Associations between countertransference reactions towards patients with borderline personality disorder and therapist experience levels and mentalization ability

Abstract

Objective This exploratory study locates countertransference as a pan-theoretical concept, comprising of thoughts, feelings, and behaviors expressed or experienced by therapists toward their patients. It aims to understand the patterns of countertransference experienced in working with borderline personality disorder. Associations between countertransference reactions and therapist-related variables of experience and mentalization ability are also examined. Method Psychotherapists (n = 117) completed the Therapist Response Questionnaire to assess patterns of countertransference experienced with a representative patient diagnosed with borderline personality disorder. They also completed a measure of mentalization ability that examined self-related mentalization, other-related mentalization, and motivation to mentalize. Results The profile of responses across eight countertransference dimensions is discussed, with the most strongly endorsed reactions being positive/satisfying, parental/protective, and helpless/inadequate. More experienced therapists reported less negative countertransference reactions in select dimensions. Therapists’ self-reported ability to reflect on and understand their own mental states was negatively correlated with a range of difficult countertransference experiences. There were few associations between their ability to make sense of others’ mental states, the motivation to mentalize, and the strength of their countertransference reactions. Conclusion The implications for countertransference management as well as therapist training and development are highlighted.

Does clinical training improve mentalization skills in future therapists? A comparison of first and last year students of clinical psychology and of engineering

“…Acceptable levels of internal consistency were reported, as well as a meaningful factor structure and correlations with expected factors such as gender, level of education, attachment, personality traits, emotional intelligence and empathy. Other studies have also found similar factor structure and levels of internal consistency (Đorđević and Đorđević, 2019;Benoit, 2020;Stanojević et al, 2020;Ahmadian and Ghamarani, 2021;Bhola and Mehrotra, 2021;Jańczak, 2021;Richter et al, 2021). Investigations of construct validity have found correlations with attachment style (Đorđević and Đorđević, 2019;Benoit, 2020;Stanojević et al, 2020;Jańczak, 2021), empathy (Ahmadian and Ghamarani, 2021;Jańczak, 2021), borderline features, emotional intelligence and personality traits (Jańczak, 2021) in the way that is according to previous knowledge about mentalization.…”

“…Three subscales can be extracted: Self-Related Mentalization (8 items) , Other-Related Mentalization (10 items), and Motivation to Mentalize (10 items). Previous studies have reported consistent factor structure and good internal consistency ranging from 0.7 to 0.86 ( Dimitrijević et al, 2018 ; Đorđević and Đorđević, 2019 ; Benoit, 2020 ; Stanojević et al, 2020 ; Bhola and Mehrotra, 2021 ; Jańczak, 2021 ; Richter et al, 2021 ). MentS was translated to Norwegian for the present study by two psychologists fluent in English.…”

“…Therapists’ mentalization capacity also predicted greater therapist-reported working alliance, greater patient reported depth, and greater patient and therapist reported degree of resolving ruptures. Also, in a study addressing problematic countertransference experiences in therapy with patients with borderline personality disorder, therapists who reported higher self-oriented mentalization skills also reported fewer problematic countertransference experiences ( Bhola and Mehrotra, 2021 ). Specifically, higher levels of self-mentalization capacity were associated with lower likelihood of an over-concerned over-involved stance and parental feelings toward clients.…”

Mentalizing capacities of mental health nurses: A systematic PRISMA review

“…They also tended to avoid discussing difficult issues or strong emotions with their clients. In Bhola and Mehrotra's (2021) study, clinical psychologists, and other mental health clinicians with higher levels of mentalizing capacity (measured with the MentS)…”

‘It's not you; it's us!’: the relevance of mental health team psychodynamics to the care of individuals with complex emotional needs

“…Such feelings are amplified towards Individuals if transferences are present in the caring relationship, giving rise to counter-transference phenomena (Freud, 1912). Individuals with Complex Emotional Needs often elicit powerful emotional responses and processes (Ramsden, Prince & Blazdell, 2020), with Mental Health Nurses reporting feelings of frustration, anger, and helplessness (Bhola & Mehrotra, 2021), mirroring those emotions described by Individuals experiencing crisis themselves. Furthermore, where the value of the therapeutic relationship and use of 'self' is widely acknowledged as being central to care-delivery for Mental Health Nurses (Hurley, 2009), a breakdown in relations resulting from the direct psychological demands from the Individuals they care for, may give rise to intrapsychic conflict and contradictory feelings, such as guilt, anxiety, and resentment (Morrissey & Higgins, 2019;Menzies Lyth, 1988).…”