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Diagnosis in transition: The influence of therapist personality
Journal Title: RICERCA PSICOANALITICA 
Author/s: Laura Muzi, Vittorio Lingiardi 
Year:  2019 Issue: 1 Language: Italian 
Pages:  18 Pg. 73-90 FullText PDF:  206 KB
DOI:  10.3280/RPR2019-001006
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In the present article the authors examine the role of the therapists’ subjectivity, in particular their personality, in the diagnostic and therapeutic process over the course of psychoanalytic treatments. First, they provide an introduction on the relationship between diagnosis and the clinician’s subjectivity focusing on the contribution of the second edition of the Psychodynamic Diagnostic Manual. They then present a review of the empirical evidence on the influence of the therapist’s individual and subjective variables in psychoanalysis and psychodynamic psychotherapy, stressing their implications for clinical practice and training. Finally, they present a theoretical-clinical overview on the therapist’s personality in psychoanalysis along with the few empirical studies on this topic, also reporting the preliminary findings of an ongoing research project which explored this variable through the Shedler-Westen Assessment Procedure (SWAP-200), an empirically validated and clinically relevant psychometric procedure designed to assess personality functioning.
Keywords: Therapist subjective variables, diagnosis, therapist personality, psychoanalytic psychotherapy

  1. Ackerman S.J., Hilsenroth M.J. (2001). A review of therapist characteristics and techniques negatively impacting the therapeutic alliance. Psychotherapy: Theory, Research, Practice, Training, 38(2): 171-185., DOI: 10.1037/0033-3204.38.2.171
  2. Ackerman S.J., Hilsenroth M.J. (2003). A review of therapist characteristics and techniques positively impacting the therapeutic alliance. Clinical Psychology Review, 23(1): 1-33., DOI: 10.1016/S0272-7358(02)00146-0
  3. American Psychiatric Association (2013). Manuale diagnostico e statistico dei disturbi mentali. Quinta edizione (DSM-5). Milano: Raffaello Cortina, 2014., DOI: 10.1016/S0272-7358(02)00146-0
  4. Anderson T., Crowley M.J., Himawan L., Holmberg J. K. & Uhlin B. D. (2016). Therapist facilitative interpersonal skills and training status: A randomized clinical trial on alliance and outcome. Psychotherapy Research, 26(5): 511-529., DOI: 10.1080/10503307.2015.1049671
  5. Aron L. (1996). A Meeting of Minds: Mutuality in Psychoanalysis Hillsdale, NJ: The Analytic Press. (trad. it.: Menti che si incontrano. Milano: Raffaello Cortina, 2003).
  6. Arthur A.R. (2001). Personality, epistemology and psychotherapists’ choice of theoretical model: A review and analysis. European Journal Of Psychotherapy, Counselling And Health, 4(1): 45-64., DOI: 10.1080/13642530110040082
  7. Baldwin S.A., Imel Z.E. (2013). Therapist effects: findings and methods. In: Lambert M.J., editor, Bergin and Garfield’s handbook of psychotherapy and behaviour change (6th ed.). New York: Wiley.
  8. Balint A., Balint M. (1939). On transference and countertransference. International Journal of Psychoanalysis, 20: 223-230.
  9. Berghout C.C., Zevalkink D.J. (2011). Therapist variables and patient outcome after psychoanalysis and psychoanalytic psychotherapy. Journal of the American Psychoanalytic Association, 59: 577-583.
  10. Betan E., Heim A.K., Zittel Conklin C., Westen D. (2005). Countertransference phenomena and personality pathology in clinical practice: An empirical investigation. American Journal of Psychiatry, 162(5): 890-898.
  11. Beutler L.E., Malik M., Alimohamed S., Harwood T. M., Talebi H., Noble S., Wong E. (2004). Therapist variables. In Lambert M.J, editor, Bergin and Garfield’s handbook of psychotherapy and behavior change (5th ed.). New York: Wiley & Sons.
  12. Black S., Hardy G., Turpin G., Parry G. (2005). Self-reported attachment styles and therapeutic orientation of therapists and their relationship with reported general alliance quality and problems in therapy. Psychology and Psychotherapy, 78: 363-377., DOI: 10.1348/147608305X43784
  13. Boswell J.F., Castonguay L.G., Pincus A.L. (2009). Trainee theoretical orientation: Profiles and potential predictors. Journal Of Psychotherapy Integration, 19(3): 291-312.
