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Transference Phenomena in the Doctor-Patient Relationship

Transference Common in Doctor Patient Relationship

Transference phenomena is a common phenomenon that occurs between patients and doctors. In a nutshell, the patient projects emotions and feelings associated with past relationships upon the doctor. Doctors also carry the weight of their past relationships and experiences. This leads to counter-transference where the doctor may unconsciously suffer from bias or prejudice toward a particular patient based upon past relationships and experiences.

Past Relationships Can Interfere with Treatment

The past relationships may be complex involving parents, siblings, spouses, romantic interests or the like. These relationships can carry powerful currents into the doctor-patient relationship on both sides. It is very important that the doctor or other medical provider carefully monitor and manage transference. This can be tricky at times since transference can be both positive and negative for the doctor-patient relationship. In fact, transference can be beneficial or even necessary in the treatment of a given patient.

Difficult Balance for Medical Providers

It can be a very difficult balance for medical providers when dealing with patients on a individualized basis. On the one hand, treating all patients exactly the same leads to an assembly line mentality where the individual does not feel recognized or appreciated by the medical provider. On the other hand, greater intimacy with a patient can lead to unhealthy transference.

Faces of Transference Phenomena

There are a number of ways transference manifests in a doctor-patient relationship. Although there are variations and degrees, these may be generically classified as positive, negative and sexualized.

With positive transference, the patient may view the doctor as caring and trustworthy. With negative transference, the patient, indifferent, adversarial and distrustful. Finally, there is sexualized transference where the patient views the relationship as intimate, romantic, and sexual. The patient may have these feelings with knowledge that they are unrealistic and unwise. However, these feelings may evolve into much more intense, eroticized fantasies with the expectation that they will be fulfilled.

When the doctor-patient relationship becomes eroticized by the patient, the patient can suffer harm in the absence of a thoughtful, caring, professional and ethical response. When the doctor reciprocates or even instigates these feelings of the patient, a red line has been crossed from which the patient is unlikely to recover.

Power Dynamics at Play in Doctor-Patient Relationship

Transference is not unique to a medical setting. It can occur in any relationship. However, the power dynamics present in the doctor-patient relationship seem to nurture transference, both good and bad.

The doctor-patient relationship can evoke memories of authority figures in the patient’s early life. These are not always positive and healthy relationships whether the patient is aware of it or not. Bringing these same power dynamics into the doctor-patient setting can predispose a patient to transference which again may be either positive or negative depending upon the nature of the past relationships.

Stirring up these memories can evoke strong emotions often torn between love, hate, fear, longing, dependency, hope and despair to name a few. In cases involving the critically ill or psychologically vulnerable where these feelings may be playing out in the patient’s self-esteem, independence and self-control. This in turn can make the patient very vulnerable to transference, good, bad, and very bad.

Medical Malpractice in Failure to Properly Manage Transference

To be clear, transference is not necessarily bad. Nor is it necessarily medical malpractice. However, it can rise to the level of medical malpractice when the doctor or other medical provider fails to properly manage it. In short, the medical provider should be aware of the risk of transference. This is particularly so with critically ill or psychologically vulnerable patients.

Given the fact that transference is quite common, it should be expected that medical providers will be alert for it and properly manage it when it is present. There the medical provider simply ignores obvious signs of negative or sexualized transference and the patient is harmed, this may arise to malpractice. Where a medical provider reciprocates or encourages eroticized transference it is, by definition, medical malpractice.

In the former where the patient suffers harm as a result of indifference to negative transference, the patient or a loved one should seriously consider contacting a medical malpractice attorney. In the latter, where the medical provider participates in eroticized transference, the patient or a loved one should absolutely contact a medical malpractice attorney.

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