This article leads on from the last one that I published, in which I wrote about my last doctors meeting and the subjects which arose in it. In this one I’m going to focus on one single issue, which also came out of that meeting, because I think it merits a whole article.
The subject is that of transference– and it’s a mighty tricky one.
I started this article with a personal idea of what this word meant in a psychological/psychoanalytical context, and it’s an idea that I have held in my mind for years, since first learning about it in A-level psychology years ago. However, having done a little bit of checking it seems that my understanding of the concept isn’t entirely accurate, and is actually slightly different from what it traditionally means.
The best definition I could find comes from GoodTherapy website, and it states:
Transference is a psychology term used to describe a phenomenon in which an individual redirects emotions and feelings, often unconsciously, from one person to another. This process may occur in therapy, when a person receiving treatment applies feelings toward—or expectations of—another person onto the therapist and then begins to interact with the therapist as if the therapist were the other individual. Often, the patterns seen in transference will be representative of a relationship from childhood.
Now my understanding of the concept, and how I feel as though I have experienced it, is slightly different. I will use the rest of this article to explain why, and then I will discuss whether or not the phenomenon is harmless or unhelpful, in my current experience of therapy.
So my understanding of the subject of transference has always been that patients often develop quite intense feelings for their doctors, and whilst it seems that traditional explorations of this subject state that the intense feelings are transferred from one person in that patients life (often the mother or father) onto the doctor I do not entirely buy this. I believe that the transference occurs when emotions and feelings are redirected unconsciously, from the intense experience of the mental illness itself, onto the doctor. I believe that this occurs due to the prolonged conversation that the patient will have with the doctor, and often only the doctor, about this experience of the mental illness.
Based off of my own observations, I will attempt to explain this.
The doctor that I have at the moment is, IMO, one of the good ones. He listens, he’s sympathetic and he doesn’t jump automatically to the prescription pad, preferring instead to talk issues through and work out what is at their core. So I have a degree of regard for him because of this. I have also worked with him for ten years now and he consequently knows me very well. However, it’s more than that. He has seen a side of me which very few other people have. Not even close friends or family.
When I go and see him it is the only time when I can be open about my schizophrenia. With everybody else in my life I have to push it down, push it to the back of my head and do my best to, basically, hide it. He is the only person that I discuss these intensely personal issues with and this means a lot because the schizophrenia is still a significant part of my life, so when I go and talk with my doctor I can give it the time I often feel it needs. And this is what’s important. I hold my doctor in high esteem because he is my confidant. He is the one who gives me informed advice and counsel, and for this I have a degree of trust for him which I don’t really have for too many other people.
However the reason that I have these feelings for him, is solely due to the subject of our conversations. I discuss something which is extremely important to me with him and him alone- I therefore transfer the gravity of the subject of our talks onto him.
And I do this because I respect and trust him. I have had terrible doctors over the years and this doesn’t happen with them, I will generally hold them in no regard whatsoever. However when I have a doctor I perceive is worth his or her salt I will transfer a sense of gravity onto them, a sense of worth- and this is because they are the only person with whom I discuss a subject of great personal gravity and worth, and I am trusting them to give me valuable advice over this subject.
So this is what I believe: that the transference occurs when the intensity of the mental illness and all the emotional depth which is connected to it, is transferred onto the doctor it is discussed with.
I am actually planning another article about this subject, because there is a lot more to this concept. However, I will leave that for the next article and explore here whether or not I believe that this occurrence is useful.
So- I have a set of feelings for my doctor which I have for very few other people in my life, and whilst I understand the reasons why this appears to happen, I am a little bit uneasy with it. There are slight problems with holding a doctor in this high esteem.
The problem arises when I analyse further how this often causes me to act in meetings. I value my doctor’s input, and his positive opinion because it reinforces my own, often rather fragile, sense of self worth. I know that I’m strong, and I’m resilient, etc, etc. But it’s still mighty nice to have someone else tell me. So what I tend to find is that I will always try and put a positive spin on matters when I talk to him. I work to articulate matters in a way which is insightful, or constructive- and herein is where the question lies: does this approach facilitate useful or non-useful interactions?
An example. On the day that I went to see him I’d had a bleak morning, and had wondered about the possibility of asking him about antidepressants. I’m really struggling to get up in the morning and this leaves me feeling low when I finally do make it up. However, by the time I’d actually reached the doctors surgery (after a brisk twenty minute walk), I was feeling much better again and basically on top of things. So entered the meeting room in a decent mood and didn’t really see the use in delving back into previous negative feelings. Or more honestly, I didn’t want to delve back into these negative feelings with him.
I think that the issue is that over the years he has told me I’m strong, resilient for x, y, z reason, and subsequently I dislike the idea of him seeing me any other way- and here is the big reveal, the thing I am highly uncomfortable with.
