Panda’s Top Tip 🐼
Help the patient to see transference as a normal part of the therapeutic process, and understanding it as a way towards meaningful change.
Key Knowledge
What is Transference?
Transference is an unconscious psychological process where feelings, attitudes, and expectations originally associated with important figures from a person’s past (often parents or early caregivers) are projected onto the therapist or another current figure.
Patients may react to their therapist as if they were a parent, partner, or other significant person, experiencing strong emotions—positive or negative—that may not accurately reflect the therapist’s behaviour.
Transference is a normal and expected part of psychodynamic therapy and can be a powerful tool for understanding and changing maladaptive relational patterns.
Working through transference allows patients to recognize and modify unconscious relational templates, improving emotional regulation and interpersonal functioning.
Transference can provoke discomfort, frustration, or resistance, and may temporarily worsen symptoms or the therapeutic alliance. Patience and skilled handling by the therapist are essential.
Why is Transference Important?
● It reveals unconscious relational patterns and conflicts rooted in early life experiences.
● It provides a live relational context to explore and understand difficulties.
● It is often the gateway to therapeutic change in psychodynamic therapy.
● Recognizing transference helps prevent ruptures in therapy and supports repair.
What Should Patients Do?
● Patients are encouraged to bring feelings about the therapist into sessions, even if these feelings are difficult or uncomfortable.
● Discussing transference openly is a sign of progress, not failure.
● Understanding transference can help patients gain insight into their emotional life and improve relationships outside therapy.
Communication Tips
● Use normalising language, e.g. “It’s very common to feel worse before you feel better in therapy, especially when difficult feelings come up”
● Encourage openness and honesty, e.g. “It sounds like you’re feeling frustrated and maybe a bit let down. That must be hard.”
● Show curiosity
● Allow for silence
● Avoid confrontation
● Frame difficulties as signs of progress, e.g. Bringing these feelings into therapy is a sign of progress, not failure.”
Example Explanation:
“What you’re describing is quite common in psychodynamic therapy. Sometimes, feelings from past relationships – like feeling ignored, judged, or abandoned- can get stirred up and directed at your therapist, even if they’re not doing anything wrong. This is called ‘transference.’ It can feel uncomfortable, and it’s understandable to want to quit when these feelings come up. But working through these emotions with your therapist can be one of the most helpful parts of therapy. It’s a chance to understand where these patterns come from and to find new ways of relating to people. I’d encourage you to talk openly with your therapist about how you’re feeling – even if it’s about them.”
CASC Practice Scenarios
Scenario 1: History Taking
Candidate Instructions
You are working in a community mental health team. Mr. Lucas “Luke” McAllister, a 35-year-old architect, has been attending weekly psychodynamic psychotherapy for four months. He now reports that therapy seems to worsen his mood and is considering quitting. Please explore his experience of psychotherapy so far, and address any role that transference may be playing.
Actor Instructions
You are Luke McAllister. Over the last four months, you have attended weekly psychodynamic therapy sessions. You were motivated to seek therapy after you started to feel low in mood and realised you struggle sometimes to maintain friendships and relationships.
The reason you are here today is that you are on the brink of quitting therapy. Each week after a session, you notice a lingering irritability and a deep sense that the sessions aren’t truly helping. You often leave feeling angry, ignored, or even like a disappointment – especially when your therapist is quiet, doesn’t answer your questions directly, or lets long silences stretch out. You’ve caught yourself thinking: “He’ll give up on me, just like Sarah did,” or, “I should end this before he does.” The feeling is so strong that you almost feel physically sick with the urge to just stop showing up. You haven’t spoken to your therapist about these exact worries – part of you feels embarrassed that you even have them, and you’re not sure they would listen.
This feeling of being abandoned is not new to you. As a child, your father, a successful businessman, was often away on long trips. Though loving when he was around, he was hard to rely on, and you always felt that he could be taken away from you at any moment. Your mother, while physically present, was emotionally distant and critical, rarely offering affection or reassurance. You learned early on to keep people at a distance, and you tend not to share your true feelings with friends or family.
