A 22-year-old woman who has recently lost her father in an automobile accident comes to her psychiatrist for psychotherapy. Over the past 7 months of undergoing therapy, she has had an increasing number of symptoms such as hallucinations, including “seeing her father in the hallway,” that are not attributable to the side effects of her drugs or a part of any other obvious physical diagnosis. This morning when speaking to her physician, she begins sobbing uncontrollably and reaches out to the physician for comfort.

What is the most likely cause of the patient’s symptoms?

The patient is most likely exhibiting the symptoms of grief. It is also important to consider major depression as well.

What differentiates normal from pathologic grief?

What are some possible symptoms of pathologic grief?

With respect to her doctor, what is the patient exhibiting?

The patient is clearly demonstrating transference. Transference occurs when a patient projects feelings about important persons in her life to her physician. In this instance, the patient is seeking the type of comfort a husband, parental figure, or good friend would typically provide. Although a physician should try to comfort his patient, he is obligated to maintain a professional doctor-patient relationship at all times.

If the physician were to treat this particular patient as if she were his daughter, what psychological terms would best describe his actions?

His actions would be demonstrating counter-transference, defined as when the physician projects feelings about important persons in his life onto the patient.

By Rakesh Razdan Ahuja, class of 2010, Yale University School of Medicine; in association with Le TT, Takiar V, eds: First Aid Cases for the USMLE Step 1. New York: McGraw-Hill, 2009.