Asociaciones entre contratransferencia y características del paciente en psicoterapia psicoanalíticaa

Autores/as

DOI:

https://doi.org/10.21615/cesp.13.3.10

Palabras clave:

Psicoterapia, Psicoterapia Psicodinámica, Características del Paciente, Contratransferencia, Respuesta Emocional del Terapeuta

Resumen

Objetivo: explorar las reacciones de contratransferencia de los terapeutas en la fase inicial de la psicoterapia psicoanalítica (entre las sesiones 4 y 5) y verificar las posibles asociaciones entre estas y las características personales del paciente (sociodemográficas, psicológicas y psicopatológicas). Método: estudio naturalista, transversal, correlacional y observacional con enfoque descriptivo-analítico. La muestra consta de 180 pares de pacientes y terapeutas, de los cuales 180 eran pacientes adultos (32.82 ± 12.66 años) y 48 terapeutas (32.69 ± 10.01 años). Resultados: la contratransferencia se ve afectada por la edad del paciente, los aspectos psicológicos de su vida anterior (traumas y apego parental) y elementos de su personalidad (habilidades de empatía y mecanismos defensivos), pero no por los síntomas que presenta. Conclusiones: los hallazgos respaldan la literatura científica, que señala la relevancia de las experiencias infantiles y las características de personalidad del paciente para evocar patrones específicos de contratransferencia en el terapeuta. Conocer tales relaciones puede ayudar a los clínicos a identificar sus propias reacciones y usarlas terapéuticamente, según corresponda.

Biografía del autor/a

Lívia Fração Sanchez, Universidade do Vale do Rio dos Sinos (UNISINOS)

PhD Student. Mestre em Psicologia Clínica. Graduada em Psicologia. Especialista em Psicoterapia Psicanalítica.

Fernanda Barcellos Serralta, Universidade do Vale do Rio dos Sinos (UNISINOS)

Psicóloga, especialista em Psicoligia Clinica (CFP), doutora em Ciências Médicas: Psiquiatria (UFRGS), docente e oesquisadora no Programa de Pós Graduação em Psicologia da Universidade do Vale do Rio dos Sinos (UNISINOS).

Citas

Barros, A. J. S., Teche, S. P., Padoan, C., Laskoski, P. B., Hauck, S., & Eizirik, C. L. (2020). Countertransference, Defense Mechanisms, and Vicarious Trauma in Work with Sexual Offenders, Journal of the American Academy of Psychiatry and the Law Online, 48(3). https://doi.org/10.29158/JAAPL.003925-20

Bacal, H. A. (2017). Más allá de la transferencia y la contratransferencia: la especificidad diádica del proceso psicoanalítico. Clínica e Investigación Relacional, 11(2), 246- 257.

Barreto, J. F., Nata, G., & Matos, P. M. (2020). Elaboration of countertransference experience and the workings of the working alliance. Psychotherapy, 57(2), 141–150. https://doi.org/10.1037/pst0000250

Behn, A., Davanzo, A., & Errázuriz, P. (2018). Client and therapist match on gender, age, and income: Does match within the therapeutic dyad predict early growth in the therapeutic alliance? Journal of Clinical Psychology, 74, 1403– 1421. https://doi.org/10.1002/jclp.22616

Bergeret, J. (2000). A personalidade normal e patológica. (3a ed). Lisboa: Climepsi.

Bernstein, D. P., Ahluvalia, T., Pogge, D., & Handelsman, L. (1997). Validity of the Childhood Trauma Questionnaire in an adolescent psychiatric population. Journal of the American Academy of Child and Adolescent Psychiatry, 36(3), 340-8. https://doi.org/10.1097/00004583-199703000-00012

Blaya, C. (2005). Tradução, adaptação e validação do Defensive Style Questionnaire (DSQ-40) para o português brasileiro. Dissertação de mestrado, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre.

