Patient personality and therapist responses in the adolescent psychotherapy: The validation of the Therapist Response Questionnaire for adolescents

Objective: The aim of this study was to explore the factor structure and psychometric properties of the Therapist Response Questionnaire for Adolescents (TRQ-A; Satir et al., 2009), a clinician-report instrument able to measure the clinician’s emotional reactions (or countertransference) to the adolescent patient in psychotherapy. Methods: A national sample of psychiatrists and psychologists (N = 185) completed the TRQ-A, as well as the Psychodiagnostic Chart for Adolescents (PDC-A; Malberg et al., 2017) from the PDM-2 (Lingiardi, McWilliams, 2017), to assess levels of emerging personality organization and emerging personality styles/syndromes regarding an adolescent patient in their care. An exploratory factor analysis (EFA) was carried out to identify the factor structure of the TRQ-A. Reliability of the TRQ-A’s scales was calculated using the Cronbach’s alpha coefficients. Bivariate correlations between these scales and variables of personality were conducted to assess the criterion validity. Results: EFA revealed six distinct countertransference scales: hostile/devaluated, positive, bored/failing, overwhelmed/scared, overinvolved, sexualized. These scales showed excellent reliability and good validity. They were significantly associated with patients’ levels of personality organization and emerging personality styles/syndromes. In particular, more severe levels of personality organization were related to the bored/failing and overwhelmed/scared countertransference. Narcissistic and antisocial/psychopathic personality styles/syndromes were associated with the hostile/devaluated and overwhelmed/scared therapist responses, and borderline style/syndrome was related to the overwhelmed/scared and overinvolved countertransference. Schizoid personality style/syndrome was associated with the bored/failing countertransference, while impulsive/histrionic style/syndrome was related to the sexualized therapist response. Positive countertransference was related to the obsessional personality style. Conclusion: The TRQ-A is a very useful instrument to evaluate countertransference reactions in clinically sensitive and psychometrically robust ways. Moreover, adolescents’ emerging personality styles/syndromes were consistently associated with specific emotional responses, which suggests that clinicians can make diagnostic and therapeutic use of their responses to patients.