Abstract

Review Article

Transference and countertransference are linked to placebo-nocebo effects and they are an auxiliary resource of unparalleled value in general medicine: Recommendations for general practitioners

Jose Luis Turabian*

Published: 28 February, 2020 | Volume 4 - Issue 1 | Pages: 001-006

Psychological phenomena of the doctor-patient relationship influence the therapeutic process. Among these phenomena are the transference (the emotions of the patient towards the doctor), and the countertransference (the emotional reactions of the doctor towards the patient). Doctor and patient are within an interactive relationship in a conscious and unconscious way: the patient is influenced by the doctor, and vice versa. Doctor is solely responsible for the control of transference and countertransference, since patients do not have a conscious perception of these phenomena. In general medicine the transference/countertransference have connotations of placebo effect and nocebo. The challenge of the doctor-patient relationship for the doctor is to realize the transference and countertransference phenomena and use them to achieve placebo effects and minimize the nocebo, and also respecting the needs of both parties, so that to improve the quality of clinical practice. Under these conditions, transference and countertransference are auxiliary resources of unparalleled value.

Read Full Article HTML DOI: 10.29328/journal.apmh.1001010 Cite this Article Read Full Article PDF

Keywords:

Communication; Physician patient relations; Psychotherapeutic processes; Transference (Psychology); Countertransference (Psychology); Placebo effect; Nocebo effect

References

  1. Turabian JL. Doctor-Patient Relationship as Dancing a Dance. Journal of Family Medicine. 2018; 1: 1-6.
  2. Turabian JL. Psychology of doctor-patient relationship in general medicine. Arch Community Med Public Health. 2019; 5: 062-068.
  3. Beck RS, Daughtridge R, Sloane PD. Physician-patient communication in the primary care office: a systematic review. J Am Board Fam Pract. 2002; 15: 25-38. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/11841136
  4. Matusitz J, Spear J. Effective doctor-patient communication: an updated examination. Soc Work Public Health. 2014; 29: 252-266. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/24802220
  5. Reyes Ortiz CA, Gheorghiu S, Mulligan T. Forgetting psychological phenomena in the elderly doctor-patient relationship. Colombia Médica. 1998; 29.
  6. Evers AWM, Colloca L, Blease C, Annoni M, Atlas LY, et al. Implications of Placebo and Nocebo Effects for Clinical Practice: Expert Consensus. Psychother Psychosom. 2018; 87: 204-210. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/29895014
  7. Jung CG. The practice of psychotherapy. Essays on the psychology of the transference and other subjects. New York: Bollingen Foundation Inc. 1954.
  8. Adler HM. The Sociophysiology of Caring in the Doctor-patient Relationship. J Gen Intern Med. 2002; 17: 874-881. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/12406360
  9. Strachey J. The Standard Edition of the Complete Psychological Works of Sigmund Freud, Volume XII (1911-1913): The Case of Schreber, Papers on Technique and Other Works. ii-vii. The Hogarth Press and the Institute of Psycho-analysis, London. 1958.
  10. Balint M, Hunt J, Joyce D, Marinker M, Woodcock J. Treatment or diagnosis. A study of repeat prescriptions in general practice. London: Tavistock Publications. 1984.
  11. Turabián Fernández JL, Pérez Franco B. The concept of treatment in familiy medicine: A contextualised and contextual map of a city hardly seen. Aten Primaria .2010; 42: 253-254. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/20207448
  12. Turabian JL. Doctor-Patient Relationship in Pharmacological Treatment: Discontinuation and Adherence. COJ & Res. 2018; 1.
  13. Turabian JL. The placebo effect from the biopsychosocial perspective of general medicine: non-effective interventions that are, in fact, effective. Int J Fam Commun Med. 2019; 3: 16-21.
  14. Cousins N. Anatomy of an illness as perceived by the patient. Reflections on healing and regeneration. New York: W.W. Norton & Company. 1979.
  15. Van Roy K, Vanheule S, Debaere V, Inslegers R, Meganck R, et al. A Lacanian view on Balint group meetings: a qualitative analysis of two case presentations. BMC Family Practice. 2014; 15: 49. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/24655833
  16. Urbina-Méndez R, Hernández-Vargas CI, Hernández-Torres I, Fernández-Ortega MA, Irigoyen-Coria A. Psychodynamic Analysis of Transference and Countertransference in the Formation of Family Physicians in Mexico. Aten Fam. 2015; 22: 58-61.
  17. Turabian JL. Interpretation of the Reasons for Consultation: Manifest and Latent Content. the Initiation of the Diagnostic Process in General Medicine. Archives of Community and Family Medicine. 2019; 2.
  18. Turabian JL. Symptomatic Acts. A Type of Guidance Signs Not to Get Lost in the Forest of the Clinic in General Medicine. Presentation and Conceptualization from Two Cases. J Case Rep Med Spec. 2019; 1-10.
  19. Zinn WM. Transference phenomena in medical practice: being whom the patient needs. Ann Intern Med. 1990; 113: 293-298. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/2375565
  20. Freedman N, Lasky R, Webster J. The ordinary and the extraordinary countertransference. J Am Psychoanal Assoc. 2009; 57: 303-331. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/19516054
  21. McNally PJ, Charlton R, Ratnapalan M, Dambha-Miller H. Empathy, transference and compassion. JR Soc Med. 2019; 112: 420-423. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/31609173
  22. Suárez F. Around the idea of "situation diagnosis". 2006.
  23. Van Marle HJ. The patient rules; the power of transference in the doctor-patient relationship. Ned Tijdschr Geneeskd. 2016; 160: D1219. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/28000579
  24. Goldberg PE. The physician-patient relationship: three psichodinamic Concepts that can be applied to primary care. Arch Fam Med. 2000; 9: 1164-1168. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/11115224
  25. Marcus ER. Transference and countertransference to medication and its implications for ego function. J Am Acad Psychoanal Dyn Psychiatry. 2007; 35: 211-218. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/17650974
  26. Cooper SH. An elusive aspect of the analyst's relationship to transference. Psychoanal Q. 2010; 79: 349-380. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/20496836
  27. Sánchez MA. Thought disorders and psychosomatic diseases. Revista Medicina. 2006; 28: 161-179.
  28. Chen PA, Cheong JH, Jolly E, Hirsh Elhence, Wager TD, et al. Socially transmitted placebo effects. Nat Hum Behav. 2019; 3: 1295-1305. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/31636406
  29. Deligianni C, Mitsikostas DD. Nocebo in Headache Treatment. In: Mitsikostas D., Benedetti F. (eds) Placebos and Nocebos in Headaches. Headache. Springer, Cham. 2019.
  30. Kirsch I. Placebo psychotherapy: synonym or oxymoron? J Clin Psychol. 2005; 61: 791-803.
  31. Luban-Plozza B. Psychological aspects of drugs. Soz Praventivmed. 1980; 25: 56-60.
  32. Balint E, Norell JS. Six minutes for the patient: interactions in general practice consultations. London: Tavistock Publications. 1973.
  33. Nolan T. The placebo effect in general practice. InnovAiT. 2019.
  34. Mitsikostas DD, Deligianni CI. Placebo and Nocebo Effects. In: Mitsikostas D., Paemeleire K. (eds) Pharmacological Management of Headaches. Headache. Springer, Cham. 2016.
  35. Chavarria V, Vian J, Pereira C, Data-Franco J, Fernandes BS, et al. The Placebo and Nocebo Phenomena: Their Clinical Management and Impact on Treatment Outcomes. Clin Ther. 2017; 39: 477-486. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/28237673
  36. Testa M, Rossettini G. Enhance placebo, avoid nocebo: How contextual factors affect physiotherapy outcomes. Man Ther. 2016; 24: 65-74. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/27133031
  37. Turabian JL, Moreno-Ruiz S. The fable of the pine and the palm tree: the two extremes. Strategies to maximize the placebo effect and minimize the nocebo effect in primary health care. Ment Health Addict Res. 2016; 1: 44-46.

