Tangled in the web: countertransference in the therapy of factitious disorders.
OBJECTIVE
Patients who simulate or actually self-induce illnesses to assume the "sick role" present a number of imposing psychotherapeutic challenges. The purpose of this article is to discuss the countertransferential reactions that are mobilized in therapy with these patients.


METHODS
Literature searches of the MEDLINE and HEALTH databases were performed using the term "factitious disorder." The resulting citations were examined for descriptions of the potential and actual countertransference responses in therapy with such patients. The few citations with relevant material were supplemented with other clinical literature on countertransference as well as observations from cases in which the authors have served as therapists or consultants.


RESULTS
Once the medical dissimulation has been exposed, the most conspicuous difficulty is in persuading the patient to agree to therapy. When therapy does take place, both the patient's overt behaviors, such as actual bodily damage, and his or her underlying emotional issues can mobilize particularly intense reactions in the therapist.


CONCLUSIONS
Recognition and management of the countertransference reactions likely to emerge in therapy with factitious disorder patients are particularly important if the therapy is to be maximally effective.
Feldman
M D
MD
University of Alabama at Birmingham 35294-0018, USA.
Feldman
J M
JM
D003379:Countertransference; D005162:Factitious Disorders / Q000523:psychology / Q000628:therapy*; D006801:Humans; D010342:Patient Acceptance of Health Care; D010817:Physician-Patient Relations; D011613:Psychotherapy; D016728:Self-Injurious Behavior / Q000517:prevention & control / Q000523:psychology; D012803:Sick Role