Countertransference Phenomena and Personality Pathology in Clinical Practice: An Empirical Investigation

• Published in: The American journal of psychiatry 2005-05, Vol.162 (5), p.890-898
• Main Authors: Betan, Ephi, Heim, Amy Kegley, Zittel Conklin, Carolyn, Westen, Drew
• Format: Article
• Language: English
• Subjects: Adult and adolescent clinical studies; Attitude of Health Personnel; Bias; Biological and medical sciences; Countertransference (Psychology); Diagnostic and Statistical Manual of Mental Disorders; Factor Analysis, Statistical; Humans; Medical sciences; Personality; Personality disorders; Personality Disorders - diagnosis; Personality Disorders - psychology; Personality Disorders - therapy; Physician-Patient Relations; Private Practice - statistics & numerical data; Professional-Patient Relations; Psychiatric Status Rating Scales - statistics & numerical data; Psychiatry; Psychiatry - statistics & numerical data; Psychology, Clinical - statistics & numerical data; Psychology. Psychoanalysis. Psychiatry; Psychometrics; Psychometrics. Diagnostic aid systems; Psychopathology. Psychiatry; Sampling Studies; Surveys and Questionnaires; Techniques and methods
• ISSN: 0002-953X; 1535-7228
• DOI: 10.1176/appi.ajp.162.5.890

OBJECTIVE: This study provides initial data on the reliability and factor structure of a measure of countertransference processes in clinical practice and examines the relation between these processes and patients' personality pathology. METHOD: A national random sample of 181 psychiatrists and clinical psychologists in North America each completed a battery of instruments on a randomly selected patient in their care, including measures of axis II symptoms and the Countertransference Questionnaire, an instrument designed to assess clinicians' cognitive, affective, and behavioral responses in interacting with a particular patient. RESULTS: Factor analysis of the Countertransference Questionnaire yielded eight clinically and conceptually coherent factors that were independent of clinicians' theoretical orientation: 1) overwhelmed disorganized, 2) helpless inadequate, 3) positive, 4) special overinvolved, 5) sexualized, 6) disengaged, 7) parental protective, and 8) criticized mistreated. The eight factors were associated in predictable ways with axis II pathology. An aggregated portrait of countertransference responses with narcissistic personality disorder patients provided a clinically rich, empirically based description that strongly resembled theoretical and clinical accounts. CONCLUSIONS: Countertransference phenomena can be measured in clinically sophisticated and psychometrically sound ways that tap the complexity of clinicians' reactions toward their patients. Countertransference patterns are systematically related to patients' personality pathology across therapeutic approaches, suggesting that clinicians, regardless of therapeutic orientation, can make diagnostic and therapeutic use of their own responses to the patient.