Transference: What is It and How Does it Work?

Brindusa Vanta, MD, DHMHS
Medical editor

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If you're just tuning in, we're in the middle of a sort of series of essays concerning how psychotherapy works. I started with an essay about the importance of the trusting relationship between therapist and client and followed that up with an overview of four different approaches to therapy techniques: the psychodynamic approach, the cognitive-behavioral approach, the family systems approach, and the humanistic approach. The plan is to write about each approach in more detail over the next four or so essays. Going in order of first appearance in the history of psychotherapy, we're due for an essay on psychodynamic psychotherapy, which is, more or less, the descendent of the form of therapy that Sigmund Freud created over a hundred years ago.

What is Transference?


Transference in psychotherapy occurs when a client projects unconscious feelings about another person onto their therapist. A common example is when a client falls in love with their psychologist. However, the feelings aren’t limited to love. A client may project distrust, anger, or disappointment onto their therapist. These unconscious feelings tend to be ones related to early childhood, such as feelings toward parents. An experienced therapist understands transference, why it happens, and how to use it to explore your feelings and relationship patterns. Transference (and countertransference) affects the therapeutic relationship and treatment outcomes. [1]


Transference is a very fundamental process that human beings are constantly doing for better and for worse. Like most fundamental things you can't help but do, such as being hungry, communicating via body language even when you don't speak, or finding yourself sexually attracted or repulsed by another, it is not at all dangerous in moderation but can create problems when done to excess. More to the point, the act of transference, like these other fundamental human processes, reveals and illuminates our motives and our thoughts that would otherwise remain hidden away from others and often even from ourselves (especially from ourselves, Freud would say). Our acts of transference provide an information-rich window into what we are desiring and what we wish to avoid. What we read into other people reveals our secret prejudices and our unfulfilled wishes. What is particularly wonderful about transference information is that it reveals or illuminates motives that people are often unaware of having or loath to fess up to. Part of Freud's genius was recognizing that transference was something that occurred on a regular basis and that the information about personal motives could be used to promote self-understanding and healing.

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As Dr. Brindusa Vanta, MD, says, “Transference and projection are related concepts, but they refer to different psychological processes. Transference involves unconsciously applying emotions from past relationships to current ones. Projection is the psychological defense mechanism where a person will attribute their own traits or feelings to others. Simply put, transference is a process where you understand and relate to someone based on your past experiences with others.”

The Role of Transference in Therapy

Transference plays a crucial role in therapy, representing the unconscious redirection of a client’s feelings and attitudes toward the therapist. These feelings are based on past experiences, especially early childhood relationships. This phenomenon can manifest in various ways during therapy sessions. 

For example, a client may transfer emotions related to parents, such as hostility or affection, onto the therapist. This process provides valuable insights into the client’s unresolved emotional conflicts and allows the therapist to explore and address underlying issues that may not be apparent or that the client doesn’t report.[2]

In a therapeutic setting, transference creates a unique dynamic that demands careful navigation by the therapist. Acknowledging and understanding transference is essential for fostering a safe, effective therapeutic environment. It requires the therapist to remain empathetic, non-judgmental, and attuned to the client’s emotional experiences. The immediate implications for the therapist-client relationship involve using transference as a tool for insight and growth rather than allowing it to hinder the therapeutic process.

The therapist must guide the client in exploring these transferred feelings, helping them gain awareness and facilitating a deeper understanding of their emotional landscape. Skillful management of transference contributes to the therapeutic alliance, promoting trust and providing a foundation for meaningful exploration and healing.

As Dr. Brindusa Vanta, MD, says, “Transference can be useful in therapy, but it can also cause challenges because it brings distorted perceptions and can create conflicts. Recognizing transference and dealing with it can improve the  interactions with others and receive more results from psychotherapy.'  

A Relationship Illusion

Consider the following illustration. Three circles are arranged so that they are more or less equidistant. Each circle has a pie-shaped wedge cut out of it so that it looks like a pie with a piece missing. These circles are oriented so that the missing wedges face each other. That is the visual description of what is in the image, but that is probably not the first thing you see when you look at the image. The first thing you are likely to see is a single triangle. There is no triangle really there, however. There are just three circles with wedges cut out of them. Your eyes see the circles with wedges, too, but your brain interprets these three independent things into a single instance of a triangle; in doing so, it adds things into the mix that aren't there to organize a familiar pattern.

