Do therapist personality and attachment impact on patient relational patterns in psychotherapy? A moderation analysis

Aim: 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, 2011). This consideration seems particularly relevant when applied to psychodynamic therapies, which share a careful appreciation of the contribution of therapist’s subjectivity (Lingiardi et al., 2017). This study aimed to investigate the relationship between therapists’ personality characteristics and empirically-derived transference dimensions, and to explore the moderating role of therapists’ attachment in the relationship between their personality functioning and patients’ secure/engaged relational pattern. Methods: Sixty psychodynamic therapists were interviewed with the Adult Attachment Interview (George et al., 1985) followed by the Clinical Diagnostic Interview to assess their personality with the Shedler-Westen Assessment Procedure-200 (Westen & Shedler, 1999). They were also asked to complete the Psychotherapy Relationship Questionnaire (Bradley et al., 2005) on a patient currently in treatment. A well-established dimensional approach to AAI classifications (Waters et al., 2007) has been employed. Results: Findings showed that the secure/engaged 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. Discussion: These findings promote a better understanding of the underlying factors of “therapist effects”, one of the most important emerging topics in psychotherapy research (Castonguay & Hill, 2017).