Tanzilli Annalisa, Boldrini Tommaso, Carone Nicola, Gualco Ivan, Lingiardi Vittorio, Williams Riccardo
Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.
Department of Developmental Psychology and Socialization, University of Padua, Padua, Italy.
Clin Psychol Psychother. 2023 Jan;30(1):97-111. doi: 10.1002/cpp.2779. Epub 2022 Aug 26.
Transference (meant in this context, as the patient relational patterns expressed towards the clinician) and therapeutic alliance play a crucial role in the treatment of personality pathology. To date, no empirical study examined the association between these two dimensions of the clinical relationship and patients' personality maladaptive traits in psychotherapy.
A national sample of therapists (N = 100) of different theoretical orientations assessed dysfunctional personality features of a patient in their care using a comprehensive and empirically grounded dimensional diagnostic approach from the Shedler-Westen Assessment Procedure-200 (SWAP-200). Moreover, they filled in the Psychotherapy Relationship Questionnaire (PRQ) to identify interpersonal patterns expressed early in treatment by the patients and the Working Alliance Inventory (WAI-T) to evaluate quality of therapeutic alliance.
Overall, the most severe and maladaptive dimensions of patients' personality were associated with more negative clinician-patient dynamics and poorer levels of therapeutic alliance in statistically significant and clinically relevant ways. Notably, the hostile transference was predicted by both SWAP Hostility and Psychopathy, whereas the SWAP Narcissism was the strongest predictor of the special/entitled transference. The latter was also predicted by SWAP Emotional Dysregulation; conversely, the SWAP Dysphoria was the most robust predictor of anxious/preoccupied pattern. The SWAP Schizoid Orientation and Psychopathy predicted avoidant/dismissing attachment pattern; moreover, they were strongly and negatively related to the SWAP Psychological Health that was the best predictor of positive transference and alliance.
Findings support that therapists' careful understanding of patients' interpersonal ways during early treatment stages may meaningfully inform diagnostic and therapeutic processes.
移情（在此语境中，指患者对临床医生所表现出的关系模式）和治疗联盟在人格病理学治疗中起着至关重要的作用。迄今为止，尚无实证研究考察这两个临床关系维度与心理治疗中患者人格适应不良特质之间的关联。
一个来自不同理论取向的治疗师全国样本（N = 100），使用基于实证的全面维度诊断方法，即谢德勒-韦斯顿评估程序-200（SWAP-200），评估其正在治疗的患者的功能失调人格特征。此外，他们填写了心理治疗关系问卷（PRQ）以识别患者在治疗早期表现出的人际模式，并填写了工作联盟量表（WAI-T）以评估治疗联盟的质量。
总体而言，患者人格中最严重和适应不良的维度与更消极的医患动态以及治疗联盟水平较差在统计学上具有显著意义且在临床上具有相关性。值得注意的是，SWAP敌意量表得分和精神病态量表得分均能预测敌意移情，而SWAP自恋量表得分是特殊/特权移情的最强预测因子。SWAP情绪失调量表得分也能预测后者；相反，SWAP烦躁量表得分是焦虑/过度关注模式的最有力预测因子。SWAP分裂样取向量表得分和精神病态量表得分能预测回避/漠视依恋模式；此外，它们与SWAP心理健康量表得分呈强烈负相关，而SWAP心理健康量表得分是积极移情和联盟的最佳预测因子。
研究结果支持，治疗师在治疗早期阶段对患者人际方式的仔细理解可能会对诊断和治疗过程提供有意义的信息。
