Patient attachment and reflective functioning as predictors for therapist countertransference

Sammanfattning: Therapists’ reactions towards patients are important for the therapeutic process, and is influenced by therapist and patient characteristics. This study aimed to improve the understanding of therapists’ emotional reactions by investigating if patients’ attachment and ability to mentalize predicted therapist countertransference in psychotherapy. Multilevel modeling was used to analyse 87 therapy-dyads in psychotherapy. Patient attachment, measured pre-treatment using self-reports, and mentalization operationalized as Reflective functioning (RF) were hypothesized to predict therapist self-reported emotional experiences (conceptualized as countertransference) over the complete treatment and in different treatment phases. Results showed that lower patient RF predicted more negative therapist countertransference in complete treatment. In the middle and final phases of therapy, lower RF predicted more negative countertransference, and higher RF predicted more positive countertransference. Higher level of avoidant attachment in patients predicted more relaxed therapist countertransference in the final phase of treatment. Findings indicate that patients’ mentalizing ability is important to consider in psychotherapy, as it has informational value for the therapeutic process.