Countertransference and therapeutic alliance in the early stage of adult psychodynamic psychotherapy

Objectives:The primary objective of this study was to assess the relationship between countertransference (CT) and therapeutic alliance (TA) during the early stages of psychodynamic psychotherapy. A secondary objective is to assess associations between CT and variables related to therapist and patient and between CT and other patient variables investigated, which were defense mechanisms, symptomology and functionality.Methodology: This was a cross-sectional study that enrolled 30 patients treated by 17 different therapists at the psychotherapy clinics of two psychiatry centers. Assessments of each patient-therapist pair were conducted between their fourth and 10th sessions.Results: The CT distance domain exhibited a moderate negative correlation with TA, particularly its sub-dimension representing the patient's capacity for work in therapy. Moderate positive correlations were observed between CT distance and the splitting defense mechanism and between CT closeness and suppression defenses, in addition to moderate negative correlation between CT indifference and the fantasy defense mechanism. Another finding was higher scores for CT indifference in association with socioeconomic classes D and E.Conclusions: The quality of CT may provide a source of information about TA. A high degree of CT distance represents a low level of TA, particularly with relation to the patient's working capacity, although presence of the splitting defense mechanism can affect CT, to the extent that it constitutes a confounding variable. The concept of CT is useful to psychotherapists, providing a source of information about the patient's internal world and about certain elements of therapy, such as the quality of TA, which is important for good treatment results.

研究目的：本研究的首要目标为评估精神动力学心理治疗早期阶段，反移情（countertransference, CT）与治疗联盟（therapeutic alliance, TA）之间的关联。次要目标则为考察反移情与治疗师、患者相关变量之间的关联，以及反移情与其他已被纳入研究的患者变量——包括防御机制、症状表现与功能状态——之间的关联。
研究方法：本研究为横断面研究，共纳入来自两家精神医学中心心理治疗诊所、由17名不同治疗师接诊的30名患者。每一组医患配对的评估均在其第4至第10次治疗会话期间完成。
研究结果：反移情距离维度与治疗联盟呈中等程度负相关，其中尤以治疗联盟中代表患者在治疗中投入工作能力的子维度相关性最为显著。此外，反移情距离与分裂样防御机制呈中等程度正相关，反移情亲密感与压抑防御机制亦呈中等程度正相关；同时反移情冷漠与幻想防御机制呈中等程度负相关。另一项发现为，社会经济阶层D与E群体的反移情冷漠得分更高。
研究结论：反移情的质量可作为反映治疗联盟的信息来源。较高的反移情距离意味着较低的治疗联盟水平，尤其与患者的治疗投入能力相关；尽管分裂样防御机制会对反移情产生影响，可作为混淆变量存在。反移情概念对心理治疗师具有实用价值，可作为了解患者内心世界及治疗部分要素（如治疗联盟质量）的信息渠道，而后者对获得良好的治疗结局至关重要。