanted feelings reemerge.
4. Incorporate routine consultation with trusted colleagues: sharing an intense patient interaction with colleagues can decrease isolation and build social support. Interdisciplinary teams should create settings where clinicians feel safe to discuss the lived experience of caring for seriously ill patients.

See reference for more information.

Adapted from Bapat AC, Bojarski EF. Transference and counter-transference in palliative care. Palliative Care Network of Wisconsin. Fast facts and concepts #371. Internet. Accessed on November 28, 2019.