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Westerling, T.W., III Laws, H. Ortega, S. Drinkwater, R. Stevens, H. Goodman, D. Beinashowitz, J. Drill, R.L. (2019). Patient Attachment and Therapist Countertransference in Psychodynamic Psychotherapy. Psychoanal. Psychol., 36(1):73-81.

(2019). Psychoanalytic Psychology, 36(1):73-81

Patient Attachment and Therapist Countertransference in Psychodynamic Psychotherapy

Thomas W. Westerling, III, Ph.D., Holly Laws, Ph.D., Shelby Ortega, Ph.D., Robert Drinkwater, Ph.D., Helen Stevens, PsyD, David Goodman, Ph.D., Jack Beinashowitz, Ph.D. and Rebecca L. Drill, Ph.D.

The present study examines relationships between patient attachment and therapist countertransference in a large, naturalistic, longitudinal study of psychodynamic psychotherapy in a safety-net hospital. This study explored patterns in the relationship between therapist countertransference and patient attachment in two ways: (a) by studying cross sectional associations between patient-reported attachment and therapist-reported countertransference at 3 months into treatment, and (b) by studying if changes in patient-reported attachment over the course of psychotherapy are associated with changes in therapist-reported countertransference. In a sample of 101 therapy dyads, patients completed self-report attachment domains and therapists completed self-report countertransference measures 3 months following initiation of psychotherapy. Results showed initial significant positive associations between patient-rated attachment anxiety and therapist-rated “parental/protective,” “special/overinvolved,” and “overwhelmed/disorganized” countertransference. A sample of 119 therapy dyads (these included dyads in which therapists and patients completed measures at any point in time) was analyzed using multilevel modeling. Results showed that initial patient-rated attachment anxiety was associated with decreases in therapist-rated parental/protective and special/overinvolved countertransference over time. Decreases in patient-rated attachment anxiety were associated with subsequent increases in therapist reports of feeling overwhelmed/disorganized. These findings provide a greater understanding of how attending to patient attachment and therapist countertransference together may cofacilitate treatment and improve patient outcomes.

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