Countertransference, alliance, and outcome in the treatment of patients with personality disorder: a longitudinal naturalistic study
ObjectiveRelational dynamics, including countertransference responses and the therapeutic alliance, are crucial in the treatment of patients with personality disorders (PD). However, few studies on PD treatment focus on the dyadic process of therapy. The present study aims to investigate association...
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Frontiers Media S.A.
2024-12-01
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| Series: | Frontiers in Psychiatry |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fpsyt.2024.1490056/full |
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| author | Randi Breivik Øvstebø Randi Breivik Øvstebø Geir Pedersen Theresa Wilberg Theresa Wilberg Jan Ivar Røssberg Jan Ivar Røssberg Hanne-Sofie Johnsen Dahl Elfrida Hartveit Kvarstein Elfrida Hartveit Kvarstein |
| author_facet | Randi Breivik Øvstebø Randi Breivik Øvstebø Geir Pedersen Theresa Wilberg Theresa Wilberg Jan Ivar Røssberg Jan Ivar Røssberg Hanne-Sofie Johnsen Dahl Elfrida Hartveit Kvarstein Elfrida Hartveit Kvarstein |
| author_sort | Randi Breivik Øvstebø |
| collection | DOAJ |
| description | ObjectiveRelational dynamics, including countertransference responses and the therapeutic alliance, are crucial in the treatment of patients with personality disorders (PD). However, few studies on PD treatment focus on the dyadic process of therapy. The present study aims to investigate associations between therapist emotional response/countertransference (CT) and patients’ experience of treatment alliance, and CT developments in therapies with treatment completion as outcome.MethodA longitudinal, observational study of patients (N = 365) treated at PD treatment units within specialist mental health services. CT was assessed repeatedly during therapy by the Feeling Word Checklist – Brief Version with three subscales—Inadequate, Confident, and Idealized. Early alliance was assessed after 6 months of treatment (Working Alliance Inventory, WAI). Treatment completion was defined as completing treatment according to schedule versus not completing treatment. Statistical analyses included Linear Mixed Models.ResultsIn the early phase of therapy, lower WAI predicted lower levels of Confident, Idealized, and higher Inadequate CT. The relation between early WAI and CT levels during treatment remained stable. The development of CT during treatment differed according to treatment completion with significant trends of increasing Inadequate CT and decreasing Idealized CT in not completed treatments. WAI and treatment completion had strong and independent effects. Further moderator analysis did not yield additional information.ConclusionThe study demonstrates significant associations between negative CTs and lower patient-rated WAI in the early phase of therapy, and a development of increasingly more negative CTs during therapy in treatments which were not completed according to schedule. The results indicate high clinical relevance of monitoring therapeutic relationships in PD treatments. Further research on the emotional and relational quality of psychotherapeutic relationships in PD treatments is needed. |
| format | Article |
| id | doaj-art-2c25a93c93d14e78bb59dff69a8f742b |
| institution | Kabale University |
| issn | 1664-0640 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Psychiatry |
| spelling | doaj-art-2c25a93c93d14e78bb59dff69a8f742b2025-01-13T13:37:37ZengFrontiers Media S.A.Frontiers in Psychiatry1664-06402024-12-011510.3389/fpsyt.2024.14900561490056Countertransference, alliance, and outcome in the treatment of patients with personality disorder: a longitudinal naturalistic studyRandi Breivik Øvstebø0Randi Breivik Øvstebø1Geir Pedersen2Theresa Wilberg3Theresa Wilberg4Jan Ivar Røssberg5Jan Ivar Røssberg6Hanne-Sofie Johnsen Dahl7Elfrida Hartveit Kvarstein8Elfrida Hartveit Kvarstein9Section for Treatment and Research, Department of Research and Innovation, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, NorwayInstitute of Clinical Medicine, University of Oslo, Oslo, NorwaySection for Treatment and Research, Department of Research and Innovation, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, NorwaySection for Treatment and Research, Department of Research and Innovation, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, NorwayInstitute of Clinical Medicine, University of Oslo, Oslo, NorwaySection for Treatment and Research, Department of Research and Innovation, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, NorwayInstitute of Clinical Medicine, University of Oslo, Oslo, NorwayDepartment of Psychology, University of Oslo, Oslo, NorwaySection for Treatment and Research, Department of Research and Innovation, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, NorwayInstitute of Clinical Medicine, University of Oslo, Oslo, NorwayObjectiveRelational dynamics, including countertransference responses and the therapeutic alliance, are crucial in the treatment of patients with personality disorders (PD). However, few studies on PD treatment focus on the dyadic process of therapy. The present study aims to investigate associations between therapist emotional response/countertransference (CT) and patients’ experience of treatment alliance, and CT developments in therapies with treatment completion as outcome.MethodA longitudinal, observational study of patients (N = 365) treated at PD treatment units within specialist mental health services. CT was assessed repeatedly during therapy by the Feeling Word Checklist – Brief Version with three subscales—Inadequate, Confident, and Idealized. Early alliance was assessed after 6 months of treatment (Working Alliance Inventory, WAI). Treatment completion was defined as completing treatment according to schedule versus not completing treatment. Statistical analyses included Linear Mixed Models.ResultsIn the early phase of therapy, lower WAI predicted lower levels of Confident, Idealized, and higher Inadequate CT. The relation between early WAI and CT levels during treatment remained stable. The development of CT during treatment differed according to treatment completion with significant trends of increasing Inadequate CT and decreasing Idealized CT in not completed treatments. WAI and treatment completion had strong and independent effects. Further moderator analysis did not yield additional information.ConclusionThe study demonstrates significant associations between negative CTs and lower patient-rated WAI in the early phase of therapy, and a development of increasingly more negative CTs during therapy in treatments which were not completed according to schedule. The results indicate high clinical relevance of monitoring therapeutic relationships in PD treatments. Further research on the emotional and relational quality of psychotherapeutic relationships in PD treatments is needed.https://www.frontiersin.org/articles/10.3389/fpsyt.2024.1490056/fullcountertransferencepersonality disordersallianceFeeling Word Checklistnon-completion |
| spellingShingle | Randi Breivik Øvstebø Randi Breivik Øvstebø Geir Pedersen Theresa Wilberg Theresa Wilberg Jan Ivar Røssberg Jan Ivar Røssberg Hanne-Sofie Johnsen Dahl Elfrida Hartveit Kvarstein Elfrida Hartveit Kvarstein Countertransference, alliance, and outcome in the treatment of patients with personality disorder: a longitudinal naturalistic study Frontiers in Psychiatry countertransference personality disorders alliance Feeling Word Checklist non-completion |
| title | Countertransference, alliance, and outcome in the treatment of patients with personality disorder: a longitudinal naturalistic study |
| title_full | Countertransference, alliance, and outcome in the treatment of patients with personality disorder: a longitudinal naturalistic study |
| title_fullStr | Countertransference, alliance, and outcome in the treatment of patients with personality disorder: a longitudinal naturalistic study |
| title_full_unstemmed | Countertransference, alliance, and outcome in the treatment of patients with personality disorder: a longitudinal naturalistic study |
| title_short | Countertransference, alliance, and outcome in the treatment of patients with personality disorder: a longitudinal naturalistic study |
| title_sort | countertransference alliance and outcome in the treatment of patients with personality disorder a longitudinal naturalistic study |
| topic | countertransference personality disorders alliance Feeling Word Checklist non-completion |
| url | https://www.frontiersin.org/articles/10.3389/fpsyt.2024.1490056/full |
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