Am J Psychiatry. 2014 Jan;171(1):102-8. doi: 10.1176/appi.ajp.2013.13020224.
The aim of this study was to examine the relationship between therapists' emotional responses and patients' personality disorders and level of psychological functioning.
A random national sample of psychiatrists and clinical psychologists (N=203) completed the Therapist Response Questionnaire to identify patterns of therapists' emotional response, and the Shedler-Westen Assessment Procedure-200 to assess personality disorders and level of psychological functioning in a randomly selected patient currently in their care and with whom they had worked for a minimum of eight sessions and a maximum of 6 months (one session per week).
There were several significant relationships between therapists' responses and patients' personality pathology. Paranoid and antisocial personality disorders were associated with criticized/mistreated countertransference, and borderline personality disorder was related to helpless/inadequate, overwhelmed/disorganized, and special/overinvolved countertransference. Disengaged countertransference was associated with schizotypal and narcissistic personality disorders and negatively associated with dependent and histrionic personality disorders. Schizoid personality disorder was associated with helpless/inadequate responses. Positive countertransference was associated with avoidant personality disorder, which was also related to both parental/protective and special/overinvolved therapist responses. Obsessive-compulsive personality disorder was negatively associated with special/overinvolved therapist responses. In general, therapists' responses were characterized by stronger negative feelings when working with lower-functioning patients.
Patients' specific personality pathologies are associated with consistent emotional responses, which suggests that clinicians can make diagnostic and therapeutic use of their responses to patients.
本研究旨在探讨治疗师的情绪反应与患者的人格障碍和心理功能水平之间的关系。
一项随机的全国范围的精神科医生和临床心理学家（N=203）完成了治疗师反应问卷，以确定治疗师情绪反应的模式，以及 Shedler-Westen 评估程序-200 评估当前正在治疗中的随机选择的患者的人格障碍和心理功能水平，并且与他们至少进行了 8 次治疗，最多 6 个月（每周一次）。
治疗师的反应与患者的人格病理之间存在一些显著的关系。偏执型和反社会型人格障碍与批评/虐待性的反移情有关，而边缘型人格障碍与无助/不足、不知所措/组织混乱和特殊/过度卷入的反移情有关。非投入性的反移情与分裂型和自恋型人格障碍有关，与依赖性和表演型人格障碍呈负相关。分裂型人格障碍与无助/不足的反应有关。正性的反移情与回避型人格障碍有关，它也与父母/保护和特殊/过度卷入的治疗师反应有关。强迫型人格障碍与特殊/过度卷入的治疗师反应呈负相关。一般来说，治疗师在与功能较低的患者合作时，会表现出更强的负面情绪。
患者特定的人格病理学与一致的情绪反应有关，这表明临床医生可以利用他们对患者的反应进行诊断和治疗。
