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Abstract
This article provides an overview of our research concepts on therapeutic competencies with regard to three main questions. The first research question deals with therapists' competencies to succesfully handle transference and countertransference in the cotext of Alliance Ruptures. Research on the Alliance-Focused Training and on subjective countertransference is presented. The second research question deals with therapists' general interpersonal skills. The research approaches outlined here concern the construct of Facilitative Interpersonal Skills (FIS) and the measurement of these skills using the FIS-task. In further studies on this topic, we are focusing on the question of which therapist characteristics are associated with higher interpersonal skills and which linguistic and phonetic features characterise therapist responses that are rated as interpersonally competent. Another study concerns the tendency of therapists to overestimate their interpersonal skills (self-assessment bias). The third main research question deals with the competence to apply therapeutic techniques and to create helpful change processes. An instrument to assess verbal techniques (Psychodynamic Intervention List) and research approaches focusing on the description and the assessment of mediators of change are presented.
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Affiliation(s)
- Antje Gumz
- Psychosomatik und Psychotherapie, Psychologische Hochschule Berlin
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Barreto JF, Matos PM. Navigating the Countertransference Experience: A Transtheoretical Specifist Model. BRITISH JOURNAL OF PSYCHOTHERAPY 2024; 40:295-309. [DOI: 10.1111/bjp.12897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
Abstract
AbstractThe attempt to identify and classify distinct experiences falling under the common designation of countertransference has been labelled the specifist tradition. In this paper, a model describing two dimensions differentiating four components of countertransference experience is proposed. For each experiential component (subjective countertransference, objective countertransference, therapeutic attitude and emerging experience), a brief description based on previous literature from diverse theoretical fields is offered, along with clinical implications and illustrations and an account of empirical literature explicitly or implicitly addressing the specific component. In conclusion, the model is presented as a heuristic guide that can serve different purposes across different therapeutic orientations, with valuable implications for practice, training and supervision.
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Berger JA, Kästner D, Gumz A. Therapeutische Eigenanteile in der Gegenübertragung. FORUM DER PSYCHOANALYSE 2024; 40:233-252. [DOI: 10.1007/s00451-023-00525-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 01/03/2025]
Abstract
ZusammenfassungGegenübertragung (GÜ) gilt mittlerweile als eines der wichtigsten Werkzeuge psychodynamischer Verfahren. Während die interpersonellen Muster des/r Patient:in, die sich in dieser wiederfinden, praktisch und theoretisch vielfach beachtet werden, ist noch wenig über die Eigenanteile des/r Therapeut:in in der GÜ bekannt. Eine Schwierigkeit in der Beforschung dieser besteht in der Erfassung eines Phänomens, das viele Forscher:innen als ich-synton und damit unbewusst begreifen. Eine Annäherung an das Thema erfolgte bisher überwiegend durch Fallberichte klinisch tätiger Autor:innen. Der vorliegende Beitrag bietet einen Überblick über die bisherige empirische Forschung zu dem Thema.Die systematische Suche erfolgte über die elektronischen Datenbanken PsycINFO, PsycArticles, PubMed und PSYNDEX und bezog nach Titel- und Abstractscreening von 1037 Studien schließlich 10 Publikationen in die Auswertung ein. Dabei wurde deutlich, dass die eingeschlossenen Studien sowohl hinsichtlich der zugrunde liegenden Definitionen von Eigenanteil und GÜ sowie der Versuche, diese messbar zu machen, stark divergieren.Um Eigenanteile im Kontext des GÜ-Geschehens zu erfassen, wird eine Erweiterung des Konzeptes von Hayes vorgeschlagen, das folgende Therapeut:innenanteile integriert: Persönlichkeitseigenschaften und Einstellungen, soziodemografische Merkmale und biografische Erfahrungen (subjektive Einschätzungen versus objektive Informationen).
