Well, That Could Have Gone Better

Key Question Being Explored in This Insight:

How can self-awareness help physicians manage countertransference and improve their relationships with challenging patients, particularly when countertransference threatens the quality of medical care?

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Institution: University of Chicago

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This video discusses the concept of countertransference in the context of medical care, particularly in the field of internal medicine. Countertransference occurs when a healthcare provider transfers their own feelings and experiences onto a patient, potentially affecting the care provided. This video highlights the importance of self-awareness and mindfulness in recognizing and managing countertransference to ensure quality patient care. Additionally, it emphasizes the need for training programs to educate and support healthcare professionals, especially young doctors, in developing these crucial skills for effective patient interactions.

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1. Definition of countertransference: Countertransference is when a therapist brings experiences or relationships from their own life into their interactions with patients, which can potentially affect the therapeutic relationship.

2. Importance of self-awareness and mindfulness: Practicing self-awareness and mindfulness when interacting with patients allows a provider to monitor their own thoughts and feelings, recognize any countertransference, and ensure that they are not letting external influences impact their care for the patient.

3. Recognizing and managing countertransference: Identifying instances of countertransference, such as reacting to a patient based on past experiences with others, is crucial in providing effective care. By acknowledging and managing these feelings, a provider can focus on the patient's needs and deliver quality healthcare.

4. Challenges in dealing with varying patient personalities: Some patients may present challenges due to their behaviors or personalities, triggering countertransference in healthcare providers. Recognizing these triggers and understanding their origin can help improve interactions and care delivery.

5. Importance of training and education: Teaching healthcare professionals about mindfulness, self-awareness, and the impact of countertransference is essential in supporting them to navigate complex patient interactions effectively. By incorporating these concepts into medical training, providers can enhance their ability to provide optimal care while managing their own emotional responses.

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Some key quotes from the video you :

1. "Countertransference is therefore when the therapist takes experiences or relationships from other places in their world."
2. "A big part of mindfulness for me is recognizing my own countertransference."
3. "I absolutely think that countertransference can be a problem, especially around difficult decision making."
4. "We are who we are because of everything else that goes on in our life, and our patients expect us to be human and bring in common sense and life experiences."
5. "I think mindfulness and acknowledgment of countertransference has certainly helped me as a physician."
6. "It's not the patient who's difficult. It's very much my interaction with the patient that's challenging."
7. "We do need to train doctors in this."
8. "Some people want you to be paternalistic, some people want you to be demanding, some people want you to be a little bit more humorous than maybe you are at baseline."

These quotes highlight the importance of understanding and addressing countertransference in the medical field to provide effective and compassionate care to patients.

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Thanks again, Adam.

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Okay, so it's the 5th of November.

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It's just gone past 5:00 PM in London, we're talking about,

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well, that could have gone better.

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Uh, let's kick off with just a

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quick preface question, really.

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So what is counter transfer

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and then why is it significant in your work?

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So countertransference is a term that I think I kind

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of stole from the, therapy literature or therapy world.

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Um, transference when we talk about psychotherapy

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is when a patient transfers, you know,

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feelings about experiences, opinions,

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from someplace else in their world to their therapist.

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Countertransference is

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therefore when the therapist takes experiences

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or relationships from other places in their world

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and transfers them to the patient.

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Um, that certainly happens in, in my field,

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internal medicine, when I have long-term relationships

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with patients, get to know patients well, work with them,

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on, you know, sometimes very simple,

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but sometimes very difficult issues

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that are important to their health.

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It's probably self-awareness.

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How do you define self-awareness in this con?

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Yes. Uh, self-awareness.

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I think about self-awareness

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and kind of mindful practice very similarly.

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Um, that's the idea that when you are interacting

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with a patient, you're almost also acting

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as a third person in the room, right?

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Monitoring how the, interactions going.

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Um, kind of being mindful of how

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your behavior is affecting the patient

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and affecting, the give

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and take between you and the patient.

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So are you mindful of yourself,

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counter transferring information

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to your patient? I mean, what does that mean?

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Yes. So, so a a big part of, of mindfulness

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for me is recognizing my own countertransference.

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So it's recognizing, boy, am I not only responding

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to the patient in front of me,

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but am I responding to how that person makes me feel

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because of outside experiences?

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Does this patient remind me of someone?

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And so instead of just reacting to the patient

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and the patient's needs

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and what the patient is bringing to our interaction,

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I'm actually pulling, you know, how I related

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to this friend from the past

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or to this relative who makes me a little crazy.

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Um, which is really not fair to the patient.

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If you think about it. Um, you're supposed to be dedicated

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to the care of this individual in front of you,

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and if other things from the rest of your life is,

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is interfering, interfering with that,

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then it's not terribly helpful.

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And does it compromise medical care?

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Can it goes too far and it compromises medical care?

