Mentalizing countertransference? <scp>A</scp> model for research on the elaboration of countertransference experience in psychotherapy

Barreto, João Francisco; Matos, Paula Mena

doi:10.1002/cpp.2177

Cited by 13 publications

(30 citation statements)

References 78 publications

(124 reference statements)

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“…Therapeutic work is a meaning making process, one in which both the patient and the therapist need to represent their inner worlds in mental state terms. 44 In this process, the therapist needs to look both inward and outward, at their own experiences and at what the patient might be doing or feeling. 5 The study findings indicate that negative countertransference manifestations were less prominent when therapists' reported better understanding of their own mental states.…”

Section: Discussionmentioning

confidence: 99%

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

Bhola

Mehrotra

2021

Trends Psychiatry Psychother

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Objective This exploratory study locates countertransference as a pan-theoretical concept, comprising of thoughts, feelings, and behaviors expressed or experienced by therapists toward their patients. It aims to understand the patterns of countertransference experienced in working with borderline personality disorder. Associations between countertransference reactions and therapist-related variables of experience and mentalization ability are also examined. Method Psychotherapists (n = 117) completed the Therapist Response Questionnaire to assess patterns of countertransference experienced with a representative patient diagnosed with borderline personality disorder. They also completed a measure of mentalization ability that examined self-related mentalization, other-related mentalization, and motivation to mentalize. Results The profile of responses across eight countertransference dimensions is discussed, with the most strongly endorsed reactions being positive/satisfying, parental/protective, and helpless/inadequate. More experienced therapists reported less negative countertransference reactions in select dimensions. Therapists’ self-reported ability to reflect on and understand their own mental states was negatively correlated with a range of difficult countertransference experiences. There were few associations between their ability to make sense of others’ mental states, the motivation to mentalize, and the strength of their countertransference reactions. Conclusion The implications for countertransference management as well as therapist training and development are highlighted.

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Section: Discussionmentioning

confidence: 99%

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

Bhola

Mehrotra

2021

Trends Psychiatry Psychother

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“…These aspects might be understood in terms of specific transference-countertransference configurations. Thus, the therapists’ capacity to “mentalize” countertransference seems to be decisive (Barreto and Matos, 2018).…”

Section: Discussionmentioning

confidence: 99%

Successful and Less Successful Psychotherapies Compared: Three Therapists and Their Six Contrasting Cases

2019

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Despite the general effectiveness of bona fide psychotherapies, the number of patients who deteriorate or fail to improve is still problematic. Furthermore, there is an increased awareness in the field that the therapists’ individual skills make a significant contribution to the variance in outcome. While some therapists are generally more successful than others, most therapists have experienced both therapeutic success and failure in different cases. The aim of this case-series study was to deepen our understanding of what matters for the therapists’ success in some cases, whereas other patients do not improve. How do the patients and their therapists make sense of and reflect on their therapy experiences in most successful and unsuccessful cases? Are there any distinctive features experienced by the participants at the outset of treatment? To explore these issues, we applied a mixed-method design. Trying to keep the therapist factor constant, we selected contrasting cases from the caseloads of three therapists, following the criterion of reliable and clinically significant symptom reduction or non-improvement at termination. Transcripts of 12 patient interviews and 12 therapist interviews (at baseline and at termination) were analyzed, applying inductive thematic analysis and the multiple-case comparison method. The comparisons within the three therapists’ caseloads revealed that in the successful cases the patient and the therapist shared a common understanding of the presenting problems and the goals of therapy and experienced the therapeutic relationship as both supportive and challenging. Furthermore, the therapists adjusted their way of working to their patients’ needs. In non-improved cases, the participants presented diverging views of the therapeutic process and outcome. The therapists described difficulties in the therapeutic collaboration but not how they dealt with obstacles. They tended to disregard their own role in the interactions and to explain difficulties as being caused by the nature of their patients’ problems. This could indicate that the therapists had difficulty in reflecting on their own contributions, accepting feedback from their patients, and adjusting their work accordingly. These within-therapist differences indicate that taking a “third position” is most needed and seems to be most difficult, when early signs of a lack of therapeutic progress appear.

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“…However, research related to counter‐transference in clinical assessment contexts have shown acceptable intraclass correlation coefficients (Laverdière, Beaulieu‐Tremblay, Descôteaux, & Simard, ), substantiating that counter‐transference reactions might consist of both subjective and objective parts (Kiesler, ). Interrater reliability, though, might differ for various counter‐transference reactions (Hafkenscheid, ), and the therapists' experience of counter‐transference can occur at very different levels of reflectivity and mentalizing (Barreto & Matos, ).…”

Section: Discussionmentioning

confidence: 99%

Between a rock and a hard place: Associations between Mentzos' “dilemma”, self‐reported interpersonal problems, and psychosocial functioning in individuals with non‐affective psychoses

Stuke

Bröcker

Bayer

et al. 2020

Clin Psychology and Psychoth

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Primary aim of this study was to determine the extent and type of self‐reported interpersonal problems in patients with non‐affective psychoses and their impact on psychosocial functioning. Furthermore, we aimed to explore potential links with the psychodynamic construct of Stavros Mentzos' “psychotic dilemma”, which describes an insufferable inner tension caused by an individual's struggle of being torn between “self‐oriented” and “object‐oriented” tendencies. In a cross‐sectional study among 129 patients with non‐affective psychoses, measures of cognition, symptom load and social functioning as well as a tentative, psychodynamic assessment of Mentzos' “dilemma” were obtained during a clinical research visit. Self‐report data on interpersonal problems were gathered using the Inventory of Interpersonal Problems (IIP‐64D) and compared with a German representative standard sample. Second, IIP‐64D scores were compared between groups with or without Mentzos' “dilemma”. Hierarchical regression analyses were performed to test for the impact of interpersonal problems on psychosocial functioning, while controlling for cognitive deficits and psychopathology. Results showed that IIP‐64D scores differed significantly from healthy controls, except for “self‐centred” and “intrusive” interpersonal styles. Participants with a potential “psychotic dilemma” scored significantly higher on the subscales: “domineering”, “self‐centred”, “cold”, and “socially avoidant” than the group without a “psychotic dilemma”. The total amount of interpersonal problems, and particularly high scores on the IIP‐64D “socially avoidant” subscale, predicted psychosocial dysfunction, whereas a “cold” interpersonal style had an opposite effect. In conclusion, specific interpersonal problems may predict psychotherapeutic outcome measures like psychosocial functioning and are partly compatible with the psychodynamic construct of Stavros Mentzos' “psychotic dilemma”.

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Mentalizing countertransference? A model for research on the elaboration of countertransference experience in psychotherapy

Cited by 13 publications

References 78 publications

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

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

Successful and Less Successful Psychotherapies Compared: Three Therapists and Their Six Contrasting Cases

Between a rock and a hard place: Associations between Mentzos' “dilemma”, self‐reported interpersonal problems, and psychosocial functioning in individuals with non‐affective psychoses

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