Research on Countertransference

Researchers in psychoanalysis often confront the dilemma of choosing between methodologic rigor and clinical relevance. One result is that many psychoanalysts have lost interest in systematic research, finding that it either confirms what they already know, or that it deals with questions that do not interest them. Bonnie Litowitz, in her plenary address at the June 2006 American Psychoanalytic Association meeting, challenged the field to formulate questions relevant to our highly subjective interpersonal or intersubjective clinical interests in ways that can be studied by the methods of objective scientific inquiry. It is refreshing to see a group of investigators who have consistently studied issues of interest to clinicians with sophisticated scientific methodology and yet come up with results that are interesting and that promise even more for the future. Drew Westen, a professor of psychology at Emory University and an honorary member of the American Psychoanalytic Association, has led such a group for some years.

An interesting example of their work, “Countertransference phenomena and personality pathology in clinical practice: An empirical investigation,” published in the American Journal of Psychiatry (2005), has just been awarded the American Psychoanalytic Association Committee on Scientific Activities Third Annual Scientific Paper Prize. Ephi Betan and colleagues enlisted the participation of 181 psychologist or psychiatrist clinicians, and asked them to use standard measures to describe a recent adult non-psychotic patient whom they had seen at least eight times and also their own thoughts, feelings, and behaviors in response to that patient. Only 40 percent of the clinicians described themselves as “psychodynamic,” and the authors emphasize that the clinicians' theoretical orientation made no difference to their responses, i.e., the study explores patients and how therapists respond to them regardless of the therapists' orientation as psychodynamic, cognitive-behavioral, or other.

Their “Counter transference Questionnaire” consisted of 79 items, which they analyzed to eight underlying factors: (1) overwhelmed/disorganized (e.g., “I feel resentful working with him/her”); (2) helpless/inadequate (e.g., “I feel I am failing to help him/her or I worry that I won't be able to help him/her”); (3) positive (e.g., “I look forward to sessions with him/her”); (4) special/overinvolved (e.g., “I disclose my feelings with him/her more than with other patients”); (5) sexualized (e.g., “I find myself being flirtatious with him/her”); (6) disengaged (e.g., “I feel bored in sessions with him/her”); (7) parental/protective (e.g., “I feel like I want to protect him/her”); and (8) criticized/mistreated (e.g., “I feel unappreciated by him/her”). They then studied the relationship between the patient's personality (based on DSM-IV criteria) and the therapist's countertransference constellation. Cluster A (odd/eccentric) patients elicited criticized/mistreated feelings in the therapist. Cluster B (dramatic/erratic) patients elicited overwhelmed/disorganized, helpless/inadequate, and sexualized responses. In addition, borderline patients were associated with special/over-involved responses and narcissistic patients with disengaged responses. Cluster C (anxious) patients led to parental/protective responses.

The authors conclude that they have a “readily administered measure that reflects shared clinical wisdom in its item content and statistical ‘wisdom’ in its factor structure.” Their work demonstrates that rigorous and sophisticated scientific methods can add to our knowledge and enrich the field, providing strategies for testing clinical hypotheses, aggregating the subjective experiences of many clinicians, comparing individual patient-clinician dyads with the patterns of others, and suggesting formulations of psychopathology, countertransference constellations, and their relationships.