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Sure. I, I absolutely think

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that countertransference can be a problem,

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because some relationships with patients,

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especially around difficult, decision making,

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in my field, general internal medicine,

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often our decision making is

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how are we gonna work up this problem?

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How are we gonna evaluate this complaint?

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Are we going to evaluate this complaint?

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And then once we have a diagnosis, you know,

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how are we gonna treat this?

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Um, what are the side effects of various treatments

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that I'm recommending?

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Or, you know, what are the possible effects

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of not treating this at all?

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Um, and,

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and if I am, considering how

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a friend of mine from 20 years ago would've responded

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to this situation rather than how the patient in front

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of me is responding to this situation, then

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that can really interfere with me doing a good job.

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And so, is the trick to be present, is it to just be,

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and to just close out everything else?

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Can you do that as a doc?

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Yeah. Um, you know,

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I would never advocate that,

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physicians close out everything from the

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outside world, right?

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We are who we are

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because of everything else that goes on in our life,

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and our patients expect us to be human

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and bring in common sense and life experiences.

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Um, but I do think what is critical is that the

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outside world is closed out enough.

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Um, so what's left is a doctor with all of his

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or her experiences, reacting to counseling

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and caring for the patient who sits in front of

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that physician, for who that patient is.

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That's fantastic answer. Okay.

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So can you provide insights out into this approach,

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how it actually improved your patient doctor

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relationship? Yeah.

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Um, so I think mindfulness

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and acknowledgement

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of countertransference has certainly helped

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me as a physician.

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Um, mostly when I'm working with patients who

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I find the interaction somewhat difficult

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or challenging, I wanna be very careful to say,

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you know, that the patient's difficult

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because it's not the patient who's difficult.

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It's very much my interaction

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with the patient who's challenging.

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And so for me it's, it's dissecting what is it

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that's making this interaction hard for me.

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Um, part of it is recognizing that there are just,

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some people because of what they bring to medical care,

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that's hard for me.

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Um, and I think I've done a pretty good job of figuring out,

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you know, which, types of patients push my buttons and

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therefore figure out, you know, how do I deal

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with the person who's very suspicious,

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the person who's very litigious,

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the person who's very anxious.

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Um, the person who's medical literacy maybe is, is very much

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below the average.

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Um, but then, maybe more personal,

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more difficult is for an individual patient.

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Um, is there counter transference going on, right?

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Um, is this a patient whose concerns,

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and whose way of interacting

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with medicine is very much standard, very much normal,

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something I do very well.

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But the problem is, is that I'm thinking

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of somebody else in my life,

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who maybe I had a difficult relationship, maybe I had,

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you know, a somewhat testy relationship with,

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and those are the people for individual patients I need

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to recognize so I can do a good job with that patient.

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So you are a very experienced, doctor.

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Uh, we've worked with each other before.

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That's how experienced you are in terms of young doctors.

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Would you say we need to be embedded

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in this in training program?

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I think we do need to train doctors in this.

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Um, it is very challenging for younger physicians,

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because I think when you're first starting out, you are

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so focused on the medicine that's in front of you, right?

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I wanna make sure that I understand

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what this person's saying, that I am making the right

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decisions, that I'm doing the right thing.

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Um, you're also thinking a lot about how you are coming off

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to the patient, right?

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Um, most of us I think start out saying, you know,

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we have a persona, right?

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That's our bedside manner. That's who we are.

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And that works with, you know, 90% of people

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and that's a great place to start.

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Um, but then you have to be able to, you know, use yourself

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as a tool in a way

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and be able to change that persona so it works

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with other people, right?

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Some people want you to be paternalistic, you know,

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some people want you to be demanding.

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Um, you know, some people want you

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to be a little bit more humorous than maybe

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you are at baseline.

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Um, and so I think the young physician, while they

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absolutely recognize that, mindfulness is important,

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they have so much else going on to make sure

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that they're just practicing good medicine.

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Um, and so I think what we need

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to do a good job in is make sure that, you know,

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we teach people the good medicine.

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Um, we instruct them so they're aware of mindfulness.

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And so when there's enough sort

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of space in their head in the visit that they can begin

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to introduce that and because, and use that.

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And that would make them better doctors, would you say?

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I think it would make them better doctors.

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And, thinking about the arc of a career, right?

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The people at the beginning

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of their careers have some great advantage over the people

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later in their careers.

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Um, they've often just spent, you know, years of immersion

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during their training.

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Um, and they know, you know, the most cutting edge science,

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which may be someone, you know, closer to my age,

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has lost a little bit.

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Um, but then maybe the people

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with more experience are a little bit more comfortable

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with themself in the room and then can use this mindfulness

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and appreciate the transference

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and countertransference

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that's going on in the relationship to do a better job.

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So that, Adam, thank you again for talking to faculty.

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Great. Really appreciate it. Good.