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Stefana A, Fusar-Poli P, Gnisci C, Vieta E, Youngstrom EA. Clinicians' Emotional Reactions toward Patients with Depressive Symptoms in Mood Disorders: A Narrative Scoping Review of Empirical Research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15403. [PMID: 36430122 PMCID: PMC9692756 DOI: 10.3390/ijerph192215403] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 06/16/2023]
Abstract
The purpose of this article is to narratively review the empirical literature on clinicians' emotional, cognitive, and behavioral responses (i.e., countertransference) to depressive and other symptoms of patients with mood disorders. Therapist subjective responses (countertransference) can negatively affect both diagnostic and therapeutic processes, especially when they are not recognized and managed promptly. However, at the same time, countertransference recognition, processing, and management can help inform the diagnostic process and improve the therapy process and outcome. In the last couple of decades, the number of studies that empirically explore countertransference toward mood disordered patients, as well as its relationship with various characteristics of both patients and treatment, has increased. Current evidence suggests that patients with depression tend to elicit more positive feelings among clinicians than patients with other severe mental disorders such as borderline personality disorder or schizophrenia. Furthermore, it documents the existence of associations between patients' severity of depressive symptoms and clinicians' subjective reactions, although the results regarding which specific countertransference patterns are evoked in relation to the different phases of the treatment are not entirely consistent. Lastly, growing evidence suggests the presence of clinicians' specific emotional reactions towards patients with suicidal ideation and behavior.
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Affiliation(s)
- Alberto Stefana
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| | - Paolo Fusar-Poli
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
- OASIS Service, South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London WC2R 2LS, UK
| | - Cristina Gnisci
- Riabilmente—Centro di Riabilitazione Monterotondo, Monterotondo, 00015 Roma, Italy
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, University of Barcelona Hospital Clinic, IDIBAPS, CIBER-SAM, 08007 Barcelona, Catalonia, Spain
| | - Eric A. Youngstrom
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Helping Give Away Psychological Science (HGAPS.org), Chapel Hill, NC 27599, USA
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Aasan OJ, Brataas HV, Nordtug B. Experience of Managing Countertransference Through Self-Guided Imagery in Meditation Among Healthcare Professionals. Front Psychiatry 2022; 13:793784. [PMID: 35250661 PMCID: PMC8891567 DOI: 10.3389/fpsyt.2022.793784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/25/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION As a part of the therapeutic relationship, a significant, well-established predictor of outcomes in psychiatric healthcare, healthcare professionals' emotional reactions to patients may affect treatment outcomes. AIM The aim of our study was to explore and describe healthcare professionals' experiences with managing countertransference using skills from a training program on self-guided imagery in meditation (SIM). METHOD Following an exploratory descriptive design, we conducted qualitative interviews with 10 healthcare professionals who care for patients with mental illness and subjected the collected data to thematic content analysis. RESULTS Participants reported that SIM had helped them to manage countertransference and had prompted changes that we categorized into three themes: managing personal vulnerability, setting clearer boundaries, and practicing self-care. CONCLUSION The results suggest that by cultivating wellbeing and dealing with unresolved inner conflicts, SIM can help healthcare professionals to manage countertransference.
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Affiliation(s)
- Olaug Julie Aasan
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
| | | | - Bente Nordtug
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
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Löffler-Stastka H, Wong G. Learning and competence development via clinical cases – what elements should be investigated to best train good medical doctors? World J Meta-Anal 2020; 8:178-189. [DOI: 10.13105/wjma.v8.i3.178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/15/2020] [Accepted: 06/19/2020] [Indexed: 02/06/2023] Open
Abstract
In European higher education, application of information technology, concentration on the learning-processes, consistent implementation, transfer learning, case-based learning, autonomous learning has been extensively studied in the last decade. Educational sciences based on neuroscientific findings use brain-based learning and teaching, including integrated thematic instructions and emotion-theory. Elements essential to this strategy, such as theory and methods for learning, competencies, attitudes, social reality, and a metadiscourse are described herein. Research on learning tends to focus on declarative knowledge, associative learning with conditional stimuli, and procedural knowledge with polythematic/crosslinking thinking. Research on competencies: In research on competencies (e.g., for clinical reasoning, decision-making), intuitive and analytical components are studied. As repeated presentation and exercising of clinical cases is crucial for an efficient learning process, the implementation of interactive scenarios including affectively involving didactics is considered. For competence-development observational methods, questionnaires/item sets or factors have to be targeted and empirically validated. Attitudes and social reality: Clinical decision-making, identification processes and attitudes (“Hidden curriculum”), as well as secondary socialization processes (integration of social norms, values, preparation of role-acquisition, occupational role) are studied via process research, conceptual research, and observational methods. With respect to social reality research, conscious and unconscious bargaining processes have to be taken into account. Methodology: Neuroscience – memory, neuronal, molecular biology, and computer science (Neurocircuits) are integrated into observational process research (e.g., affective-cognitive interface, identification processes) and conceptual research is added and studied on the meta-level, including discussion of research paradigms. This discussion provides ongoing feedback to projects in a hermeneutic circle.
