Therapists’ subjective variables and transference-countertransference configuration: An empirical investigation

Introduction: Despite a prevalent culture that presumed therapists to be uniform across different patients’ group and treatment modalities, a growing body of evidence highlights that certain therapists’ personal characteristics could positively or negatively influence the quality of the therapeutic relationship (e.g., Ackerman & Hilsenroth, 2003). Some theoretical contributions suggest that therapists’ variables are able to influence the patients’ emotional, cognitive and behavioral reactions toward them (i.e., a broader definition of transference; Gelso, 2014). Furthermore, countertransference is increasingly been viewed as a joint creation involving contributions from both clinician and patient (Gabbard, 2001). In particular, preliminary evidences suggest that therapist attachment might affect therapeutic relationship through interaction effects with other patient or therapist variables, but methodological weaknesses of these studies highlight the need for more rigorously designed research (Degnan et al., 2016). Furthermore, studies on therapist personality seem to conceptualize this variable more as general attributes rather than measure a broad spectrum of personality traits and styles in a systematic and complex way. Thus, it remains an under-researched area despite its clinical relevance (for a review, see Lingiardi et al., 2018). This study aimed to investigate the relationship between therapists’ personality characteristics and attachment representations with empirically-derived transference and countertransference dimensions. Methods: Fifty-five psychodynamic therapists were interviewed with the Adult Attachment Interview (AAI) followed by the Clinical Diagnostic Interview (CDI) to assess their personality with the Shedler-Westen Assessment Procedure-200 (SWAP-200). They were also asked to complete the Psychotherapy Relationship Questionnaire (PRQ) and the Therapist Response Questionnaire (TRQ) on a patient currently in treatment who fulfilled the following inclusion criteria: (1) aged at least 18 years; (2) presenting no organic syndrome, psychotic disorder, or syndrome with psychotic symptoms that could complicate the assessment of any variable in the study; and (3) in treatment for a minimum of four sessions and a maximum of 6 months (in an individual setting with at least one session per week). In order to compensate the underrepresentation of specific AAI classifications, a well-established dimensional approach (Waters et al., 2007) has been employed. Results: Findings showed that the therapist personality characteristics that were more strongly represented in this sample were obsessive-compulsive and narcissistic with respect to SWAP-200 PD scores, and obsessive-compulsive and dysphoric-high functioning/depressive with respect to SWAP-200 Q-factor scores. Moreover, more than half of the therapists were classified as having secure attachment, but a moderate percentage fell into the dismissing and unresolved attachment categories. Only a few therapists were classified as insecure/preoccupied. Results also showed that patient secure/engaged transference factor was positively associated with therapists’ healthy personality functioning, and negatively related to SWAP-200 scales characterized by emotional dysregulation and interpersonal problems. These scales were also associated with patients’ relational patterns characterized by hostility or dismissive attitudes. Furthermore, the relationship between therapists’ personality functioning and patients’ secure/engaged relational pattern was moderated by higher level of therapists’ attachment security. Regarding therapists’ emotional responses, no differences were found between therapists with secure vs. insecure attachment styles, but healthier therapist personality functioning was negatively related to helpless/inadequate countertransference pattern. Interestingly, narcissistic Q-factor was found to be related to positive countertransference pattern. Conclusion: These findings seems particularly relevant when applied to psychodynamic therapies, which share a careful appreciation of the contribution of therapist’s subjectivity. Therapists’ improved knowledge of the role of their own subjective characteristics in the therapeutic relationship could be particularly useful to better understand their actions in therapy, guide therapeutic interventions, track in-session processes with their patients, and deal with ruptures in the therapeutic alliance, in order to provide better treatments. Moreover, this information would be particularly relevant in the supervisory relationship, which is one of the most important components in psychodynamic therapists’ professional development. Overall, this study aimed to promote a better understanding of the underlying factors of “therapist effects”, one of the most important emerging topics in psychotherapy research (Castonguay & Hill, 2017)