Your relationship with Sarah was the most significant of your life. For two years between the age of 18 and 20 you were deeply in love, but you always held a part of yourself back. You subconsciously expected her to leave. You often tested her commitment by becoming distant or bringing up minor disagreements, almost as if you were trying to see if she’d get frustrated and give up. She always stayed, which both reassured you and made you more anxious. You were planning to eventually propose when, one evening, she simply said she couldn’t do it anymore and walked away. There was no argument, no explanation, just silence. This completely blindsided you and confirmed your deepest fear: that people will always leave, and that it’s better to be the one to end things on your own terms. You have not had another proper relationship at all since Sarah. Now, in therapy, when your therapist’s silence feels like a withdrawal or his neutrality feels like indifference, your mind immediately goes to the shock and pain of Sarah’s departure. You strongly feel the urge to flee therapy.
Open to explanation, you wonder if anyone else has ever become more distressed in therapy, whether these strong reactions are “normal,” and – honestly – if it’s worth persevering. You want practical reassurance: why would talking about things that make you feel worse actually help?
If the interviewer is understanding and curious, you might talk more openly about your urge to “leave first,” the sense of powerlessness, or about replaying conversations in your mind, doubting if you said the right thing. If they rush or seem dismissive, you’ll answer briefly or shut down.
Feedback for Scenario 1
Knowledge & Clinical Skills
A good candidate will:
● Ask about Luke’s emotional reaction after therapy and the nature of the therapy process e.g. (e.g., “What’s it like when your therapist is silent with you?” “Have you noticed patterns in how you feel both during and after sessions?”)
● Elicit Luke’s feelings of being ignored and like he is a disappointment. You identify that Luke ‘expects to be let down’, something that is core to transference – and connect this to past relationships (e.g. “afraid he’ll give up on me, like my ex did; feeling judged, like my mum”)
● Suggest that Luke consider bringing these feelings to his next session
Communication
A good candidate will:
● Explain transference without jargon
● Normalise Luke’s experience and treat his worries as reasonable
● Encourage Luke that these reactions are a sign that important psychological work may actually be happening
● Frame talking about transference with his therapist as part of the therapeutic journey, not confrontation
● Reassure Luke that feeling worse before feeling better is common in deep therapy work
● Clarify Luke’s key goals or hopes for therapy to aid motivation
Example phrases:
“Often, talking about these tough feelings with your therapist can help break old patterns and actually move therapy forward. Would you be willing to discuss some of this next time?”
“It’s tough, but many people find that when they stick with it, things do gradually improve.”
Scenario 1: Example Video
Reviewers
Dr Damir Rafi is a psychiatry speciality registrar in forensics, currently working in London.
Dr Sarah Barber is a Psychiatry Registrar, currently taking time out of clinical work to complete a PhD in psychiatric epidemiology.
Dr Vinitha Soundararajan is a psychiatry specialty registrar in general adult psychiatry and psychotherapy. She is currently working in London.
References and Resources
1. About psychotherapy. Royal College of Psychiatrists. Accessed from https://www.rcpsych.ac.uk/members/your-faculties/medical-psychotherapy/about-psychotherapy on 23/9/25
Disclaimer:
This article is intended for use as a learning resource for doctors training in Psychiatry in the UK. It is not intended for patients. If you are looking for information about mental health conditions, please visit www.rcpsych.ac.uk/mental-health to find readable, user-friendly and evidence-based information on mental health problems, treatments and other topics written by qualified psychiatrists, with help from patients and carers. If you are looking for help for a mental health condition, please visit https://www.mind.org.uk/ for information about where help is available.
The article was written by UK doctors and cross-checked against various published sources (see Reference list). We endeavour to keep information up to date, but it should not be relied on for clinical decision making. Consult local guidelines and senior colleagues whenever you are not sure.