  14. Bruck E., Winston A., Aderholt S., Muran J.C. (2006). Predictive Validity of Patient and Therapist Attachment and Introject Styles. American Journal of Psychotherapy, 60(4): 393-406.
  15. Chapman B.P., Talbot N., Tatman A.W., Britton P.C. (2009). Personality traits and the working alliance in psychotherapy trainees: An organizing role for the Five Factor Model?. Journal Of Social And Clinical Psychology, 28(5): 577-596.
  16. Coady N.F. (1991). The association between client and therapist interpersonal processes and outcomes in psychodynamic psychotherapy. Research on Social Work Practice, 1(2): 122-138., DOI: 10.1177/104973159100100202
  17. Colli A., Tanzilli A., Dimaggio G., Lingiardi V. (2014). Patient personality and therapist response: An empirical investigation. American Journal of Psychiatry, 171(1): 102-108.
  18. Crits-Christoph P., Mintz J. (1991). Implications of therapists effects for the design and analysis of comparative studies of psychotherapies. Journal of Consulting and Clinical Psychology, 45: 1001-1004., DOI: 10.1037/0022-006X.59.1.20
  19. Degnan A., Seymour-Hyde A., Harris A., Berry K. (2016). The role of therapist attachment in alliance and outcome: A systematic literature review. Clinical Psychology & Psychotherapy, 23(1): 47-65.
  20. Dinger U., Strack M., Leichsenring F., Schauenburg H. (2007). Influences of patients' and therapists' interpersonal problems and therapeutic alliance on outcome in psychotherapy. Psychotherapy Research, 17(2): 148-159.
  21. Fluckinger C., Del Re A.C., Wampold B.E., Symonds D., Horvath A.O. (2012). How central is alliance in psychotherapy? A multilevel longitudinal meta-analysis. Journal of Consulting Psychology, 59(1): 10-17.
  22. Fonagy, P. (2015). The effectiveness of psychodynamic psychotherapies: An update. World Psychiatry: Official Journal Of The World Psychiatric Association (WPA), 14(2): 137-150.
  23. Fontana M., a cura di (2017). La diagnosi e le sue implicazioni nella clinica psicoanalitica. Roma: Giovanni Fioriti Editore.
  24. Freud S. (1912). Consigli al medico nel trattamento analitico. In: OSF, Vol. VI. Torino: Bollati Boringhieri, 1974.
  25. Freud S. (1937). Analisi terminabile e interminabile. In OSF, Vol. XI. Torino: Bollati Boringhieri, 1974.
  26. Gabbard G. O. (2009). Transference and countertransference: Developments in the treatment of narcissistic personality disorder. Psychiatric Annals, 39: 129-136., DOI: 10.3928/00485713-20090301-03
  27. Gazzillo F., Lingiardi V., Del Corno F., Genova F., Bornstein R. F., Gordon R. M., McWilliams N. (2015). Clinicians’ emotional responses and Psychodynamic Diagnostic Manual adult personality disorders: A clinically relevant empirical investigation. Psychotherapy, 52(2): 238-246.
  28. Gill M.M. (1994). Psicoanalisi in transizione. Milano: Raffaello Cortina Editore, 1996.
  29. Gold S. H., Hilsenroth M. J., Kuutmann K., Owen J. J. (2015). Therapeutic alliance in the personal therapy of graduate clinicians: Relationship to the alliance and outcomes of their patients. Clinical Psychology & Psychotherapy, 22(4): 304-316.
  30. Gordon R. M., Gazzillo F., Blake A., Bornstein R. F., Etzi J., Lingiardi V., Tasso A. F. (2016). The relationship between theoretical orientation and countertransference expectations: Implications for ethical dilemmas and risk management. Clinical Psychology & Psychotherapy, 23(3): 236-245.
  31. Heinonen E., Knekt P., Jääskeläinen T., Lindfors O. (2014a). Therapists’ professional and personal characteristics as predictors of outcome in long-term psychodynamic psychotherapy and psychoanalysis. European Psychiatry, 29(5): 265-274.
  32. Heinonen E., Lindfors O., Härkänen T., Virtala E., Jääskeläinen T., Knekt P. (2014b). Therapists' professional and personal characteristics as predictors of working alliance in short-term and long-term psychotherapies. Clinical Psychology & Psychotherapy, 21(6): 475-494.
  33. Heinonen E., Lindfors O., Laaksonen M. A., Knekt P. (2012). Therapists’ professional and personal characteristics as predictors of outcome in short-and long-term psychotherapy. Journal of Affective Disorders, 138(3): 301-312.
