Trends in Psychiatry and Psychotherapy
https://trends.org.br/article/doi/10.1590/2237-6089-2014-0061
Trends in Psychiatry and Psychotherapy
Original Article

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

Contratransferência e aliança terapêutica no início da psicoterapia psicodinâmica de adultos

Diogo de Bitencourt Machado; Stefania Pigatto Teche; Catherine Lapolli; Beatriz Franck Tavares; Laura Sigaran Pio de Almeida; Giovana Barreto da Silva; Pedro Vieira da Silva Magalhães; Cláudio Laks Eizirik

http://dx.doi.org/10.1590/2237-6089-2014-0061 Trends Psychiatry Psychother, vol.37, n3, p.133-142, 2015
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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

Resumo

Objetivos: 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 alta CT que indica distância está relacionada a baixa AT, sobretudo em relação a capacidade de trabalho do paciente, ainda que a presença de cisão pode influenciar a CT, de forma que representa uma variável de confusão. A CT é um conceito útil ao psicoterapeuta, servindo como fonte de informações sobre o mundo interno do paciente e sobre elementos da psicoterapia, como a qualidade da AT, importante para os bons resultados dos tratamentos.

Palavras-chave

Psicoterapia, psicoterapia psicanalítica, psicanálise, contratransferência, aliança terapêutica

References

Freud S. Edição eletrônica brasileira das obras psicológicas completas de Sigmund Freud, versão 2.0. 1910.

Freud S. Recomendações aos médicos que exercem a psicanálise. Obras completas de Sigmund Freud. 1912;12.

Tyson R. Countertransference evolution in theory and practice. J Am Psychoanal Assoc. 1986;34:251-74.

Eizirik CL, Aguiar RW, Schestatski SS. Psicoterapia de orientação analítica: fundamentos teóricos e clínicos. 2015.

Winnicott DW. Hate in the counter-transference. Int J Psychoanal. 1949;30:69-74.

Heimann P. On counter-transference. Int J Psychoanal. 1950;31:81-4.

Racker H. Os significados e usos da contratransferência. Estudos sobre técnica psicanalítica.. 1982:100-19.

Racker H. Estudos sobre técnica psicanalítica. 1982:120-57.

Gabbard GO. A contemporary psychoanalytic model of countertransference. J Clin Psychol. 2001;57:983-91.

Westra HA, Aviram A, Connors L, Kertes A, Ahmed M. Therapist emotional reactions and client resistance in cognitive behavioral therapy. Psychotherapy (Chic). 2012;49:163-72.

Gabbard GO. Countertransference: the emerging common ground. Int J Psychoanal. 1995;76:475-85.

Zaslavsky J, Santos MP. Tendências atuais da contratransferência. Contratransferência: teoria e prática clínica. 2005:28-53.

Eizirik CL, Libermann Z, Costa F. A relação terapêutica: transferência, contratransferência e aliança terapêutica. 2008:74-84.

Freud S. (1912) Standard edition. 1958.

Zetzel ER. Current concepts of transference. Int J Psychoanal. 1956;37:269-76.

Knapp P. Terapia cognitivo-comportamental na prática psiquiátrica. 2007.

Horvath AO, Del Re AC, Fluckiger C, Symonds D. Alliance in individual psychotherapy. Psychotherapy (Chic). 2011;48:9-16.

Ackerman SJ, Hilsenroth MJ. A review of therapist characteristics and techniques positively impacting the therapeutic alliance. Clin Psychol Rev. 2003;23:1-33.

McCabe R, Priebe S. The therapeutic relationship in the treatment of severe mental illness: a review of methods and findings. Int J Soc Psychiatry. 2004;50:115-28.

Sharf J, Primavera LH, Diener MJ. Dropout and therapeutic alliance: A meta-analysis of adult individual psychotherapy. Psychotherapy (Chic). 2010;47:637-45.

Machado D, Coelho FMC, Giacomelli AD, Donassolo MAL, Abitante MS, Dall'Agnol T. Systematic review of empirical studies of countertransference in adults psychotherapy. Trends Psychiatry Psychother. 2015;36:173-85.

Najavits LM, Griffin ML, Luborsky Frank A, Weiss RD, Liese B. Therapists' emotional reactions to substance abusers: a new questionnaire and initial findings. Psychotherapy (Chic). 1995;32:669-77.

