Relationship between countertransference and emotional communication in the counselling process

Attà Negri, Francesco De Bei, Christopher Christian, Diego Rocco

Abstract


Background: The negative effects of the unmanaged countertransference on session outcome are well documented, but little is known about the impact of countertransference reactions on the in-session elaboration processes. This study investigated the impact of countertransference reactions on the quality of client and counsellor’s in-session work as revealed by their linguistic style, assuming that linguistic style shows the quality of speakers’ referential process, i.e., their ability to translate into words and reorganize the client’s emotional experiences.


Methods: To test this hypothesis twenty-three in-training psychotherapists were asked to rate their emotional reactions through the Therapist Response Questionnaire at the end of the first three counselling sessions with one of their clients, for a total of 69 sessions. These sessions were recorded, transcribed, and evaluated by three external observers who applied the Countertransference Behavior Measure. Finally, the transcripts were analyzed by applying the computerized linguistic measures of the referential process.


Results: We found that countertransference reactions were associated to clients’ specific speech styles characterized by a lower referential process especially in the case of dominant, helpless, overwhelmed, and parental countertransference reactions. For the counsellors, we observed a linguistic style marked by emotional distancing.


Conclusions: This study confirms that linguistic indicators can capture the impact of countertransference reactions, which shows to hinder the emotional elaboration in the counselling sessions.


Keywords


Countertransference; referential activity; reorganization activity; therapeutic hindrances; counselling intervention.

Full Text:

PDF

References


Barreto, J. F., Nata, G., & Matos, P.M. (2020). Elaboration of countertransference experience and the workings of the working alliance. Psychotherapy, 57(2), 141–150. https://doi.org/10.1037/pst0000250

Betan, E., Heim, A. K., Zittel, C., Conklin, C., & Westen, D. (2005). Countertransference phenomena and personality pathology in clinical practice: An empirical investigation. American Journal of Psychiatry, 162(5), 890–898. http://doi.org/10.1176/appi.ajp.162.5.890

Bucci, W. (1984). Linking words and things: Basic processes and individual variation. Cognition, 17(2), 137–153. https://doi.org/10.1016/0010-0277(84)90016-7

Bucci, W. (1997). Psychoanalysis and cognitive science. Guilford Press.

Bucci, W. (2021a). Emotional Communication and Therapeutic Change: Understanding Psychotherapy Through Multiple Code Theory. Routledge. https://doi.org/10.4324/9781003125143

Bucci, W. (2021b). Development and validation of measures of referential activity. Journal of Psycholinguistic Research, 50(1), 17–27 (2021). https://doi.org/10.1007/s10936-021-09760-9

Bucci, W. (2021c). Overview of the referential process: The operation of language within and between people. Journal of Psycholinguistic Research, 50(1), 3–15. https://doi.org/10.1007/s10936-021-09759-2

Bucci, W., & Freedman, N. (1978). Language and hand: The dimension of referential competence. Journal of Personality, 46(4), 594–622. https://doi.org/10.1111/j.1467-6494.1978.tb00188.x

Bucci, W., Kabasakalian, R., & the Referential Activity Research Group. (2004). Instructions for scoring Referential Activity (RA) in transcripts of spoken narrative texts. Retrieved from http://www.thereferentialprocess.org

Bucci, W., Maskit, B., & Murphy, S. (2016). Connecting emotions and words: The referential process. Phenomenology and the Cognitive Sciences, 15(3), 359–383. https://doi.org/10.1007/s11097-015-9417-z

Cartwright, C., Barber, C., Cowie, S., & Thompson, N. (2018). A trans-theoretical training designed to promote understanding and management of countertransference for trainee therapists. Psychotherapy Research, 28(4), 517–531. https://doi.org/10.1080/10503307.2016.1252071

Cartwright, C., Hayes, J. A., Yang, Y., & Shires, A. (2021) “Thinking it through”: toward a model of reflective practice for trainee psychologists’ countertransference reactions. Australian Psychologist, 56 (2), 168–180. https://doi.org/10.1080/00050067.2021.1893599

Cartwright, C., Hayes, J.A., Yang, Y., & Shires, A. (2021). “Thinking it through”: toward a model of reflective practice for trainee psychologists’ countertransference reactions. Australian Psychologist, 56(2), 168–180.https://doi.org/10.1080/00050067.2021.1893599

Cartwright, C., Rhodes, P., King, R., & Shires, S. (2014). Experiences of Countertransference: Reports of Clinical Psychology Students. Australian Psychologist, 49(4), 232–240. https://doi.org/10.1111/ap.12062

Christian, C., Barzilai, E., Nyman, J., & Negri, A. (2021). Assessing key linguistic dimensions of ruptures in the therapeutic alliance. Journal of Psycholinguistic Research, 50(1), 143–153. https://doi.org/10.1007/s10936-021-09768-1

Cicchetti, D. V. (1994). Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychological Assessment, 6(4), 284–290. https://doi.org/10.1037/1040-3590.6.4.284

Cicchetti, D. V., & Sparrow, S. A. (1981). Developing criteria for establishing interrater reliability of specific items: Applications to assessment of adaptive behavior. American Journal of Mental Deficiency, 86(2), 127–137.

