Managing Transference and Countertransference - Essay Example

MANAGING TRANSFERENCE AND COUNTERTRANSFERENCE By Location Managing Transference and Countertransference Introduction Within a therapeutic context, transference and countertransference phenomena might occur, making it important to understand them. Understanding them within the nursing context is also important because they can help in influencing the relationship between the nurses and patients (King & O’Brien, 2011). Transference in psychology refers to the aspect where a person redirects the relationships that they had in their childhood to a therapist in the present (Andersen, 2012). Sigmund Freud came up with this term and indicated that it is usually an unconscious process and it mostly tends to be inappropriate in the present as patients tend to exhibit a wished-for relationship with the therapist. Patients tend to take the role of a child while the therapist takes that of a parent where the patients trust the therapist to provide a solution that would make them better. In most cases, a transference relationship occurs between a patient and a therapist where the therapist has the responsibility of developing a treatment plan that the patient trusts (Axelman & Kashami 2009). Countertransference on the other hand, is the response that the therapist elicits based on the transference communication made by the patient unconsciously (Redman, 2009). Countertransference occurs only when there are transference feelings exhibited, which is an essential part of a therapeutic relationship between a therapist and a patient. The importance of countertransference is that it acts as a guide for the expectations that patients have for the relationship developed. Transference and countertransference relationships are essential because they help therapists not to make decisions or react to situations by thinking about them carefully (Jones, P. 2005). With the importance attached to these relationships when it comes to patient care, it is pertinent for these relationships to be managed effectively. Based on this overview, this essay will delve into the managing of transference and countertransference in patient care. Transference is a where a patient tends to project their mental representations of their experiences to the present (Bradley, 2005). Transference only transfers the relationship and not the person, which might influence the behaviour and feelings of the patient in the present. For patients, they apply transference by taking the role of a helpless child when they are ill and might view the therapist as the mother who is to make everything better. A transference relationship allows for the representation of a past experienced relationship to the present that encourages the patient to cope with their current situation. The enactment of the feelings and needs that the patient might have can be communicated through the transference projection by the patient, which a therapist can use. The emotions and behaviour exhibited through a transference relationship might either have a positive or negative influence on the treatment plan (Owens, 2007). However, if the negative aspects do not affect the treatment plan that the therapist has advised then it is not important for a therapist to challenge them. Therefore, the guide in transference relationship and communication is the unconscious expectations that the patients might have and also their perception. In many cases, patients tend to have quite high expectations of such expectations as they pour out their emotions to their therapists (Kalas, 2013). For instance, a patient might tell a therapist that once people get to know her, they leave her and she becomes all alone. The therapist might assure her that he would not abandon her, to which the patient might take to mean something else. In essence, such a scenario helps explain the distortion in terms of understanding that a patient might have about this assurance (Dombeck, 2005). The distortion might come when the patient starts to brag that the therapist fancies her because she could have misinterpreted this statement. However, some reactions by patients cannot be considered as transference especially when a patient becomes agitated because their caregiver arrives late to an appointment. A patient being angry because of the service they should receive is appropriate if the service is inappropriate and this cannot be under the transference umbrella. In instances where a patient might be in search of an intimate relationship with the therapist, it is vital to the therapist to recognize this early and still treat the patient with the utmost respect. A therapist should not discontinue care of the patient because of this, but they should continue with the treatment plan and operate within ethical boundaries. Arguably, there three Factors that Influence the Increase of Transference, which are: Situation-When patients are in situations that make them feel helpless and afraid increases their need to have a protective relationship with the therapist. Setting- When a therapist has to see a patient regularly within a therapeutic setting and the emotional needs of the patient have to be attended to influences transference. Patients tend to cooperate more with their treatment when they feel recognized by therapists while the changing of therapist might hinder their cooperation. Personality-If a patient is ill and afraid they develop a vulnerable personality and the attention of the health care provider is on them, they likely develop transference feelings. In order for a psychiatric team to be able to treat patients, they have to manage the transference relationship without them interpreting the transference emotions explicitly. When the transference emotions of patients are interpreted explicitly, some might feel humiliated or misunderstood in terms of their needs (Gabbard & Horowitz, 2009). When therapists get to this point, the application of dynamic psychotherapy will be critical when attempting to resolve transference. The aim of dynamic psychotherapy is to help a patient to bring out their feelings without necessarily enacting their expectations, which is a more reflective state of mind (Dahl & Hanne, 2012). In order for this relationship to have an impact, the therapist has to first recognize the importance of this relationship to the patient. Therapists may view their interaction with the patient as a routine practice, but they should also consider the impact that their visit might have on the patient. The implication of this is that patients might develop an emotional connection to the therapist and when they decide to leave without informing their patients, this can derail their road to getting better (Sadock, A., Sadock, Kaplan,& Ruiz, 2011). Therapists or health workers have to be reliable because if they are not, then patients are highly likely to become hostile and fail to comply. They should also be courteous to patients because if they are not, then the therapeutic alliance will not be successful. The transference becoming complicated might be as a result of the therapist being unreliable making the treatment ineffective. Patients also feel calmer when therapists keep their appointment times and it also indicates that they are professional. Another way for managing transference is through having professional boundaries exist between a therapist and a patient (Thompson, 2009). Operating within professional boundaries and having structures that are ethical facilitate the treatment to take place. Boundaries can be on the behaviour that a therapist and patient can have by setting limits as to how far each can go (Sharfstein, Dickerson,& Oldham, 2009). As much as situations may arise where a therapist might feel theneed to act more like a friend to the patient than act