Countertransference (CT) is usually conceptualized as emerging in the course of psychotherapy. This study explores whether CT manifests itself in the context of assessment and if the modality of exposure to participants (interviewer and observer) affects the intensity and nature of CT. Evaluators either led (direct exposure) or observed (indirect exposure) a 6-hour interview with a subject focusing on attachment and personality. Interviewers and evaluators then completed a measure of CT, the Therapist Response Questionnaire for a total of 43 subjects. Results show significant CT reactions for both interviewers and observers that were globally as intense in both conditions, although lower positive/satisfying and helpless/inadequate CTs were reported by observers. Moreover, intraclass correlations suggest that interviewers' and observers' CT reactions toward the same interviewee show an important degree of similarity. These results highlight the presence of CT in assessment contexts and support the existence of an objective part to CT reactions.

Reflective functioning (RF), meaning the capacity to interpret mental states (intentions, emotions, thoughts, desires, and beliefs) underlying one’s own and others’ behaviors, may help understand the dysfunctional self-regulation associated with anxiety disorders. However, research on anxiety and RF in clinical samples is scarce. This study aimed to assess whether mothers’ and youths’ RF was associated with youths’ (a) anxiety disorders and symptoms and (b) internalizing symptoms. Another goal was to explore whether RF predicted anxiety and internalizing symptoms beyond the more commonly established effect of attachment. Canadian children and adolescents aged between 8 and 16years, and their mothers were recruited in an outpatient psychiatric clinic (clinical group with a diagnosed anxiety disorder, n=30, mean age=11.5±2.8years) and in the general population (non-clinical group, n=23, mean age=11.5±2.1years). The Child Attachment Interview was used to assess youths’ attachment along with three dimensions of RF (global, regarding self, regarding others). Mothers’ attachment and RF were assessed with the Adult Attachment Interview. Children’s and adolescents’ anxiety and internalizing symptoms were measured with the Behavior Assessment Scale for Children, second version. The clinical and non-clinical groups did not differ in mothers’ or youths’ RF. However, in the overall sample, youths’ RF regarding themselves and maternal attachment preoccupation were associated with internalizing symptoms. Sequential regression analyses revealed that higher RF regarding self predicted a higher level of self-reported internalizing symptoms, beyond the effect of maternal attachment (β=0.43, p<0.05). This study’s finding suggests that clinically anxious children and adolescents have adequate RF. We propose that the sustained hypervigilance and apprehension associated with anxiety make anxious youths sensitive to their own and others’ mental states. Our findings suggest that psychotherapeutic treatments for anxiety should make use of patients’ RF abilities to help them make sense of their symptoms and thus reduce them.

Objective: Attachment theory is of great relevance to psychotherapy process and outcome. The labor-intensive and time-consuming nature of attachment codification impedes its widespread use in clinical practice. The Attachment Questionnaire (AQ), a clinician-rated instrument, was developed to address these limitations. However, the status of validation of the AQ remains preliminary. The objective of this study is to further validate the AQ by evaluating its factor structure and convergent validity. Methods: To this end, 389 psychotherapists completed the AQ and assessed patients' personality disorders and level of functioning. Results: Factor analyses revealed that a five-factor solution provided a better fit than the original four-factor solution. The additional factor, inhibited exploration, captured difficulties in open, nondefensive, exploration of memories and their effects. Correlations between AQ factors and criterion variables support the convergent validity of the AQ. Conclusions: These results are discussed in light of patients' characteristics and recent advances in attachment research. K E Y W O R D S attachment, clinical assessment, clinician-rated measure, factor structure, personality disorders J. Clin. Psychol. 2019;75:546-561. wileyonlinelibrary.com/journal/jclp 546 |