USMLE Psychiatry: Transference and Countertransference in Clinical Psychology

Transference vs Countertransference in clinical psychology and therapy

What is transference?

Transference is when the patient projects feelings about someone they know onto the physician, or psychiatrist. That ‘someone they know’ is usually an important figure in their life or childhood. For example, a patient lost his caring mother at a young age, and now unconsciously sees his mother and the qualities of his mother in the doctor. Notice, transference is the transfer of projected feelings from a patient to the physician.

Transference: Patient –> Physician

Therapy with Freud on Transference and Countertransference; Credit Image: Wikipedia

What is Countertransference?

Unlike transference, Countertransference is when the clinical doctor or psychiatrist projects feelings about someone they know onto the patient. This may be triggered unconsciously. For example, a patient may remind the physician of one of his younger siblings. Notice, countertransference is the opposite of transference. Countertransference is thus the transfer of projected feelings from a physician to a patient.

Countertransference: Physician –> Patient

Countertransference from therapists can interfere with the therapeutic relationship between the patient and physician.

Psyche projection between patients and physicians; Credit Source: Needpix

What are the different types of transference in the patient and physician relationship?

There are three types of transference in psychoanalytical theory: 1) positive transference, 2) negative transference, and 3) sexualized transference.

Positive Transference:

Positive transference occurs when the patient projects positive feelings onto the therapist. The doctor reminds the patient of a positive important figure or relationship in the patient’s past or childhood. For example, the patient may see her older caring brother in the doctor and opens up more about her troubles. The transference is positive because the patient sees her therapist as trustworthy and caring like her older brother.

Negative Transference:

Negative transference occurs when the patient projects negative feelings onto the therapist. For example, the patient may be angry and often yell at the physician because the patient sees her ex-husband in the doctor.

Sexualized Transference:

Sexualized transference occurs when the patient feels romantically or sexually attracted to his or her therapist doctor.

USMLE Practice Question on Transference and Countertransference for Psychiatry-Psychology

Test your knowledge on transference and countertransference in this USMLE practice question.

Question

A-52-year-old woman is being treated by a male psychiatrist for depression stemming from her recent divorce. Recently, the patient has been coming to her appointments dressed up and wearing expensive perfume. She has also started flirt with the doctor. The patient’s demeanor and appearance had initially reminded the psychiatrist of his aunt. He is uncomfortable with the patients new behavior pattern and tells her so. She becomes very angry and storms out of his office, cancelling all remaining appointments on her way out. which of the following behavior is an example of negative transference ?

A. The doctor seeing the patient as his aunt.
B. The doctor telling the patient he is uncomfortable. 
C. The patient being angry with the doctor.
D. The patient dressing up for appointments.
E. The patient flirting with doctor.

Answer:

The questions asks for negative transference, so anything with countertransference would be wrong. Remember, countertransference occurs when the physician projects feelings of an important figure in his or her personal life onto the patient.

Answers A and B are about the doctor and countertransference. A and B are incorrect.

Answer D and E are positive transferences and are incorrect. This can also be sexualized transference since flirting and dressing up indicate the patient’s possible romantic feelings projected onto the doctor.

Answer C is correct. The patient’s anger at the doctor indicates a negative transference, in which the doctor’s rejection triggers her unconscious projection of her divorced husband’s bad traits onto the doctor. We actually do not know which past important figure the patient is projecting, but her anger at least shows a negative projection.

Works Cited

1. First Aid USMLE 2019. Psychology-Psychiatry Section. Transference.

2. Prasko, J., Diveky, T., et al. Transference and countertransference in cognitive behavioral therapy. https://www.ncbi.nlm.nih.gov/pubmed/21048803

3. Markin, RD., McCarthy, KS., et al. Transference, countertransference, emotional expression, and session quality over the course of supportive expressive therapy: the raters’ perspective. https://www.ncbi.nlm.nih.gov/pubmed/23234493

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