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Work-related stress
Published in Janet Thomas, Understanding and Supporting Professional Carers, 2021
In order for projection to take place a recipient must be available. In the above example, the manager may have perceived antipathy from the counsellors and she might then have felt incompetent at her job, in which case transference of negative emotion has taken place. If her confidence had remained unaffected by the counsellors’ negative behaviour, she would have resisted the transference. In the case of Kirsty (see page 13) the counsellor values the client’s emotional needs, thus imparting a sense of worth to the client. Counsellors and other carers may unconsciously pick up anxiety from their clients. Clients and carers may be able to gain a sense of calm from a counsellor or manager who is able to keep their head in a crisis. These are all examples of transference.
“Problem Patients”
Published in Paul Ian Steinberg, Psychoanalysis in Medicine, 2020
Physicians are rarely trained to do psychotherapy involving transference interpretations, but by realizing that the patient’s exaggerated reaction to some aspect of his relationship with his doctor (or other healthcare provider) is based on earlier relationships, the physician knows not to react personally (for example, by behaving in an angry or defensive manner). Rather, the physician should treat the reaction as he would a physical symptom: accept it as part of the patient, and as worthy of interest. For example, if the patient expects the physician to be available to listen to him for as long as he wants, whenever he wants, the latter might enquire what the patient hopes would occur if this could happen. The main point is to try to understand what the patient is expressing, either in words or by his behavior. Both rejecting the troublesome patient and trying to make him happy by complying with him are equally futile. The real question is, what makes the patient so troublesome, and what is he searching for in his relationship with the physician? This is an important part of what is explored in psychoanalytic psychotherapy. That is, we do not need to either refuse or agree with the patient’s request of us, if it seems beyond what is reasonable. We can be interested in it, try to interest the patient in it, and explore it with him. Not all patients will cooperate with this, but some will, and we will know we have provided an opportunity for the patient to learn something in our relationship with him.
Stories from a special care baby unit
Published in Anne McFadyen, Special care babies and their developing relationships, 2019
Language is a tool with many limitations but it is also a medium which offers possibilities. These possibilities for 'learning' about the many ways in which the world is experienced, or indeed the unique way in which the world is experienced by each of us, are more likely to be realised if we desist from classifying and coding what we hear. Of course, we will always classify what we hear to some extent. Part of the process of empathising probably involves classification, in that we match experience heard about to a story from our own lives and then experience our own feelings about it. We do this unconsciously. Our unconscious feeling state is also influenced by projections we receive from the story teller. Empathy involves the process of 'transference', as well as that of classification and matching. Projective identification, a kind of communication that is not dependent on or constrained by language, plays a central role.
Appreciating the Role of the Unconscious in Situations of Patient Ambivalence
Published in The American Journal of Bioethics, 2022
Michael James Redinger, Razvan Popescu
The clinical ethics literature has a small, yet nuanced, appreciation for the need for clinical ethicists to have a basic understanding of the tools of modern psychology which are grounded, in part, in psychodynamic theory and inform effective interpersonal communication. Shelton, Geppert, and Jankowski argue convincingly that clinical ethicists must be trained in the interpersonal skills which explicitly enable clinical ethicists to engage the emotionally-laden aspects of complex cases and at least one tool to assess quality in ethical consultation highly emphasizes the need for competent and reliable interpersonal skills (Shelton, Geppert, and Jankowski 2016; Wasson et al. 2016). George Agich notes that individual psychological dynamics manifesting in the form of unconscious defense mechanisms in the patient or surrogate and embedded in family dysfunction often limit the individual’s ability to engage in conscious ethical reflection (Agich 2011). Noorani and Dyer helpfully advise clinicians on how to respond to negative patient transference occurring outside of mental health treatment settings in order to avoid its detrimental impact and, finally, Redinger and Gibb suggest that clinical ethics consultants are well served by an ability to recognize how unconscious transference/counter-transference reactions can interrupt decision-making by patients and surrogates and impact the consultant’s own emotions (Noorani and Dyer 2017; Redinger and Gibb 2020).
Identifying existential concerns as an analytical tool: an eye-opener for the doctor
Published in Education for Primary Care, 2020
Jan-Helge Larsen, Helle Therese Kirkegaard, Gunnar Nordgren, Joanna Ahlkvist
During consultations, doctors are subject to emotional transference from patients. Many emotions are negative and pertain to worry about disease, death, powerlessness, fatigue, irritation, pain, anger and loneliness. Potent emotions originate from patients’ encounters with their own existential concerns [3], especially when these concerns conflict with patients’ needs and aspirations (See the story about Peter’s knee below). When a patient is given an opportunity to present both symptoms and the thoughts and feelings that are triggered then the doctor may be able to identify and verbalise the patient’s existential concerns [17]. This relieves the patient and makes them feel less lonely whilst enhancing the doctor’s understanding of the situation. Doctors avoid annoyance, frustration, dissatisfaction and anger, and their helper role will require less energy. For many doctors, helping, comforting and rescuing were the very reasons for becoming a doctor, and helping the patient to share important thoughts and feelings allows the doctor to fulfil their role.
Longing and Fear: The Ambivalence About Having a Relationship in Psychotherapy
Published in American Journal of Clinical Hypnosis, 2019
Transference is the oldest particularization of psychotherapeutic relational factors (e.g., Freud, 1912, 1915). Transference (as process) refers to the transferring of perceptions, interpretations, and feelings from real experiences in the past (in the imperfect form in which they were perceived, processed, and encoded) onto the therapist in the present. Transference (as noun) is a person’s filter of anticipations and expectations of others. Freud believed transference was inevitable in psychotherapy—that individuals regularly live out their unremembered past conflicts with new people in the present. Freud found transference to be an obstacle to a person’s release from old ways of suffering and in response developed techniques and principles for peeling off the memory portion of a patient’s response to the therapist for the patient to observe and learn from (“interpreting” the transference). Transference has been used as a picture window into patients’ pasts and their core relational paradigms. The concept is that patients are “showing” us in real time what they are unable to describe (to us or themselves). They are unable to describe what was originally encoded as unformulated experience (implicit memories) or what was encoded verbally and conceptually but was prohibited from awareness. When the term transference is used, the implication used to be that the person’s read of the therapist was a distortion. Nowadays, it is understood that a patient’s reaction to the therapist is not de facto a distortion. Sometimes it is; sometimes it is not; usually it contains aspects of both.