Elaboration of countertransference experience and the workings of the working alliance.

Abstract

Alliance may impact psychotherapy outcomes both as a precondition that enables therapeutic work and an evolving process that is therapeutic in itself. This study examined the participation of the elaboration of countertransference experience (ECE) in alliance variation between therapist-client dyads early in therapy and within dyads over time. A total of 44 session assessments nested within 12 dyads were modeled through longitudinal multilevel analyses and utilized to examine the associations between the ECE dimensions of Immersion and Reflection and alliance components across 4 time points within the first 10 sessions of psychotherapy. Results supported the importance of initial ECE to explain differences in alliance between dyads, the particular relevance of ECE with clients presenting lower levels of personality organization, and the effect of personality difficulties on alliance change. Unexpected results were found concerning the correlations between ECE and alliance and their covariation over time. In conclusion, ECE dimensions appear to be involved in alliance formation, both in initial differences between dyads and in changes over time within the same case. ECE seems particularly important with more personality-disturbed clients. Future research should disentangle therapist and client contributions and examine the participation of ECE in the resolution of alliance ruptures. Clinical Impact StatementQuestion: Is alliance formation associated with the psychological processes that therapists use in making sense of their experiences with clients, defined as the elaboration of countertransference experience (ECE)? Findings: Therapists' engagement in their subjective experience (Immersion) in the beginning of psychotherapy is higher in dyads with a better emotional bond. With clients with personality difficulties, therapists' explicit meaning-making (Reflection) may benefit clients' sense of collaboration and goal consensus. Meaning: In practice and in training, therapists should be helped to understand how to make use of what they experience in and between sessions in ways that improve psychotherapeutic processes and outcomes. Next Steps: Future research should disentangle therapist and client contributions to ECE and examine its participation in the resolution of alliance ruptures.

Attachment mismatches and alliance: Through the pitfalls of mentalizing countertransference.

“…Forty-four session assessments were received (see Procedure). More information on the participants can be found in Barreto et al (2020).…”

“…Attachment and sociodemographic data were collected prior to the second session. The process variables (from ECE-RS and Working Alliance Inventory—Short Revised [WAI-SR]) were measured after sessions 2, 5, 8, and 10 (see Barreto et al, 2020, for more information on procedure and inclusion criteria).…”

“…Therapists’ reflection tended to show negative associations with clients’ personality disturbance as measured through self-report within Kernberg’s model of personality organization. Yet, with clients presenting higher personality disturbance, therapists’ reflection positively predicted clients’ alliance tasks/goals component (Barreto et al, 2020).…”

Three Dimensional Approaches to Personality Disorders: a Review on Personality Functioning, Personality Structure, and Personality Organization

“…Studies have shown that the domains and levels of personality organization are useful for the assessment of the patient’s commitment to therapy and willingness/ability to change [ 138 , 154 – 157 , 158 ••, 159 ]. Overall, higher levels of personality organization (less severe impairment) were associated with better treatment outcome [ 160 ], whereas patients with PPO and low levels of BPO (more severe impairment) were more likely to drop out of treatment [ 161 ], associated with helpless and overwhelmed emotional responses by the therapists [ 162 ], as well as difficult countertransferential reactions, reduced quality of the therapeutic alliance [ 163 ], and non-completion to treatment [ 160 , 164 ]. Short-term psychotherapy has proven to be more effective for NPO patients, whereas long-term psychotherapy was more effective at long-term follow-up for patients with low personality organization [ 165 ].…”

Asociaciones entre contratransferencia y características del paciente en psicoterapia psicoanalíticaa

“…Na etapa inicial de uma psicoterapia, a CT pode ser utilizada para o monitoramento do mundo interno do terapeuta (Prasko et al, 2010;Gullestad & Killingmo, 2020) e, na medida em que informa sobre este, pode ser utilizada para melhorar as interpretações e para estabelecer a aliança terapêutica (Westerling et al, 2019;Barreto, Nata, & Matos, 2020). O início de uma psicoterapia é permeado por ansiedades paranoides (Gabbard, 2016).…”