How much we talk about therapeutic relationshipwe also talk about the emotional experiences and mental representations that the clinician experiences in front of the patient.
This peculiar element of the psychotherapy setting has been conceptualized in different ways within the best-known theoretical-metadoological models: the authors spoke of countertransference (Racker, 1957), projective identification (Ogden, 1982) or interpersonal cycles (Safran, 1984).
Beyond terminology, these constructs share the central idea that part of the internal experience of the therapist in session derives from the patient’s relational patterns and that knowing and modulating this internal experience contributes to determining the quality of the process and the outcome of the treatment, and that this is worth especially when there are personality disorders or serious symptoms of axis I. but what are the factors that can influence the influence emotional responses of the psychotherapist?
Some empirical studies of the last decade have identified typical emotional response patterns of the therapist in the session and then evaluate their relationship with the paintings of pathological personality found in patients.
The results indicated a correlation between personality disorders of the A cluster A and critical/mistreating reactive patterns, between clusters B and emotions of impotence, hostility, detachment and abuse and finally between paintings of the patient’s cluster C and hot emotional and protective patterns of the therapist (Betan et al., 2005).
In a recent Italian survey (Colli et al., 2014) even more detailed data emerged according to whom patients with paranoid or antisocial personality disorder tend to elicit critical or mistreating responses while subjects with borderline personality induce feelings of impotence or hyperciovation in the therapist.
Answers of inadequacy and impotence They were also frequent in the face of subjects with schizoid personality while the hypercress reactions were also induced by patients with obsessive-compulsive personality. Finally, if on the one hand the schizotypical patients correlated with distancing and refusal reactions of their therapist, on the other hand the Bleequate emotions positive were instead significantly associated with subjects with avoidance personality.
Parallel to this vein, other authors (Rossberg et al., 2010) have investigated the relationship between the severity of the patient’s symptoms and countersign emotions, finding a positive association between the entities of symptoms and feelings of inadequacy and refusal lived by the clinician during psychotherapy.
The countertransferal reactions Of confidence, they were also negatively correlating with the gravity of axis psychopathology only. Only recently an interesting investigation (Lingiardi, Tanzilli & Colli, 2015) assessed what report to intervene between all the aforementioned elements by assuming, in particular, that the severity of symptoms The patient can be considered a variable capable of mediating the relationship between psychopathology of the patient’s personality and negative emotional reactions of the therapist.
The authors – taking into consideration a sample of 198 Italian psychotherapists with different methodological approaches – have actually confirmed many of the data of the previous research by finding significant associations between the level of entity of the symptoms and the degree of negative emotional responses of therapists such as: frustration, impotence, inadequacy and above all overwhelming/disorganization.
In addition, clinicians reported intense countertranensferal reactions of apprehension and fear Able to hinder the management of the therapeutic relationship, and these reactions were shared by all professionals, beyond the psychotherapeutic approach of references and regardless of other variables of the therapist (age, gender, level of experience).
The hypothesis that the extent of the symptoms could mediate the relationship between personality disorder Elecated emotions in clinicians was only partially confirmed in clinicians.
While for some disorders (dependent, narcissistic, schizoid, paranoid, antisocial and obsessive-compulsive) the mediation of the symptoms was totally absent, when the patient was suffering from a schizotypical personality disorder, borderline, histrionic and avoidance, the severity of the symptoms was to increase the probability of negative countertrans, even if the symptoms were a role. partial mediation and moderate impact (on average 30%).
The only exception was that of the borderline personality disorder for which the presence of the symptoms seemed to play an important role in its association with the feelings of impotence or overpowering/disorganization of the therapist: in this case, in fact, the seriousness of the symptoms rather than the personality structure that eliced the countertransference (explaining 58- 63% of the total association).
In conclusion, the vein of investigations carried out onAssociation between patient psychopathology (of axis I and axis II) and emotions of the therapist During the treatment he confirmed the presence of a significant correlation between these elements. However, the main limit of these studies was to have evaluated only a linear association model, when – by definition – two subjects in relation influence each other in a mutual way.
Research in the future could include more complex analyzes of the therapeutic relationship where the countertranens of the reactions and the symptoms are considered variables within a very complex and equally fascinating circular system.
Essential bibliographic indications
Betan, E., Heim., Ak, Zittel Coklin, C., & Western, D. (2005). Countertransference Phenomena and Personality Pathology in Clinical Practice: an empirical investigation. The American Journal of Psychiatry, 162, 890-898.
Colli, A., Tanzilli, A., of Maggio G., & Lingiardi, V. (2014). Patient Personality and Therapist Response: an empirical investigation. The American Journal of Psychiatry, 171, 102-108.
Lingiardi, V., Tanzilli A., & Colli, A. (2015). Does the Severity of Psychopathological Syptoms Mediate The Relationship Bethaeen Patient Personality and Therapist Response? Psychotherapy, 52 (2), 228-237.
Rossberg, Ji, Karterrud, S., Pedersen, G., & Friis, S. (2010). Psychiatric Sympoms and Countertransference feelings: an empirical investigation. Psychiatry Research, 178, 191-195.