Breivik, R., Wilberg, T., Evensen, J., Røssberg, J. I., Dahl, H. S. J., & Pedersen, G. (2020). Countertransference feelings and personality disorders: A psychometric evaluation of a brief Psychotherapy Research 11 version of the Feeling Word Checklist (FWC-BV). BMC Psychiatry, 20(1). https://doi.org/10.1186/s12888-020-02556-6

Brody, F., & Farber, B. (1996). The effects of therapist experience and patient diagnosis on countertransference. Psychotherapy: Theory, Research, Practice and Training, 33(3), 372-80. https://doi.org/10.1037/0033-3204.33.3.372

Canavarro, M. C. (1999). Inventário de Sintomas Psicopatológicos: BSI. In M. R. Simões, M. Gonçalves, & L. S. Almeida (Eds.). Testes e provas psicológicas em Portugal, 2, (pp. 87-109). Braga: SHO/APPORT.

Cartwright, C., Rhodes, P., King, R., & Shires, A. (2014). Experiences of Countertransference: Reports of Clinical Psychology Students. Australian Psychologist, 49(4), 232–240. https://doi.org/10.1111/ap.12062

Chartonas, D., Kyratsous, M., Dracass, S., Lee, T., & Bhui, K. (2017). Personality disorder: Still the patients psychiatrists dislike? BJ. Psych Bulletin, 41(1), 12–17. https://doi.org/10.1192/pb.bp.115.052456

Colli, A., Tanzilli, A., Dimaggio, G., & Lingiardi, V. (2014). Patient Personality and therapist response: An empirical investigation. American Journal of Psychiatry, 171(1), 102-8. https://doi.org/10.1176/app1.ajp.2013.13020224

Colli, A., & Ferri, M. (2015). Patient personality and therapist countertransference, Current Opinion in Psychiatry, 28(1), 46-56. https://doi.org/10.1097/YCO.0000000000000119

Cowan, A., Ashai, A., & Gentile, P. J. (2020). Psychotherapy with Survivors of Sexual Abuse and Assault. Innov Clin Neurosci, 17(1-3), 22–26.

Dahl, H-S. J., Røssberg, J. I., Bogwald, K. P., Gabbard, G. O., & Hoglend, P. A. (2012). Countertransference feelings in one year of individual therapy: An evaluation of the factor structure in the Feeling Word Checklist-58. Psychotherapy Research. 22(1), 12-25. https://doi.org/10.1080/10503307.2011.622312

Daurella, N. (2018). Transferencia y contratransferencia desde la perspectiva del psicoanálisis relacional: a la búsqueda de la responsividad óptima. Revista Internacional Psicoanalítica Aperturas, 59(27), 1-21.

Davis, M. H. (1983). Measuring individual differences in empathy: Evidence for a multidimensional approach. Journal of Personality and Social Psychology. 44(1), 113-26. https://doi.org/10.1037/0022-3514.44.1.113

Dazinger, P. R., & Welfel, E. R. (2000). Age, gender, and health bias in counselors: An empirical analysis. Journal of Mental Health Counseling, 22, 135-49.

Derogatis, L. R., & Melisaratos, N. (1983). The brief symptom inventory: An introductory report. Psychological Medicine, 13(3), 595-605. https://doi.org/10.1017/S0033291700048017

Dewald, P. (1989). Psicoterapia: Uma abordagem dinâmica. Porto Alegre: Artes Médicas.

Eizirik, C. L. (1997). Rede social, estado mental e contratransferência: Estudo de uma amostra de velhos da região urbana de Porto Alegre [tese]. Porto Alegre: Universidade Federal do Rio Grande do Sul.

Eizirik, M., Schestastky, S., Kruel, L., & Ceitlin, L. H. F. (2011). Countertransference in the initial visit of women victims of sexual violence. Revista Brasileira de Psiquiatria, 33(1), 16-22. https://doi.org/10.1590/S1516-44462010005000019

Eizirik, C. L., Aguiar, R. W., & Schestatsky. S. (2015). Psicoterapia de orientação analítica: Fundamentos teóricos e clínicos. Porto Alegre: Artmed.

Fontelles, M. J., Simões, M. G., Farias, S. H., & Fontelles, R. G. S. (2009). Metodologia da pesquisa científica: Diretrizes para a elaboração de um protocolo de pesquisa. Trabalho realizado no Núcleo de Bioestatística Aplicado à Pesquisa da Universidade da Amazônia – UNAMA.

