A 48-year-old man begins psychotherapy due to depression and escalating conflicts with his boss. He makes progress in the therapy sessions and reports feeling less depressed. The patient has also gained insight into how his father was rarely available to him while growing up and recently told his father, "I am angry that you were never there for me." The following week, the psychiatrist unexpectedly cancels a session to attend to an emergency. At the next appointment, the patient says, "I feel as if you are not interested in listening to me, like I am not your priority." Which of the following is the most likely explanation of this patient's attitude toward his psychiatrist?

Question

A 48-year-old man begins psychotherapy due to depression and escalating conflicts with his boss.  He makes progress in the therapy sessions and reports feeling less depressed.  The patient has also gained insight into how his father was rarely available to him while growing up and recently told his father, "I am angry that you were never there for me."  The following week, the psychiatrist unexpectedly cancels a session to attend to an emergency.  At the next appointment, the patient says, "I feel as if you are not interested in listening to me, like I am not your priority."  Which of the following is the most likely explanation of this patient's attitude toward his psychiatrist?

Quizplus · Accepted Answer

Transference is the unconscious shifting of emotions or desires associated with a person from the past to another person in the present. Transference emotions often originate from feelings toward early significant figures, particularly parents. When the psychiatrist cancels the session unexpectedly, the patient's negative childhood experiences with his unavailable father are activated and unconsciously brought into the present with the psychiatrist. Transference can be positive or negative and frequently affects doctor-patient relationships (both psychiatric and nonpsychiatric). Positive transference plays a role in patients trusting their physicians as many patients have a positive expectation that doctors are compassionate caregivers (similar to their parents). Patients who were abused as children sometimes have difficulty seeking care or complying with the care they receive due to negative expectations of being taken advantage of or being harmed by a caregiving figure. (Choice A) In acting out, unconscious feelings or impulses are expressed through actions (eg, if this patient had impulsively broken items in the psychiatrist's office due to rage at his perceived abandonment). (Choice B) In displacement, a person expresses unacceptable feelings intended for one person to a more neutral person or object (eg, if this patient did not express his anger to his father and instead berated the psychiatrist). Because the patient disclosed his anger to his father directly, he would not be using displacement. (Choice C) Projection involves misattributing one's own unacceptable feelings to another person (eg, if the patient were unable to acknowledge his disappointment toward his psychiatrist about canceling and instead perceived his psychiatrist as being upset with him). (Choice D) In reaction formation, uncomfortable feelings are transformed into their opposites (eg, if this patient expressed deep appreciation for the psychiatrist's care rather than acknowledging his disappointment). (Choice E) Regression is a defense mechanism in which an individual returns to an earlier level of functioning to alleviate psychological distress (eg, if the patient sulked and refused to speak rather than maturely discussing his feelings with the psychiatrist). Educational objective: Transference is the unconscious shifting of emotions associated with a significant person from one's past to a person in the present. __________ References: Crossing theoretical lines: the role and effect of transference in nonanalytic psychotherapies. (http://www.ncbi.nlm.nih.gov/pubmed/22962976) How should clinicians respond to transference reactions with cancer patients? (http://www.ncbi.nlm.nih.gov/pubmed/28553900) Transference, transference interpretations, and transference-focused psychotherapies. (http://www.ncbi.nlm.nih.gov/pubmed/22962977)

A 48-Year-Old Man Begins Psychotherapy Due to Depression and Escalating