Exploring Countertransference in Child and Parental Couple Therapy: Development of the TRQ-C and TRQ-PC

Introduction. Countertransference defined as the therapist’s emotional entanglement with the patient, constitutes a critical aspect of the therapeutic process, influencing therapeutic outcomes and the quality of the therapeutic alliance. While it has been extensively investigated in adult psychotherapy, countertransference in the context of developmental stages, specifically in child psychotherapy and parent couple therapy, remains significantly under-researched. The present study aims to fill this gap by pursuing two primary objectives: first, to synthesize current findings on countertransference in child psychotherapy and parental couple therapy; and second to proposing and outline the validation process for two new instruments designed to evaluate countertransference in these specific therapeutic contexts. Methods. A comprehensive literature review was conducted using databases such as PsycINFO, PubMed, and Scopus, covering publications from 1980 to 2023. Keywords included “countertransference”, “child psychotherapy”, “parental couple therapy”, “developmental age”, and “assessment tools”. Inclusion criteria focused on studies that explicitly discussed countertransference. Selected studies were evaluated based on their relevance, methodological rigor, and focus on countertransference in therapeutic settings involving children and parental couples. The review included qualitative, quantitative, and mixed-method studies to ensure a holistic and comprehensive understanding of the topic. Additionally, preliminary drafts of two measurement instruments were developed based on identified themes and validated constructs from the literature. The proposed instruments, adapted from the Therapist Response Questionnaire for Adults (TRQ) and Adolescents (TRQ-A), include the Therapist Response Questionnaire for Children (TRQ-C) and the Therapist Response Questionnaire for Parental Couples (TRQ-PC). Both instruments underwent two stages of consensus, one theoretical and one statistical. Theoretical consensus involved a panel of 50 experts, comprising child therapists and couple therapists, who provided initial feedback on the instruments’ items. They assessed the items’ validity, reliability, and ability, capturing all possible nuances of countertransference using a five-point Likert scale. For statistical consensus, a pilot test was conducted with a sample of 25 child therapists and 25 couples therapists, each assessing countertransference in an equal number of therapeutic scenarios. Results. The literature review revealed a lack of empirical studies on countertransference in child and parental couple therapy, although numerous clinical studies exist. The review highlighted significant variability in the conceptualization and measurement of countertransference across different studies, despite recurring themes. In child psychotherapy, countertransference often manifests through protective instincts, emotional resonance with the child’s experiences and potential over-identification with the child’s vulnerabilities. Therapists may experience strong emotional responses influenced by their own childhood experiences. Identified key themes also included role reversal. In parental couple therapy, countertransference involves complex dynamics such as triangulation, and managing conflicting allegiances. Therapists might unconsciously align with one parent against the other, or experience conflicts due to their own parental experiences. Key themes also included emotional biases, and the challenge of maintaining neutrality. The proposed instruments, the Therapist Response Questionnaire for Children (TRQ-C) and the Therapist Response Questionnaire for Parental Couples (TRQ-PC), underwent initial validation processes. The items received excellent results in both the theoretical and statistical consensus stages, leading to the refinement of the instruments, modifying or deleting problematic items. Conclusion. This study provides a comprehensive narrative review of countertransference in child psychotherapy and therapy with parental couples, highlighting the nuanced ways in which countertransference can influence therapeutic outcomes. The development and preliminary validation of the TRQ-C and TRQ-PC represent significant advancements in the systematic assessment of countertransference in these contexts. These instruments permit therapists with reliable means to assess and manage their countertransference reactions, thereby enhancing therapeutic efficacy and patient therapeutic outcomes. Furthermore, as highlighted in the literature, assessing countertransference can represent a key tool in the diagnostic process providing meaningful and patient-tailored diagnoses also enriching case formulations and guiding the treatment planning. The findings underscore the importance of continuous training and supervision in managing countertransference, especially in developmental and familial therapy contexts. Future research should focus on further validating these instruments across diverse populations and clinical settings, as well as exploring the impact of countertransference management on therapy outcomes and its variations according to clinical conditions and patient’ symptoms in order to improve the overall quality of care.