The Diagnostic Use of Countertransference in Psychodynamic Practice

Countertransference is a crucial component of the therapeutic relationship that is strongly related to multifaceted processes involved in producing the patient’s change in psychotherapy. This construct has evolved from the classical and narrow psychoanalytic conceptualization, referring it as an obstacle to the therapeutic progress, to a broader and intersubjective perspective. Notably, countertransference has become a valuable source of knowledge for better understanding the patients’ psychological functioning, and in particular all the relational dynamics, which are associated with their relatively stable patterns of thinking, feeling, behaving and regulate emotions and impulses (i.e., personality). The Psychodynamic Diagnostic Manual-Second Edition (PDM-2; Lingiardi, McWilliams, 2017) has emphasized the psychodiagnostic use of the clinician’s subjectivity. Patients tend to evoke average expected countertransference reactions in therapeutic relationship, which likely resemble the typical responses activated in significant others in their life. Thus, carefully therapists’ recognition and work through own countertransference reactions may help them inform a more sensitive diagnostic process, generate accurate and clinically meaningful case formulations, and facilitate planning effective therapeutic interventions. The research and clinical implications of this perspective are addressed, paying a particular attention to countertransference responses toward patients with narcissistic personality disorder.