Academic journal article American Journal of Psychotherapy

Transference in Patients and Caregivers

Academic journal article American Journal of Psychotherapy

Transference in Patients and Caregivers

Article excerpt

Transference occurs in many relationships and personal interactions as well as in the therapeutic setting. Caregiving is a dynamic role. Transference issues arise from a highly interactive and complex relationship. Our patients and families communicate with us constantly if we remain open to the messages. The role of the immediate caregiver is vital to the well being of the patient. Understanding the complexities of the interaction helps us to understand the dynamics of the caring relationship. Presented in this paper are examples of the varied forms of transference issues that arise in a caregiving relationship. Improved communication-to identify and address these issues-helps to meet therapeutic goals by optimizing the health care partnering.

KEYWORDS: caregiving; transference; caregivers; dynamics of caring


Caregiver versus caretaker versus care partner. Even the names we give to those who care for others are fraught with significance. Whatever we call "caregivers", they are subject to transference, which occurs automatically. At one time we believed that transference only occurred in the psychoanalytical setting, but now we realize transference occurs all the time in relationships. (Adshead, 1998; Günther, 1994; Padrone, 1994). Sigmund Freud discovered transference and Melanie Klein extended it. Dr. Klein believed that transference could occur even in young children, whereas Sigmund and Anna Freud denied that such displacement of feelings were possible in the very young (Klein, 1932; Freud, 1895). Other psychiatrists, for example, Bird in a classic paper published in the 1950s, recognized that transference is a universal phenomenon (Segal, 1973). It is important to consider transference in patient-caregiver interactions because analysis of the process can benefit all those involved (Abetz, 2009; Epstein-Lubow, 2009; Buschenfeld, 2009). Transference occurs both ways: the caregiver has transference to the patient and his family, and the patient has transference to his caregivers (Alesii, 2005; Kreutzer, 2009; Lo, 2009).


Mr. X. was a 75 -year-old man with dementia of Lewy bodies (Hanson, 2009), which had advanced to the stage where he was incontinent of urine, but not feces. He was oriented to self: he knew who he was, but not where he lived or what date it was. He was able to ambulate with difficulty and needed a wheelchair for long distances. Mr. X. had many Parkinsonian features, bradykinesia, rigidity, and tremors. His medications were carbidopa-levodopa (Sinemet®) 25/100mg, three times daily and memantine hydrochloride. (Namenda®) 10mg, twice daily. He needed help with all activities of daily living and so had 24 -hour care with two nurses' aides. He viewed the daytime nurses' aide, Ms. A., as the "bad one" and referred to her as "he". Mr. X. often complained that Ms. A. was maltreating him because he thought she was overly strict and dominating. There was no evidence of abuse that anyone could see. The nighttime aide, Ms. B., he considered "the good one" and often called her by his wife's name.


Mr. X. had negative transference to the daytime aide, Ms. A., and positive transference to the nighttime aide, Ms. B. Ms. A. reminded him of his father who was a strict disciplinarian and with whom he had frequent fights as a child. The fact that he called Ms. A. "he" shows the power of transference that transcends gender (see Berman, 1985). He had positive transference to the nighttime aide Ms. B, who reminded him of his mother and wife, both of whom he adored. This case also illustrates "splitting", a defense in which a patient views one individual as all bad and another as all good. Melanie Klein understood that young children split inner representations of objects into all-good and all-bad caricatures as a defense against a persecuting mother (Klein, 1932). She showed how splitting allowed children to manage aggression and how it was a perfecdy natural process with a potential for pathology (Segal, 1973). …

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