Countertransference and therapeutic alliance in the early stage of adult psychodynamic psychotherapy

Abstract

Objectives: The primary objective of this study was to assess the relationship between countertransference (CT) and therapeutic alliance (TA) during the early stages of psychodynamic psychotherapy. A secondary objective is to assess associations between CT and variables related to therapist and patient and between CT and other patient variables investigated, which were defense mechanisms, symptomology and functionality. Methodology: This was a cross-sectional study that enrolled 30 patients treated by 17 different therapists at the psychotherapy clinics of two psychiatry centers. Assessments of each patient-therapist pair were conducted between their fourth and 10th sessions. Results: The CT distance domain exhibited a moderate negative correlation with TA, particularly its sub-dimension representing the patient's capacity for work in therapy. Moderate positive correlations were observed between CT distance and the splitting defense mechanism and between CT closeness and suppression defenses, in addition to moderate negative correlation between CT indifference and the fantasy defense mechanism. Another finding was higher scores for CT indifference in association with socioeconomic classes D and E. Conclusions: The quality of CT may provide a source of information about TA. A high degree of CT distance represents a low level of TA, particularly with relation to the patient's working capacity, although presence of the splitting defense mechanism can affect CT, to the extent that it constitutes a confounding variable. The concept of CT is useful to psychotherapists, providing a source of information about the patient's internal world and about certain elements of therapy, such as the quality of TA, which is important for good treatment results. Keywords:Psychotherapy, psychoanalytic therapy, psychoanalysis, countertransference, therapeutic alliance. ResumoObjetivos: O objetivo principal desta pesquisa foi avaliar a relação entre a contratransferência (CT) e a aliança terapêutica (AT) no início da psicoterapia psicodinâmica. O objetivo secundário é avaliar a associação da CT com as variáveis da dupla e da CT com as demais variáveis do paciente avaliadas, que foram os mecanismos de defesa, sintomatologia e funcionalidade. Metodologia: Trata-se de um estudo transversal com 30 pacientes do ambulatório de psicoterapia de dois serviços de psiquiatria, atendidos por 17 terapeutas. As avaliações ocorreram entre quarto e décimo encontros da dupla. Resultados: A dimensão da CT distância apresentou correlação negativa moderada com a AT, especialmente sua dimensão que representa a capacidade de trabalho em terapia do paciente. Foram verificadas correlações moderadas positivas entre CT distância e cisão e entre CT proximidade e supressão, além da correlação moderada negativa da CT indiferença com fantasia. Outro dado encontrado foi a presença de maiores níveis da CT indiferença diante de pacientes da classe socioeconômica D e E. Conclusões: A qualidade da CT pode servir de fonte de informações sobre a AT. A presença de ...

Associations between clinicians' emotional responses, therapeutic alliance, and patient suicidal ideation

“…The observed associations in the current model are also in line with empirical research on patients with depression, suggesting that perceptions of the therapeutic alliance were mostly predicted by patient pretreatment tendencies but were also influenced by the real relationship with the therapist (Zilcha-Mano, 2014). The possible impact of clinicians' emotional responses on the therapeutic alliance and treatment outcomes is further supported by studies finding that symptom improvement is positively correlated with clinicians' positive emotional responses to their patient and negatively correlated with negative responses (Ligiéro & Gelso, 2002;Machado et al, 2015;Rossberg et al, 2010).…”

Countertransference feelings and personality disorders: a psychometric evaluation of a brief version of the Feeling Word Checklist (FWC-BV)

“…Existing studies also differ in terms of whether TA is patient-rated, therapist-rated or based on both perspectives. To summarise, two studies reported a negative correlation between negative aspects of CT feelings and TA [18,26], while others found both negative correlations between negative CT feelings and TA and positive correlations between positive CT feelings and TA [12,23,31].…”

“…For therapists to become aware of this phenomenon, it must be given attention. There is a need for research on the psychometric properties of instruments used in CT research to make future studies more robust [26]. A brief questionnaire, such as the FWC-BV, will obviously not capture all important CT feelings, but it can provide insight into meaningful aspects or patterns of feelings during therapy processes.…”

“…The term therapeutic alliance (TA) refers to the working relationship between the therapist and patient. To date, only a few studies have investigated the relationship between TA and CT [12,18,23,26,31]. Both the TA measurement instruments and results of these studies vary widely.…”

Translation and cross-cultural adaptation of the Rating Scale for Countertransference (RSCT) to American English

“…10 The RSCT has been used in several studies of CT in Brazilian samples, investigating CT and its association with patient characteristics in psychotherapy with an analytical orientation 11 ; CT and its demographic and clinical correlates in first consultations with women who had been the victims of sexual violence 12 ; and CT and the therapeutic alliance at the start of psychodynamic psychotherapy. 13 However, its applicability has hitherto been limited because it was developed in Portuguese, which hampered its adoption by researchers in other countries and its publication in international periodicals.…”