Clarke, J.J., Rees, C.S., Breen, L.J., & Brody Heritage, B. (2022). Managing emotional labour in the provision of psychotherapy – what matters most. Clinical Psychologist (online first). https://doi.org/10.1080/13284207.2022.2121644

Clarkin, J. F., Yeomans, F. E., & Kernberg, O. F. (1999). Psychotherapy for borderline personality. Wiley.

Dubé, J. É., & Normandin, L. (2007). Mental activity and referential activity of beginning therapists: A construct validity study of the Countertransference Rating System (CRS). American Journal of Psychotherapy, 61(4), 351–374. https://doi.org/10.1176/appi.psychotherapy.2007.61.4.351

Esposito, G., Passeggia, R., Pepicelli, G., Cannata, A., Parlato F., & Freda, M. F. (2020). Mentalizing the university experience: an exploratory study on the relationship between university students' reflective functioning, psychological well-being and academic performance. Mediterranean Journal of Clinical Psychology, 8(2). https://doi.org/10.6092/2282-1619/mjcp-2415

Fauth, J. (2006). Toward more (and better) countertransference research. Psychotherapy: Theory, Research, Practice, Training, 43(1), 16–31. https://doi.org/10.1037/0033-3204.43.1.16

Fertuck, E.A., Dambreville, N., Diamond, D. et al. (2021). Referential activity differentially mediates expression of positive and negative emotions in borderline personality disorder. Journal of Psycholinguistic Research, 50(1), 155–167. https://doi.org/10.1007/s10936-021-09767-2

Fleiss, J. L. (1981). Statistical methods for rates and proportions. Wiley.

Fleiss, J. L., & Cohen, J. (1973). The equivalence of weighted kappa and the intraclass correlation coefficient as measures of reliability. Educational and Psychological Measurement, 33, 613–619. https://doi.org/10.1177/001316447303300309

Friedman, S. M., & Gelso, C. J. (2000). The development of the Inventory of Countertransference Behavior. Journal of Clinical Psychology, 56(9), 1221–1235. https://doi.org/10.1002/1097-4679(200009)56:9<1221::AID-JCLP8>3.0.CO;2-W

Fuertes, J. N., Charles J. Gelso, C. J., Owen, J. J., & Cheng, D. (2015). Using the Inventory of Countertransference Behavior as an observer-rated measure. Psychoanalytic Psychotherapy, 29(1), 38–56.

http://doi.org/10.1080/02668734.2014.1002417

Gabbard, G. O. (2001). A contemporary psychoanalytic model of countertransference. Journal of Clinical Psychology, 57(8), 983–991. https://doi.org/10.1002/jclp.1065

Gabbard, G. O. (2004). Long-term psychodynamic psychotherapy. A basic text. American Psychiatric Publishing.

Gabbard, G. O. (2020). The role of countertransference in contemporary psychiatric treatment. World Psychiatry, 19(2), 243–244. https://doi.org/10.1002/wps.20746

Gelso, C. J., & Hayes, J. A. (2002). The management of countertransference. In J. C. Norcross (Ed.), Psychotherapy relationships that work: Therapist contributions and responsiveness to patients (pp. 267–283). Oxford University Press.

Gelso, C. J., & Hayes, J. A. (2007). Countertransference and the inner world of the psychotherapist: Perils and possibilities. Routledge. https://doi.org/10.4324/9780203936979

Gelso, C. J., Latts, M., Gomez, M., & Fassinger, R. E. (2002). Countertransference management and therapy outcome. Journal of Clinical Psychology, 58(7), 861–867. https://doi.org/10.1002/jclp.2010

Gelso, C.J., & Kline, K.V. (2022). Some directions for research and theory on countertransference. Psychotherapy Research, 32(1), 46–51. https://doi.org/10.1080/10503307.2021.1968529

Gennaro, A., Rocco, D., Negri, A., Auletta, A., Marinaci, T., Dell’Arciprete, G., Kerusauskaite, S., & Salvatore, S. (2022). The Role of Interpretation in Fostering the Psychotherapy Process: Evidence from a Single Case Study. Mediterranean Journal of Clinical Psychology, 10(1). https://doi.org/10.13129/2282-1619/mjcp-3

Griffero, T. (2017). Atmosferologia: Estetica degli spazi emozionali. Mimesis.