Quick Answers

Exploring Countertransference in Therapy and Medicine

00:00:00 - Countertransference is a term that I think I kind of stole from the, therapy literature or therapy world. transference when we talk about psychotherapy is when a patient transfers, you know, feelings about experiences, opinions, from someplace else in their world to their therapist. Countertransference is therefore when the therapist takes experiences or relationships from other places in their world

00:00:32 - that certainly happens in, my field, internal medicine, when I have long-term relationships with patients, get to know patients well, work with them, on, you know, sometimes very simple, but sometimes very difficult issues that are important to their health. I think about self-awareness and kind of mindful practice very similarly. that's the idea that when you are interacting with a patient, you're almost also acting

00:01:04 - Monitoring how the, interaction's going. kind of being mindful of how your behavior is affecting the patient and affecting, the give and take between you and the patient. A big part of, of mindfulness for me is recognizing my own counter transference. So it's recognizing, boy, am I not only responding

Countertransference and Patient Care Challenges

00:01:35 - but am I responding to how that person makes me feel because of outside experiences? Does this patient remind me of someone? And so instead of just reacting to the patient and the patient's needs and what the patient is bringing to our interaction, I'm actually pulling, you know, how I related to this friend from the past or to this relative who makes me a little crazy. which is really not fair to the patient.

00:02:07 - to the care of this individual in front of you, and if other things from the rest of your life is, is interfering, interfering with that, then it's not terribly helpful. I absolutely think that countertransference can be a problem, because some relationships with patients, especially around difficult, decision making. in my field, general internal medicine,

00:02:38 - how are we gonna work up this problem? How are we gonna evaluate this complaint? Are we going to evaluate this complaint? And then once we have a diagnosis, you know, how are we gonna treat this? what are the side effects of various treatments that I'm recommending? Or, you know, what are the possible effects of not treating this at all? and, and if I am, considering how a friend of mine from 20 years ago would've responded

Navigating Countertransference in Patient Care

00:03:11 - of me is responding to this situation, then that can really interfere with me doing a good job. We are who we are because of everything else that goes on in our life, and our patients expect us to be human and bring in common sense and life experiences. but I do think what is critical is that the outside world is closed out enough. so what's left is a doctor with all of his

00:03:45 - and caring for the patient who sits in front of that physician, for who that patient is. I think mindfulness and acknowledgement of counter transference has certainly helped me as a physician. mostly when I'm working with patients who I find the interaction somewhat difficult or challenging, I wanna be very careful to say,

00:04:15 - because it's not the patient who's difficult. It's very much my interaction with the patient who's challenging. And so for me it's, it's dissecting what is it that's making this interaction hard for me. part of it is recognizing that there are just, some people because of what they bring to medical care, that's hard for me. and I think I've done a pretty good job of figuring out, you know, which, types of patients push my buttons and

Challenges of Recognizing Countertransference in Patient Interactions

00:04:49 - with the person who's very suspicious, the person who's very litigious, the person who's very anxious, the person whose medical literacy maybe is, is very much below the average. but then, maybe more personal, more difficult is for an individual patient. is there counter transference going on, right? is this a patient whose concerns,

00:05:18 - with medicine is very much standard, very much normal, something I do very well. But the problem is, is that I'm thinking of somebody else in my life, who maybe I had a difficult relationship, maybe I had, you know, a somewhat testy relationship with, and those are the people for individual patients I need to recognize. So I can do a good job with that patient. We do need to train doctors in this. it is very challenging for younger physicians,

00:05:55 - so focused on the Medicine that's in front of you, right? I wanna make sure that I understand what this person's saying, that I am making the right decisions, that I'm doing the right thing. you're also thinking a lot about how you are coming off to the patient, right? most of us I think start out saying, you know, we have a persona, right? That's our bedside manner. That's who we are. And that works with, you know, 90% of people

Adapting Persona for Effective Patient Care

00:06:23 - but then you have to be able to, you know, use yourself as a tool in a way and be able to change that persona so it works with other people, right? Some people want you to be paternalistic, you know, some people want you to be demanding. you know, some people want you to be a little bit more humorous than maybe you are at baseline. and so I think the young physician, while they

00:06:57 - they have so much else going on to make sure that they're just practicing good medicine. and so I think what we need to do a good job in is make sure that, you know, we teach people the good medicine. we instruct them so they're aware of mindfulness. And so when there's enough sort of space in their head in the visit, that they can begin to introduce that and because, and use that thinking about the arc of a career, right?

00:07:26 - of their careers have some great advantage over the people later in their careers. they've often just spent, you know, years of immersion during their training. and they know, you know, the most cutting edge science, which may be someone, you know, closer to my age, has lost a little bit. but then maybe the people with more experience are a little bit more comfortable with themself in the room and then can use this mindfulness and appreciate the transference

Understanding and Managing Countertransference in Medicine

00:07:57 - to do a better job.

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