Projection and Transference
“The following material is from the
book, The Ethics of Touch, by Cherie Sohnen-Moe and Ben
Benjamin.” Cherie is well published with several textbooks that have
been used in colleges as required reading for more than 8 years.
She provides a tremendous amount of information available at
Projection occurs when a person has a thought or feeling that he or
she isn't comfortable with and then "projects" it onto others, or
considers it the other person's issue. For example, if a practitioner
feels sad, he or she may be experiencing the client's sadness, and ask
about it. When a practitioner is unaware of feeling angry, he or she may
perceive the client as angry, or angry with the practitioner. The
primary danger of projection is that the practitioner may not understand
what the client is truly feeling, and will fail to help him or her in an
appropriate way. Instead, the practitioner tries to help the client with
issues and in ways that the practitioner needs. Keep in mind that
projection mostly occurs on an unconscious level.
Example 1: A practitioner has recently lost a loved
one and has been grieving for several weeks. A client comes in for a
session and isn't as animated as usual. The practitioner makes an
assumption that the client is feeling sad, and begins to offer words of
comfort, such as "Don't worry, everything will be OK," or "It's OK to
feel sad." The practitioner gives the client a reassuring pat on the
shoulder. The client responds by saying, "What do you mean? I feel
fine." The practitioner then says, "It's normal not to want to admit it
when you feel down or sad, but this is a safe environment for you." The
client is perplexed and leaves, wondering, "What was up with that
practitioner?" and feels uncomfortable returning.
Example 2: A practitioner with a great deal of
unresolved anger about a recent relationship sees a client for a
session. Throughout the session, the client makes several requests for a
change in the manner in which the treatment is carried out. After each
request, the practitioner feels uneasy and concludes that the client is
dissatisfied and angry with the practitioner. The practitioner also
feels hurt and uncomfortable after each request and begins to withdraw
and become distant. As a result, the client becomes more demanding, and
feels the practitioner is not present. The treatment ends with the
client feeling dissatisfied with the quality of the practitioner's work
and the practitioner feeling disrespected.
A client seeks treatment believing the practitioner knows best.
Clients defer to the practitioner's judgment because they desire to be
helped by an authority figure that possesses greater knowledge, healing
ability and, therefore, power. Since a power differential exists in any
health care relationship, the client may be inclined to respond to the
practitioner as he or she would other authority figures, and in doing
so, may recreate elements of similar past relationships. This situation
is known as transference, a normal, unconscious phenomenon that appears
during a therapeutic process. Professional helping relationships usually
have a strong transference element in which the parent-child
relationship is unconsciously re-established. In transference,
unresolved needs, feelings and issues from childhood are transferred
onto the helper. Whenever there is a power differential in a
relationship, there is a strong potential for transference and
counter-transference to arise. Transference also may occur in other
relationships in which there is a real or perceived power differential,
such as with a boss, teacher or clergy.
Learning to recognize transference in
yourself and in others is essential for building a successful practice.
Creating and maintaining strong boundaries is essential in working with
clients who are in transference with you. When clients seek out therapy
for specific reasons they are usually looking for an expert to help them
with their issues. They come to believe that we know more about them
than they do themselves. They come looking for answers to their pain
and dysfunctions. They come looking to get the unmet needs of early
childhood attended to without really knowing it. The fact that clients
take their clothes of to some extent creates a vulnerability that is
unique to the massage profession. The power of touch also takes people
to a deeper part of themselves where these unmet needs and repressed
feelings live. It is an unconscious process in all relationships.
The power of touch in stimulating transference hasn't been formally
studied, but anecdotal evidence suggests that touch, especially when
it's intentional and done with care, can create regressive experiences.
Clients frequently disclose personal information, talk about their
emotional problems or demand special treatment. On an unconscious level,
clients often expect practitioners to help them emotionally and in other
areas, as well. These are transference reactions. Practitioners need to
understand and deal with these situations in a gentle, appropriate
manner. In mature adult clients, these feelings will likely be
recognized and not control their behavior; however, in individuals
incapable of handling these feelings, transference may become the
dominant reality and cause frequent disappointment and feelings of
rejection, often followed by anger and withdrawal. Maintaining clear
boundaries is crucial for handling transference and ensuring it does not
negatively impact the therapeutic relationship.
Signs of Transference
- The client frequently asks you personal questions.
- The client calls you at home, knowing that calls should be
placed to your office.
- After only one or two treatments, the client is overly
complimentary of you and your work.
- The client tries to bargain with you for a reduced rate.
- The client regularly requests that you change your schedule to
accommodate his or her schedule.
- The client brings you gifts.
- The client repeatedly invites you to social engagements and
feels rejected when you explain your policy of separating your work
and social life.
- The client asks you to do "a little bit more" at the end of most
treatment sessions and expresses disapproval if you don't comply.
- The client asks you to help him/her solve personal problems.
- The client frequently asks you questions in areas that you've
previously explained aren't within your scope of practice.
- This client often mentions that you remind him/her of someone.
- The client has difficulty maintaining a physical boundary and
attempts to inappropriately hug or touch you at the end of each
- The client has difficulty leaving after the session and tries to
engage you in conversation.
- The client gives you intimate details about his or her personal
The Blending of Transference and Counter-Transference
Together, transference and counter-transference form a potentially
volatile mixture within power differential relationships. Transference
and counter-transference affect the answers to the questions we posed
before: How is the person who holds the power using that power, and how
is the person with less power responding? When both individuals in a
relationship are psychologically mature, there is greater assurance that
they will use or handle power in a healthy way; nevertheless, such
maturity doesn't ensure that transference and counter-transference won't
The practitioner working with psychologically immature clients has a
serious responsibility, because such clients may be unaware of the
transference they bring to the therapeutic relationship. The
practitioner must cultivate his/her own awareness of both transference
and counter-transference and consciously mitigate against their effects.
Individuals more prone to transference include children or adolescents,
needy clients, and clients that have been referred by mental-health
professionals to assist in the processing of psychological issues.
A good goal for practitioners is to minimize the potential for
unconscious "acting out" of power issues in the therapeutic
relationship; nevertheless, the person who holds the power in a
relationship may have difficulty recognizing transference and
counter-transference. Getting supervision on a regular basis gives the
practitioner the opportunity to explore these issues, gain clarity and
learn methods for dealing effectively and ethically within the
Professional Boundaries -
Projection and Transference
Pictures of my old office (a good example of how a treatment room should be set
notice there is a separate reception area to do general business, a changing
area, the table is clean with freshly pressed sheets and there are extra towels
to provide additional covering for modesty and warmth.