Hayes, J. A., Gelso, C. J., Goldberg, S., & Kivlighan, D. M. (2018). Countertransference management and effective psychotherapy: Meta-analytic findings. Psychotherapy, 55(4), 496–507. https://doi.org/10.1037/pst0000189

Hayes, J. A., Gelso, J. C., & Hummel, A. M. (2011). Managing countertransference. Psychotherapy, 48(1), 88–97. http://doi.org/10.1037/a0022182

Hayes, J. A., Nelson, D. L. B., & Fauth, J. (2015). Countertransference in successful and unsuccessful cases of psychotherapy. Psychotherapy, 52(1), 127–133. https://doi.org/10.1037/a0038827

Hayes, J. A., Riker, J. B., & Ingram, K. M. (1997). Countertransference behavior and management in brief counselling: A field study. Psychotherapy Research, 7(2), 145–154. https://doi.org/10.1080/10503309712331331933

Hinshelwood, R. D. (2019). Countertransference. In L. Abensour, C. Laks Eizirik, R. Michels, & R. Rusbridger (Eds.), Key papers on countertransference (pp. 7– 40). Routledge. https://doi.org/10.4324/9780429476433

Izard, C. E., King, K. A., Trentacosta, C. J., Laurenceau, J. P., Morgan, J. K., Krauthamer-Ewing, E. S., et al. (2008). Accelerating the development of emotion competence in head start children. Development and Psychopathology, 20 (1), 369–397. https://doi.org/10.1017/S0954579408000175

Jacobs, T. J. (2019). Countertransference past and present: a review of the concept. In L. Abensour, C. Laks Eizirik, R. Michels, & R. Rusbridger (Eds.), Key papers on countertransference (pp. 7– 40). Routledge. https://doi.org/10.4324/9780429476433

Kächele, H., Erhardt, I., Seybert, C., & Buchholz, M.B. (2015). Countertransference as object of empirical research? International Forum of Psychoanalysis, 24(2), 96–108. https://doi.org/10.1080/0803706X.2012.737933

Kahn, Z., & Hoffman, L. (2021). Putting it into words: A clinical and linguistic analysis of trauma narratives in two short-term exposure therapies for co-morbid PTSD and SUD. Journal of Psycholinguistic Research, 50(1), 207–221. https://doi.org/10.1007/s10936-021-09770-7

Kiesler, D. J. (2001). Therapist countertransference: In search of common themes and empirical referents. Journal of Clinical Psychology, 57(8), 1053–1063. http://dx.doi.org/10.1002/jclp.1073

Laverdiere, O., Beaulieu-Tremblay, T., Descoteaux, J., & Simard, V. (2018). Countertransference and psychological assessment: Direct and indirect exposure. The Journal of Nervous and Mental Disease, 206(6), 455–460. https://doi.org/10.1097/NMD.0000000000000827

Lieberman, M. D., Eisenberger, N. I., Crockett, M. J., Tom, S. M., Pfeifer, J. H., &Way, B. M. (2007). Putting feelings into words: affect labelling disrupts amygdala activity in response to affective stimuli. Psychological Science, 18(5), 421–428. https://doi.org/10.1111/j.1467-9280.2007.01916.x

Ligiéro, D., & Gelso, C. J. (2002). Countertransference, attachment, and the working alliance: The therapist’s contribution. Psychotherapy, 39(1), 3–11. http://doi.org/10.1037/0033-3204.39.1.3

Löffler-Stastka, H., Sell, C., Zimmermann, J., Huber, D., & Klug, G. (2019). Is countertransference a valid source of clinical information? Investigating emotional responses to audiotaped psychotherapy sessions. Bulletin of the Menninger Clinic, 83(4), 353–375. https://doi.org/10.1521/bumc_2019_83_02

Machado, D. B., Coelho, F. M., Giacomelli, A. D., Donassolo, M. A., Abitante, M. S., Dall’Agnol, T., & Eizirik, C. L. (2014). Systematic review of studies about countertransference in adult psychotherapy. Trends in Psychiatry and Psychotherapy, 36(4), 173–185. https://doi.org/10.1590/2237-6089-2014-1004

Mariani, R., Di Trani, M., Negri, A., Tambelli, R. (2020). Linguistic analysis of autobiographical narratives in unipolar and bipolar mood disorders in light of multiple code theory. Journal of Affective Disorders, 273, 24–31. https://doi.org/10.1016/j.jad.2020.03.170

