Clinician Reactions When Working with Adolescent Patients: The Therapist Response Questionnaire for Adolescents

Clinician Emotional Responses and Therapeutic Alliance When Treating Adolescent Patients With Narcissistic Personality Disorder Subtypes: A Clinically Meaningful Empirical Investigation

“…F. Kernberg, , 1998P. F. Kernberg et al, 2000;Ronningstam, 2011Ronningstam, , 2012Smith et al, 2016;Tanzilli et al, 2017Tanzilli et al, , 2019, our findings confirmed that specific clinicians' emotional responses and levels of therapeutic alliance were associated with distinct NPD subtypes in a coherent and meaningful way. Thus, clinicians' understanding of their own countertransference reactions to patients and of the quality of mutual collaboration and connection with them may be useful when making thorough case formulations and planning interventions or treatments tailored to narcissistic adolescents' individual characteristics (Malone & Malberg, 2017).…”

“…Identify distinct therapist response patterns that are meaningfully related to adolescent patients with specific NPD subtypes. Consistent with the clinical and empirical literature mentioned above (e.g., Gabbard & Crisp, 2018;Satir et al, 2009;Tanzilli et al, 2019), it was expected that there would be significant and positive associations of the grandiose/malignant subtype with disengaged/hopeless and angry/criticized countertransference patterns; the fragile NPD subtype with overinvolved/worried pattern; and the high-functioning exhibitionistic subtype with warm/attuned pattern. Moreover, these associations would not be accounted for by clinicians' gender and theoretical orientation, but would be influenced by clinical experience, as more experienced clinicians would have fewer strong and negative reactions.…”

“…Clinicians assess each item on a 7-point Likert scale ranging from 1 (not true) to 7 (very true). In this study, we used an empirically supported TRQ-A version (Tanzilli et al, 2019) consisting of six patterns of therapist responses: (1) warm/attuned, which describes an experience of close connection, trust, and collaboration with the patient (e.g., "I have warm, almost parental feelings toward him/ her"; "I feel like I understand him/her"); (2) angry/criticized, which indicates feelings of anger, hostility, and irritation, as well as a sense of being dismissed and devaluated by the patient (e.g., "I get enraged at him/her"; "I feel criticized by him/her"); (3) disorganized/frightened, which describes feelings of being overwhelmed by the patient's emotions and needs, and an intense sense of anxiety and dread toward the patient (e.g., "I feel I am 'walking on eggshells' around him/her, afraid that if I say the wrong thing s/he will explode, fall apart, or walk out"; "I feel anxious working with him/her"); (4) overinvolved/ worried, which indicates excessive engagement in the therapeutic relationship, including difficulties maintaining setting, and feelings of being critical of the patient's parents (e.g., "I worry about him/her after sessions more than other patients"; "I talk about him/her with my spouse or significant other more than my other patients"); (5) disengaged/hopeless, which describes a strong sense of frustration, inadequacy, and impotence, as well as feelings of boredom and withdrawal (e.g., "I feel hopeless working with him/her"; "I don't feel fully engaged in sessions with him/her"); and (6) sexualized, which indicates sexual tensions in the therapeutic relationship with the patient (e.g., "I feel sexual tension in the room"; "His/her sexual feelings toward me make me anxious or uncomfortable"). These scales show good internal consistency (Streiner, 2003): warm/attuned (α = .92), angry/criticized (α = .90), disorganized/frightened (α = .89), overinvolved/worried (α = .87), disengaged/hopeless (α = .86), and sexualized (α = .70).…”

“…Colli, Tanzilli, Dimaggio, & Lingiardi, 2014). To our knowledge, only two studies have examined the relationship between countertransference reactions and personality styles/ syndromes in adolescent psychotherapy (Satir, Thompson-Brenner, Boisseau, & Crisafulli, 2009;Tanzilli, Gualco, Baiocco, & Lingiardi, 2019). Tanzilli et al (2019) found that patients with emerging NPD tend to elicit a sense of frustration, hopeless withdrawal, and lack of emphatic attunement in their therapists.…”

“…To our knowledge, only two studies have examined the relationship between countertransference reactions and personality styles/ syndromes in adolescent psychotherapy (Satir, Thompson-Brenner, Boisseau, & Crisafulli, 2009;Tanzilli, Gualco, Baiocco, & Lingiardi, 2019). Tanzilli et al (2019) found that patients with emerging NPD tend to elicit a sense of frustration, hopeless withdrawal, and lack of emphatic attunement in their therapists. Satir et al (2009) examined clinician emotional responses related to specific personality styles (high-functioning/perfectionistic, dysregulated, depressed/inadequate, and constricted/obsessional) empirically identified in a sample of young female patients with eating disorders.…”