How is it possible to have such a strong optical illusion of a triangle present in the image when there is no triangle there? Basically, what makes this possible is that people viewing the figure have a lot of prior experience with triangles and "instinctively" or reflexively read the whole figure of the triangle into existence based on features of the image that suggest features of triangles we've known in the past. This processing occurs at an automatic, unconscious level within the brain, which does not require verbal communication; you have no choice but to see the triangle, just as you have no choice not to understand the words on this page (or the sounds in your ear). Optical illusions of this type illustrate what the brain is, which is a pattern-matching and pattern-generating machine. The brain naturally recognizes and interprets patterns in the world around us. When confronted with unfamiliar or vague information, it attempts to impose familiar patterns onto the information in an attempt to make sense of it. This automatic tendency is the basis of optical illusions, and it is part of the basis of paranoia and a whole lot of interesting psychological phenomena, among them transference.

If seeing the triangle is an example of an optical illusion, transference is a kind of relationship illusion. It occurs easily and effortlessly when we first meet someone and try to form an understanding of who they are based on first impressions. It is an unconscious process because it occurs without effort. You only know it has happened when the person you thought you had a handle on goes and does something completely unexpected.

Relationship Schemas

It is not easy to get to know another person. When we first meet people, what we appreciate about them is their surface. By surface, I mean our first impressions of who they are and not just how they look (although that is clearly part of it). A person's depths—for example, how responsible they are, how they treat others, and how they carry themselves when under stress—are not immediately visible or knowable. Deeper appreciations of a person's character are apparent only over time and repeated contacts and opportunities for observing what that person does. In effect, we have to explore and witness each part of the people we form relationships with before we can accurately say that we know them well. Though it is undeniably true that trustworthy knowledge about relationships takes time and exploration to develop, it is also true that many people fail to understand this. Older people who have "been around the block" (e.g., who have been burned and hurt by relationship failures) understand, but young and inexperienced people rarely do, and people in love especially rarely do.

The reason why it is difficult to get to know someone quickly exposes a deep fact about the limits of human knowledge, which is that all human knowledge is fundamentally indirect, based on potentially faulty perception processes, and subject to error. We interpret the world through the lens of our senses; we can't appreciate it directly. I take this position to be a fundamental truth about the nature of reality. However, some people who believe in direct and literal revelation (such as revelation from God) may see this issue differently. Some will view knowledge about God as being directly revealed. Others may believe in God but acknowledge that human understanding of God's revelation may still require interpretation and is subject to human limitations. 

Though we cannot know things directly (at least with regard to other people), we can group things that seem to belong together to form a sort of knowledge cluster, or mental map, or (as psychologists call it) a "schema." Once schemas have formed to organize knowledge about a thing inside someone's mind, those schemas are used as an aid in understanding and interpreting new information that concerns the things each schema is about. Think of schemas as a sort of reference book that sensory input can be compared against. The brain looks for a match between appearances out in the world (the way someone looks, acts, etc.) and what is known about the world in the form of schemas. The brain does this because if a match can be found between something new and something old, all the stored knowledge inside the schema can be applied to the new situation without having to figure it all out again.

Let's make this all more concrete by giving an example. Suppose you get into a fight with someone you know who has a crew cut, and you end up coming to blows. You learn about those blows from the evidence of your senses. You ache, you're bruised, and you feel pain! You learn that this person is likely to be violent, and this knowledge about crew cut-guy's violence potential gets stored in a schema that represents and organizes your knowledge about this person. A week goes by, and there you are, minding your own business, when you happen to glance up and see a crew cut. Your immediate reaction is to get ready for a fight. This sense of urgency goes away quickly, however, when you realize that this new person is not the person you fought with but rather someone else. In this manner, knowledge taken from your senses is compared against your existing relationship schemas to aid you in quickly appreciating whether you are in danger. It's a good thing you have these relationship schemas to organize your knowledge and trigger an alarm because otherwise, you might have again walked into a punch!

