Child and Adolescent Psychiatric Research Department, Psychiatric University Hospital, University of Basel, Basel, Switzerland.
Juvenile Forensic Department, Psychiatric University Hospital, University of Basel, Basel, Switzerland.
BMC Psychiatry. 2021 Nov 23;21(1):590. doi: 10.1186/s12888-021-03549-9.
Patient suicidality is a frequently experienced topic for psychotherapists. Especially adolescents with borderline personality pathology (BPP) often exhibit suicidal tendencies. Previous research which examined therapists' countertransference towards suicidal patients suggested that therapists are negatively affected and distressed by them. We hypothesize that this emotional response of the therapists is related to specific sessions in which suicidality came up as a topic. Accordingly, the objective of this study consists in examining therapists' emotional state on a session level of analysis.
The sample consisted of N = 21 adolescents (age 13-19 years) with BPD or subthreshold BPD. Therapists' emotional states were measured in n = 418 sessions using the Session Evaluation Questionnaire. Principal component analysis was used to reduce dimensionality of the therapist response. The emotional states were compared depending on whether suicidality has been addressed in the session (SS) or not (NSS).
Two components could be identified. Firstly, therapists were more aroused, excited, afraid, angry and uncertain after SS than after NSS. Secondly, therapists were more aroused, excited, definite and pleased after SS than after NSS.
Suicidality does not always have to be a burden for therapists: Both a "distress" and an "eustress" component occur in this context from which the latter is supposed to help clinicians master a difficult situation. Since countertransference feelings are often not fully conscious, it is necessary to do research on therapists' emotional states after sessions in which suicidality is addressed. This is crucial to both prevent the therapeutic process from being endangered and preserve clinicians' mental health. Clinical implications and limitations are discussed.
患者的自杀意念是心理治疗师经常面临的话题。尤其是具有边缘型人格病理（BPP）的青少年经常表现出自杀倾向。先前研究检查了治疗师对自杀患者的反移情，表明治疗师会受到影响，并对其感到困扰。我们假设治疗师的这种情绪反应与自杀意念作为主题出现的特定治疗阶段有关。因此，本研究的目的在于检查治疗师在治疗阶段分析层面上的情绪状态。
样本包括 21 名患有 BPD 或边缘型人格障碍阈下状态的青少年（年龄 13-19 岁）。使用治疗阶段评估问卷（Session Evaluation Questionnaire）在 n = 418 次治疗阶段中测量治疗师的情绪状态。使用主成分分析（Principal component analysis）来降低治疗师反应的维度。根据在治疗阶段是否涉及自杀意念（SS）来比较情绪状态（SS）和非自杀意念阶段（NSS）。
可以确定两个成分。首先，与非自杀意念阶段相比，治疗师在涉及自杀意念的治疗阶段后更加激动、兴奋、恐惧、愤怒和不确定。其次，与非自杀意念阶段相比，治疗师在涉及自杀意念的治疗阶段后更加激动、兴奋、明确和高兴。
自杀意念并不一定是治疗师的负担：在这种情况下，会出现“痛苦”和“正性压力”两个成分，后者应该有助于临床医生掌握困难的情况。由于反移情感受通常不是完全有意识的，因此有必要对治疗师在涉及自杀意念的治疗阶段后的情绪状态进行研究。这对于防止治疗过程受到威胁和保护临床医生的心理健康至关重要。讨论了临床意义和局限性。
