Lo Buglio Gabriele, Zaninotto Leonardo, Göksal Renan, Bayasgalan Uyangakhishig, Barsanti Alice, Booth Brad D, Carone Nicola, Mighri Anmar, Miola Alessandro, Muzi Laura, Lingiardi Vittorio, Solmi Marco, Boldrini Tommaso
Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.
Local Health Unit No. 6 ("Euganea"), Department of Mental Health, Padua, Italy.
Front Psychol. 2025 Jun 25;16:1501273. doi: 10.3389/fpsyg.2025.1501273. eCollection 2025.
To conduct a scoping review of primary research studies on clinicians' emotional responses (i.e., countertransference) when working with individuals with antisocial personality and/or psychopathy traits or disorders. A secondary aim is to map clinicians' personal opinions on managing these individuals clinically, as they can influence clinical decision-making.
A PRISMA-ScR compliant scoping review was conducted. PubMed, Web of Science, and EBSCO/PsycINFO were searched for studies published from 01/01/1990 to 06/12/2023, including clinicians providing clinical care to individuals with antisocial or psychopathy traits or disorders assessed via standardized and validated tools and focusing on their cognitive, emotional and behavioral responses, with no restriction regarding context/location and study design (protocol: https://osf.io/eaquj).
Twelve studies were included, mostly from Europe, mainly focusing on clinicians working with individuals with ASPD. Only two studies addressed psychopathy. Key findings were organized into four concepts: (a) "common emotional responses," which included nervousness, fear of aggression, detachment, and frustration experienced by the clinician; (b) "willingness to deliver clinical care," indicating the key role of clinicians' confidence in their perceived knowledge and skills to provide effective psychological treatment and highlighting that clinicians working in forensic mental health settings exhibit a higher motivation to provide clinical care compared to those in non-forensic settings; (c) "emotional responses related to misogynistic behaviors," showing additional challenges for assigned female therapists in group therapy; (d) "opinions about clinical management and therapeutic alliance," emphasizing the crucial role of the clinician's respect, recognition, and flexible yet firm boundaries.
Individuals with antisocial and psychopathy traits or disorders pose significant challenges in terms of clinicians' emotional responses, highlighting the need for tailored training and supervision to enhance their competence and confidence. The absence of cohort studies and randomized controlled trials on this subject, along with the limited evidence on psychopathy, warrants for further research.
对关于临床医生在治疗具有反社会人格和/或精神病态特质或障碍的个体时的情绪反应（即反移情）的原始研究进行范围综述。第二个目的是梳理临床医生在临床上管理这些个体的个人观点，因为这些观点会影响临床决策。
进行了一项符合PRISMA-ScR的范围综述。在PubMed、科学网和EBSCO/PsycINFO中检索1990年1月1日至2023年12月6日发表的研究，包括通过标准化和验证工具评估具有反社会或精神病态特质或障碍的个体并为其提供临床护理的临床医生，研究重点为他们的认知、情绪和行为反应，对背景/地点和研究设计无限制（方案：https://osf.io/eaquj）。
纳入了12项研究，大多来自欧洲，主要关注治疗反社会型人格障碍个体的临床医生。仅有两项研究涉及精神病态。主要发现归纳为四个概念：（a）“常见情绪反应”，包括临床医生所经历的紧张、对攻击行为的恐惧、疏离和挫败感；（b）“提供临床护理的意愿”，表明临床医生对自身所感知的提供有效心理治疗的知识和技能的信心的关键作用，并强调与非法医环境中的临床医生相比，法医心理健康环境中的临床医生表现出更高的提供临床护理的积极性；（c）“与厌女行为相关的情绪反应”，显示出指定的女性治疗师在团体治疗中面临的额外挑战；（d）“关于临床管理和治疗联盟的观点”，强调临床医生的尊重、认可以及灵活而坚定的界限的关键作用。
具有反社会和精神病态特质或障碍的个体在临床医生的情绪反应方面带来了重大挑战，凸显了需要进行针对性培训和监督以提高他们的能力和信心。关于该主题缺乏队列研究和随机对照试验，以及关于精神病态的证据有限，因此有必要进一步研究。
