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.

The aim of this study was to examine the stability of the factor structure and psychometric properties of the Therapist Response Questionnaire (Betan, Heim, Zittel Conklin, & Westen, 2005; Zittel Conklin & Westen, 2003), a clinician report instrument able to measure the clinician's emotional reactions to the patient in psychotherapy. A national sample of psychiatrists and clinical psychologists (N = 332) of psychodynamic and cognitive-behavioral orientation completed the Therapist Response Questionnaire, as well as the Shedler-Westen Assessment Procedure-200 (Westen & Shedler, 1999a, 1999b), to assess personality disorders and level of psychological functioning, regarding a patient currently in their care. They also administered the Symptom Checklist-90-Revised (Derogatis, 1994) to the patients. Exploratory and confirmatory factor analyses revealed 9 distinct countertransference factors that were similar to 8 dimensions identified in the original version of the measure: (a) helpless/inadequate, (b) overwhelmed/disorganized, (c) positive/satisfying, (d) hostile/angry, (e) criticized/devalued, (f) parental/protective, (g) special/overinvolved, (h) sexualized, and (i) disengaged. These scales showed excellent internal consistencies and good validity. They were especially able to capture the quality and intensity of emotional states that therapists experience while treating personality-disordered patients, as well as to better differentiate them; additionally, they tapped into the complexity of clinicians' reactions toward patients experiencing severe psychiatric symptomatology. Results seem to confirm that Therapist Response Questionnaire is a valid and reliable instrument that allows to evaluate patterns of countertransference responses in clinically sensitive and psychometrically robust ways, regardless of therapists' orientations. The clinical and research implications of these findings are addressed.

The authors present a new transcript-based method for the assessment of therapeutic alliance ruptures and resolutions in psychotherapy-the Collaborative Interaction Scale (CIS)-and discuss the structure and theoretical background of the scale and the rating procedure. To assess interrater reliability, three raters independently evaluated 32 psychotherapy sessions (2,984 patient utterances and 2,984 therapist utterances) using the CIS, which demonstrated good interrater reliability (average kappa=.66-.81). In evaluating the relationship between therapist interventions and patient alliance rupture and collaborative processes, the authors found significant correlations between therapist negative interventions and patient alliance ruptures and among therapist positive interventions, patient collaborative processes, and indirect rupture markers. Results indicate that the CIS is a reliable rating system, useful in both empirical research and clinical assessments.

Countertransference can be viewed as a source of valuable diagnostic and therapeutic information and plays a crucial role in psychotherapy process and outcome. Some empirical researches have showed that patients' specific personality characteristics tend to evoke distinct patterns of emotional response in clinicians. However, to date there have been no studies examining the impact of patients' symptomatology on the association between their personality and therapists' responses. This research aimed to (a) investigate the relationship between patients' symptom severity and clinicians' emotional responses; and (b) explore the possible mediated effect of symptom severity on the relationship between patients' personality pathology and countertransference responses. A sample of psychiatrists and clinical psychologists (N = 198) of different theoretical orientations completed the Shedler-Westen Assessment Procedure-200 and the Therapist Response Questionnaire on a patient currently in their care, who then completed the Symptom Checklist-90-Revised. The findings showed that patients' symptomatology partially mediates the relationship between their specific personality disorders (in particular, schizotypal, borderline, histrionic, and avoidant) and therapists' emotional responses, but in general, the impact of symptom severity is less sizable than one aroused by patients' personality style. Higher levels of patients' symptom severity are most associated with an intense feeling of being overwhelmed, disorganization, helplessness, and frustration in clinicians. These countertransference reactions are not accounted for by therapists' different therapeutic approaches and other variables (as gender, age, profession, and experience). The clinical implications of these results are addressed.

This study investigates the relationship between the Depth of elaboration, the therapeutic alliance, and dimensions of the psychotherapy process--the therapist interventions, the patient contributions, and patient/therapist patterns of interaction. Sixty psychotherapy sessions that were audio-taped and transcribed were rated by external judges by using a battery of instruments that included the Psychotherapy Process Q-Set (Jones, 1985, 2000), the Working Alliance Inventory-Observer (Horvath, 1981, 1982; Horvath & Greenberg, 1989), and the Depth Scale of Session Evaluation Questionnaire (Stiles & Snow, 1984a). The results show a significant positive correlation between Depth and therapeutic alliance, as well as between Depth, therapeutic alliance, and some variables of the therapeutic process. The findings indicate the importance of therapist interventions that focus on the patient's affects, relational patterns, and the "here and now" of the relationship in the increase of the Depth of elaboration and therapeutic alliance. The clinical implications of this study will be discussed.