Transference and Personality Pathology: Toward the Empirically Derived and Clinically Useful Prototypes of Relational Patterns

Since Freud’s initial recognition that patients may enact interpersonal patterns in the relationship with the analyst, the concept of transference has revised radically. In contemporary terms, it refers broadly to patterns of thought, feeling, motivation and behavior that emerge in the therapeutic relationship and reflect enduring aspects of the patient’s personality and interpersonal functioning. Although the clinical literature on transference phenomena in psychotherapy is rich and the body of research is not limited, little interest has been shown in empirical investigation of patients’ relational patterns related to their personality pathology. The aims of this study was to: 1) examine the stability of the factor structure and psychometric properties of the Psychotherapy Relationship Questionnaire (PRQ; Bradley et al. 2005), a clinician-report measure of transference phenomena in the treatment; 2) investigate the relationship between patients’ relational patterns and specific personality disorders; 3) provide the empirically derived prototypes of relation patterns in patients with personality pathology. A national sample of psychiatrists and clinical psychologists (N=300) of psychodynamic and cognitive-behavioral orientation completed the PRQ, as well as the Shedler–Westen Assessment Procedure–200 (Westen, Shedler, 1999) to assess personality disorders and level of psychological functioning, regarding a patient currently in their care. Exploratory and confirmatory factor analyses identified five distinct transference patterns that were conceptually coherent and psychometrically robust. They were associated with specific personality disorders. Finally, the prototypes of relational patterns in personality-disordered patients provided an empirically derived and clinically useful description of transference processes that strongly resembled clinical theories. The relevant diagnostic and clinical implications of these findings were addressed.