João Francisco Barreto

The elaboration of countertransference experience (ECE), defined as the implicit and explicit psychological work to which therapists submit their experiences with patients, may be approached as a mentalizing process of a particular kind. Through ECE, therapists’ experiences acquire and increase in mental quality and become available for meaning-making and intentional clinical use. We claim that such an ongoing process facilitates important common factors and enhances therapist responsiveness in psychotherapy. In this poster, we present a model for assessing ECE in psychotherapy research, comprising six diversely mentalized countertransference positions and seven dimensions of elaboration along which countertransference experience can be mentalized.

Introduction: Therapeutic alliance has been widely recognized as an important predictor of psychotherapy outcome across therapeutic orientations. In particular, evidence suggests that client-rated alliance and assessment at early stages of the therapeutic process may be especially relevant. Although several determinants of alliance have been investigated in the last decades, few studies have analyzed the interaction between therapists’ and clients’ attachment orientations for predicting alliance development. On the other hand, the kind and severity of the clients’ problems pose different challenges on the therapeutic alliance. Presumably, therapists’ capacity to manage countertransference (CT) demands coming from these dimensions will influence the extent to which the alliance is affected. Objective: We examine predictive factors of client-rated early alliance. More specifically, we test whether (a) therapists’ and clients’ attachment orientations interact for predicting therapeutic alliance; (b) clients’ level of personality organization (PO) affects therapeutic alliance; (c) the severity of clinical problems impacts alliance; (d) the previous predictors interact in influencing client-rated early alliance; and (e) therapists’ CT management mediates/moderates the previous associations. Method: The sample is composed of 11 Portuguese psychotherapy dyads working in different community contexts and participating in on-line format and on a voluntary basis. Predictors were assessed before 2nd session, namely therapist and client attachment anxiety and avoidance (ECR-RS) and client personality organization (IPO) and clinical condition (CORE-OM). Client-rated therapeutic alliance (WAI-SR) and therapist-rated session-specific countertransference management (CFI) were measured after the 2nd session. Results and discussion: Results are contrasted with previous research. Among other findings, the effect of CORE-OM risk dimension on alliance was significant only in the present of CFI as a mediator, indicating a suppressor effect. This finding appears to support our hypotheses, with countertransference management buffering the negative effect of clinical risk on alliance and thus protecting the therapeutic process.

A counter-complementary stance towards the relational pull exerted by clients may play an important role in the change process. Initial evidence suggests that this can be facilitated by a dissimilar or non-complementary match between relational preferences within the therapeutic dyad and by attachment security in therapists. In this paper, we study the impact of patient and therapist attachment dimensions on the evolution of therapist and client-rated session evaluation in initial stages of psychotherapy. As part of an ongoing research project, longitudinal data from 12 therapeutic dyads of diverse theoretical orientations are presented, covering 3 time-points: prior to 2nd session, after 2nd session, and after 5th session. Results tend to confirm the impact of therapist and client attachment on session quality, particularly concerning the depth component. The non-complementary hypothesis is supported by several results.

Introduction: Evidence suggests that the severity of personality difficulties, regardless of their type, may be the most important determinant of current and future dysfunction. Otto F. Kernberg’s model of personality organization (PO) describes severity of personality disturbance as a continuum from normal-neurotic functioning, through borderline, to psychotic personality, along which the predominance of primitive defenses and the concomitant identity disturbance augments, with reality testing compromised in the psychotic pole. The increasing influence of primitive, intense emotions lacking integration often manifest in affect dysregulation and behavioral correlates such as anger expression and impulsive self-destructive behaviors. Still, there is little research into the paths through which PO affects symptoms, in which emotion (dys)regulation must play an important role. Objectives: We examine direct and indirect effects of PO on indices of psychological distress, hypothesizing the importance of global and specific types of emotion (dys)regulation as partial or total mediators. Method: A sample of 1099 Portuguese participants completed an on-line survey including measures of PO (IPO Portuguese short version), emotion regulation (DERS), and symptoms (BSI). Mediation models were tested through Structural Equation Modeling. Results and discussion: PO has a significant effect on all three BSI global indices, with explained variances from 52% to 71%. Global emotion dysregulation was confirmed as partial mediator in all cases, with models accounting for up to 74% of symptom variance. Among IPO dimensions, Instability of Others showed the highest total effect on symptoms (β=.46, p<.001), and global emotion dysregulation was also a significant partial mediator in this model. Within DERS, strategies and goals were the dimensions mediating the effect of PO on symptoms – models with these two mediators explained up to 69% of symptom variation. Implication for practice and research are discussed.