Formiga, N. S., Rocha, M. C. O., Pinto, A. D. S. S., Reis, D. A. D., Costa, S. M. D. S., & Leime, J. (2013). Fidedignidade da estrutura fatorial da Escala Multidimensional de Reatividade Interpessoal (EMRI). Estudos Interdisciplinares em Psicologia, 4(1), 64-79.

Freud, S. (2006). As perspectivas futuras da terapia psicanalítica. In: Edição Standard Brasileira das Obras Psicológicas Completas de Sigmund Freud. Rio de Janeiro: Imago, 11. (Original publicado em 1910).

Gabbard, G. O. (2016). Psiquiatria Psicodinâmica na prática clínica (5a Ed.). Porto Alegre: Artmed.

Geiser, F., Schulz-Werner, A., Imbierowicz, K., Conrad, R., & Liedtke, R. (2003). Impact of the turning-against-self defense mechanism on the process and outcome of inpatient psychotherapy. Psychotherapy Research, 13(3), 355-370. https://doi.org/10.1093/ptr/kpg033

Genova, F., & Gazzillo, F. (2018). Personality Organization, Personality Styles, and the Emotional Reactions of Treating Clinicians. Psychodynamic Psychiatry, 46(3), 357–392. https://doi.org/10.1521/pdps.2018.46.3.357

Goldfeld, P. R. M., Terra, L., Abuchaim, C., Sordi, A. O., Wiethaeuper, D., Bouchard, M. A., … Ceitlin, L. H. F. (2008). Mental states as part of countertransference responses in psychotherapists facing reports of traumatic events of mourning and sexual violence. Psychotherapy Research, 18(5), 523-34. https://doi.org/10.1080/10503300801968640

Grassi-Oliveira, R., Stein, L. M., & Pezzi, J. C. (2006). Tradução e validação de conteúdo da versão em português do Childhood Trauma Questionnaire. Revista de Saúde Pública, 40(2), 249-55.

Greenberg, J., & Mitchell, S. (2003). Relações de objeto na teoria psicanalítica. Lisboa: Climepsi Editores. (Obra original publicada em 1983)

Grudtner, R. R. (2009). Estudo da contratransferência e sua associação com características do paciente em psicoterapia analítica. Dissertação de mestrado, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre.

Gullestad, S. E., & Killingmo, B. (2020). The theory and practice of psychoanalytic therapy. Listening for the subtext (pp. 128). Routledge.

Hauck, S., Schestatsky, S., Terra, L., Knijnik, P., Sanchez, P., & Ceitlin, L. H. F. (2006). Adaptação transcultural para o português brasileiro do Parental Bonding Instrument (PBI). Revista de Psiquiatria do Rio Grande do Sul, 28(2), 162-8. https://doi.org/10.1590/S0101-81082006000200008

Hayes, J. A., Gelso, C. J., Goldberg, S., & Kivlighan, D. M. (2018). Countertransference management and effective psychotherapy: Meta-analytic findings. Psychotherapy, 55(4), 496–507.

Hoffart, A., & Friis, S. (2000). Therapists' emotional reactions to anxious inpatients during integrated behavioral-psychodynamic treatment: A psychometric evaluation of a feeling word checklist. Psychotherapy Research 10(4), 462-73. https://doi.org/10.1093/ptr/10.4.462

Holmes, J. (2014). Countertransference Before Heimann. Journal of the American Psychoanalytic Association, 62(4), 603–629. https://doi.org/10.1177/0003065114546164

Holmqvist, R., Hansjons-Gustafsson, U., & Gustafsson, J. (2002). Patients’ relationship episodes and therapists’ feelings. Psychology and Psychotherapy, 75, 393-409.

Ivey, D. C., Wieling, E., & Harris, S. M. (2000). Save the young the elderly have lived their lives: Ageism in marriage and family therapy. Family Process, 39, 163-75.

Jimenez, J. P., & Altimir, C. (2019). Beyond the hermeneutic/scientific controversy: A case for a clinically sensitive empirical research paradigm in psychoanalysis. The International Journal of Psychoanalysis, 100(5), 940–961. https://doi.org/10.1080/00207578.2019.1636253

Jordão, A. B., & Ramires, V. R. R. (2010). Vínculos afetivos de adolescents borderline e seus pais. Psicologia: Teoria e pesquisa, 26(1), 89-98.

