Ans is 'b' i.e. Doctor's feelings towards the patient TransferenceTransference is the phenomenon whereby unconsciously transfer feelings and attitudes from a person or situation in the past on to a person or situation in the present. The process is at least partly inappropriate to the present.Characteristic features of TransferenceTransference is unconsciousIt is at least partly inappropriate to the presentIt is the transferring of a relationship, not a personOnly an aspect of a relationship, not the entire relationship, is transferredPoints to noteThe process of transference is not conscious, and the patient unwittingly projects a needed aspect of a previously experienced or wished-for relationship on to doctor.Because it is a relationship that is "transferred", the patient and doctor are expected to take complementary roles.So a patient who is afraid that he or she is seriously ill may adopt a helpless child-like role and project an omnipotent parent-like quality on to the doctor, who is then expected to provide a solution.Projection and transferenceTransference involves the projection of a mental representation of previous experience on to the present.Other people are treated as though they are playing the complementary role needed for the projected relationship.There are subtle (unconscious) behavioural "nudges" to take on these feelings and behavioursExamples to explain transferenceSuppose a patient is in a session with a therapist and the therapist says something that sets him of and he get way angry at him.He lash back with anger and says things that really have nothing to do with him at all.He has said something that triggers another relationship from the past and that anger from the old relationship gets transferred onto him.Another example is love transference and this is very common in therapyA lady patient go to see therapist and starts having strong feelings about him. He reminds her of someone from the past - her father and now seems to be transferring feelings that she had towards her father on to the therapist and she wants him to meet the needs that she had towards daddy.CountertransferenceDefinitionCountertransference is the response that is elicited in the recipient (therapist) by the other9s (patient9s) unconscious transference communications.Countertransference response includes both feelings and associated thoughts.When transference feeling are not an important part of the therapeutic relationship, there can obviously be no countertransference.CountertransferenceIncludes the feelings evoked in the doctor by the patient's transference projections.These can be a useful guide to the patient's expectations of relationships.They are easier to identify if they are not congruent with the doctor's personality and expectation of his or her role.Awareness of the transference-countertransference relationship allows reflection and thoughtful response rather than unthinking reaction from the doctor.The degree to which the projected role is congruent with some aspect of the personality of the recipient will affect the likelihood of his or her adoptions it.An understanding of transference and countertransference is essential to good practice in psychiatry. Being aware of the hidden agenda in the clinical relationship will help the doctor recognize some of the patients wishes and fears which are not full conscious and which can contribute to conflict or intense dependency. The doctor is then more likely to stand back a little from patients emotional demand and avoid getting caught up in agenda.Mr D was a young man with a long history of unstable relationships, depressive episodes and alcohol misuse attending a day hospital. He was often hostile to his keyworker whom he accused of not caring whether he lived or died. The keyworker was an experienced community psychiatric nurse and was confident that she was neither negligent nor uncaring about her patient. She was aware that Mr D projected a scenario in which he was neglected and at risk, while she was experienced as a callous uncaring parent. Her recognition of this transference allowed her to remain calm and supportive and not to retaliate.<< A role may be congruent with an aspect of the therapist's personality and he or she may unconsciously accept and collude with the projection.Ms E had a long history of repeated treatment episodes for eating disorder, depression and relationship problems. Following a move to university, the university general practitioner referred her to the local psychiatric service for treatment. She confided in the young SHO that he was the first doctor to whom she had been able to talk freely, and that she had told him things she had never told previous doctors. The doctor enjoyed this idealisation and accepted that he had a special relationship with the patient.