Stereotyping and Transference

1. Stereotyping and Transference PBL 28 – Chris Kwan

2. Your Thoughts? Jolly Loves to cook Loves food Fun Molly Weasley (Harry Potter) Baloo (The Jungle Book) Silly Friendly Silly Jolly Friendly Pumba (The Lion King) Hurley (Lost)

3. Your Thoughts? BASTARD! DISGUSTING! PRICK! RUDE! Comic Book Guy (The Simpsons) Fat Bastard (Austin Powers) BRATTY! EVIL! BRATTY! EVIL! LAZY! GLUTTON! Snorlax (Pokemon) Eric Cartman (South Park) Porky Minch (Earthbound/MOTHER)

4. The Point is… • There are many stereotypes of obese people (often reinforced in popular media) • More positive ones: Jolly, loves cooking/food, fun, friendly • More negative ones: Gluttonous, disgusting, lazy, being disagreeable in general (or even villainous!) • Medical: they always have diabetes, cardiovascular disease etc • Not all obese people fit such stereotypes! • It’s not a matter of fitting ‘positive’ stereotypes or ‘negative’ ones • Try not to automatically assume that someone WILL fit in a particular stereotype before you interact with them

5. Stereotypes • Assuming that everyone of one group will fit particular characteristics, based on observation of one or more characteristics • E.g. all blondes are stupid, all lawyers are treacherous, all gays are camp, only Caucasians can be racist etc • Based upon culture • E.g. KFC West Indies Cricket ad: amusing in Australia, flagrantly racist in USA • May be positive (but often negative)

6. Transference • Having an intense emotional response to a person without a rational basis • Transference: patient having these sorts of feelings towards Dr • Likening Dr as a control-freak  won’t comply • Wanting Dr to recommend Tx  subtly persuade Dr to give that Tx • Counter-Transference: Dr having these sorts of feelings towards patient • Assuming patient won’t care  not trying to help • Assuming patient will listen  will try to help

7. Transference (cont.) • Factors that increase transference: • Anxiety about own physical and/or psychological safety • E.g. denial when being told of terminal Dx • Frequent contact with a service or individual • E.g. feeling helpless w/ stroke rehab because you need frequent checks from physiotherapist • Vulnerable personalities (may project own expectations onto the present) • E.g. expecting that all doctors don’t care because the first one you saw acted very cool and indifferent

8. Implications • You can miss out on proper Dx because of attributive bias, OR you only paid selective attention to patient’s problems • Patients with mental illness have many missed Dx because doctors assume that they are crazy/lying all the time  won’t take them seriously • House MD: morbidly obese patient was comatose. Upon waking, patient kept being hassled about diabetes (but he actually had lung cancer)

9. The Therapeutic Relationship • Three elements: • Therapeutic alliance: rational contract between Dr and patient • Transference: patient’s feelings towards Dr • Counter-transference: Dr’s feelings towards patient

10. Difficulties in Relationships

11. Improving the Relationship • Positive transference = placebo effect • Basically try to make consultations more positive: • Expect a good outcome • Encourage patient involvement to enhance understanding and satisfaction • Let patients know that you care • This positive regard should be genuine and not sexualised • Negative reactions can’t always be denied (but try to acknowledge them)

12. Summary • Prior observations tend to alter your expectations • Stereotypes might be based upon real observations but it doesn’t mean that EVERYONE will ALWAYS fit the stereotype (e.g. not all obese people will develop diabetes) • It’s difficult to change your preconceptions but at least acknowledge them to reduce their impact on your consultations

13. References • http://tvtropes.org/pmwiki/pmwiki.php/Main/BigFun • http://tvtropes.org/pmwiki/pmwiki.php/Main/UnfortunateImplications • This week’s lecture notes on Stereotyping and Transference • Germov J. Second Opinion: Introduction to Health Sociology