People (by definition) form schemas about all manner of things they know something about, including themselves (which you've heard of before, labeled as the "self-concept"), other people they know, and how they get along with those people they know. It is exactly these schemas concerning relationships that get transferred from one person to another in the process of transference. You see that crew cut and brace for a beating (or get ready to give one). It's a different person this time wearing that crew cut, but they were initially close enough in appearance for you to mistake one for the other and treat the new person as though he was the old person.

It's not just crew cuts that can lead us to confuse one person for another, and it's not just violence that we can respond to. Transference is far more general than this simple example. It's transference, for example, when you see someone who reminds you of a former lover, and you get sad for a moment. It's transference when you assume that a doctor is competent because she wears a white coat and carries a stethoscope, when the banker's pin-striped suit leads you to infer wealth and stability, and when the neighbors appear to be richer than they really are because they have a (leased) BMW. 

It's a form of transference when a woman who was abused by her father gets involved romantically with a partner who also abuses her. It's also transference when a confident man (or woman) leads you to trust them and then steals your money or when a politician leads you to believe that they will act one way, causing you to vote for them, and then they proceed to act another way you didn't expect. We respond to characteristics that aren't really there, and what is more remarkable is that we don't tend to notice that we've done it; we do it automatically and without thinking. The illusion is so seamless it appears to have been out there in the world such that anyone else looking would see the same thing. That's not the case, however. Transference is really an interpretation and an illusion that is generated inside the brain as the brain tries to organize the world.

As was the case with the triangle illusion, we try to make sense of the things we are confronted with by matching their appearance to things we've known before. We organize things we see so that they fit the things we already know, and we fill in the blanks that aren't there with the rest of the patterns we know from our schemas. We can set ourselves up for problems when we do this—for instance, by extending trust or intimacy (sexual or otherwise) to people who haven't earned it. In this way, we end up harming ourselves some of the time by failing to appreciate the dangers that are really present. The positive flip side of this equation is that we can also learn to benefit from transference by learning to accurately recognize novel situations as dangerous because they remind us of past dangers.

Identifying Transference: A Guide

Recognizing transference in therapy is crucial for both therapists and clients, as it unveils unconscious patterns of emotions and behaviors and sheds light on unresolved issues from the past. Identifying transference can pave the way for transformative therapeutic experiences.[2]

Some signs and symptoms that you may be experiencing transference while in therapy include:

  • Intense emotional reactions toward the therapist
  • Projecting qualities of significant figures from the past onto the therapist
  • Unexplained shifts in your feelings and attitudes during sessions
  • Strong emotional responses disproportionate to the current situation
  • Difficulty establishing boundaries and a blurred sense of therapist-client roles

Transference doesn’t just happen in therapy—it can occur with friends, family members, romantic partners, co-workers, and beyond. Here are strategies for recognizing transference with non-therapist people:

  • Reflect on recurring emotional reactions toward others, especially strong or unexpected responses.
  • Identify patterns of idealization or devaluation in relationships.
  • Explore any intense emotional reactions that seem disproportionate to the current context.
  • Pay attention to instances where past experiences may be influencing present perceptions.
  • Seek feedback from trusted friends or colleagues about potential patterns in interpersonal dynamics.

Transference as a Therapy Tool

Though transference happens automatically and unconsciously, it is possible to learn to become aware of transference. Becoming aware of transferences is a good thing because it can help you become a more conscious, proactive person. Proactive, aware people are better able than passive, reactive people to influence their lives for the better and to learn from mistakes. They tend to have a better quality of life than passive reactive persons.

There are many ways to become more aware of your own transferences. One way is to write journal or blog entries about what is happening in your life and then read them over, looking for patterns you have that get you into trouble. Another way is to work with a therapist who can help you become aware of what your transference is. The psychoanalytically oriented school of therapy was the first to identify how becoming aware of transference could serve as a tool for personal growth, and they are still the best-trained professionals to help you accomplish this goal.

