McGill University, Department of Psychiatry & Douglas Mental Health University Institute, McGill Group for Suicide Studies, Montréal (Québec), Canada; Psychiatric Liaison Service, Lausanne University Hospital, 23, 1011, Beaumont, Lausanne, Switzerland.
McGill University, Department of Psychiatry & Douglas Mental Health University Institute, McGill Group for Suicide Studies, Montréal (Québec), Canada; Pôle Universitaire de Psychiatrie de l'enfant et de l'adolescent - Centre Psychothérapique de Nancy, Laxou, France.
J Affect Disord. 2020 Mar 15;265:669-678. doi: 10.1016/j.jad.2019.11.115. Epub 2019 Nov 28.
Previous findings showed that suicidal patients elicit mostly negative countertransference such as distress, hopelessness, feelings of inadequacy, and apprehension, and that a concurrent personality disorder is associated with more feelings of entrapment and mistreatment, among other adverse reactions. No studies were however conducted on instant countertransference (iCT), i.e., after a single encounter, for example in an emergency setting. We aimed to evaluate the impact of suicidal ideations, self-harm and presence of personality disorders on instant Countertransference (iCT).
Caregivers rated their iCT with two validated and standardized questionnaires after a first emergency or outpatient consultation. Suicidal ideation, self-harm and personality disorders were tested as predictors for iCT in a multivariate and multilevel analysis.
Thirty caregivers rated their iCT towards 321 patients. Personality disorders and suicidal ideation, but neither recent nor past history of self-harm, predicted iCT. Common iCT included tension, lack of self-confidence and feeling of being tied. iCT specifically associated with suicidal ideation included distress, lack of hope, confusion, and sense that the patient's life had little worth. In contrast, iCT towards patients with personality disorders suggested tension in the therapeutic relationship (low affiliation with patient, anger, disappointment, devaluation).
Caregiver's characteristics were not considered in the analysis. Furthermore, while countertransference also includes unconscious phenomena, only conscious iCT was assessed.
Patients with suicidal ideation and personality disorders elicit common but also specific negative iCT. Mental health institutions need to devote specific resources (such as clinical supervision and training) to help caregivers manage their iCT.
先前的研究结果表明，自杀患者会引发大多数负面的反移情反应，如痛苦、绝望、无力感和恐惧，而同时存在人格障碍则与更多的被困感和虐待感等不良反应有关。然而，目前还没有研究涉及即时反移情（iCT），即在单次接触后，例如在紧急情况下。我们旨在评估自杀意念、自残和人格障碍对即时反移情（iCT）的影响。
护理人员在首次急诊或门诊就诊后，使用两种经过验证和标准化的问卷评估他们的即时反移情。自杀意念、自残和人格障碍被测试为即时反移情的预测因子，采用多元和多层次分析。
30 名护理人员对 321 名患者进行了即时反移情评估。人格障碍和自杀意念，而不是近期或过去的自残史，预测了即时反移情。常见的即时反移情包括紧张、缺乏自信和束缚感。与自杀意念特别相关的即时反移情包括痛苦、缺乏希望、困惑和患者生命没有价值的感觉。相比之下，针对有人格障碍的患者的即时反移情则暗示治疗关系紧张（与患者的联系较少、愤怒、失望、贬低）。
在分析中没有考虑护理人员的特征。此外，虽然反移情还包括无意识现象，但只评估了有意识的即时反移情。
有自杀意念和人格障碍的患者会引发常见但也有特定的负面即时反移情。心理健康机构需要投入特定的资源（如临床监督和培训）来帮助护理人员管理他们的即时反移情。
