Machado Diogo de Bitencourt, Teche Stefania Pigatto, Lapolli Catherine, Tavares Beatriz Franck, de Almeida Laura Sigaran Pio, da Silva Giovana Barreto, Magalhães Pedro Vieira da Silva, Eizirik Cláudio Laks
Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
Department of Mental Health, Universidade Federal de Pelotas, Pelotas, RS, Brazil.
Trends Psychiatry Psychother. 2015 Jul-Sep;37(3):133-42. doi: 10.1590/2237-6089-2014-0061.
The primary objective of this study was to assess the relationship between countertransference (CT) and therapeutic alliance (TA) during the early stages of psychodynamic psychotherapy. A secondary objective is to assess associations between CT and variables related to therapist and patient and between CT and other patient variables investigated, which were defense mechanisms, symptomology and functionality.
This was a cross-sectional study that enrolled 30 patients treated by 17 different therapists at the psychotherapy clinics of two psychiatry centers. Assessments of each patient-therapist pair were conducted between their fourth and 10th sessions.
The CT distance domain exhibited a moderate negative correlation with TA, particularly its sub-dimension representing the patient's capacity for work in therapy. Moderate positive correlations were observed between CT distance and the splitting defense mechanism and between CT closeness and suppression defenses, in addition to moderate negative correlation between CT indifference and the fantasy defense mechanism. Another finding was higher scores for CT indifference in association with socioeconomic classes D and E.
The quality of CT may provide a source of information about TA. A high degree of CT distance represents a low level of TA, particularly with relation to the patient's working capacity, although presence of the splitting defense mechanism can affect CT, to the extent that it constitutes a confounding variable. The concept of CT is useful to psychotherapists, providing a source of information about the patient's internal world and about certain elements of therapy, such as the quality of TA, which is important for good treatment results.
本研究的主要目的是评估在心理动力心理治疗早期阶段反移情（CT）与治疗联盟（TA）之间的关系。次要目的是评估CT与治疗师和患者相关变量之间的关联，以及CT与所研究的其他患者变量（即防御机制、症状学和功能）之间的关联。
这是一项横断面研究，纳入了在两个精神病学中心的心理治疗诊所接受17位不同治疗师治疗的30名患者。对每对患者-治疗师在其第4次至第10次治疗期间进行评估。
CT距离领域与TA呈中度负相关，特别是其代表患者治疗工作能力的子维度。除了CT冷漠与幻想防御机制之间呈中度负相关外，还观察到CT距离与分裂防御机制之间呈中度正相关，以及CT亲近与压抑防御之间呈中度正相关。另一个发现是，CT冷漠在社会经济阶层D和E中得分较高。
CT的质量可能提供有关TA的信息来源。高度的CT距离代表低水平的TA，特别是与患者的工作能力相关，尽管分裂防御机制的存在会影响CT，因为它构成了一个混杂变量。CT的概念对心理治疗师很有用，它提供了有关患者内心世界和治疗某些要素（如TA的质量）的信息来源，而TA的质量对良好的治疗效果很重要。
