Ever noticed feeling irritated or bored in the presence of a patient?Perhaps you’ve felt particularly enamoured by a patient, or anxious and defensive in the presence of another. A clinician’s emotional response to their patient is termed countertransference. It can take any form—dislike, disgust, attraction—nothing is off limits. Modern conceptualisations suggest countertransference encompasses all the clinician’s feelings and attitudes—conscious and unconscious—towards the patient. Its presence can cause dread in even the most seasoned clinicians. I remember the anxiety, guilt, and intense feelings of inadequacy that accompanied my first experience of intense countertransference towards a patient. I desperately hoped it would disappear as insidiously as it had crept up on me.

As I carried my secret around, I casually questioned colleagues about their experiences of countertransference. Most looked bewildered, others horrified. I knew I couldn’t be the only clinician who had succumbed to the reality-bending experience that is countertransference. If others had experienced it, they were certainly unwilling to share it. A quick and dirty Google search reveals countertransference is a common struggle for many healthcare professionals.

Current literature suggests it is something to be ‘managed’, pushed away lest it interfere with the clinician’s objectivity. But dismissing or ignoring countertransference can at best be counter-therapeutic, at worst harmful. Being vigilant to countertransference can sidestep a myriad of therapeutic pitfalls, including perhaps the most damaging, when the clinician is blindly seduced into re-enacting unhelpful patterns that created the patient’s original wounds. This can happen even during therapies where the focus is on restructuring unhelpful cognitions or supporting behaviour change. I’ve heard clinicians claim “I’m doing cognitive-behavioural therapy. I don’t buy that stuff.” One’s interest in countertransference is not there to be “bought”: it will happen whether you like it or not, and it pays no heed to theoretical orientation.

Michelle Rydon-Grange, clinical psychologist

Betsi Cadwaladr University Health Board (BCUHB), North Wales Forensic Psychiatric Service, Llanfairfechan, UK

[email protected]

Competing interests: I have read and understood the BMJ Group policy on declaration of interests and have no relevant interests to declare.