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12.1.1 Definition of Patient Transference
Transference is an unconscious way patients relate to the genetic counselor based
on their own history of relating to others (Djurdjinovic 2009 ; Weil 2010 ).
Transference concerns how the patient perceives the counselor and how the patient
behaves toward the counselor. For instance, patients may project onto the counselor
attitudes, roles, and expectations based on previous encounters with others.
Transference is a patient’s misperception of the counselor that can occur from the
first moment of contact and even in anticipation of the genetic counseling session.
An important aspect of transference is that the patient’s feelings and reactions tend
to be overreactions to the reality of the situation. Because transference often is an
unconscious process, patients are unaware they are experiencing it (Djurdjinovic
2009 ). It’s normal to have transference (e.g., experiencing an immediate attraction
to or dislike of someone for no apparent reason). Upon some reflection, however,
you realize it’s because the individual reminds you of a family member or friend.
Transference tends to be stronger when the counseling relationship is longer,
more in-depth, and/or particularly distressing; and it may involve positive affect
(e.g., feelings of affection or dependency), negative affect (e.g., feelings of hostility
and aggression), or mixed affect (e.g., ambivalence toward those in authority).
Patients may also experience cultural transference, relating to you by transferring
positive or negative feelings from prior experiences with individuals from your cul-
tural group. Indeed “...transference and countertransference always take place
between two or more people who have a culture, ethnic and racial identity, class
status, and the like” (Lewis 2010 p. 215).
Patients who have transference reactions toward you may perceive you in one or
more of five ways (Watkins 1985 ):
- Counselor as an ideal: You are the perfect individual. Patient behaviors may include
excessively complimenting you, and/or agreeing with everything you say. Similarly
aged patients, for instance, may identify with your seemingly perfect life. - Counselor as seer: You have all the right answers. Patient behaviors may include
repeatedly asking you what you would do. Keep in mind, however, that patients
may have cultural values which lead them to place health-care providers in a
position of authority (cf. Cura 2015 ). In such cases, their behaviors may not be
transference but rather a reflection of common attitudes from their culture. - Counselor as nurturer: You are their source of strength. Patient behaviors may
include acting helpless, displaying excessive crying and emotionality, and mak-
ing urgent requests/demands for solutions to their problems. - Counselor as frustrater: You are the spoiler of their experience. Patients may be
excessively defensive, have minimal to no self-disclosure, and inappropriately
blame you for the bad news you communicate (cf. Schema et al. 2015 ). - Counselor as nonentity: You are an inanimate figure with no feelings, unique
perspectives, or needs. Patient behaviors may include topic shifting, talking
12 Genetic Counseling Dynamics: Transference, Countertransference