"Keeping mind in mind in psychotherapy": the influence of therapists' reflective functioning and personality on working alliance

There has been increasing recognition over the last two decades that certain therapists’ personal characteristics could influence the quality of the therapeutic alliance. Despite therapists’ who are aware and explore mental states in themselves and their patients, as well as mentalize about patients’ emotional experiences, are more likely to form positive alliances (Markowitz et al., 2011), empirical evidence on the relationship between the therapists’ reflective functioning (RF) and therapeutic alliance are still scarce. Furthermore, the therapists’ personality remains an under-researched area despite its clinical relevance (Werbart et al., 2018). This study aimed to investigate the relationship between therapists’ RF, their personality characteristics and the impact of these two variables on overall therapeutic alliance. Sixty novice psychodynamic therapists were interviewed with the Clinical Diagnostic Interview to assess their personality with the Shedler-Westen Assessment Procedure-200 (SWAP-200; Westen, Shedler, 1999) and then, 1–2 weeks later, with the Adult Attachment Interview (AAI; George et al., 1985). Therapists’ RF was coded according to the Reflective Functioning Scale (Fonagy et al., 1998) from the AAI transcripts by two independent raters. Therapists were also asked to complete the Working Alliance Inventory (WAI-T; Horvath, Greenberg, 1989) on a patient currently in treatment. Findings showed that therapists’ RF was positively associated with their healthy personality functioning, and negatively related to those SWAP-200 scales characterized by emotional dysregulation or interpersonal detachment. Moreover, results indicated a strong predictive relationship between therapist RF and therapist report of working alliance. These findings suggest that these therapists’ subjective characteristics may be important skills involved in the therapeutic process that, in turn, could contribute to patients’ structural change (Lingiardi et al., 2018).