and rigid limits on their patients’ requests. Clinicians
could also avoid the expression of their thoughts and
feelings during a session because they fear an angry
reaction, or instead offer sudden and aggressive interpretations
or confrontations of patient behavior. Likewise,
with narcissistic patients, therapists may come to feel
bored, distracted, disengaged, and frustrated (Table 2).
These kinds of emotional responses could provoke an
emotional disattunement, with lack of interest and
empathy ultimately leading to impasse and treatment
termination.
Regarding cluster C patients, we found several significant
patterns of therapist response. Of particular note was
the protective and positive feelings of therapists toward
avoidant patients, perhaps experiencing a wish to repair
some deficiencies or failures in their patients’ relationships
with parents or significant others. Overprotective
feelings could induce the therapist to avoid the exploration
of the patients’ painful feelings or aggressive affects,
considering these individuals to be too fragile and
vulnerable.
Our results partially diverge from previous studies that
found that cluster C patients do not seem to evoke negative
feelings in their therapists (19, 20). In our sample,
clinician responses to patients with dependent personality
were characterized by positive and protective feelings but
also by feelings of helplessness and inadequacy; therapists
can feel like their hands have been tied or that they have
been put into an impossible bind. These results may
indicate that if the therapist “buys into” the patient’s view
of him- or herself as helpless or incapable, such a perception
is capable of arousing first parental and warm feelings,
and secondly negative feelings (3, 33, 34).
This study has some limitations. First, the same
clinician provided data about both a patient’s personality
pathology and his or her own countertransference,
which may be a source of measurement bias. A more
rigorous research design would include an independent
assessment of patients’ personality disorders or the use
and rigid limits on their patients’ requests. Clinicians
could also avoid the expression of their thoughts and
feelings during a session because they fear an angry
reaction, or instead offer sudden and aggressive interpretations
or confrontations of patient behavior. Likewise,
with narcissistic patients, therapists may come to feel
bored, distracted, disengaged, and frustrated (Table 2).
These kinds of emotional responses could provoke an
emotional disattunement, with lack of interest and
empathy ultimately leading to impasse and treatment
termination.
Regarding cluster C patients, we found several significant
patterns of therapist response. Of particular note was
the protective and positive feelings of therapists toward
avoidant patients, perhaps experiencing a wish to repair
some deficiencies or failures in their patients’ relationships
with parents or significant others. Overprotective
feelings could induce the therapist to avoid the exploration
of the patients’ painful feelings or aggressive affects,
considering these individuals to be too fragile and
vulnerable.
Our results partially diverge from previous studies that
found that cluster C patients do not seem to evoke negative
feelings in their therapists (19, 20). In our sample,
clinician responses to patients with dependent personality
were characterized by positive and protective feelings but
also by feelings of helplessness and inadequacy; therapists
can feel like their hands have been tied or that they have
been put into an impossible bind. These results may
indicate that if the therapist “buys into” the patient’s view
of him- or herself as helpless or incapable, such a perception
is capable of arousing first parental and warm feelings,
and secondly negative feelings (3, 33, 34).
This study has some limitations. First, the same
clinician provided data about both a patient’s personality
pathology and his or her own countertransference,
which may be a source of measurement bias. A more
rigorous research design would include an independent
assessment of patients’ personality disorders or the use
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