  34. Henry W.P., Schacht T.E., Strupp H.H. (1990). Patient and therapist introject, interpersonal process, and differential psychotherapy outcome. Journal of Consulting and Clinical Psychology, 58( 6): 768-774., DOI: 10.1037/0022-006X.58.6.768
  35. Hersoug A.G. (2004). Assessment of therapists’ and patients’ personality: Relationship to therapeutic technique and outcome in Brief Dynamic Psychotherapy. Journal of Personality Assessment, 83(3): 191-200.
  36. Hilliard R.B., Henry W.P., Strupp H.H. (2000). An interpersonal model of psychotherapy: Linking patient and therapist developmental history, therapeutic process, and types of outcome. Journal of Consulting and Clinical Psychology, 68(1): 125-133., DOI: 10.1037/0022-006X.68.1.125
  37. Hoffman I. (1998). Rituale e spontaneità in psicoanalisi. Roma: Astrolabio, 2000.
  38. Høglend P., Dahl H., Hersoug A.G., Lorentzen S., Perry J.C. (2011). Long-term effects of transference interpretation in dynamic psychotherapy of personality disorders. European Psychiatry, 26(7): 419-424.
  39. Holt R.R., Luborsky L. (1955). The selection of candidates for psychoanalytic training. Journal of the American Psychoanalytic Association, 3: 666-681.
  40. Horowitz L., Gabbard G.O., Allen J.G., Frieswyk S.H., Colson D.B., Newsom G.E., Coyne L. (1996). Psicoterapia su misura. Pazienti borderline e patologie mentali gravi. Milano: Raffaello Cortina Editore, 1998.
  41. Horvath A.O., Del Re A.C., Fluckinger C., Symonds D. (2011). Alliance in individual psychotherapy. Psychotherapy, 48(1): 9-16.
  42. Jung C.G. (1951). Questioni fondamentali di psicoterapia. In: Opere, Vol. XVI. Torino: Bollati Boringhieri, 1981.
  43. Kiesler D.J. (1966). Some myths of psychotherapy research and the search for a paradigm. Psychological Bulletin, 65(2): 110-136.
  44. Lawson D.M., Brossart D.F. (2003). Link among therapist and parent relationship, working alliance, and therapy outcome. Psychotherapy Research, 13(3): 383-394.
  45. Lingiardi V., Colli A., Muzi L. (2018). A Clinically Useful Assessment of Patients’ (and Therapists’) Mental Functioning: M-Axis Implications for the Therapeutic Alliance. Psychoanalytic Psychology, 35(3): 306-314.
  46. Lingiardi V., McWilliams N., a cura di (2017). Psycodynamic Diagnostic Manual Second Edition: (PDM-2). New York: Guilford Press (trad. it.: Manuale Diagnostico Psicodinamico, seconda edizione. Milano: Raffaello Cortina Editore, 2018).
  47. Lingiardi V., Muzi L., Tanzilli A., Carone N. (2018). Do therapists’ subjective variables impact on psychodynamic psychotherapy outcomes? A systematic literature review. Clinical Psychology & Psychotherapy, 25: 85-101.
  48. Lingiardi V., Tanzilli A., Colli A. (2015). Does the severity of psychopathological symptoms mediate the relationship between patient personality and therapist response?. Psychotherapy, 52(2): 228-237.
  49. Luborsky L., McLellan A. T., Diguer L., Woody G., Seligman D. A. (1997). The psychotherapist matters: Comparison of outcomes across twenty-two therapists and seven patient samples. Clinical Psychology: Science and Practice, 4(1): 53-65.
  50. Mitchell S.A. (1997). Influence and Autonomy in Psychoanalysis. Hillsdale, N.J: Analytic Press.
  51. Muzi L., Talia A., Carone N., Taubner S., Lingiardi V. (under review). The influence of therapist personality on the therapeutic alliance and the moderating role of attachment representations. Clinical Psychology & Psychotherapy.
  52. Muzi L., Talia A., Lingiardi V. (2018). Do therapist personality and attachment impact on patient relational patterns in psychotherapy? A moderation analysis. Paper presented in the 49th Society of Psychotherapy Research International Annual Meeting, Amsterdam, The Netherlands.
  53. Najavits L.M., Strupp H.H. (1994). Differences in the effectiveness of psychodynamic therapists: A process-outcome study. Psychotherapy: Theory, Research, Practice, Training, 31(1): 114-123., DOI: 10.1037/0033-3204.31.1.114
  54. Nissen-Lie H.A., Havik O.E., Høglend P.A., Monsen J.T., Rønnestad M.H. (2013). The contribution of the quality of therapists’ personal lives to the development of the working alliance. Journal of Counseling Psychology, 60(4): 483-495.
