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Transference and countertransference matter because strong feelings can arise in therapy that have little to do with the actual people in the room, and recognising this prevents a clinician misreading the relationship. Transference is when a patient unconsciously redirects feelings, expectations, or patterns from an earlier significant relationship, often a parent, onto the therapist. For example, imagine a patient who reacts to a young therapist with the same defiant anger she once felt toward a strict parent, even though the therapist has done nothing to provoke it. In practice, recognising transference helps a therapist understand a patient's reaction as coming from the past, not from anything happening in the present session.

Transference is a psychodynamic concept, unresolved feelings toward an earlier figure are unconsciously projected onto the therapist, who comes to stand in for that original relationship. Countertransference is the mirror-image process, the therapist's own emotional reaction to the patient, which can arise from the therapist's own history or be evoked by the patient's material. Countertransference is not always a problem: a skilled therapist can use their own emotional reaction as information about how the patient makes others feel. Say a therapist notices herself feeling unusually protective toward a patient, and recognises this reflects the patient's own pattern of eliciting rescue from others. In practice, supervision exists partly to help therapists notice and use countertransference constructively, rather than acting on it unreflectively.

• A patient becomes persistently hostile and suspicious toward a therapist who has done nothing to provoke it. What is this?
• A therapist finds herself feeling helpless and useless in a way that mirrors what the patient describes. Which process is this?
• How does the therapeutic alliance differ from transference?

• Transference, the patient redirects feelings from a past relationship onto the therapist, unlike countertransference, which is the therapist's own emotional reaction to the patient.
• Countertransference, can inform understanding of the patient's relational pattern, rather than being simply a therapist error to eliminate.
• Working alliance, the genuine, present-day collaborative agreement on therapy goals, whereas transference reflects feelings displaced from the past.
• Real relationship, the actual current rapport between patient and therapist, unlike transference or countertransference, both of which originate outside the present interaction.

• Resistance is opposition to the process of therapy rather than a feeling directed at the therapist.
• Positive transference involves idealisation and warmth toward the therapist.
• Countertransference is the therapist's own emotional reaction to the patient.
• The therapeutic alliance is the realistic working partnership.
• Reaction formation is behaving in a way opposite to an unacceptable impulse.

• Name the learning, social or research principle being tested before reading the options.
• Identify the antecedent, behaviour, consequence or cognitive process in the vignette.
• Compare the direction of effect with the nearest competing principle.
• Apply the same rule to a new example to confirm that the answer transfers.