Gegenübertragung und Indikationsstellung für Psychotherapie/ Countertransference and treatment selection among psychotherapy patients

Abstract

Although treatment selection in psychotherapy can be conceptualized as an interactive process, as yet there is few empirical research that aimed at addressing the significance of therapists' emotional reactions to their patients when selecting appropriate psychotherapeutic treatments. The present naturalistic-observational cross-sectional study investigates therapists' countertransference which was assessed after the completion of the intake interview. 13 psychotherapists rated their countertransference feelings regarding 237 patients who presented at a psychotherapy outpatient university department, using a 17-items feeling word checklist. By means of factor analysis, three dimensions of the countertransference ratings could be found: 1. sympathy; 2. helpfulness; 3. anger. Clusteranalytically, patients could be assigned to four groups that are characterized by specific countertransference patterns: 1. positive countertranference (n = 82); 2. weak countertransference (n=124); 3. ambivalent countertransference (n=16); and 4. negative countertransference (n=13). The frequencies of both diagnostic categories and selected treatments proved to differ between the clusters. In the positive countertransference cluster, patients with depressive disorders were more frequent and patients with somatoform disorders less frequent. In the positive countertransference cluster, the indication of cognitive-behavioral therapy was especially frequent. Regarding the combination of positive countertransference and selection of cognitive treatment, the result of a previous study could be replicated. This finding proved to reflect different countertransference attitudes and indication preferences of therapists with different therapeutic philosophy orientations (psychodynamic vs. cognitive-behavioral).

Keywords: Countertransference; Indication; Therapist variable; Treatment selection; Working alliance.