Countertransference — MRCPsych Paper B MCQ

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ModeratePsychotherapyCountertransferenceMRCPsych Paper B

A trainee repeatedly experiences unexpectedly intense sadness during sessions with a recently bereaved patient who describes the bereavement without visible emotion. In supervision, the trainee considers whether this reaction contains information about the therapeutic relationship. What is the best term for the therapist's emotional response itself, before making any inference about how it arose?

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Correct answer: E — Countertransference

Countertransference is the therapist's emotional response to the patient and the therapeutic interaction. The trainee's unexpectedly intense sadness is therefore countertransference and may provide clinically useful information when explored in supervision. Projective identification is a more specific proposed mechanism in which a patient unconsciously locates or evokes an intolerable affect in another person; it cannot be concluded merely from the therapist experiencing sadness. Transference describes the patient's displacement of feelings and relational expectations onto the therapist. Reaction formation involves expressing an attitude opposite to an unacceptable impulse, while identification involves assimilating characteristics of another person. The question asks for the emotional response itself rather than its possible origin, making countertransference the single best answer.

Reference: Royal College of Psychiatrists. Boundaries, section: “What should I do if I become aware of developing feelings towards a patient?” Accessed 19 August 2026. https://www.rcpsych.ac.uk/members/workforce-wellbeing-hub/psychiatrists-support-service/helpsheets/boundaries