professionally, they should refrain from this at all times. On the contrary, transference feelings are the ones that pave the way to countertransference, meaning that the latter cannot exist if not the former. Therapists tend to be the recipients of transference feelings and it is important for them to understand the emotions projected towards them (Mengel & Fields, 2007). A therapist might take up the role that the patient associates them to as a product of the past scenarios in the mind of the patients. A therapist or therapist should be able to accept the roles that their patients assign to them as this makes the treatment process to be easy. For instance, if a patient confides in their therapist that they feel that they can trust them with anything, they should accept this and show countertransference. They should unconsciously collude with the projection that the patients have of themin order to help them (Daniels, 2014). When the therapist responds in an angry or rejecting manner to a patient, they heighten the anxiety of patients or their demands. Their demands might lead them to seek the services of another therapist that they might feel would treat them better. Additionally, therapists should also identify the needs of their patients because others might just have an interest in a contact relationship and not cure. In some instances, some patients might be problematic, which they harbour the thought that no treatment plan works for them. They might go to one therapist to another trying to prove to them that other therapists have failed to treat them. The effect that this has on the therapist is that they feel discouraged not to try helping them because others have failed. However, patients might continue with treatment with a therapist that is mature, fair, and empathetic despite them being difficult to deal with. Psychoanalytical therapists are required to use the distortions that the patients bring out as the focus of the treatment. Nonanalytical therapists take the same distortions without interpreting them and understand them for the sake of the treatment plan. If not managed properly, countertransference can attract court cases as this becomes unprofessional misconduct and a malpractice issue as per state licensing boards. Therapists should also act out the roles assigned to them by patients without necessarily understanding them and avoid as much as possible reacting prematurely. They should also not panic when they see that they see that a patient is not responding to treatment by viewing them as exploiting services without them wanting to get better. The immature reaction that a therapist might take would be to discharge the patient based on this assumption. In such instances, a therapist should reflect and be aware of their thoughts and feelings. By reflecting before reacting, they are able to have a grasp of whether the action they are about to take deviates from their professionally required behaviour. Therapists should have the understanding that patients might develop feelings for therapists and that they have to react in a professional manner regardless of this fact. They should know that they can affect their patients and also understand that people have blind spots and should not be judgedby them. In managing countertransference, therapists have to be self-aware of their weaknesses as this is the main key towards them modifying their behavior (Scheick, 2011). When therapists are not self-aware then they risk acting out their repressed emotions and needs in an irresponsible way and can be potentially harmful to patients. In addition, therapists should also be aware of their self-needs and self-dynamics. The failure of being aware of these aspects can lead therapists to exploiting their patients in search of dominance or intimacy. Awareness also requires a therapist be aware of their internal conflicts so that they avoid getting their patients involved in them. Learning to differentiate where transference based reactions or reality based reactions should be applied is essential. Knowing this will manage the relationship and will help in avoiding non-compliance by the patient. Professional therapists should also not blame their patients when they feel that their transference emotions are overpowering them. When they blame their patients they take up the role of prosecutor, which is not helpful in such a relationship. At times, patients might attack therapists by accusing them of being incompetent, which might attract a defensive response from the therapist (Goldstein, 2013). Sadly, such accusations can hit home for some therapists and for those that cannot manage their anger might react in a way that might scare the patient. Other than managing anger, therapists should also manage their sexual feelings when treating trauma patients as a countertransference pattern (Courtois &Ford, 2013). Working with patients that have psychotic states can be stressful to therapists because they have the potential to inflict painful states of mind to those treating them. The stress influenced by them can make therapists be angry, despair and cause confusion, which can in turn cause burn out on the therapists (Jones 2005). In such situations, therapists are advised to reflect, involve a team to help in treating a difficult patient, and seek the services of specialist psychotherapists to help them deal with their countertransference reactions. Undergoing personal therapy can help a therapist to become more aware of their unconscious needs and underlying fears that will influence them to better handle their patients (Driver, Crawford,& Stewart 2013, p. 18). The understanding of transference and countertransference is needful because it can help in improving medical practice in general (Arnd-Caddigan 2006, p. 293). Essentially, when a therapist recognizes the unconscious needs and fears of their patients that can be able to treat them effectively. The therapists will also be able to prevent a situation where they react without taking much thought on the demands of their patients. Therapists also have to manage transference by being reliable, having boundaries, and acknowledging the importance of the transference relationship to the patient (Stein & Wilkinson 2008, p. 138). Failure to apply these elements is likely to make a treatment plan not be successful for patients because they might fail to comply. Moreover, therapists should not focus on interpreting the transference emotions that they show because this influence patients to feel intimidated. As much as patients may exhibit inappropriate behaviour towards their therapists, therapists should be as professional as possible so as to retain them. When therapists are aware of their needs then they are able to interact with their patients better. Managing of transference emotions and countertransference responses can go along way in ensuring that a patients treatment plan is effective and should be understood by all nursing practitioners. Bibliography Andersen, L.L. 2012. Interaction, Transference, and Subjectivity: A Psychoanalytical approach to Fieldwork.Journal of Research Practice. 8 (2), pp. Axelman, M. & Kashami, D.K. 2009. Issues faced by therapists with visible disabilities: The role of transference, anxiety, and the notion of otherness in the therapeautic relationship. P. 32. Bradley, R., Heim, A. K. & Westen, D. 2005. Transference patterns in the psychotherapy of personality disorders: empirical investigation. The British Journal of Psychiatry. 186 (4), pp. 342-349. Courtois, C. A., & Ford, J. D. 2013. Treatment of complex trauma: a sequenced, relationship-based approach. New York, Guilford Press. Pp. 321. Daniels, A. B. 2014. Jungian crime scene analysis: an imaginal investigation. Karnac Books. Dombeck, M. 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