Therapist reactions to patient personality: A pilot study of clinicians’ emotional and neural responses using three clinical vignettes from in treatment series

Tanzilli, Annalisa; Trentini, Cristina; Grecucci, Alessandro; Carone, Nicola; Ciacchella, Chiara; Lai, Carlo; Sabogal-Rueda, Miguel David; Lingiardi, Vittorio

doi:10.3389/fnhum.2022.1037486

Cited by 3 publications

(1 citation statement)

References 183 publications

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“…Firstly, because they are a complex and jointly created phenomenon that involves contributions from both members of the therapeutic dyad (Gelso & Hayes, 2007;Stefana, 2017). As a consequence, the overall affective reactions of the therapist are potentially informative about specific personality traits or pathologies (Stefana et al, 2020;Tanzilli et al, 2022) or mood states of the patient. Second, countertransference reactions, i.e., a subset of reactions in which unresolved conflicts of the therapist have been implicated (Gelso & Hayes, 1998, 2007 -are modestly related to poorer therapy outcomes, while their successful management is associated with better outcomes (Hayes et al, 2018).…”

Section: Development and Initial Validation Of The Clinician Affectiv...mentioning

confidence: 99%

Development and Initial Validation of the Clinician Affective REsponse (CARE) Scale

Stefana¹,

Fusar‐Poli²,

Langfus³

et al. 2023

Preprint

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Background: This study aimed to develop and preliminarily validate a self-report inventory of the patterns of thoughts, feelings, and behaviors of the therapist toward the patient during an individual psychotherapy session using modern psychometric methods. Methods: An initial pool of 116 items was generated and its quality was evaluated by subject matter experts. Validation data was gathered from licensed psychotherapists (N=554). Exploratory factor analysis (EFA) and item response theory–graded response modeling were used to select items, confirmatory factor analysis (CFA) to determine whether the factor structure fitted the data well, and k-fold cross-validation to ascertain the robustness of the model. Criterion validity was evaluated by correlating the scale’s scores with the characteristics of therapists, patients, and treatment.Results: The Clinician Affective REsponse (CARE) scale has a three-factor structure: Positively Engaged (k=5, α=.77), Enmeshed (k=5, α=.73), and Stuck (k=5, α=.76). CFA provided the following fit indices: X2/df=1.53, CFI=.98, TLI=.97, RMSEA=.03, and SRMR=.04; whereas K-fold cross-validation (k=4) fit indices were: X2/df=1.44, CFI=.96, TLI=.96, RMSEA=.04, and SRMR=.05. The positively engaged subscale correlated positively with the Global Assessment of Functioning (GAF) score (r=.17, p<.001). The Enmeshed subscale correlated positively with therapy duration (r=.14, p<.001). The Stuck subscale correlated negatively with the GAF score (r=-.25, p<.001) and positively with the Clinical Global Impressions score (r=.19, p<.001).Discussion: Results provide preliminary evidence for the validity and reliability of the CARE scale and suggest that it may be a valuable tool in clinical, training, or research settings, useful for capturing the clinicians’ session-level emotional processes.

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Section: Development and Initial Validation Of The Clinician Affectiv...mentioning

confidence: 99%

Development and Initial Validation of the Clinician Affective REsponse (CARE) Scale

Stefana¹,

Fusar‐Poli²,

Langfus³

et al. 2023

Preprint

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Rethinking treatment failures. Research on a group of Italian psychotherapists

Oasi,

De Salve,

Rossi

et al. 2024

Front. Psychol.

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IntroductionPsychotherapeutic failures involve situational, relational, and personal factors. Dropout refers to a patient’s unilateral termination of treatment without the therapist’s knowledge or approval. Premature termination occurs when therapy is discontinued before achieving a sufficient reduction in initial problems.ObjectiveThis study explores the role of therapist’s emotional response (countertransference), gender, psychotherapeutic orientation, and patient diagnosis in the context of psychotherapeutic failures.MethodA mixed-method approach was used. Fifty-nine Italian psychotherapists, practicing mostly privately with at least 5 years of experience, were recruited through Italian professional internet websites. The Therapist Response Questionnaire and the Impasse Interview were administered to each psychotherapist. Each therapist was asked to reflect on their last dropout patient. Quantitative (MANOVA) and qualitative analyses (textual content analysis) were conducted with SPSS and T-LAB, respectively.ResultsThe quantitative analyses revealed that the most frequent countertransference response was Helpless/Inadequate, with female therapists experiencing this more frequently than male therapists. The qualitative analyses identified two main factors explaining most of the variance in countertransference responses: Parental/Protective versus Hostile/Angry, and Positive/Satisfying versus Helpless/Inadequate, with Helpless/Inadequate central. Additionally, the qualitative analysis of treatment interruption methods revealed two factors explaining over 50% of the variance. Lack of communication was linked to negative themes, while mediated and direct communication were associated with positive terms. Direct communication was characterized as useful, while mediated communication was linked to dropout and attachment figures.ConclusionUnder pressure, psychotherapists’ anxiety levels increase, often managed ambivalently or avoidantly. These results suggest that awareness of psychotherapist emotional responses is important to limit psychotherapeutic failures. These findings offer valuable insights for clinical practice.

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Development and preliminary validation of the Clinician Affective REsponse (CARE) scale

Stefana,

Fusar-Poli,

Langfus

et al. 2024

RES PSYCHOTHER-PSYCH

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The present study reports on the development and validation of the clinician affective response (CARE) scale. The CARE scale was designed as a self-report measure of therapists’ patterns of thoughts, feelings, and behaviors toward the patient during an individual psychotherapy session. An initial pool of 116 items was generated, and its quality was evaluated by subject matter experts. Validation data were gathered from licensed psychotherapists (n=554). We used exploratory factor analysis and item response theory-graded response modeling to select items, confirmatory factor analysis to test how well the factor structure fit the data, and k-fold cross-validation to ascertain the robustness of the model. Criterion validity was evaluated by correlating the scores of the scale with the characteristics of therapists, patients, and treatment. The selected model consists of 15 items and a 3-factor structure, which showed excellent model fit, good internal consistency, and evidence of criterion validity. The CARE scale, short and quick to complete, enables therapists to reflect on and recognize their inner experiences and quantify these experiences in ways conducive to statistical analysis and research. Furthermore, the monitoring of these affective reactions toward their patients can guide therapeutic interventions and inform clinical supervisors.

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Therapist reactions to patient personality: A pilot study of clinicians’ emotional and neural responses using three clinical vignettes from in treatment series

Cited by 3 publications

References 183 publications

Development and Initial Validation of the Clinician Affective REsponse (CARE) Scale

Development and Initial Validation of the Clinician Affective REsponse (CARE) Scale

Rethinking treatment failures. Research on a group of Italian psychotherapists

Development and preliminary validation of the Clinician Affective REsponse (CARE) scale

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