Therapist responsiveness and clinical relationship in the treatment of patients with personality disorders: An empirical investigation

Introduction: Therapist responsiveness refers to a crucial component of the clinician-patient relationship, defining how the therapist is with the patient and manifests flexibility, sensitivity, empathy, and availability. Being a responsive therapist means getting emotionally attuned to the patient, being able to read the interpersonal dynamics developing in the hic et nunc of the clinical interaction, and providing the most appropriate interventions consistent with the emerging relational context. Recent studies have emphasized the impact of this dimension in the treatment of patients with personality disorders (PD), but knowledge in this field of investigation is very limited. This research aimed to investigate the association between therapist responsiveness and some characteristics of the therapist, patient, and clinical relationship in the early stages of the psychotherapy. Methods: 82 pairs of therapists and patients (with PD) completed two instrument batteries consisting of the patient and therapist versions of the Patient’s Experience of Attunement and Responsiveness Scale, the Working Alliance Inventory-SF, the Depth Scale of the SEQ, respectively. The therapists’ battery also included the Therapist Response Questionnaire and the Comparative Psychotherapy Process Scale, while the patients’ battery included the Defense Mechanisms Rating Scale-SF-30. Results: Overall, therapist responsiveness was related to the quality of the therapeutic alliance and the depth of content processing that emerged during the psychotherapy sessions. Good therapist responsiveness was strongly associated with the use of psychodynamic techniques. A negative correlation was found between therapist responsiveness, helpless/inadequate and disengaged countertransference patterns, and patients’ worse defensive functioning. Finally, a statistically significant patient-therapist divergence was found in the assessment of therapist responsiveness. Patients tended to evaluate therapists’ responsiveness more positively than the clinicians themselves. Discussion: This study seeks to shed light on the interpersonal processes in the patient-therapist dyads that help guide the therapeutic process toward better outcomes. The findings have clinically significant implications and promote the development of best practices for planning effective individualized treatments for patients with PD.