Figures:

Figure 1

Figure 1

Figure 1

Figure 2

Similar Articles

Recently Viewed

  • Microbiome-Gut-Brain Axis: AI Insights
    Amaan Arif, Prekshi Garg and Prachi Srivastava* Amaan Arif, Prekshi Garg, Prachi Srivastava*. Microbiome-Gut-Brain Axis: AI Insights. Insights Biol Med. 2024: doi: 10.29328/journal.ibm.1001027; 8: 001-010
  • Navigating Diagnostic Dilemmas in Subacute Subdural Hemorrhage: A Case Report
    Alicia Cárdenas García*, Sara García Mateo, María Sol González Bennike, Berta Alonso García, María Teresa Gómez Álvarez, Francisco de Borja Hernández Moreno and Clara Ponce Aceituno Alicia Cárdenas García*, Sara García Mateo, María Sol González Bennike, Berta Alonso García, María Teresa Gómez Álvarez, Francisco de Borja Hernández Moreno, Clara Ponce Aceituno. Navigating Diagnostic Dilemmas in Subacute Subdural Hemorrhage: A Case Report. Arch Case Rep. 2024: doi: 10.29328/journal.acr.1001091; 8: 039-041
  • Endoscopic Endonasal total Removal of a Suprasellar, Preinfundibular Retro Chiasmatic Craniopharyngioma: A Surgical Case Report
    Alessandra Alfieri, Armando Rapanà and Ferdinando Caranci Alessandra Alfieri, Armando Rapanà, Ferdinando Caranci. Endoscopic Endonasal total Removal of a Suprasellar, Preinfundibular Retro Chiasmatic Craniopharyngioma: A Surgical Case Report. Arch Case Rep. 2024: doi: 10.29328/journal.acr.1001090; 8: 036-038
  • Pediatric Dysgerminoma: Unveiling a Rare Ovarian Tumor
    Faten Limaiem*, Khalil Saffar and Ahmed Halouani Faten Limaiem*, Khalil Saffar, Ahmed Halouani. Pediatric Dysgerminoma: Unveiling a Rare Ovarian Tumor. Arch Case Rep. 2024: doi: 10.29328/journal.acr.1001087; 8: 010-013
  • PET TAC and Resting state EEG-fMRI in Evaluation of the Ability to Understand and want in Patients Affected by Dementias with Neuro-psychiatric Disorders and other Mental Disorders
    Mirko Avesani*, Graziella Beghini, Francesco Agnoliucilla Franchi, Camilla Vianello, Assunta Zamparelli, Cristiana Trevisan, Cinzia Scarpa, Nicola Siliprandi, Manuela Camiciaaura Adamiaura Rossiicia Mazzocchi, Maria Antonietta Conforto and L Mirko Avesani*, Graziella Beghini, Francesco Agnoli, Lucilla Franchi, Camilla Vianello, Assunta Zamparelli, Cristiana Trevisan, Cinzia Scarpa, Nicola Siliprandi, Manuela Camicia, Laura Adami, Laura Rossi, Licia Mazzocchi, Maria Antonietta Conforto, L. PET TAC and Resting state EEG-fMRI in Evaluation of the Ability to Understand and want in Patients Affected by Dementias with Neuro-psychiatric Disorders and other Mental Disorders. Arch Case Rep. 2024: doi: 10.29328/journal.acr.1001086; 8: 001-009

Read More

Most Viewed

Read More

Help ?