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Cited by 419Personality Disorders and PsychopathologyPsychoanalysis and Psychopathology ResearchPsychotherapy Techniques and Applications

Countertransference Phenomena and Personality Pathology in Clinical Practice: An Empirical Investigation

Betan, Ephi, Heim, Amy Kegley, Zittel Conklin, Carolyn, Westen, Drew·2005·American Journal of Psychiatry
DOI 10.1176/appi.ajp.162.5.890
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Abstract

OBJECTIVE: This study provides initial data on the reliability and factor structure of a measure of countertransference processes in clinical practice and examines the relation between these processes and patients' personality pathology. METHOD: A national random sample of 181 psychiatrists and clinical psychologists in North America each completed a battery of instruments on a randomly selected patient in their care, including measures of axis II symptoms and the Countertransference Questionnaire, an instrument designed to assess clinicians' cognitive, affective, and behavioral responses in interacting with a particular patient. RESULTS: Factor analysis of the Countertransference Questionnaire yielded eight clinically and conceptually coherent factors that were independent of clinicians' theoretical orientation: 1) overwhelmed/disorganized, 2) helpless/inadequate, 3) positive, 4) special/overinvolved, 5) sexualized, 6) disengaged, 7) parental/protective, and 8) criticized/mistreated. The eight factors were associated in predictable ways with axis II pathology. An aggregated portrait of countertransference responses with narcissistic personality disorder patients provided a clinically rich, empirically based description that strongly resembled theoretical and clinical accounts. CONCLUSIONS: Countertransference phenomena can be measured in clinically sophisticated and psychometrically sound ways that tap the complexity of clinicians' reactions toward their patients. Countertransference patterns are systematically related to patients' personality pathology across therapeutic approaches, suggesting that clinicians, regardless of therapeutic orientation, can make diagnostic and therapeutic use of their own responses to the patient.

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  • Many narcissistic individuals do not voluntarily seek out treatment, and thus cases of narcissism studied in clinical contexts may differ quite substantially from those found in other settings.

    “Although clinical manifestations of narcissism certainly warrant attention, especially given the consequences of these traits for therapeutic alliances (e.g., Betan et al. 2005), it is important to note that many narcissistic individuals do not voluntarily seek out treatment and thus cases of narcissism studied in this context may differ quite substantially from those found in other settings.”

    From Controversies in Narcissism (2017) · cites this paper as Betan et al. 2005

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Authors
Betan, E., Heim, A. K., Zittel Conklin, C., & Westen, D.
Affiliations
Emory University (US)
Venue
American Journal of Psychiatry
Publisher
American Psychiatric Association Publishing
Published
2005-05-01
Volume
162
Issue
5
Pages
890-898
ISSN
  • 0002-953X (ISSN-L)
  • 1535-7228
DOI
10.1176/appi.ajp.162.5.890
OpenAlex
W2110931294
Cited by
419
References
2
Citations by year
2026: 11 · 2025: 20 · 2024: 40 · 2023: 13 · 2022: 20 · 2021: 21 · 2020: 23 · 2019: 25 · 2018: 22 · 2017: 19 · 2016: 18 · 2015: 30 · 2014: 27 · 2013: 19 · 2012: 13
FWCI
18.90
Type
journal article
Language
en
Open access
closed
Locations
  • American Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institute of Mental Health (R01MH062378, MH-62378, MH62377, R01MH062377)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
  • Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
countertransference, personality pathology, narcissistic personality disorder, patient-clinician interaction, factor structure, psychometric reliability
MeSH terms
Attitude of Health Personnel, Countertransference, Factor Analysis, Statistical, Humans, Personality Disorders, Physician-Patient Relations, Private Practice, Professional-Patient Relations, Psychiatric Status Rating Scales, Psychiatry, Psychology, Clinical, Psychometrics, Surveys and Questionnaires, Sampling Studies, Bias, Diagnostic and Statistical Manual of Mental Disorders

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