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Articles   |    
Patient Personality and Therapist Response: An Empirical Investigation
Antonello Colli, Ph.D.; Annalisa Tanzilli, Ph.D.; Giancarlo Dimaggio, M.D.; Vittorio Lingiardi, M.D.
Am J Psychiatry 2014;171:102-108. doi:10.1176/appi.ajp.2013.13020224
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The authors report no financial relationships with commercial interests.

From the Department of Human Science, Carlo Bo University of Urbino, Urbino, Italy; the Faculty of Medicine and Psychology, Sapienza University, Rome; and the Center for Metacognitive Interpersonal Therapy, Rome.

Address correspondence to Dr. Colli (antonello.colli@uniurb.it).

Copyright © 2014 by the American Psychiatric Association

Received February 18, 2013; Revised May 07, 2013; Revised July 12, 2013; Revised July 30, 2013; Accepted August 01, 2013.


Objective  The aim of this study was to examine the relationship between therapists’ emotional responses and patients’ personality disorders and level of psychological functioning.

Method  A random national sample of psychiatrists and clinical psychologists (N=203) completed the Therapist Response Questionnaire to identify patterns of therapists’ emotional response, and the Shedler-Westen Assessment Procedure−200 to assess personality disorders and level of psychological functioning in 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).

Results  There were several significant relationships between therapists’ responses and patients’ personality pathology. Paranoid and antisocial personality disorders were associated with criticized/mistreated countertransference, and borderline personality disorder was related to helpless/inadequate, overwhelmed/disorganized, and special/overinvolved countertransference. Disengaged countertransference was associated with schizotypal and narcissistic personality disorders and negatively associated with dependent and histrionic personality disorders. Schizoid personality disorder was associated with helpless/inadequate responses. Positive countertransference was associated with avoidant personality disorder, which was also related to both parental/protective and special/overinvolved therapist responses. Obsessive-compulsive personality disorder was negatively associated with special/overinvolved therapist responses. In general, therapists’ responses were characterized by stronger negative feelings when working with lower-functioning patients.

Conclusions  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.

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TABLE 1.Partial Correlations Between Therapist Response Questionnaire Factors and SWAP-200 Personality Disorders (N=203)a
Table Footer Note

a SWAP-200=Shedler-Westen Assessment Procedure–200. The table lists partial r, two–tailed.

Table Footer Note

*p≤0.05. **p≤0.01. ***p≤0.001.

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TABLE 2.Narrative Descriptions of Countertransference Factors Measured Using the Therapist Response Questionnaire and Correlated With Each SWAP-200 Personality Disordera
Table Footer Note

a These narrative descriptions of therapists’ responses to patients with personality disorders are created by aggregating the items making up each Therapist Response Questionnaire factor associated with a specific personality disorder on the Shedler-Westen Assessment Procedure–200 (SWAP-200).



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Which of the following countertransference responses is associated with paranoid and antisocial personality disorders?
Which of the following personality disorders evoke stronger and more heterogeneous reactions in clinicians, who tend to feel overwhelmed, incompetent, or inadequate and to experience a sense of confusion and frustration in sessions?
Contrary to previous studies, patients with which of the following personality disorders tend to evoke feelings of helplessness and inadequacy in their therapists?
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