Trends in Psychiatry and Psychotherapy
https://trends.org.br/article/doi/10.47626/2237-6089-2020-0025
Trends in Psychiatry and Psychotherapy
Original Article

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

Poornima Bhola, Kanika Mehrotra

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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.

Keywords

Countertransference, borderline personality disorder, mentalization, psychotherapy, psychotherapists.

References

1. Löffler-Stastka H, Datz F, Parth K, Preusche I, Bukowski X, Seidman C. Empathy in psychoanalysis and medical education - what can we learn from each other? BMC Med Educ. 2017;17:74. doi.org/10.1186/s12909-017-0907-2

2. Hayes JA, Gelso CJ, Goldberg S, Kivlighan DM. Countertransference management and effective psychotherapy: meta-analytic findings. Psychotherapy. 2018;55:496-507.

3. Freud S. The future prospects of psycho-analytic therapy. In: Strachey J. The standard edition of the complete psychological works of Sigmund Freud, Vol XI 1910: five lectures on psychoanalysis, Leonardo da Vinci and Other Works. London: The Hogarth Press and the Institute of Psycho-analysis; 1957. p. 139- 52.

4. Fauth J. Toward more (and better) countertransference research. Psychotherapy (Chic). 2006;43:16-31.

5. Gelso C, Hayes J. Countertransference and the inner world of the psychotherapist: Perils and possibilities. New Jersey: Lawrence Erlbaum Publishers; 2007.

6. Schwartz R, Smith S, Chopko B. Psychotherapists’ countertransference reactions toward clients with antisocial personality disorder and schizophrenia: an empirical test of theory. Am J Psychother. 2007;61:375-93.

7. Kernberg O, Selzer M, Koenigsberg H, Appelbaum A. Psychodynamic psychotherapy of borderline patients. New York: Basic Books; 1989.

8. McWilliams N. Psychoanalytic diagnosis. New York: Guilford; 1994.

9. Reid WH., Wise MG. DSM-IV training guide. New York: Brunner/Mazel; 1995.

10. Gabbard GO. An overview of countertransference with borderline patients. J Psychother Pract Res. 1993;2:7-18.

11. Gabbard G, Wilkinson S. Management of countertransference with borderline clients. Northvale, New Jersey, London: Jason Aronson Inc.; 2000.

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

13. McIntyre S, Schwartz R. Therapists‘ differential countertransference reactions toward clients with major depression or borderline personality disorder. J Clin Psychol. 1998;54:923-31.

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

15. Bourke M, Grenyer B. Psychotherapists‘ response to borderline personality disorder: A core conflictual relationship theme analysis. Psychother Res. 2010;20:680-91.

16. Kächele H, Albani C, Pokorny D, Blaser G, Grüninger S, König S, et al. Reformulation of the Core Conflictual Relationship Theme (CCRT) categories: the CCRT-LU category system. Psychother Res. 2002;12:319-38.

17. Colli A, Tanzilli A, Dimaggio G, Lingiardi V. Patient personality and therapist response: an empirical investigation. Am J Psychiatry. 2014;171:102-8.

18. Zittel Conklin C, Westen D. The therapist response questionnaire. Atlanta: Emory University, Departments of Psychology and Psychiatry and Behavioral Sciences; 2003.

19. Knaus S, Grassl R, Seidman C, Seitz T, Karwautz A, Löffler-Stastka H. Psychiatrists‘ emotional reactions: useful for precise diagnosis in adolescence? Bull Menninger Clin. 2016;80:316-25.

20. Lingiardi V, Muzi L, Tanzilli A, Carone N. Do therapists‘ subjective variables impact on psychodynamic psychotherapy outcomes? A systematic literature review. Clin Psychol Psychother. 2017;25:85-101.

21. Stiles W, Shapiro D. Abuse of the drug metaphor in psychotherapy process-outcome research. Clin Psychol Rev. 1989;9:521-43.

22. Teyber E, McClure F. Handbook of psychological change: psychotherapy processes & practices for the 21st century. Hoboken: John Wiley & Sons Inc.; 2000. p. 62-87.

23. Liebman R, Burnette M. It‘s not you, it‘s me: an examination of clinician- and client-level influences on countertransference toward borderline personality disorder. Am J Orthopsychiatry. 2013;83:115-25.

24. Van Breda A, Feller T. Social work students’ experience and management of countertransference. Social Work (Stellenbosch). 2014;50:469-84.

25. Reich A. On countertransference. Int J Psychoanal. 1951;32:25-31.

26. Reich A. Further remarks on countertransference. Int J Psychoanal. 1960;41:389-95.

27. Auchincloss EL, Samberg E. Psychoanalytic terms and concepts. New Haven: Yale University Press; 2012.

28. Normandin L, Bouchard MA. The effects of theoretical orientation and experience on rational, reactive, and reflective countertransference. Psychother Res.. 1993;3:77-94.

