Transference in Psychiatric Care: A Teen's Journey

Q: Transference in Psychiatric Care: A Teen's Journey

Hello, online friend： I suggest considering a change of physician! It seems that this treatment relationship is bringing about negative emotions instead. <br>Alternatively, you might need to incorporate psychotherapy alongside your treatment; discussing these feelings with your t

Transference

Hello, Doctor: I have been seeing a male physician regularly since the third year of junior high school due to bullying in school and family background issues.
Now I am in the second year of high school and have been diagnosed with depression and anxiety.
I have weekly follow-up appointments to chat with my doctor and discuss my medication.
I have developed a fondness for him because I have been seeing him for a long time, and he has a bit of a sense of humor and is very gentle.
I often look up information about him online, watch videos of his lectures, listen to his favorite songs, and engage in activities he enjoys.
I fantasize daily about him patting my head or shaking my hand.
Even though he is middle-aged, I imagine being his wife.
This has been going on for over six months.
When my family suggested seeing other doctors, I resisted strongly and felt that it would be disloyal to him and that I would be betraying his trust.
Additionally, when the doctor suggested I return for follow-ups every two weeks, I used various excuses to convince him to schedule my appointments weekly instead, as the weekly visits were financially burdensome for my family and caused me guilt.
My self-harm has become more severe, and I have attempted suicide three times in the past six months due to these issues.
Eventually, I had to withdraw from school, putting a lot of pressure on my family.
My depression has not improved, and I worry that my doctor might give up on me, switch my care to another physician, or feel overwhelmed by the pressure I might be causing him.
He has expressed that he feels distressed about my situation and reassured me that he is not a god and that I am also human, asking for a little more time.
However, I feel that I am causing him significant stress and confusion, so I started hiding my condition from my family and doctor.
When I engage in self-harm, I lie and say I haven't done it, refusing to let the doctor see my injuries.
I would like to ask the doctor how to resolve this issue or improve my situation.
Thank you, Doctor!

Yangmao, 10~19 year old female. Ask Date: 2020/12/19

Dr. Wu Enliang reply Psychiatry

Hello, online friend: I suggest considering a change of physician! It seems that this treatment relationship is bringing about negative emotions instead.
Alternatively, you might need to incorporate psychotherapy alongside your treatment; discussing these feelings with your therapist could be an opportunity for change.
Dr.
Wu En-Liang.

Reply Date: 2020/12/19

More Info

Understanding transference in psychiatric care is a complex yet crucial aspect of therapeutic relationships, especially for adolescents dealing with mental health issues such as depression and anxiety. Your experience highlights several key elements of transference, which is the phenomenon where patients project feelings, desires, and expectations onto their therapist based on past relationships and experiences.
In your case, it seems that your long-term relationship with your psychiatrist has fostered a strong emotional connection. This is not uncommon, especially for individuals who have faced trauma, such as bullying or challenging family dynamics. The warmth and humor of your psychiatrist likely contributed to a sense of safety and trust, which is essential for effective therapy. However, this emotional attachment can also lead to complications, such as the fantasies you described about being close to him or fearing abandonment if you were to switch doctors.

Firstly, it’s important to recognize that these feelings are a natural part of the therapeutic process. Many patients develop strong attachments to their therapists, which can be beneficial in building trust and facilitating open communication. However, when these feelings become overwhelming or lead to self-destructive behaviors, as you mentioned with your self-harm and suicidal thoughts, it’s crucial to address them directly.

Here are some strategies that might help you navigate this situation:
1. Open Communication: It’s vital to discuss your feelings with your psychiatrist. While it may feel uncomfortable, sharing your thoughts about your attachment can provide clarity and help your doctor understand your perspective better. This conversation can also help you explore the reasons behind your fantasies and fears, which is an essential part of your therapeutic journey.

2. Setting Boundaries: Understanding the professional boundaries in the therapist-patient relationship is crucial. Your psychiatrist is there to support you, but it’s important to maintain a professional distance to ensure that the focus remains on your healing. Discussing boundaries with your psychiatrist can help you feel more secure in the therapeutic relationship.

3. Coping Strategies: Since you mentioned self-harm and suicidal thoughts, it’s essential to develop healthier coping mechanisms. Work with your psychiatrist to create a safety plan that includes strategies for when you feel overwhelmed. This could involve grounding techniques, journaling, or engaging in activities that bring you joy or relaxation.

4. Family Involvement: While you may feel reluctant to involve your family, having their support can be beneficial. Consider discussing your situation with a trusted family member who can help advocate for your needs and provide additional support. This can also alleviate some of the pressure you feel about your treatment.

5. Therapeutic Alternatives: If you feel that your current treatment approach isn’t working, it’s okay to explore other options. This could include group therapy, where you can connect with peers who share similar experiences, or even seeking a second opinion from another mental health professional.
6. Mindfulness and Self-Compassion: Practicing mindfulness can help you stay grounded in the present moment and reduce anxiety about your relationship with your psychiatrist. Additionally, cultivating self-compassion can help you be kinder to yourself during difficult times, reducing feelings of guilt or shame about your struggles.

7. Regular Check-ins: Establish a routine for discussing your progress and feelings with your psychiatrist. Regularly checking in about your emotional state can help you feel more in control and less anxious about your treatment.

In conclusion, navigating transference in therapy is a delicate process, especially for adolescents facing mental health challenges. By fostering open communication, setting boundaries, and developing healthy coping strategies, you can work towards a more balanced therapeutic relationship. Remember, your psychiatrist is there to help you, and addressing these feelings directly can lead to a deeper understanding of yourself and your healing journey.

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