Objective: The aim of this study was to
examine the relationship between therapists’
emotional responses and patients’
personality disorders and level of psychological
functioning.
Method: A random national sample of
psychiatrists and clinical psychologists
(N=203) completed the Therapist Response
Questionnaire to identify patterns
of therapists’ emotional response, and the
Shedler-Westen Assessment Procedure2
200 to assess personality disorders and
level of psychological functioning in a randomly
selected patient currently in their
care and with whom they had worked for
a minimum of eight sessions and a maximum
of 6 months (one session per week).
Results: There were several significant
relationships between therapists’ responses
and patients’ personality pathology. Paranoid
and antisocial personality disorders
were associated with criticized/mistreated
countertransference, and borderline personality
disorder was related to helpless/
inadequate, overwhelmed/disorganized, and
special/overinvolved countertransference.
Disengaged countertransference was associated
with schizotypal and narcissistic
personality disorders and negatively associated
with dependent and histrionic
personality disorders. Schizoid personality
disorder was associated with helpless/
inadequate responses. Positive countertransference
was associated with avoidant
personality disorder, which was also related
to both parental/protective and
special/overinvolved therapist responses.
Obsessive-compulsive personality disorder
was negatively associated with special/
overinvolved therapist responses. In general,
therapists’ responses were characterized
by stronger negative feelings when
working with lower-functioning patients.
Conclusions: Patients’ specific personality
pathologies are associated with consistent
emotional responses, which suggests that
clinicians can make diagnostic and therapeutic
use of their responses to patients.