Transferencecountertransference

A clinical interview involves the establishment or renewal of a relationship between two people, who happen to be in specific rotes of a doctor and a patient. While it is a professional encounter, lite doctor needs to be aware that both parties bring other feelings, attitudes and expectations to the consultation.

Doctors continue to be held in higher esteem by the public than any other profession. Doctors are often seen like parents, powerful figures who arc due respect and who can be trusted. This may be used to facilitate treatment by fostering compliance and enhancing confidence. Tranxfrrvm e is the term applied to this unconsciously driven process by which patients develop feelings and attitudes to their doctor which are transferred from important figures in their past: this is normal, and is usually helpful, and occurs without the awareness of either the doctor or the patient.

However, if the patient's early life was unhappv. particularly in relationships w ith parents, this may adversely inlluence the relationship with the doctor. Most often this involves either unmet dependency or mistrust. With the former the impetus is to attempt to break down normal professional boundaries, while with the latter rapport cannot be established and hostility and suspiciousness may permeate the consultation, The doctor requires to recognise w hen abnormal transferences develop and then to slick to the reality of the relationship: occasionally it may he necessary to bring the development of abnormal transference to the patient's conscious awareness so that the feelings can be re-attributed appropriately or. if necessary, to arrange alternative medical help.

Countertransference refers to those feelings that the patient stirs up in the doctor, which can originate in the doctor's own past. Countertransference is important to recognise and resolve il" it repeatedly affects the doctor-patient relationship, or causes personal difficulties for the doctor.

KEY POINTS

• The clinical examination has three phases - history-taung, examination (physical and menial) and explanation. Of these, the last is the most important to the patent

• Good interview skills enhance tfie therapeutic alliance with the patent This may benefit the diagnostic process and the diruca! management

• Some people are naturally better at communicaling than others Cut training will remedy deficiencies in the motivated.

• Personal appearance and demeanour may also influence the patient-doctor relationship

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