Transference and Countertransference
by Lisa Marie Hilz
Transference and countertransference are both normal phenomena that may arise during the course of the therapeutic relationship. Understanding these phenomena in nursing is important because the primary focus of nursing is the nurse-patient relationship (Imura, 1991). This discussion will describe how these phenomena occur, and how they may manifest in the nurse-patient relationship. Furthermore, this discussion will highlight nursing interventions in these situations, in order to provide insight into how nurses can maintain and improve the therapeutic focus and environment. Transference
Transference is the "transference" of past feelings, conflicts, and attitudes into present relationships, situations, and circumstances. According to psychoanalytic theory, transference evolves from unresolved or unsatisfactory childhood experiences in relationships with parents or other important figures (Wilson & Kneisl, 1996). From the behavioral orientation, people may be considered habit-forming in how they relate and interact with others. These habits involve the development of attitudes and preconceived ideas based on the learning and retention of information from past relationships. This may precipitate behavioral and thought patterns in subsequent relationships, even though certain actions and attitudes may be inappropriate for the current interaction (Strayhorn, 1982). As nurses generally have the most consistent and frequent contact with patients as compared with other disciplines, the potential for nurses to be objects of transference is significant. Meanings and Role Casting
Transference, in essence, is the casting of roles (Taylor, 1994). Inappropriate meanings are assigned to the relationship by the patient. For example, Strayhorn (1982) discussed a patient who experienced anxiety around his father as a child. The father was a doctor, critical and impersonal, and generally demanded perfection from his son. As an adult, this patient consistently felt discomfort around male doctors. The more similar in personality a male physician was to his father, the more likely and intense was the transference. A nurse may unknowingly remind the patient of significant figure from their past, although the patient may not be fully aware of this. Also, one individual alone may not always be the object of transference. The patient may assign inappropriate meanings to their relationship with a group of nurses, or the entire unit staff. Nursing Interventions
Nurses need to intervene in cases of transference when it becomes apparent that the patient's therapeutic progress is inhibited due to the effects of the phenomenon. It is important to mention that in some cases transference is positive, positive in the sense that the transferred feelings and attitudes toward the nurse result from past fulfilling experiences and relationships. According to Wilson and Kniesl (1996), the therapeutic relationship is usual able to progress throughout its course in positive transference. However, most transference involves both positive and negative aspects. The negative may heavily outweigh the positive in some situations. For example, a patient may react in a therapeutically antagonistic manner, expressing excessive dependency or angry, bitter, or contemptuous feelings towards a particular nurse or group of staff. Thus, discomfort arises in both parties. The patient may be uncomfortable in expressing these feelings in such a negative manner, and the nurse will usually dislike being the object of such expression. In cases of transference, the relationship does not usually need to be terminated (e.g., assigning another primary nurse to care for the patient), except when the transference poses a serious barrier to therapy or safety. The nurse should work with the patient in sorting out the past from the present, and assist the patient into identifying the transference and reassign a...
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