I don’t like the idea of him seeing me as weak. I don’t like appearing defeatist, or fatalistic or negative basically.
It’s not conscious. I’m not so needy that I consciously push down subjects which make me appear weaker- it’s more that by the time I sit down in front of him I’m already feeling better and therefore don’t see the need to delve back into areas which will be painful. I subconsciously decide to talk about other factors, and subjects which are less negative.
However, I’m aware of it now and a part of me is wondering whether this is healthy, whether this is the best way to act within a doctor/patient relationship.
I shouldn’t feel ashamed of the weaker aspects to my personality, to my behavior. This is a fact which is so fundamental I fear that I’m missing it. If I’m ashamed to voice this side of myself in a doctors meeting, which is surely the best and most appropriate time to, then when will I allow myself time to vocalise it? It is surely a highly unsustainable way to face the world- simply pushing all the negative stuff down, refusing to acknowledge its existence.
I shouldn’t embrace the urge to only voice those thoughts which make me seem capable, and push down the opposite when I’m talking to him. Doesn’t this represent me working to keep up an opinion I perceive he has of me- like I’m showing off instead of truly opening up. Am I concerned too much with his positive opinion? Am I too eager for his positive reinforcement? A part of me wants to hurl at the notion that some subconscious part of me craves his approval– I like to think I’m better than that, that I have greater self-respect than that.
Lastly, and perhaps this is the most fundamental point here. If I’m not as open with him about how negative I feel at times, it means he’s not getting the full picture of where I am. If he isn’t aware of how down I feel at times then can he really give the best advice? I think the issue is that I’m tip-toing around the idea of anti-depressants in my mind- the fact that I can hardly admit the idea to myself leads onto the fact that I can’t admit it to my doctor.
So all of the above represents me beating myself up: I shouldn’t push back the weaker parts of me for fear of someone else seeing them, especially not my flipping doctor.
However. There is another side to all of this. Whilst it is clear and apparent that a part of me does gain something from my doctor’s positive reinforcement and affirmation, and despite the fact that it makes the raging feminist inside of me want to hurl, there is another reason that I would prefer to keep the conversation in the positive as much as possible.
In remaining positive I am more likely to pin-point solutions. In remaining positive I am forward-focused and optimistic about my capabilities of overcoming the issues I have, and I also reinforce my own strength by voicing it myself. I’m aware of my own insight and it’s something which gives me pride- I would rather talk within this framework than expend energy vocalising the negatives. All that does is leave me feeling low, and I don’t need to spend any more time feeling low.
Moreover, the fact that I don’t like showing my weakness to my doctor is a matter of pride and there actually is a positive reason for it. I really don’t like the idea of opening up completely, baring all the deepest parts of me to a man whom I only see once every six months. I do think he’s a good doctor and I respect him for that, but I don’t want to show him the most fragile parts of me. I already discuss a subject which is deeply personal, the idea of going deeper still is too scary. I usually don’t feel comfortable doing that- although as I write this I’m wondering whether my reasons for this are entirely sound.
I have always approached doctors meetings in this way. Ever since I perceived, years and years ago whilst being in hospital that it was their good opinion which would provide the key to the doors and grant me my own freedom. I’ve never really opened up to doctors more than I perceived was strictly necessary over my negative symptoms. I prefer to hold them at arms length and the best way to do that is to hold them at arms length in doctor’s meetings; to tow the line, spout all things positive and simply use the time to reinforce my own positive sense of myself. This allows me to hold onto a degree of control in the meeting- which is obviously completely fundamental.
I do wonder though. I wonder about anti-depressants when I’m feeling particularly low, but the insightful part of me knows that those really down moments are actually becoming less and less. They never last too long and generally, honestly, I don’t think that I need them. I think that I truly believe that I can get where I want to be without them- but then another part of me is worried because I thought I could do more than I could before, and then I got unwell again.
I think that ultimately, I have to trust my inner voice. I think that I gain more from keeping these therapeutic encounters in the positive, holding my doctor at arms length somewhat and gaining something from the positive reinforcement that this usually entails. I don’t need to rail against that- it’s natural that I would pursue the policy which reaffirms my own strength and ability. I’m aware now of the fact that I am very good at putting a positive spin on literally anything, and so I must just be mindful of that fact, and if things get bad (worse), suck up my pride and actually vocalise the issue to my doctor.
I will end on the question- does the relationship I have with my doctor mirror that which I have historically had with my parents? This is the traditional understanding of the concept of transference, and a proponent of the theory would state that it likely does, or that it mirrors some significant relationship in my life- they would state that the feelings I have for my doctor are not transferred from the subject of our therapeutic conversations onto him, but from another person onto him. I will explore this idea more fully in the next article.
Thanks for reading 🙂