Psychotherapists' Countertransference Reactions toward Clients with Antisocial Personality Disorder and Schizophrenia: An Empirical Test of Theory

By Schwartz, Robert C.; Smith, Shannon D. et al. | American Journal of Psychotherapy, October 1, 2007 | Go to article overview

Psychotherapists' Countertransference Reactions toward Clients with Antisocial Personality Disorder and Schizophrenia: An Empirical Test of Theory


Schwartz, Robert C., Smith, Shannon D., Chopko, Brian, American Journal of Psychotherapy


Contemporary theoretical and clinical literature asserts that countertransference reactions are common and may be specific to clients' presenting concerns and interpersonal styles. Although this phenomenon has broad implications for psychotherapy training and practice, little empirical research is available to support these claims. This study investigated the phenomenon of client-induced countertransference toward two client populations that may evoke strong reactions in psychotherapists-persons with Antisocial Personality Disorder and Schizophrenia. Results of a MANOVA and follow-up ANOVAs indicate that psychotherapists displayed significantly stronger feelings of being dominated (i.e., exploited, manipulated, talked down to) by clients with Antisocial Personality Disorders. Counselors manifested significantly stronger positive feelings (i.e., being liked and welcomed and being in charge, that is, being put in a decision-making role) when working with clients having Schizophrenia. We discuss research and clinical implications of these findings.

Sigmund Freud coined the term countertransference (CT) almost 100 years ago (Freud, 1910/1958). When describing this construct, Freud asserted that these reactions occur in a mental health professional "as a result of the patient's influence on his unconscious feelings, and we . . . insist that he shall recognize this countertransference in himself" (p. 144). In Freud's conceptualization of the construct, CT is defensive, nonobjective, and should be eliminated. Similarly, many modern psychotherapy training textbooks use Freud's classical perspective when describing CT. For example, Hill and O'Brien (1999) define CT as reactions to a client, which originate from the helper's unresolved issues. Corey (1996) refers to CT as the reactions professionals have toward clients that may interfere with objectivity, perhaps because of the professional's own needs or unresolved personal conflicts, which may become entangled in the therapeutic relationship. This classical view of CT, described by Freud (1938) as evidence of psychotherapists' incomplete self-knowledge and inability to maintain an effective therapeutic distance from clients, has led to considerable debate about the phenomenon (Robbins & Jolkovski, 1987). For example, Gelso and Hayes (2001) contend that the original perspective of CT is narrow and incomplete because it only emphasizes psychotherapists' self-generated reactions. As Kiesler (2001) states, "a major factor that hinders clinical integrations and theoretical elaborations regarding CT involves the language of its original conceptualization" (p. 1054).

The contemporary definition of CT is more expansive, including various intrapersonal reactions in the psychotherapist manifested because of contact with a client (Blanck & Blanck, 1979). This definition allows the view of CT phenomena as potentially helpful in the therapeutic process because these reactions are not limited to psychotherapists' self-generated negative, biased, and disruptive responses. For example, recent literature on CT has increasingly addressed what Winnicott (1949) termed objective CT. This form of CT refers to feelings, attitudes, and reactions in a psychotherapist elicited from the client's interpersonal behaviors (Kiesler, 2001). Winnicott described objective CT as "the analysts love and hate in reaction to the actual personality and behavior of the patient based on objective observation" (p. 195). Recent authors in this area (e.g., Mclntyre & Schwartz, 1998; Schwartz, 2001) have used the more direct term induced CT to describe this common and clinically important phenomenon. That is, some CT reactions may be induced in psychotherapists due to the presenting concerns, personality characteristics, or interpersonal styles of clients (rather than as byproducts of psychotherapists' own unconscious conflicts).

Interpersonal-communication theory (Kiesler, 1988, 1996) highlights the thought that interpersonal responses in a psychotherapist may be "'pulled for" by clients during counseling sessions and that these interpersonal reactions may be generalizable to significant others in the client's life (or other psychotherapists working with the client). …

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