Ligiéro DP, Gelso CJ. Countertransference, attachment, and the working alliance: the therapist's contribution. Psychother Theory Res Pract Train. 2002;39:3-11.

Dahl HS, Røssberg JI, Bøgwald KP, Gabbard GO, Høglend PA. Countertransference feelings in one year of individual therapy: an evaluation of the factor structure in the Feeling Word Checklist-58. Psychother Res. 2012;22:12-25.

Gabbard GO. Tratamentos em psiquiatria dinâmica. Psiquiatria psicodinâmica na prática clínica. 2007:79-102.

Keidann CE, Dal Zot JS. Avaliação. Psicoterapia de orientação analítica: fundamentos teóricos e práticos. 2005:193-205.

Eizirik CL, Costa F, Kapczinski F, Piltcher R, Gauer R, Libermann Z. Observing countertransference in brief dynamic psychotherapy. Psychother Psychosom. 1991;56:174-81.

Silveira Júnior Ede M, Polanczyk GV, Eizirik M, Hauck S, Eizirik CL, Ceitlin LH. Trauma and countertransference: development and validity of the Assessment of Countertransference Scale (ACS). Rev Bras Psiquiatr. 2012;34:201-6.

Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). 2000.

Marmar CR, Weiss DS, Gaston L. Toward the validation of the California Therapeutic Alliance Rating System. Psychol Assess. 1989;1:46-52.

Gaston L. Reliability and criterion-related validity of the California Psychotherapy Alliance Scales - patient version. Psychol Assess. 1991;3:68-74.

Marcolino JAM, Iacoponi E. Escala de Aliança Psicoterápica da Califórnia na versão do paciente. Rev Bras Psiquiatr. 2001;23:88-95.

Derogatis LR, Unger R. Symptom checklist-90-revised. The Corsini Encyclopedia of Psychology. 2010:1-2.

Laloni DT. Escala de avaliação de sintomas 90-R (SCL-90-R): adaptação, precisão e validade. 2001.

Andrews G, Singh M, Bond M. The Defense Style Questionnaire. J Nerv Ment Dis. 1993;181:246-56.

Blaya C, Dornelles M, Blaya R, Kipper L, Heldt E, Isolan L. Brazilian-Portuguese version of defensive style questionnaire-40 for the assessment of defense mechanisms: construct validity study. Psychother Res. 2007;17:261-70.

Associação Brasileira de Empresas de Pesquisa (ABEP). 2008.

Gabbard GO. Therapeutic interventions: what does the therapist say and do?. Long-term psychodynamic psychotherapy: a basic text. 2005:68-92.

Eizirik M, Polanczyk G, Schestatsky S, Jaeger MA, Ceitlin LHF. Contratransferência no atendimento inicial de vítimas de violência sexual e urbana: uma pesquisa qualitativa/quantitativa. Rev Psiquiatr Rio Gd Sul. 2007;29:197-204.

Dougall JL, Schwartz RC. The influence of client socioeconomic status on psychotherapists' attributional biases and countertransference reactions. Am J Psychother. 2011;65:249-65.

Brody EM, Farber BA. The effects of therapist experience and patient diagnosis on countertransference. Psychotherapy (Chic). 1996;33:372-80.

McIntyre SM, Schwartz RC. Therapists' differential countertransference reactions toward clients with major depression or borderline personality disorder. J Clin Psychol. 1998;54:923-31.

Rossberg JI, Karterud S, Pedersen G, Friis S. An empirical study of countertransference reactions toward patients with personality disorders. Compr Psychiatry. 2007;48:225-30.

Singer B, Luborsky L. Countertransference: the status of clinical versus quantitative research. Effective psychotherapy: a handbook of research. 1977:433-541.

Rosenberger EW, Hayes JA. Therapist as subject: a review of the empirical countertransference literature. J Couns Dev. 2002;80:264-70.

Hayes JA, Gelso CJ, Hummel AM. Managing countertransference. Psychotherapy (Chic). 2011;48:88-97.

Kächele H, Erhardt I, Seybert C, Buchholz MB. Countertransference as object of empirical research?. Int Forum Psychoanal. 2013;21:1-13.

Kiesler DJ. Therapist countertransference: in search of common themes and empirical referents. J Clin Psychol. 2001;57:1053-63.

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