There is wide consensus that, in early stages of psychotherapy, a good alliance is an important predictor of positive outcome. Although the relation between client (C) attachment and alliance is relatively well established, results seem more ambiguous regarding therapist (T) attachment dimensions. Recent research suggests that the complexity of clients’ problems may work as a moderator. Additionally, T and C attachment dimensions may interact in ways that affect alliance. In particular, dissimilar or non-complementary matches of T and C relational dimensions may benefit the therapeutic process. Difficulties coming from the relational match and/or clinical severity may require Ts to regulate their own reactions, turning countertransference management (CtM) into a relevant dimension in the process. In this study, we examine individual and dyadic predictors of the initial development of alliance. As part of an ongoing research project, longitudinal data from 12 therapeutic dyads of diverse theoretical orientations are presented, covering 3 time-points: prior to 2nd session, after 2nd session, and after 5th session. Most significant results involved alliance evolution instead of session-specific ratings, which may mean that alliance variations are more relevant than momentary assessments. Attachment dissimilarities within dyads were positively associated with Bond evolution and CtM. Cs clinical problems and attachment anxiety moderated the effect of T avoidance on Bond evolution, such that: T avoidance hindered Bond evolution from 2nd to 5th session with more problematic Cs but seemed to benefit Bond evolution with less problematic Cs; and Bond evolution was better combining more avoidant Ts with less anxious Cs or less avoidant Ts with more anxious Cs. CtM seems to signal difficulties in therapy, but followed a pattern difficult to interpret with the current results.

The elaboration of countertransference experience (ECE) is the implicit and explicit psychological work to which therapists submit their experiences with patients, and may be defined as a mentalizing process of a particular kind through which therapists’ experiences acquire and increase in mental quality and become available for meaning-making and intentional clinical use. Research addressing psychotherapists’ mentalizing processes is extremely scarce, and very few studies within this field involved real patients as participants. In addition, despite the clearly established association between the constructs, no studies to our knowledge have yet investigated the impact of attachment on therapist mentalization processes in psychotherapy. In this poster, we present a model for assessing ECE in research and report preliminary findings from an ongoing longitudinal study currently involving 16 therapists working with 24 adult patients in natural settings of individual psychotherapy. Seventy-five post-session therapists’ written comments were used for an assessment of mentalization processes by two independent judges, with both therapist and patient self-reported attachment (avoidance and anxiety) being tested as possible predictors through multilevel analysis with therapists/patients at level 2. Results indicate overall good interrater reliability, high proportions of between-therapist/patient variance, and significant effects of several individual and dyadic attachment dimensions on ECE.

RESUMO: Introducao – A adaptacao ao ensino superior reveste-se de experiencias academicas que podem constituir fonte de stress para os estudantes. A implementacao de novos modelos pedagogicos, no âmbito do processo de Bolonha, introduz novas variaveis cujo impacto, designadamente em termos de saude, importa conhecer. Este estudo tem como objetivo analisar as associacoes entre modelo pedagogico (Problem Based Learning – PBL vs. modelos proximos do tradicional) e variaveis psicologicas (coping, desregulacao emocional, sintomas psicossomaticos, percecao de stress e afeto). Metodologia – O estudo tem um design transversal. Foram usados os seguintes questionarios online: Brief-COPE, Escala de Dificuldades de Regulacao Emocional, Questionario de Manifestacoes Fisicas de Mal-Estar, Escala de Stress Percebido e Escala de Afeto Positivo e Negativo. A amostra e constituida por 183 estudantes do primeiro ano (84% do genero feminino) de cursos da Escola Superior de Tecnologia da Saude do Porto ...

The working alliance has been recognized as a predictor of psychotherapy outcome across therapeutic orientations. Despite mixed findings regarding the effect of problem severity on the alliance formation, there is evidence suggesting that therapist factors may interfere in this association. This study examined how clients baseline clinical features affected the early alliance and the possible role of therapists countertransference management as a mediator. Thirteen therapeutic dyads were assessed at 2 different time points. Clients clinical dimensions were assessed prior to the 2nd session, and therapists countertransference management and clients ratings of the alliance were measured after the 2nd session. Positive associations were found between clients subjective wellbeing, social functioning, risk, and global psychological distress and countertransference management dimensions and total score. Empathy-based countertransference management suppressed the negative impact of clinica...