Mariani, R., Maskit, B., Bucci, W., & De Coro A. (2013). Linguistic measures of the referential process in psychodynamic treatment: The English and Italian versions. Psychotherapy Research, 23(4), 430–447. https://doi.org/10.1080/10503307.2013.794399

Markin, R. D., McCarthy, K. S., & Barber, J. B. (2013). Transference, countertransference, emotional expression, and session quality over the course of supportive expressive therapy: The raters’ perspective, Psychotherapy Research, 23(2), 152–168. https://doi.org/10.1080/10503307.2012.747013

Maskit, B. (2021). Overview of computer measures of the referential process. Journal of Psycholinguistic Research, 50(1), 29–49. https://doi.org/10.1007/s10936-021-09761-8

Maskit, B., & Murphy, S. (2011). The Discourse Attributes Analysis Program.

Retrieved from http://www.thereferentialprocess.org/the-discourse-attributes-analysis-program-daap

Maskit, B., Bucci, W., & Murphy, S. (2012). Computerized language measures. Retrieved from https://sites.google.com/site/referentialprocess/dictionary-measures-and-computer-programs

Maskit, B., Bucci, W., Murphy, S. et al. (2021). Referential activity as a measure of episodic memory. Journal of Psycholinguist Research 50(1), 85–101. https://doi.org/10.1007/s10936-021-09766-3

Millon, T. R., Davis, R., & Millon, C. (1997). Millon Clinical Multiaxial Inventory-III manual (MCMI-III) (2nd ed.). Pearson Assessments.

Mitchell, S. A. (1997). Influence and autonomy in psychoanalysis. Analytic Press.

Mohr, J. J., Gelso, C. J., & Hill, C. E. (2005). Client and counsellor trainee attachment as predictors of session evaluation and countertransference behavior in first counselling sessions. Journal of Counselling Psychology, 53(3), 298–309. https://doi.org/10.1037/0022-0167.52.3.298

Murphy, S., Melandri, E. & Bucci, W. (2021). The effects of storytelling on emotional experience: an experimental paradigm. Journal of Psycholinguistic Research, 50(1), 117–142 (2021). https://doi.org/10.1007/s10936-021-09765-4

Negri, A., & Ongis, M. (2021). Stimulus features of the object relations technique affecting the linguistic qualities of individuals’ narratives. Journal of Psycholinguistic Research, 50(1), 65–83. https://doi.org/10.1007/s10936-021-09764-5

Negri, A., Andreoli, G., Mariani, R., De Bei, F., Rocco, D., Greco, A., & Bucci, W. (2020). First validation of the Referential Process Post-session Scale – Therapist version (RPPS-T). Clinical Neuropsychiatry, 17 (6), 319–329. https://doi.org/10.36131/cnfioritieditore20200601

Negri, A., Christian, C., Mariani, R., Belotti, L., Andreoli, G., & Danskin, K. (2019). Linguistic features of the therapeutic alliance in the first session: A psychotherapy process study. Research in Psychotherapy: Psychopathology, Process and Outcome, 22(1), 71–82. https://doi.org/10.4081/ripppo.2019.374

Nelson, K.L., Murphy, S.M. & Bucci, W. (2021). Narrativity and referential activity predict episodic memory strength in autobiographical memories. Journal of Psycholinguistic Research, 50(1), 103–116. https://doi.org/10.1007/s10936-021-09763-6

Norcross, J. C., & Lambert, M. J. (2018). Psychotherapy relationships that work III. Psychotherapy, 55(4), 303-315. http://dx.doi.org/10.1037/pst0000193

Norcross, J. C., & Wampold, B. E. (2019). Personalizing psychotherapy: Results, conclusions, and practices. In J. C. Norcross & B. E. Wampold (Eds.), Psychotherapy relationships that work: Evidence-based therapist responsiveness (pp. 329–341). Oxford University Press. https://doi.org/10.1093/med-psych/9780190843960.003.0011

Parth, K., Datz, F., Seidman, C., & Löffler-Stastka, H. (2017). Transference and countertransference: A review. Bulletin of the Menninger Clinic, 81(2), 67–211. https://doi.org/10.1521/bumc.2017.81.2.167

Racker, H. (1968). Transference and countertransference. Karnac.