Kächele, H., Erhardt, I., Seybert, C., & Buchholz, M. B. (2015). Countertransference as object of empirical research? International Forum of Psychoanalysis, 24(2), 96–108. https://doi.org/10.1080/0803706X.2012.737933

Latts, M. G., & Gelso, C. J. (1995). Countertransference behavior and management with survivors of sexual assault. Psychotherapy: Theory, Research, Practice and Training, 32(3), 405¬15.

Liebman, R. E., & Burnette, M. (2013). It’s Not You, It’s Me: An Examination of Clinician-and Client-Level Influences on Countertransference Toward Borderline Personality Disorder. American Journal of Orthopsychiatry, 83(1), 115-25.

Lingiardi, V., Tanzilli, A., & Colli, A. (2015). Does the severity of psychopathological symptons mediate the relantionship between patient personality and therapist response? Psychotherapy, 52(2), 228-37. https://doi.org/10.1037/a0037919

Lins, T., & Alvarenga, P. (2015). Controle Psicológico Materno e Problemas Internalizantes em Pré-Escolares Psicologia: Teoria e Pesquisa, 31(3), 311-319. https://doi.org/10.1590/0102-37722015032092311319

Machado, D. de B., Teche, S. P., Lapolli, C., Tavares, B. F., Almeida, L. S. P., Silva., G. B., ... Eizirik, C. L. (2015). Countertransference and therapeutic alliance in the early stage of adult psychodynamic psychotherapy. Trends in Psychiatry and Psychotherapy, 37(3), 133-42.

McIntyre, S. M., & Schwartz, R. C. (1998). Therapists’ differential countertransference reactions toward clients with major depression or borderline personality disorder. Journal of Clinical Psychology, 54(7), 923-31.

McLaughlin, K. A. (2016). Future directions in childhood adversity and youth psychopathology. Journal of Clinical Child & Adolescent Psychology, 45(3), 361-382. https://doi.org/10.1080/15374416.2015.1110823

Michaud, L., Ligier, F., Bourquin, C., Corbeil, S., Saraga, M., Stiefel, F., … Richard-Devantoy, S. (2020). Differences and similarities in instant countertransference towards patients with suicidal ideation and personality disorders. Journal of Affective Disorder, 265, 669-678. https://doi.org/10.1016/j.jad.2019.11.115

Moller, R. L., Serralta, F. B., Bittencourt, A. A., & Benetti, S. P. da C. (2018). Manifestações contratransferenciais no processo terapêutico de uma paciente com personalidade borderline. Psico-USF, 23(4), 705-17. https://doi.org/10.1590/1413- 82712018230410

Nissen-Lie, H. A., Dahl, H.-S. J., & Høglend, P. A. (2020). Patient factors predict therapists’ emotional countertransference differently depending on whether therapists use transference work in psychodynamic therapy. Psychotherapy Research, 1–13. https://doi.org/10.1080/10503307.2020.1762947

Parker, G., Tupling, H., & Brown, L. B. (1979). A parental bonding instrument. British Journal of Medical Psychology, 52(1), 1-10. https://doi.org/10.1111/j.2044-8341.1979.tb02487.x

Plotkin, F. (2000). Treatment of the Older Adult: The Impact On the Psychoanalyst. Journal of the American Psychoanalytic Association, 48(4), 1591–1616. https://doi.org/10.1177/00030651000480042001

Prasko, J., Diveky, T., Grambal, A., Kamaradova, D., Mozny, P., Sigmundova, Z., … Vyskocilova, J. (2010). Transference and countertransference in cognitive behavioral therapy. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub, 154(3), 189-97.