Alliance may impact psychotherapy outcomes both as a precondition that enables therapeutic work and an evolving process that is therapeutic in itself. This study examined the participation of the elaboration of countertransference experience (ECE) in alliance variation between therapist-client dyads early in therapy and within dyads over time. A total of 44 session assessments nested within 12 dyads were modeled through longitudinal multilevel analyses and utilized to examine the associations between the ECE dimensions of Immersion and Reflection and alliance components across 4 time points within the first 10 sessions of psychotherapy. Results supported the importance of initial ECE to explain differences in alliance between dyads, the particular relevance of ECE with clients presenting lower levels of personality organization, and the effect of personality difficulties on alliance change. Unexpected results were found concerning the correlations between ECE and alliance and their covariation over time. In conclusion, ECE dimensions appear to be involved in alliance formation, both in initial differences between dyads and in changes over time within the same case. ECE seems particularly important with more personality-disturbed clients. Future research should disentangle therapist and client contributions and examine the participation of ECE in the resolution of alliance ruptures. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Abstract Introduction The Inventory of Personality Organization (IPO) is a self-report measure intended to assess the severity of personality disturbance according to Otto F. Kernberg's model. Objective To study factor structure and psychometric properties of the Portuguese version of IPO (IPO-Pt). Method Two independent samples of 586 individuals each were used for exploratory and confirmatory factor analyses. Different models were compared in terms of reliability and validity. Results A three-factor solution resulted, comprising dimensions labeled as Instability of Self, Instability of Others, and Psychosis. Internal consistency and temporal stability yielded acceptable to excellent results. Correlations with measures of self-concept coherence, emotion dysregulation, psychoticism, symptom severity, and personality disturbance were as expected, and sensitivity to clinical status was confirmed. Conclusion IPO-Pt shows encouraging psychometric qualities and its latent structure resonates with important aspects of Kernberg's model, previous findings, and the DSM-5 level of personality functioning scale.

As a construct, the elaboration of countertransference experience (ECE) is intended to depict the implicit and explicit psychological work to which therapists submit their experiences with clients. Through ECE, defined as a mentalizing process of a particular kind, therapists' experiences are presumed to acquire and increase in mental quality and become available for meaning-making and judicious clinical use. In this paper, we claim that such an ongoing process facilitates engagement with common therapeutic factors, such as the therapeutic alliance and countertransference management, enhancing therapist responsiveness in psychotherapy. We synthesize relevant literature on countertransference, mentalization, and, in particular, therapists' mentalization, informed by a systematic literature review. As a result, we propose a model for assessing ECE in psychotherapy, comprising 6 diversely mentalized countertransference positions (factual-concrete, abstract-rational, projective-...

Barreto, J. F. (2019). Donald K. Freedheim Student Development Award Winner. Psychotherapy Bulletin, 54 (3), 86-87.

https://www.researchgate.net/publication/337335672_Donald_K_Freedheim_Student_Development_Award_Winner

https://societyforpsychotherapy.org/congratulations-to-the-society-for-the-advancement-of-psychotherapy-2019-student-paper-award-winners/

Report on the prize awarded by APA Division 29 to the article "Mentalizing countertransference? A model for research on the elaboration of countertransference experience in psychotherapy" (doi: 10.1002/cpp.2177)

Alliance may impact psychotherapy outcomes both as a precondition that enables therapeutic work and an evolving process that is therapeutic in itself. This study examined the participation of the elaboration of countertransference experience (ECE) in alliance variation between therapist-client dyads early in therapy and within dyads over time. A total of 44 session assessments nested within 12 dyads were modeled through longitudinal multilevel analyses and utilized to examine the associations between the ECE dimensions of Immersion and Reflection and alliance components across 4 time points within the first 10 sessions of psychotherapy. Results supported the importance of initial ECE to explain differences in alliance between dyads, the particular relevance of ECE with clients presenting lower levels of personality organization, and the effect of personality difficulties on alliance change. Unexpected results were found concerning the correlations between ECE and alliance and their covariation over time. In conclusion, ECE dimensions appear to be involved in alliance formation, both in initial differences between dyads and in changes over time within the same case. ECE seems particularly important with more personality-disturbed clients. Future research should disentangle therapist and client contributions and examine the participation of ECE in the resolution of alliance ruptures. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