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Affiliation(s)
- Henriette Löffler-Stastka
- Department of Psychoanalysis and Psychotherapy, and Postgraduate Unit, Teaching Center, Medical University of Vienna, Vienna 1090, Austria
| | - Guoruey Wong
- Faculté de Médecine, Université de Montréal, Montréal H3T 1J4, Quebec, Canada
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Breivik R, Wilberg T, Evensen J, Røssberg JI, Dahl HSJ, Pedersen G. Countertransference feelings and personality disorders: a psychometric evaluation of a brief version of the Feeling Word Checklist (FWC-BV). BMC Psychiatry 2020; 20:141. [PMID: 32228529 PMCID: PMC7106844 DOI: 10.1186/s12888-020-02556-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 03/18/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The Feeling Word Checklist (FWC) is a self-report questionnaire designed to assess therapists' countertransference (CT) feelings. The primary aim of the study was to evaluate the psychometric properties of a brief, 12-item version of the Feeling Word Checklist (FWC-BV). The second aim was to validate the factor structure by examining the associations between the FWC-BV factors, patients' personality pathology and therapeutic alliance (TA). METHODS Therapists at 13 different outpatient units within the Norwegian Network of Personality Disorders participated, and the study includes therapies for a large sample of patients (N = 2425) with personality pathology. Over a period of 2.5 years, therapists completed the FWC-BV for each patient in therapy every 6 months. Statistical methods included exploratory (EFA) and confirmatory (CFA) factor analysis. Internal consistency was estimated using Mc Donald's coefficient Omega (ωt). The Structured Clinical Interview for DSM-IV - Axis II (SCID II) and Mini International Neuropsychiatric Interview (MINI) were used as diagnostic instruments, and patient-rated TA was assessed using the Working Alliance Inventory (WAI-SR). RESULTS Factor analyses revealed three clinically meaningful factors: Inadequate, Idealised and Confident. These factors had acceptable psychometric properties. Most notably, a number of borderline PD criteria correlated positively with the factors Inadequate and Idealised, and negatively with the factor Confident. All the factors correlated significantly with at least one of the WAI-SR subscales. CONCLUSIONS The FWC-BV measures three clinically meaningful aspects of therapists' CT feelings. This brief version of the FWC seems satisfactory for use in further research and in clinical contexts.
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Affiliation(s)
- R Breivik
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4959, Nydalen, 0424, Oslo, Norway.
- University of Oslo, Institute of Clinical Medicine, P.O. Box 1171, Blindern, 0318, Oslo, Norway.
| | - T Wilberg
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4959, Nydalen, 0424, Oslo, Norway
- University of Oslo, Institute of Clinical Medicine, P.O. Box 1171, Blindern, 0318, Oslo, Norway
| | - J Evensen
- Division of Mental Health and Addiction, Oslo University Hospital, Nydalen Outpatient Clinic, P.O. Box 4925, 0424, Oslo, Norway
| | - J I Røssberg
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4959, Nydalen, 0424, Oslo, Norway
- University of Oslo, Institute of Clinical Medicine, P.O. Box 1171, Blindern, 0318, Oslo, Norway
| | - H S J Dahl
- Division of Mental Health and Addiction, Vestfold Hospital Trust, P.O. Box 2168, 3103, Tønsberg, Norway
| | - G Pedersen
- Division of Mental Health and Addiction, Department of Personality Psychiatry, Oslo University Hospital, Oslo, Norway
- NORMENT, KG Jebsen Center for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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