Transference and counter transference is one of most important aspects of treatment between patient and practitioner. In a clinical setting we do not always have the opportunity to have consecutive treatments with the same patient and as a result may not be able to acknowledge or notice these occurrences. It is not often that I have the opportunity to see a patient on a regular basis or even twice for that matter. As a result, it is not possible for me to notice or recognize any transference that the patient my have towards me. At times however, I clearly know the impose counter-transference & boundaries issues which patient and I experience. When my patients are of similar race or age range, I feel a stronger tide towards them.
I feel they could relate to me and me to them during treatments. One case was an older Spanish patient which we had. I had strong counter transference toward this patient. He was older Spanish man, with a baldhead, and limping from a post-stroke. He was very energetic and had very high spirit.
His personality and certain things he would say reminded me off my grandfather. After leaving the treatment room and coming back to give him a treatment he would be singing, which I though, "that's is so typical of my grandfather, always happy." I thought this man was adorable, having gone through so much and yet full of life. I felt very comfortable with him. I definitely felt I had some type of connection with him, I felt more sympathy towards him than other patients. Although, I felt this way towards this patient I did not express or demonstrate it. I kept myself focused and acted in a professional manner.
At the same time of this occurrence there were other things that went on pertaining to transference and counter transference. The Intern and I definitely had some type of strong transference and counter transference going on. There was a clash of personalities between the intern and me. We totally did not get along. I felt uneasy and that she did not want me there in the room with her.
Why? I thought that maybe she felt challenged. I don't know, but I felt I asked the patient questions that she forgot to ask. I also gave her my opinion about treatment principle, which I do not think she appreciated. With my previous interns, I was very much part of the intake and treatment process.
The interns and I would ask questions. If one forgot, the other would ask the rest of the questions. By working together we would acquire a full cover intake. I was trained by my previous interns to being an active part of the process, and expected that this past internship was going to be the same but it was not. This particular intern was very arrogant, thought she was always right, and looked down upon me. She made her feelings clear to me and I really hated working with her.
I noticed she really hated whenever I gave her any suggestions about treatments principle, even when the supervisor would say the same thing she totally would ignore it. The reason she felt this way, I think, was because she was an intern and I am an assistant. There was definitely a superiority complex / power struggle thing going on here. Maybe she felt humiliated by me noticing thing she did not. I certainly did not mean to humiliate her.
I think she should understand, me being an assistant, that I am there to help her. It was not uncommon for her to forget things that I might catch on and let her know. That is what I am supposed to be there for isn't it? In addition to observing, aren't I supposed to assist? I am not saying that I was more knowledgeable than my intern but I was able to catch some mistakes of hers because I of my position as an intern. I'm sort of an outsider looking in on an interviewer and interviewee. I am able to focus on what both are saying instead just listening to the patient. Because of my suggestions to the intern, I definitely felt resentment from her towards me.
It was definitely not a friendly atmosphere or a good energy between us. When the intern treated the post-stroke patient she always performed the same treatments. After more than two months of this treatment, there was never any improvement in the patient but the intern continued with the same protocol. I were the intern, after not seeing any improvements after a couple of months, I would have tried a different protocol such as scalp acupuncture which has been known to be very successful in treating post- stroke patients. There are so many things in acupuncture and herbs that are helpful but she did not want to use them. I felt a stronger connection between the patient and me more than the patient with the intern.
It may be have been because we were both Spanish. He liked the intern, but it was more about getting treatments done. While getting treated by the intern, the patient would discuss his family, his wife, and moving to Florida. Within treatments I developed some type of counter transference and the patient some type of transference.
I always maintain professional behavior and I was more a listener and show sympathy towards him. I felt comfortable until one day saw him in the hall way, I said, "Hi, how are you?" I was in a rush but he kept talking to me, so I was force to listen to him. He told me I looked great so I gave him the same complement back, I told him he was tan. He told me he moved to Florida and that he bought a house. He told me I could stay over when I go down there. I say, "okay" just to be polite.
He gave me his number and he asked me for mine. I thought " I do not want to give you my number, are you crazy?" So I told him I had to go to class, I'll call him when I go to Florida. I totally felt comfortable with him until the moment he ask me for my number, maybe I remind him of someone or maybe by me giving him the extra attention I imply something, in my opinion I stayed very professional. All of sudden I felt uncomfortable, I felt he was invading my privacy, he was crossing the boundary by asking me for my telephone number. But I also felt that I could not tell him that it was inappropriate for me to give him my number. Maybe I felt this way because he reminded me of my grandfather and he might have been hurt if I reject his number, yet I was aware giving him my number was not the right thing to do, so I walked away.
I feel is very important to be aware of the counter-transference, transference and boundaries issues around the treatment area. Knowing how to address these issues to the patient is also very important, this is something I have to work on.