Core issue: transference in the working phase
The client’s statement, “You are just like my mother, always checking on me,” is not primarily about the weekend question. It is an example of
transference—the unconscious redirection of feelings, expectations, or relational patterns from a significant past figure onto the nurse. In a structured therapeutic relationship, this phenomenon most often emerges during the
working phase, when trust has developed enough for deeper, often conflicted material to surface.
Transference is not a treatment failure or a sign that the nurse has done something wrong; it is clinically expected material that can be used therapeutically. The nurse’s task is to recognize the pattern, maintain a consistent professional role, and help the client examine what is being re-enacted. This is the rationale for staying in role and exploring the feeling rather than defending against it, changing the subject, or transferring care.
Watch out! The client has no history of violence and calms within a minute. This is not an emergency or a boundary violation requiring reassignment. Asking a male nurse to take over would reinforce avoidance and communicate that the client’s feelings are dangerous or unacceptable.
Why the other options are incorrect
| Option | Problem |
|---|
| 1. Ask a male nurse to take over | Treats transference as a failure of the nurse’s gender or person, rather than as therapeutic material. It disrupts continuity and avoids the core issue. |
| 2. Stop asking about weekends | Reinforces the client’s belief that his emotional reactions control the session. It also removes a legitimate area of exploration and prevents insight. |
| 3. Tell him the nurse is not his mother and move on | A defensive, reality-correcting response. It shuts down exploration of the transference and misses the opportunity to link past relational patterns to present behavior. |
Therapeutic use of self and the professional relationship
The concept of
therapeutic use of self, articulated by Peplau and still foundational in psychiatric nursing, means the nurse deliberately uses their own responses—including reactions to transference—as part of the therapeutic process. This requires the nurse to remain aware of their own emotional reactions, sometimes called
countertransference, so that they do not act on them impulsively. In this scenario, the nurse might feel accused or frustrated, but the professional response is to stay curious rather than defensive.
The therapeutic relationship consists of a work component and an interpersonal component; transference belongs to the interpersonal component and becomes therapeutic only when it is named and examined within the professional frame. The nurse can respond in a way that acknowledges the feeling without accepting the distortion as fact. For example, the nurse might say, “It sounds like my asking about your weekend brought up strong feelings. Tell me more about what it was like when your mother checked on you.” This keeps the focus on the client’s experience rather than on the nurse’s identity.
Why exploration leads to insight
Exploring the transference helps the client see that his intense reaction to a routine question may be less about the nurse and more about unresolved feelings toward his mother. In recovery from alcohol use disorder, such relational patterns can be closely tied to triggers for use.
Bringing the pattern into awareness gives the client a chance to separate past relationships from present ones, which is a core goal of the working phase. This is consistent with the view that the therapeutic relationship itself is a central mechanism of change, not merely a backdrop for other interventions.
Key point! The correct response is not to avoid the transference or to correct it, but to stay in role and explore it. This preserves the therapeutic frame, models emotional regulation, and turns a potentially disruptive moment into therapeutic material.