Therapist response and patient personality and psychopathology: An empirical investigation

Aim: Although it is widely recognized that therapist’s emotional responses to a patient (in particular, with personality disorders) can inform both diagnostic and therapeutic interventions, systematic empirical research to date has been limited. The goals of this study were to (a) examine the relationship between therapists’ responses and patients’ personality pathology and level of psychological functioning (verifying that countertransference responses cannot be accounted for by therapist theoretical orientation), (b) to explore these associations in a clinical population of patients with eating disorders, and (c) to assess the possible mediating effect of patients’ symptoms severity on the relationship between patients’ specific personality disorders and therapists’ responses. Methods: A national random sample of psychiatrists and clinical psychologists (N=299) completed the Therapist Response Questionnaire and the Shedler-Westen Assessment Procedure-200 on a randomly selected patient currently in their care and with whom they had worked for a minimum of eight sessions and a maximum of 6 months (one session per week). Patients (N=203) filled in the Symptom Checklist-90-Revised. Results: Specific personality disorders evoked distinct countertransference responses in therapists of different theoretical preferences and, in general, therapists’ responses were characterized by stronger negative feelings when working with lower-functioning patients. Patients’ severity symptomatology partially mediated the relationship between patients’ personality disorders and therapists’ reactions. Discussion: Patients’ specific personality pathologies are associated with consistent emotional responses, which suggests that clinicians can make diagnostic and therapeutic use of their responses to patients.