Rocco, D., De Bei, F., Negri, A., & Filipponi, L. (2021). The relationship between self-observed and other-observed countertransference and session outcome. Psychotherapy (Chicago, Ill.), 58(2), 301–309. https://doi.org/10.1037/pst0000356

Rocco, D., Mariani, R., & Zanelli, D. (2013). The role of non-verbal interaction in a short-term psychotherapy: Preliminary analysis and assessment of paralinguistic aspects. Research in Psychotherapy: Psychopathology, Process and Outcome, 16(1), 54–64. https://doi-org.ezproxy.unibg.it/10.4081/ripppo.2013.102

Rocco, D., Pastore, M., Gennaro, A., Salvatore, S., Cozzolino, M., & Scorza, M. (2018). Beyond Verbal Behavior: An Empirical Analysis of Speech Rates in Psychotherapy Sessions. Frontiers in Psychology, 9, Article 978. https://doi.org/10.3389/fpsyg.2018.00978

Rosenberger, E. W., & Hayes, J. A. (2002). Origins, consequences, and management of countertransference: A case study. Journal of Counselling Psychology, 49(2), 221–232. https://doi.org/10.1037/0022-0167.49.2.221

Settineri, S., Sicari, F., Pagano Dritto, I., Frisone, F., Strangis Mobilia, F., & Merlo, E. M. (2019). Application of art therapy in adolescence: photo-novel analysis as an expressive technique. Mediterranean Journal of Clinical Psychology, 7(2). http://dx.doi.org/10.6092/2282-1619/2019.7.2247

Shrout, P. E., & Fleiss, J. L. (1979). Intraclass correlations: Uses in assessing rater reliability. Psychological Bulletin, 86(2), 420–428. https://doi.org/10.1037/0033-2909.86.2.420

Singer, B. A., & Luborsky, L. (1977). Countertransference: The status of clinical versus quantitative research. In A. S. Gurman & A. M. Razin (Eds.), Effective psychotherapy: A handbook of research (pp. 433– 451). Pergamon.

Situmorang D. D. B. (2020). The issues of transference and countertransference in tele-psychotherapy during COVID-19 outbreak. Asian journal of psychiatry, 54, 102427. https://doi.org/10.1016/j.ajp.2020.102427

Sommantico, M., De Rosa, B., & Parrello, S. (2017). Counselling University students: A psychoanalytic approach. Mediterranean Journal of Clinical Psychology, 5(1). http://dx.doi.org/10.6092/2282-1619/2017.5.1354

Tabibnia, G., Lieberman, M. D., & Craske, M. G. (2008). The lasting effect of words on feelings: words may facilitate exposure effects to threatening images. Emotion, 8(3), 307–317. https://doi.org/10.1037/1528-3542.8.3.307

Tanzilli, A., Colli, A., Del Corno, F., & Lingiardi, V. (2016). Factor structure, reliability, and validity of the Therapist Response Questionnaire. Personality Disorders: Theory, Research, and Treatment, 7(2), 147–158. https://doi.org/10.1037/per0000146

Tishby, O. (2022). Countertransference—Introduction to a special section. Psychotherapy Research, 32(1), 1–2.

https://doi.org/10.1080/10503307.2021.1879404

Tishby, O., & Wiseman, H. (2022). Countertransference types and their relation to rupture and repair in the alliance. Psychotherapy Research, 32(1), 16–31. https://doi.org/10.1080/10503307.2020.1862934

Van Wagoner, S. L., Gelso, C. J., Hayes, J. A., & Diemer, R. A. (1991). Countertransference and the reputedly excellent therapist. Psychotherapy, 28, 411-421. https://doi.org/10.1037/0033-3204.28.3.411

Westra, H. A., Aviram, A., Connors, L., Kertes, A., & Ahmed, M. (2012). Therapist emotional reactions and client resistance in cognitive behavioral therapy. Psychotherapy, 49(2), 163–172. https://doi.org/10.1037/a0023200

Zennaro, A., Ferracuti, S., Lang, M., & Sanavio, E. (2008). MCMI III, Millon Clinical Multiaxial Inventory III Ed., Manuale. Giunti.

Zhang, X., & Bucci, W. (2021). Locating nodal moments within psychotherapy sessions: A mixed-methods study using a computerized measure and therapist comments. Journal of Psycholinguistic Research, 50(1), 223–230. https://doi.org/10.1007/s10936-021-09772-5

Zhou, Y., Maskit, B., Bucci, W., Fishman, A., & Murphy, S. (2021). Development of WRRL: A new computerized measure of the reflecting/reorganizing function. Journal of Psycholinguistic Research, 50(1), 51–64. https://doi.org/10.1007/s10936-021-09762-7




DOI: https://doi.org/10.13129/2282-1619/mjcp-3442

Refbacks

  • There are currently no refbacks.