  55. Norcross J. (2011) (Ed.). Psychotherapy Relations that Work: Evidence-based Responsiveness, 2nd ed. New York: Oxford University Press.
  56. Owen J., Hilsenroth M.J. (2014). Treatment adherence: The importance of therapist flexibility in relation to therapy outcomes. Journal of Counseling Psychology, 61(2): 280-288.
  57. Racker H. (1957). Studi sulla tecnica psicoanalitica. Transfert e controtransfert. Roma: Armando, 1970.
  58. Reading R.A. (2013). Investigating the role of therapist reflective functioning in psychotherapy process and outcome. Dissertation Abstracts International, 74.
  59. Renik O. (1993). The analyst subjectivity and the analyst objectivity. International Journal of Psychoanalysis, 79: 487-497.
  60. Riemann F., Cheney W.D. (1968). The personality structure of the analyst and its influence on the course of treatment. American Journal of Psychoanalysis, 28: 69-79.
  61. Rosenzweig S. (1936). Some implicit common factors in diverse methods of psychotherapy. Journal of Psychotherapy Integration, 12(1): 2002, Special Issue: Classics in Psychotherapy Integration Revisited. Special Section: Special Series: Classics in Psychotherapy Integration Revisited. 5-9.
  62. Russ E., Shedler J., Bradley R., Westen D. (2008). Refining the construct of narcissistic personality disorder: Diagnostic criteria and subtypes. The American Journal of Psychiatry, 165: 1473-1481.
  63. Samstag L.W. Muran J.C., Wachtel A., Slade A., Safran J.D., Winston A. (2008). Evaluating negative process: A comparison of working alliance, interpersonal behavior, and narrative coherency among three psychotherapy outcome conditions. American Journal of Psychotherapy, 62(2): 165-194.
  64. Schauenburg H., Buchheim A., Beckh K., Nolte T., Brenk-Franz K., Leichsenring F., Strack M., Dinger U. (2010). The influence of psychodynamically oriented therapists’ attachment representations on outcome and alliance in inpatient psychotherapy. Psychotherapy Research, 20: 193-202., DOI: 10.1080/10503300903204043
  65. Shedler J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 65(2): 98-109.
  66. Stolorow R.D., Atwood G.E. (1992). I contesti dell’essere. Le basi intersoggettive della vita psichica. Torino: Bollati Boringhieri, 1995.
  67. Talia A., Muzi L., Lingiardi V., Taubner S. (2018). How to be a secure base: Therapists’ attachment representations and their significance for attunement in psychotherapy. Attachment & Human Development, advanced online publication.
  68. Tanzilli A., Muzi L., Ronningstam E., Lingiardi V. (2017). Countertransference when working with narcissistic personality disorder: An empirical investigation. Psychotherapy, 54(2): 184-194.
  69. Thompson C. (1988). The role of analyst personality in therapy. In: Wolstein B., editor, Essential papers on countertransference. New York: University Press.
  70. Topolinski S., Hertel G. (2007). The role of personality in psychotherapists’ careers: Relationships between personality traits, therapeutic schools, and job satisfaction. Psychotherapy Research, 17(3): 378-390., DOI: 10.1080/10503300600830736
  71. Wampold B.E., Imel Z.E. (2015). The great psychotherapy debate: The evidence for what makes psychotherapy work., 2nd ed. New York: Routledge/Taylor & Francis Group.
  72. Westen D., Shedler J. (1999a). Revising and assessing Axis II part 1: Developing a clinically and empirically valid assessment method. American Journal of Psychiatry, 156: 258-272.
  73. Westen D., Shedler J. (1999b). Revising and assessing Axis II, part 2: Toward an empirically based and clinically useful classification of personality disorders. American Journal of Psychiatry, 156: 273-285.
  74. Widiger T.A., Costa P.J. (2013). Personality disorders and the five-factor model of personality, 3rd ed. Washington, DC, US: American Psychological Association.
  75. Winnicott D.W. (1965). Gioco e realtà. Roma: Armando, 1974.

Laura Muzi, Vittorio Lingiardi, Diagnosis in transition: The influence of therapist personality in "RICERCA PSICOANALITICA" 1/2019, pp. 73-90, DOI:10.3280/RPR2019-001006

   

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