As a construct, the elaboration of countertransference experience (ECE) is intended to depict the implicit and explicit psychological work to which therapists submit their experiences with clients. Through ECE, defined as a mentalizing process of a particular kind, therapists' experiences are presumed to acquire and increase in mental quality and become available for meaning-making and judicious clinical use. In this paper, we claim that such an ongoing process facilitates engagement with common therapeutic factors, such as the therapeutic alliance and countertransference management, enhancing therapist responsiveness in psychotherapy. We synthesize relevant literature on countertransference, mentalization, and, in particular, therapists' mentalization, informed by a systematic literature review. As a result, we propose a model for assessing ECE in psychotherapy, comprising 6 diversely mentalized countertransference positions (factual-concrete, abstract-rational, projective-impulsive, argumentative, contemplative-mindful, and mentalizing), 2 underlying primary dimensions (experiencing, reflective elaboration), and 5 complementary dimensions of elaboration. Strengths and limitations of the model are discussed.

The working alliance has been recognized as a predictor of psychotherapy outcome across therapeutic orientations. Despite mixed findings regarding the effect of problem severity on the alliance formation, there is evidence suggesting that therapist factors may interfere in this association. This study examined how clients’ baseline clinical features affected the early alliance and the possible role of therapists’ countertransference management as a mediator. Thirteen therapeutic dyads were assessed at 2 different time points. Clients’ clinical dimensions were assessed prior to the 2nd session, and therapists’ countertransference management and clients’ ratings of the alliance were measured after the 2nd session. Positive associations were found between clients’ subjective wellbeing, social functioning, risk, and global psychological distress and countertransference management dimensions and total score. Empathy-based countertransference management suppressed the negative impact of clinical risk on alliance. Our findings suggest that clinical problems activate countertransference management, which in turn may buffer their negative effect on alliance.

Introduction: The Inventory of Personality Organization (IPO) is a self-report measure intended to assess the severity of personality disturbance according to Otto F. Kernberg's model. Objective: To study factor structure and psychometric properties of the Portuguese version of IPO (IPO-Pt). Method: Two independent samples of 586 individuals each were used for exploratory and confirmatory factor analyses. Different models were compared in terms of reliability and validity. Results: A three-factor solution resulted, comprising dimensions labeled as Instability of Self, Instability of Others, and Psychosis. Internal consistency and temporal stability yielded acceptable to excellent results. Correlations with measures of self-concept coherence, emotion dysregulation, psychoticism, symptom severity, and personality disturbance were as expected, and sensitivity to clinical status was confirmed. Conclusion: IPO-Pt shows encouraging psychometric qualities and its latent structure resonates with important aspects of Kernberg's model, previous findings, and the DSM-5 level of personality functioning scale.

The elaboration of countertransference experience (ECE), defined as the implicit and explicit psychological work to which therapists submit their experiences with patients, may be approached as a mentalizing process of a particular kind. Through ECE, therapists’ experiences acquire and increase in mental quality and become available for meaning-making and intentional clinical use. We claim that such an ongoing process facilitates important common factors and enhances therapist responsiveness in psychotherapy. In this poster, we present a model for assessing ECE in psychotherapy research, comprising six diversely mentalized countertransference positions and seven dimensions of elaboration along which countertransference experience can be mentalized.

A counter-complementary stance towards the relational pull exerted by clients may play an important role in the change process. Initial evidence suggests that this can be facilitated by a dissimilar or non-complementary match between relational preferences within the therapeutic dyad and by attachment security in therapists. In this paper, we study the impact of patient and therapist attachment dimensions on the evolution of therapist and client-rated session evaluation in initial stages of psychotherapy. As part of an ongoing research project, longitudinal data from 12 therapeutic dyads of diverse theoretical orientations are presented, covering 3 time-points: prior to 2nd session, after 2nd session, and after 5th session. Results tend to confirm the impact of therapist and client attachment on session quality, particularly concerning the depth component. The non-complementary hypothesis is supported by several results.

