Countertransference phenomena and personality pathology in clinical practice: an empirical investigation.
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.


METHODS
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.
Betan
Ephi
E
Georgia School of Professional Psychology, 980 Hammond Dr., Suite 100, Atlanta, GA 30328, USA. ebetan@argosyu.edu
Heim
Amy Kegley
AK
Zittel Conklin
Carolyn
C
Westen
Drew
D
D001291:Attitude of Health Personnel; D015982:Bias; D003379:Countertransference; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005163:Factor Analysis, Statistical; D006801:Humans; D010554:Personality Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D010817:Physician-Patient Relations; D011331:Private Practice / Q000706:statistics & numerical data*; D011369:Professional-Patient Relations; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011570:Psychiatry / Q000706:statistics & numerical data; D011586:Psychology, Clinical / Q000706:statistics & numerical data; D011594:Psychometrics; D012494:Sampling Studies; D011795:Surveys and Questionnaires