Therapists’ Feelings in Psychodynamic Therapy: A Study of self-reported Countertransference and long-term Outcome

Abstract

The therapeutic relationship is one factor that makes consistent contribution to outcome independent of type of therapy. The emotional exchange between persons is a vital part of any relationship, and psychotherapists’ feelings are an inescapable aspect of every session. The overall aim in this dissertation was to investigate a significant domain within the therapists’ countertransference, that is, the feelings the therapists became aware of, acknowledged, remembered, and were willing to report on a feeling word checklist (FWC-58) after each session. <br> Data from the First Experimental Study of Transference (FEST), a randomized clinical trial with dismantling design, was used. FEST aimed at studying the effects of a core ingredient in dynamic psychotherapy; transference work. Transference work was defined as therapist interventions focusing on the patient-therapist interaction. Hundred patients were randomized to therapy with or without transference work for one year. <br> Long-term effects of transference work in the context of parental CT (composed of the feeling words: Motherly, Affectionate, Dominating and Important), and patients’ level of personality pathology were investigated. The results showed that both parental CT and the patients’ personality pathology strongly influenced the long-term effect of transference work: In the context of increasing parental CT the positive effect of transference work became even more positive for patients with high level of personality pathology. For patients with low levels of personality pathology the positive effect of transference work became negative. In-depth qualitative and quantitative analyses of two cases complemented the statistical analyses. <br> These studies add to the literature which suggests that patient characteristics, technique variables, and therapist variables interact in complex ways to determine psychotherapy outcome. More specifically, the results are consistent with theory and research that emphasizes the therapists’ need to be actively aware of their countertransference. In addition, patients with high levels of personality pathology might need an emotionally involved therapist.