333- Reflect transference feelings. For example, “You said you don’t want to discuss
your infertility history because you think it may make me uncomfortable?”
Further discussion might prompt the patient to acknowledge that negative reac-
tions from family members have made her wary of talking about it with anyone.
You could then assure her you can handle whatever she wishes to disclose. - Interpret transference feelings directly. For example, “Sometimes when people
feel they’ve been sharing too much, they get uncomfortable about their relation-
ship with that person. Do you suppose this is happening here?”
While some authors believe transference (and countertransference) is a part of
every relationship, including the genetic counseling relationship (e.g., Kessler
1992 ; Reeder et al. 2017 ), others believe its occurrence depends more upon the
depth of the relationship that forms and on the interplay of the personalities of the
genetic counselor and patient (Djurdjinovic 2009 ). Regardless of whether transfer-
ence occurs in all relationships, it’s important to keep in mind that not every patient
reaction is transference. Patients may be responding appropriately to the situation
and to you (e.g., feeling annoyed if you’re late to the session, feeling confused if
your presentation of information is too complicated or rushed), and/or behaving in
accordance with their cultural beliefs (e.g., that health-care providers are authori-
ties who will tell them what to do). If, however, you have not made a mistake, cul-
tural differences are not apparent, and the patient’s reaction is greatly exaggerated
(e.g., being furious because you’re a couple of minutes late), transference may be
occurring.
12.1.3 Definition of Counselor Countertransference
Countertransference has been described as the same phenomenon as patient
transference, but in the opposite direction (Cerney 1985 ). Countertransference is
“an inevitable and potentially valuable aspect of clinical interactions...[and it]
refers to conscious and unconscious emotions, fantasies, behaviors, perceptions,
and psychological defenses that the genetic counselor experiences as a response
to any aspect of the genetic counseling situation” (Weil 2010 , p. 176).
Countertransference can include emotional reactions and projections toward
patients that may not be particularly appropriate to the current genetic counseling
relationship (Djurdjinovic 2009 ; Reeder et al. 2017 ; Weil 2010 ). For example,
you might find yourself feeling angry with a patient who took drugs during a
pregnancy when you have struggled with infertility. Or, when a patient who is
around your age tells you she was diagnosed with ovarian cancer, you may find
yourself asking questions because of your own anxiety—“Did you have any
symptoms? How did you find out you had it?” Similar to transference, counter-
transference involves misperceptions (e.g., viewing a patient as too dependent
when he or she is not) and overreactions (e.g., anger over a patient behavior that
most counselors would be able to take in stride).
12.1 Transference and Countertransference