There is wide consensus that, in early stages of psychotherapy, a good alliance is an important predictor of positive outcome. Although the relation between client (C) attachment and alliance is relatively well established, results seem more ambiguous regarding therapist (T) attachment dimensions. Recent research suggests that the complexity of clients’ problems may work as a moderator. Additionally, T and C attachment dimensions may interact in ways that affect alliance. In particular, dissimilar or non-complementary matches of T and C relational dimensions may benefit the therapeutic process. Difficulties coming from the relational match and/or clinical severity may require Ts to regulate their own reactions, turning countertransference management (CtM) into a relevant dimension in the process. In this study, we examine individual and dyadic predictors of the initial development of alliance. As part of an ongoing research project, longitudinal data from 12 therapeutic dyads of diverse theoretical orientations are presented, covering 3 time-points: prior to 2nd session, after 2nd session, and after 5th session. Most significant results involved alliance evolution instead of session-specific ratings, which may mean that alliance variations are more relevant than momentary assessments. Attachment dissimilarities within dyads were positively associated with Bond evolution and CtM. Cs clinical problems and attachment anxiety moderated the effect of T avoidance on Bond evolution, such that: T avoidance hindered Bond evolution from 2nd to 5th session with more problematic Cs but seemed to benefit Bond evolution with less problematic Cs; and Bond evolution was better combining more avoidant Ts with less anxious Cs or less avoidant Ts with more anxious Cs. CtM seems to signal difficulties in therapy, but followed a pattern difficult to interpret with the current results.

Introduction: Evidence suggests that the severity of personality difficulties, regardless of their type, may be the most important determinant of current and future dysfunction. Otto F. Kernberg’s model of personality organization (PO) describes severity of personality disturbance as a continuum from normal-neurotic functioning, through borderline, to psychotic personality, along which the predominance of primitive defenses and the concomitant identity disturbance augments, with reality testing compromised in the psychotic pole. The increasing influence of primitive, intense emotions lacking integration often manifest in affect dysregulation and behavioral correlates such as anger expression and impulsive self-destructive behaviors. Still, there is little research into the paths through which PO affects symptoms, in which emotion (dys)regulation must play an important role.

Objectives: We examine direct and indirect effects of PO on indices of psychological distress, hypothesizing the importance of global and specific types of emotion (dys)regulation as partial or total mediators.

Method: A sample of 1099 Portuguese participants completed an on-line survey including measures of PO (IPO Portuguese short version), emotion regulation (DERS), and symptoms (BSI). Mediation models were tested through Structural Equation Modeling.

Results and discussion: PO has a significant effect on all three BSI global indices, with explained variances from 52% to 71%. Global emotion dysregulation was confirmed as partial mediator in all cases, with models accounting for up to 74% of symptom variance. Among IPO dimensions, Instability of Others showed the highest total effect on symptoms (β=.46, p<.001), and global emotion dysregulation was also a significant partial mediator in this model. Within DERS, strategies and goals were the dimensions mediating the effect of PO on symptoms – models with these two mediators explained up to 69% of symptom variation. Implication for practice and research are discussed.

Introduction: Therapeutic alliance has been widely recognized as an important predictor of psychotherapy outcome across therapeutic orientations. In particular, evidence suggests that client-rated alliance and assessment at early stages of the therapeutic process may be especially relevant. Although several determinants of alliance have been investigated in the last decades, few studies have analyzed the interaction between therapists’ and clients’ attachment orientations for predicting alliance development. On the other hand, the kind and severity of the clients’ problems pose different challenges on the therapeutic alliance. Presumably, therapists’ capacity to manage countertransference (CT) demands coming from these dimensions will influence the extent to which the alliance is affected.

Objective: We examine predictive factors of client-rated early alliance. More specifically, we test whether (a) therapists’ and clients’ attachment orientations interact for predicting therapeutic alliance; (b) clients’ level of personality organization (PO) affects therapeutic alliance; (c) the severity of clinical problems impacts alliance; (d) the previous predictors interact in influencing client-rated early alliance; and (e) therapists’ CT management mediates/moderates the previous associations.

Method: The sample is composed of 11 Portuguese psychotherapy dyads working in different community contexts and participating in on-line format and on a voluntary basis. Predictors were assessed before 2nd session, namely therapist and client attachment anxiety and avoidance (ECR-RS) and client personality organization (IPO) and clinical condition (CORE-OM). Client-rated therapeutic alliance (WAI-SR) and therapist-rated session-specific countertransference management (CFI) were measured after the 2nd session.

Results and discussion: Results are contrasted with previous research. Among other findings, the effect of CORE-OM risk dimension on alliance was significant only in the present of CFI as a mediator, indicating a suppressor effect. This finding appears to support our hypotheses, with countertransference management buffering the negative effect of clinical risk on alliance and thus protecting the therapeutic process.