Countertransference feelings and personality disorders: a psychometric evaluation of a brief version of the Feeling Word Checklist (FWC-BV)

Abstract

Background: The Feeling Word Checklist (FWC) is a self-report questionnaire designed to assess therapists' countertransference (CT) feelings. The primary aim of the study was to evaluate the psychometric properties of a brief, 12-item version of the Feeling Word Checklist (FWC-BV). The second aim was to validate the factor structure by examining the associations between the FWC-BV factors, patients' personality pathology and therapeutic alliance (TA). Methods: Therapists at 13 different outpatient units within the Norwegian Network of Personality Disorders participated, and the study includes therapies for a large sample of patients (N = 2425) with personality pathology. Over a period of 2.5 years, therapists completed the FWC-BV for each patient in therapy every 6 months. Statistical methods included exploratory (EFA) and confirmatory (CFA) factor analysis. Internal consistency was estimated using Mc Donald's coefficient Omega (ω t). The Structured Clinical Interview for DSM-IV-Axis II (SCID II) and Mini International Neuropsychiatric Interview (MINI) were used as diagnostic instruments, and patient-rated TA was assessed using the Working Alliance Inventory (WAI-SR). Results: Factor analyses revealed three clinically meaningful factors: Inadequate, Idealised and Confident. These factors had acceptable psychometric properties. Most notably, a number of borderline PD criteria correlated positively with the factors Inadequate and Idealised, and negatively with the factor Confident. All the factors correlated significantly with at least one of the WAI-SR subscales. Conclusions: The FWC-BV measures three clinically meaningful aspects of therapists' CT feelings. This brief version of the FWC seems satisfactory for use in further research and in clinical contexts.

Associations between countertransference reactions towards patients with borderline personality disorder and therapist experience levels and mentalization ability

“…Positively-valenced feelings and behaviors can be associated with the risk of therapist over-involvement with the client and a loss of objectivity. Breivik et al 39 speculated that therapists may report more positive feelings either due to defensive processes or lack of awareness of their negative feelings towards patients with personality disorders.…”

Patient factors predict therapists’ emotional countertransference differently depending on whether therapists use transference work in psychodynamic therapy

“…These feelings can be challenging, even disturbing, but they may provide useful information about the internal dynamics of the patient (Gullestad & Killingmo, 2020;Sandler, 1976). Indeed, several recent empirical investigations (e.g., Breivik et al, 2020;Colli et al, 2014;Lingiardi et al, 2015;Putrino et al, 2019;Tanzilli et al, 2017) have revealed systematic patterns of associations between patients' pre-treatment functioning and therapists' feelings reported after therapy sessions, suggesting that, to some extent, therapists' in-session feelings mirror the patient's internal psychological experiences (Putrino et al, 2019). The relationship between therapists' emotional states and the patients' psychological functioning may also depend on the therapist's use of therapeutic methods and types of intervention.…”

“…Yet another and even more inclusive definition, later termed the "totalistic definition" (Kernberg, 1965), was first addressed by Heimann (1950) and Little (1951), and implied that countertransference includes the whole range of (conscious and unconscious) emotions, fantasies, and thoughts that therapists experience in their therapeutic work with patients. In this definition, CT is seen to comprise those emotions that predominantly stem from the therapists' own personal material as well those which primarily stem from the patient as a form of "projective communication" (e.g., Bion, 1962), or the emotions that arise as a response to the interpersonal "pull" of the patient (Sandler, 1976). Even if communicating something about the patient, it is now commonly held that the therapist would need a "personal hook" (Gabbard, 1995) for the emotional CT response to materialize, creating a constant challenge for the therapist to sort this out (Ogden, 2004).…”

“…In clinical theory, personality pathology, e.g. Borderline Personality Disorder (BPD), is proposed to elicit powerful CT reactions because of the intense, primitive, and often regressive transference typically exhibited by these patients (Breivik et al, 2020;Kernberg, 1984). Indeed, strong associations between therapist CT and patient PD have also been observed in empirical studies.…”

Asociaciones entre contratransferencia y características del paciente en psicoterapia psicoanalíticaa

“…Pacientes com transtorno de personalidade provocam em seus terapeutas níveis elevados de aprisionamento, raiva e irritação e baixos níveis de afiliação, simpatia, empatia e carinho (Brody & Farber, 1996;McIntyre & Schwartz, 1998;Colli, Tanzilli, Dimaggio, & Lingiardi, 2014;Michaud et al, 2020), e sentimentos mais negativos e turbulentos do que outros pacientes (Chartonas, Kyratsous, Dracass, Lee, & Bhui, 2017;Genova & Gazzillo, 2018). Os pacientes com transtornos da personalidade mais graves, dos grupamentos A (paranoide, esquizoide e esquizotípica) e B (antissocial, borderline, narcisista e histriônica), evocam mais sentimentos negativos e menos sentimentos positivos no terapeuta que os pacientes do grupamento C (esquiva, dependente e obsessivo-compulsivo) (Røssberg et al, 2007;Breivik et al, 2020).…”