Therapists' affective reactions and treatment selection. An empirical study on countertransference feelings in the diagnostic process

In psychotherapy research,the working alliance has proved to be one of the most important prognostic factors. However, the therapeutical relationship and therapist's affective reaction during the diagnostic process have not received as much attention. The present study was designed to describe therapists' feelings in the diagnostic interview, to investigate associations with patient variables and to test possible effects on treatment selection. It was based on the ratings of n = 12 therapists about n = 301 patients. The affective reactions of the therapists were assessed by 31 self-report items. Factor analysis revealed four dimensions: 1.anger, 2. sympathy, 3. helping attitude, 4. hopelessness. There were strong associations of a positive countertransference with therapists' judgments of patients' competencies, a common understanding of the illness, the quality of the working alliance and favorable prognostical outlooks. Cluster analysis on the basis of therapists' countertransference ratings revealed five subgroups of patients. These countertransference clusters differed with respect to frequencies of diagnostical classifications and selection of psychotherapeutic measures and settings. The results point to the high significance of therapists' emotional reactions in the diagnostic process and suggest that treatment selection should be conceptualized from an interactional perspective.