Transference and Countertransference

Article excerpt

TOPIC. The utility of transference and countertransference in professional nursing relationships.

PURPOSE. TO provide an introductory text for nurses new to these concepts.

SOURCES. Literature specific to transference and countertransference illustrated by examples related to professional practice.

CONCLUSIONS. Transference and countertransference influence relationships in ways that under certain conditions may be unhelpful to all concerned. Understanding how transference and countertransference manifest themselves has implications for the safe structuring of professional relationships.

Search terms: Countertransference, nursing relationships, transference

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Transference and countertransference manifest themselves in all relationships--therapeutic, personal, and professional. Do the ideas of transference and countertransference have utility for health professionals and their work? Transference and countertransference are evidently complex events and are not easily verifiable. Given the relative dearth of empirical validation for these occurrences, the ideas may seem to have little relevance outside psychoanalytically informed therapies. Nonetheless, the concepts seemingly remain potent.

In addition to a rich psychoanalytic literature (e.g., Banon, Evan-Grenier, & Bond, 2001; Gibault, 2002), references to transference and countertransference are found in current nursing literature (O'Brian, 2001; Winship & Hardy, 1999). Some knowledge of the ideas seems important, given the closeness of many nursing relationships. Understanding the concepts may help in making sense of complex events, even if we never fully understand their meanings.

Before entering into a detailed discussion and review of related literature, it is important to define briefly the terms that form the organizing framework for this discussion.

The unconscious is an area of the mind outside of perception that contains aspects of personalities that are inaccessible to conscious awareness. This expression of our personality, therefore, is beyond conscious control. Unconscious conflicts cannot be studied directly and perhaps are never fully understood. Aspects of unconscious struggles, nevertheless, can be inferred from behaviors. According to Freud's theory, the unconscious is the id: the home of our instincts and impulses and repressed material.

Transference is the technical term used to describe an unconscious transferring of experiences from one interpersonal situation to another. It is concerned with revisiting past relations in existing circumstances. Thoughts and feelings about significant others from one's past are projected onto a therapist (or others) and influence the therapeutic relationship. Transference informs the therapist about unresolved issues and is used to further the development of the relationship and the therapeutic process.

Countertransference refers to a consequence of transference and is complex in that it has different meanings. For example, the term is used to describe not only a direct personal reaction to transference but also the entirety of experiences in response to another person. The term is used when therapists respond to the patient's transference issues with transference issues of their own. One purpose of psychotherapy supervision is for the therapists to receive feedback and guidance to make them aware of unconscious projections and responses to the patient and the patient's transference.

Throughout psychoanalytic literature, transference is viewed as a source of conflict and creativity and can influence life choices, including occupations. A person might repeatedly be drawn to settings, relationships, and people, for better or worse, because of links with previous life events. Consequently, the past and present are indiscriminate. Understanding the concepts of transference and countertransference, therefore, might help nurses understand more dearly the possible genesis of some human behavior and direct the nurse to implement the most effective interventions. …

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