Putrino, N., Casari, L., Mesurado, B., & Etchevers, M. (2019). Psychotherapists’ emotional and physiological reactions toward patients with either borderline personality disorder or depression. Psychotherapy Research. https://doi.org/10.1080/10503307.2019.1690176

Queirós, M., & Caseiro, J (2018). Child maltreatment and mental disorders: the role of epigenetics. Nascer e Crescer [online]. 27(3), 166-175. https://doi.org/10.25753/BirthGrowthMJ.v27.i3.13431

Røssberg, J. I., Karterud, S., Pedersen, G., & Friis, S. (2010). Psychiatric symptoms and countertransference feelings: An empirical investigation. Psychotherapy Research, 178(1), 191-5. https://doi.org/10.1016/j.psychres.2009.09.019

Sampaio, L. R., Guimarães, P. R. B., Camino, C. P. S, Formiga, N. S., & Menezes, I. G. (2011). Estudos sobre a dimensionalidade da empatia: Tradução e adaptação do Interpersonal Reactivity Index (IRI). Psico, 42(1), 67-76.

Schwartz, R. C., & Wendling, H. M. (2003). Countertransference reactions toward specific client populations: A review of empirical literature. Psychological Reports, 92(2), 651-4. https://doi.org/10.2466/pr0.2003.92.2.651

Schwartz, R. C., Smith, S. D., & Chopko, B. (2007). Psychotherapists’ countertransference reactions toward clients with antisocial personality disorder and schizophrenia: An empirical test of theory. American Journal of Psychotherapy, 61(4), 375-93. https://doi.org/10.1176/appi.psychotherapy.2007.61.4.375

Serralta, F.B., & Streb, L.G. (2002). Notas sobre pesquisa em psicoterapia psicanalítica: situação atual e perspectivas. Revista Brasileira de Psicoterapia, 5(1), 53-65.

Silveira Jr, E. De M. (2010). Validação da escala para avaliação da contratransferência (EACT) no atendimento psiquiátrico inicial de vítimas de traumas psíquicos. Dissertação de mestrado não publicada, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre.

Silveira Jr, E. De M., Polanczy, G. V., Hauck, S., Eizirik, C. L., & Ceitlin, L. H. F. (2011). Can countertransference at the early stage of trauma care predict patient dropout of psychiatric treatment? Revista Brasileira de Psiquiatria, 33(4), 379-84. https://doi.org/10.1590/S1516-44462011000400012

Tabina, K. C., Kendall, C. J., Garret. R. K., & Stagner, B. H. (2020). Considering psychodynamic therapy for older adults. Psychodynamic Psychiatry, 48(2), 152–162. https://doi.org/10.1521/pdps.2020.48.2.152

Tanzilli, A., Muzi, L., Ronningstam, E., & Lingiardi, V. (2017). Countertransference when working with narcissistic personality disorder: An empirical investigation. Psychotherapy, 54(2), 184– 194. https://doi.org/10.1037/pst0000111

Vedel, A., Larsen, L., & Aamand, A. (2020). The Efficacy of Individual Psychological Interventions with Non-Clinical Older Adults: A Systematic Review. European Psychologist, 25, 200-210. https://doi.org/10.1027/1016-9040/a000410

Westerling, T. W. III, Drinkwater, R., Laws, H., Stevens, H., Ortega, S., Goodman, D., … Drill, R. L. (2019). Patient attachment and therapist countertransference in psychodynamic psychotherapy. Psychoanalytic Psychology, 36(1), 73-81. https://doi.org/10.1037/pap0000215

Williams, E. N., Judge, A. B., Hill, C. E., & Hoffman, M. A. (1997). Experiences of novice therapists in prepracticum: Trainees’, clients’, and supervisors’ perceptions of therapists’ personal reactions and management strategies. Journal of Counseling Psychology, 44, 390-9.

Zaslavsky, J., & dos Santos, M. J. P. (2006). Contratransferência: Teoria e prática clínica. Porto Alegre: Artmed.

Publicado

2020-11-24

Cómo citar

Sanchez, L. F., & Serralta, F. B. (2020). Asociaciones entre contratransferencia y características del paciente en psicoterapia psicoanalíticaa. CES Psicología, 13(3), 162-179. https://doi.org/10.21615/cesp.13.3.10

Número

Sección

Investigación con Adultos

Artículos más leídos del mismo autor/a

Nota: Este módulo requiere de la activación de, al menos, un módulo de estadísticas/informes. Si los módulos de estadísticas proporcionan más de una métrica, selecciona una métrica principal en la página de configuración del sitio y/o en las páginas de propiedades de la revista.