By Muhammad Qasim
The Institute of Psychiatry at Benazir Bhutto Hospital organised a lecture on management of ‘Transference and Counter Transference’ in every day psychiatry to address the important issue in lives of psychiatrists and people suffering from mental illnesses.
Dr. Akmal Makhdum, who worked as a house officer at the Institute of Psychiatry in 1980s and is now a distinguished psychiatrist in the UK, delivered the lecture on the subject. Dr. Makhdum, who is working as chief of psychiatry in specialist services in Suffox Mental Health Authority, UK, delivers a lecture once a year at the Institute of Psychiatry.
Head of Institute of Psychiatry Professor Dr. Fareed Aslam Minhas explained to ‘The News’ that Dr. Makhdum expressed that over a period of three decades there has been a significant departure in psychiatry from the dynamic theories and analytic hypotheses of the mind. This shift is primarily in terms of aetiology and genesis of abnormal mental phenomena. The emphasis is on the organic basis of illnesses thus promoting the idea that both patients and doctors are being pushed by neurochemicals in the brain. Dr Makhdum said that heavy workload and limited time has started the practice to gear up the consultation towards more medication based approach. It leaves little room for the notions of psychodynamics of the symptoms of mental illnesses thus ignoring several important factors including transference and counter transference. The concepts of transference and counter transference were explained by Sigmund Freud as the reflection of infantile, sexual and unconscious tendencies, necessary for discussion and must be resolved for success of therapy. Jungian hypothesis deviated from Freud’s explanation and postulated it as non-erotic and hidden unconscious aspects, which may take a sexual role in narcissistic and autocratic people.
Dr Makhdum explained that both schools of thought however believe that transference is the projection of non-rational energies onto the therapist. “The therapists, if not careful, can be drawn into web of projection too deeply. At one time, they may experience exhilarating feeling of being praised by patients as “the great saviour” and at other times may be condemned as “a total failure” and not good enough. If not resolved, transference can be diffused through extra time, medication and deflection.”
He said that counter transference represents doctor’s own psyche.
The depth of transference may vary from patient to patient, but counter transference remains the product of doctor’s mind. Some times it is represented by various off the cuff marks and unwelcome diagnosis of personality disorder or terms like attention seeking given by psychiatrists to patients and sometimes to colleagues or other staff. Such remarks speak more of the “brander” than the “branded”, he said. He said that psychiatrists, trainees in specialty of psychiatry, nurses, social workers, psychologists and community nurses face these issues in their everyday practice. “It is commonly seen that trainee psychiatrists are ill equipped to tackle transference projected onto them. They should learn to handle such situations, to be able to end a therapeutic relationship and resolve the issue.”
Dr. Makhdum suggested that they should be very sceptical while using the diagnosis of personality disorder, lest it may be the doctor’s own counter transference causing it to happen. Staff of Institute of Psychiatry, psychologists and participants from Military Hospital, Rawalpindi attended the lecture.