Physicians' emotional reactions to patients: recognizing and managing countertransference

Traditionally, physicians have been socialized to repress emotional responses to patients in an effort to maintain clinical objectivity. In this article we call into question that assumption, maintaining that rather than being hindrances such natural responses can be facilitators to the development of stronger physician-patient relationships. We focus on the concept of countertransference, defined here broadly as incompletely recognized emotional reactions a physician has toward a patient or his/her circumstances. In this article we differentiate between internally-focused and externally-focused countertransference. Internally-focused countertransference refers to unrecognized reactions that reflect the unique psychological state of the physician, whereas externally-focused countertransference focuses on the reactions that primarily derive from the behaviors or other characteristics of the specific patient or circumstances. We conclude by presenting a 3-step strategy for recognizing and managing countertransference responses to patients.