Countertransference Triggered Activity in Treatment. Good, Bad or Useful?

Abstract

The aim of the “Dismantling Psychotherapy Research Study” was to evaluate whether the psychotherapist is more or less active in connection to his or her countertransference, the therapist-patient-interaction and the patient’s level of object relationship quality. We worked with 234 tape- recorded therapy sessions with depressed patients from the Munich Psychotherapy Study (Huber, 2012), a comparative quasi-experimental study of psychoanalysis (PA), psychodynamic therapy (PD) and Cognitive behavioral therapy (CBT). The study aimed to maximize external validity by examining non-manualized and representative psychotherapies under the conditions of day-to-day practice. The tape recordings were rated and analyzed using the Psychotherapy Process Q-Set (PQS), the Countertransference Questionnaire/Therapist response questionnaire (CTQ/TRQ), the Shedler-Westen-Assessment Procedure-200 (SWAP) and the Quality of Object Relations Scale (QORS).   90 patients with a definite diagnosis of depressive disorder and 12 clinical psychologists/psychotherapists with at least 5 years of professional experience took part in the study. Findings show a clear correlation between the therapist’s activity and the ongoing countertransference. Further, the therapist’s activity is linked to the patient’s emotional and psychological state. This implies a more active therapeutic work as well as a better therapy outcome treating healthier patients. However, therapy outcome is not necessarily related to the patient’s object relation quality. Nevertheless, it has become clear that a therapist responding with negative countertransference and acting it out impairs not only the patient-therapist-interaction but also the therapeutic process itself. The findings illustrate that there are specific countertransference feelings related to the patients’ respective unconscious transference. We conclude to encourage therapists to use their own countertransference reactions as a diagnostic and therapeutic asset.