As we were wrapping up our therapy session, I said, “I wanted to let you know that I will be going on vacation for a week at the end of the month. Can we move our usual appointment time slot to the following week?”

She angrily replied, “I hate you” and stormed out of my office.

After overcoming my shock and bewilderment, I called her to process what happened. I had engaged this patient in therapy for about three months. We were working on identifying problematic patterns in her relationships, and we had a set appointment time every other week. When I called her, she apologised for her comment and proceeded to tell me how she believed that, by taking a vacation, I was leaving her and did not care about her.

A lightbulb lit up in my mind. I had unintentionally recreated her fear of being abandoned.

Her reaction to me was an example of transference. It is a patient’s emotional response “transferred” to the provider from a significant person (or persons) from the patient’s life. Transference is an unconscious process and can manifest in various ways, such as anger, jealousy, erotic attraction, parental deference, or mistrust.

If we are not attuned to the existence of transference, we could react in a detrimental manner such as rejecting the patient and not wanting to provide further care, being complicit in reinforcing their maladaptive relationship patterns, or blurring boundaries.

These emotional responses can occur with all doctors. Being observant about transference can help avoid overreacting or inappropriately reacting to our patients.

Competing interests: I have read and understood BMJ policy on declaration of interests and declare that I have no competing interests.

Kaustubh G Joshi, associate professor of clinical psychiatry

University of South Carolina School of Medicine, Department of Neuropsychiatry and Behavioral Science, Columbia, South Carolina, USA

[email protected]