When patients and physicians get mixed up: An investigation and differential description of collusion by means of a case series of supervisions

Introduction

Collusion designates a specific type of transference-countertransference interaction between two or more persons, linked by an unconscious and shared unresolved issue, which they avoid on an intrapsychic level by externalizing it in the interpersonal space.

Objective

To find a way to identify collusion and to delineate it from other transference-countertransference interactions. We conducted this study based on a case series approach.

Methods

The study material consisted of audiotaped clinicians-centered supervisions with oncologists. The case series methodology involved the systematic examination of a purposive sample of supervisions, with the aim to understand how and why they differ from one another with respect to the relational dynamic between the physician and his/her patient.

Results

Four cases/supervisions were selected as they allowed to situate collusion on the spectrum of transference-countertransference interactions. We report on it by describing a countertransference reaction, two transference-countertransference interactions, and a collusion.

Conclusions

The study reveals the challenges and pitfalls of research on collusion. The results allow to confirm the criteria of our working definition of collusion and to delineate collusion from other transference-countertransference interactions, which represents a first step for the empirical investigation of collusion.