Did you ever wonder why the therapist and the client aren't looking at each other? The reason is that this "no eye contact" arrangement was thought to promote a transference relationship with the therapist. The therapist limits eye contact and does not offer personal details. This way, the therapist becomes a blank slate onto which the client can project their transferences. In theory, the client's behavior will change as they become more aware of what they are doing. In the real world, this insight is often not enough to create real changes in the client's life. It is helpful, but something more is often needed to get the client to behave differently than they have been. The map is not the territory, but some clients and some therapists can mistake one for the other.

What does this transference-encouraging look like in practice? I'll give you an example from my own life. While on internship early in my career, I had to participate in my own therapy as a client. I had been reprimanded by a supervisor for being late to a meeting before this therapy process started, and I was feeling paranoid about being judged unfairly. Very shortly after I started with my therapist, I found myself feeling that he was judging me, too, and I found myself getting pissed at him. I'm sure he would have picked up on this in short order, but I beat him to it in this instance, telling him, "This therapy relationship is going to work out fine—I hate you already."

I had the advantage of being educated about transference before the above exchange took place, so my ability to be self-aware about it shouldn't be taken as the norm. My anger toward my therapist, however, was classic transference. Another typical scenario is for a client to develop a crush on a therapist, to feel ownership of the therapist's time (feeling jealous when the therapist is unavailable), or to respond to the therapist as though the therapist was acting like a parent used to act (judgmental, for example, or overly permissive) and getting upset or sensitive when opportunities for slights or limit setting occur.

The aware therapist recognizes over-reactions for transference and interprets these back to the client, "I don't think you are a bad person, but you seem to think that is what I think of you. Am I perhaps reminding you of past relationships you've been in where you have felt similarly treated?" The occurrence of transference then becomes an opportunity for the growth of the client's self-awareness. If you can recognize the patterns you are susceptible to falling into, you aren't as much at their mercy anymore.


It's not just clients who are vulnerable to transference. Therapists routinely (if grudgingly) also form transferences with their clients. This is called countertransference.[3]

A typical countertransference might occur when a therapist starts feeling angry with a client who describes doing something similar to something that previously harmed (or would harm) the therapist or someone the therapist cares about. A therapist I'm friendly with recently described a situation where a client was talking about feeling good about not being expected to take care of his elderly parent. The parent preferred the client's brother to provide care, and the client enjoyed the freedom of being the less responsible child. The therapist found herself suddenly angry with her client because she was a "responsible child" with an irresponsible brother, and she felt unfairly burdened with elder care responsibilities. It wasn't exactly fair for her to get angry at her client, and she didn't show it or let the anger feeling interfere with her duties, but she did feel it, and it was there because of countertransference.

Experienced and ethical therapists notice when they are forming countertransferences and handle them appropriately. This means that they take steps to deal with their own issues so they do not impose on their work. If they cannot manage their reaction on their own, they seek out their own therapy or supervision situation where they can get help in dealing with it. If they cannot deal with it, they must then stop working with the triggering client if feasible and recommend another therapist. Therapists should strive to never abandon clients, but this doesn't mean that sometimes everyone isn't better off with a therapist recusing themselves from working with a particular client.[3]

Recognizing countertransference is as hard as recognizing transference. It is ultimately the therapist's responsibility to figure it out, however.


Transference is a truly amazing process, casting light as it does on hidden thoughts, feelings, wishes, and motivations that would otherwise remain hidden and troubling. Freud's recognition and characterization of transference were brilliant in and of itself (although I believe there were writers who recognized the phenomena before he did). Still, the thing that puts his contribution over the top to genius status is his recognition that transference could be used as a therapy tool. The psychoanalytic therapy he pioneered featured analysis of transference as a central element, and generations of psychoanalytically oriented therapists since his time have continued to recognize the importance and centrality of transference to the work of therapy. Awareness of transference is no cure-all. It is really best suited for problems that are relational, such as anger or depression problems. It is not particularly helpful if you are working with a client diagnosed with conditions like schizophrenia or autism. Nevertheless, it is a useful and brilliant tool and technique for all therapists to know about and use appropriately to the benefit of clients. It is a major contribution of the psychodynamic approach to the universe of psychotherapy techniques.

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