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

30. Bateman AW, Fonagy P. Mentalization-based treatment of BPD. J Pers Disord. 2004;18:36-51.

31. Cologon J, Schweitzer RD, King R, Nolte T. Therapist reflective functioning, therapist attachment style and therapist effectiveness. Adm Policy Ment Health. 2017;44:614-25.

32. Cartwright C, Gibson K. Reflective practice: understanding and managing countertransference. Clin Psychol (Aust Psychol Soc). 2015;1:33-7.

33. Fuertes JN, Gelso CJ, Owen JJ, Cheng D. Real relationship, working alliance, transference/countertransference and outcome in time-limited counseling and psychotherapy. Couns Psychol Q. 2013;26:294-312.

34. Betan E, Heim A, Conklin CZ, Westen D. Countertransference phenomena and personality pathology in clinical practice: an empirical investigation. Am J Psychiatry. 2005;162:890-8.

35. Tanzilli A, Colli A, Del Corno F, Lingiardi V. Factor structure, reliability, and validity of the Therapist Response Questionnaire. Personal Disord. 2016;7:147-58.

36. George D, Mallery P. SPSS for Windows step by step. Boston: Allyn & Bacon; 2003.

37. Dimitrijević A, Hanak N, Dimitrijević AA, Marjanović ZJ. The Mentalization Scale (MentS): a self-report measure for the assessment of mentalizing capacity. J Pers Assess. 2017;1:1-13.

38. Gignac G, Szodorai E. Effect size guidelines for individual differences researchers. Pers and Individ Dif. 2016;102:74-78.

39. Breivik R, Wilberg T, Evensen J, Røssberg JI, Dahl HS, Pedersen G. Countertransference feelings and personality disorders: a psychometric evaluation of a brief version of the Feeling Word Checklist (FWC-BV). BMC Psychiatry. 2020;20:141.

40. Tanzilli A, Lingiardi V, Hilsenroth M. Patient SWAP-200 personality dimensions and FFM traits: Do they predict therapist responses? Personal Disord. 2018;9:250-62.

41. Kernberg OF. Borderline personality organization. J Am Psychoanal Assoc. 1967;15:641-85.

42. Bender DS, Skodol AE. Borderline personality as a self-other representational disturbance. J Pers Disord. 2007;21:500-17.

43. Tanzilli A, Muzi L, Ronningstam E, Lingiardi V. Countertransference when working with narcissistic personality disorder: an empirical investigation. Psychotherapy. 2017;54:184-94.

44. Barreto J, Matos P. Mentalizing countertransference? A model for research on the elaboration of countertransference experience in psychotherapy. Clin Psychol Psychother. 2018;25:427-39.

45. Bourke, ME, Grenyer BF. Therapists’ metacognitive monitoring of the psychotherapeutic process with patients with borderline personality disorder. J Psychiatr Pract. 2017;23;246-53.

46. Hayes JA, Gelso CJ, Hummel AM. Managing countertransference. In: Norcross JC, ed. Psychotherapy relationships that work: evidence-based responsiveness. London: Oxford University; 2011. p. 239-58.

47. Linehan M, Cochran B, Mar C, Levensky E, Comtois K. Therapeutic burnout among borderline personality disordered clients and their therapists: development and evaluation of two adaptations of the Maslach Burnout Inventory. Cogn Behav Pract. 2000;7:329-37.

48. Diamond D, Clarkin JF, Stovall-McClough KC, Levy KN, Foelsch PA, Levine H, et al. Attachment theory and the psychoanalytic process. Philadelphia: Whurr Publishers; 2003.

49. Reading R, Safran J, Origlieri A, Muran J. Investigating therapist reflective functioning, therapeutic process, and outcome. Psychoanal Psychol. 2019;36:115-21.

50. Kernberg O, Yeomans F, Clarkin J, Levy K. Transference focused psychotherapy: overview and update. Int J Psychoanal. 2008;89:601-20.

51. Shaw C, Lanceley E, Lo C, Hales S, Rodin G. The assessment of mentalization: measures for the patient, the therapist and the interaction. J Contemp Psychother. 2020;50:57-65.

52. Cartwright C, Barber C, Cowie S, Thompson N. A trans-theoretical training designed to promote understanding and management of countertransference for trainee therapists. Psychother Res. 2016;28:517-31.

53. Cartwright C, Rhodes P, King R, Shires A. A pilot study of a method for teaching clinical psychology trainees to conceptualise and manage countertransference. Aust Psychol. 2015;50:148- 56.

54. Ensink K, Maheux J, Normandin L, Sabourin S, Diguer L, Berthelot N, et al. The impact of mentalization training on the reflective function of novice therapists: a randomized controlled trial. Psychother Res. 2013;23:526-38.

55. Welstead HJ, Patrick J, Russ TC, Cooney G, Mulvenna CM, Maclean C, et al. Mentalising skills in generic mental healthcare settings: can we make our day-to-day interactions more therapeutic? BJPsych Bull. 2018;42:102-8.

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