Countertransference in Swedish psychotherapists: testing the factor structure of the Therapist Response Questionnaire

Abstract

Questionnaires need testing of reliability and factor structure before clinical use or research in new languages or cultures. The aim of this study was to evaluate the Therapist Response Questionnaire (TRQ) in Sweden compared to corresponding factor analyses in USA and Italy. A national sample of psychotherapists (N=242) registered their countertransference with a single client using TRQ. The data were analyzed with confirmatory factor analysis (CFA) to test factor structures from previous studies, and exploratory factor analysis (EFA). The CFA did not verify the factor structure from the previous studies. The EFA extracted seven factors as the best solution: Helpless/Inadequate, Overwhelmed/Disorganized, Hostile/Angry, Parental/Protective, Disengaged, Special/Overinvolved, Sexualized. Analysis of convergent validity indicated that five of these could be considered equivalent to factors in the previous studies, and the remaining two were conceptually related to corresponding factors. Even though the factor structure was not confirmed by the CFA, the concordance was large, indicating a reliable self-report instrument with promising validity for measurement of complex aspects of countertransference. Common countertransference themes can inform psychotherapy supervision and education, give feedback to the therapist, and lay ground for a taxonomy for therapist reactions and feelings.

General patterns in psychotherapists’ countertransference.

“…We believe that a personoriented approach to research is a promising perspective. For example, the present cluster analysis suggested three clusters of therapists, characterized by elevated scores on singular factors from the previous factor analysis (Berg et al, 2019), and in addition to this, three new patterns characterized by specific combinations among factors (representing 43% of the therapists). A variableoriented approach using for example only factor analysis could not detect the latter groups of therapists.…”

“…(b) The individual clusters should be as homogeneous as possible, preferably with a homogeneity coefficient (HC) < 1 per cluster. However, as all but one factor were rather skewed (Berg et al, 2019), a higher HC was expected for most clusters. (c) The clusters should be theoretically meaningful.…”

“…3,000 emails), Facebook groups for psychologists, and supervisors at universities training psychotherapists. The sample is the same as used in a previous study (Berg et al, 2019). A webform was used to collect information from the individual therapist.…”

“…Each item is rated on a 5-point Likert scale, ranging from 1 ( not true ) to 5 ( very true ). The Swedish translation of TRQ was used, standardized by Berg et al (2019), and scores were calculated on seven TRQ factors: Helpless/Inadequate, Overwhelmed/Disorganized, Hostile/Angry, Parental/Protective, Disengaged, Special/Overinvolved, and Sexualized. The scales constructed on the basis of these factors had an acceptable internal consistency (Cronbach’s α .68 ≤ α ≤ .87; Berg et al, 2019).…”

“…As to countertransference, there are factor-analytical studies using questionnaires, such as the Therapist Response Questionnaire (TRQ; Betan et al, 2005), that suggest different categories of countertransference (Berg et al, 2019; Betan et al, 2005; Tanzilli et al, 2016). Berg et al (2019), for example, identified the following seven factors: Helpless/Inadequate, Overwhelmed/Disorganized, Hostile/Angry, Parental/Protective, Disengaged, Special/Overinvolved, and Sexualized. To our knowledge, no cluster analysis using these factors has been performed.…”