OBJECTIVE: The primary aim of this thesis is to examine differences in therapists’ emotional reactions, according to patient diagnosis. This is researched within the context of psychotherapy with patients diagnosed with personality disorders. Secondary aims is directed at investigating how therapists experience might influence these reactions, along with factors of symptom severity and functioning. Lastly, differences in emotional reactions between individual and group therapy is investigated in the context of psychotherapy with borderline personality disorder, since this has not been investigated ealier, as far as known.
BACKGROUND: Patient-therapist relations are affected by many factors, patient personlity pathology is assumed to be one important factor according to existing litterature. Therapists’ emotional reactions to the patient are important in more than one way. Emotional reactions can be used to recognize and identify imortant informations about the patients’ psychopathology and essential therapeutic processes affecting the therapy. If handled properly, the therapist inner work with emotional reactions can be a key to solving impasses. If not handled properly, therapists emotional reactions can be a threat to treatment outcome for patients with personality disorder, and might adversely affect the therapist as well.
METHOD: 11 trained therapist from the Department of Personality Psychiatry, Psychiatry of Region Nordjylland, Aalborg reported, a minimum of two sessions, of 55 patients diagnosed with personality disorders, on the Feeling Word Checklist-58 (FWC-58), in an outpatient setting. The thesis is designed as a clinical observational study, with a cohort that features repeated cross sectional analysis.
RESULTS: The study indicated that patients with cluster B diagnosis evoked less positive feelings of feeling important and confident and more negtive feelings of being rejected and on guard, than patients with cluster C diagnosis. Though the most prominent negative reactions evoked by patients with cluster B diagnosis was feelings of being on guard, overwelmed and inadequate. The therapist experienced more variation, or fluctuation, with patients with cluster B diagnosis than with cluster C diagnosis. The study identified that feelings of importance, and more so of feeling confident, increased with therapists’ working experience with personality disorders, but is not able to account for these positive feelings. Differences in emotional reactions between individual and group therapy was identified in the course of treatment with cluster B patients, in which therapist felt more on guard, overwelmed and inadequate in individual therapy than in group therapy. Through analysis of a subsample the study indicated that as severity of symptoms and functioning (GAF split version) increases, so does feelings of rejection, being on guard, overwelmed and inadequate. Through analysis of another subsample it is indicated that severity of personality pathology might affect therapists’ feelings of importance, whereas this feeling is significantly lower when treating patients at a more specialized level.
CONCLUSION: Overall therapists experience more positive emotional reactions to patients with personality disorders, than negative emotional reactions. In therapy with patients diagnosed with cluster B disorders more negative and less positive emotional reactions are experienced, especially differences of feeling confident is estimated to be most extensive in clinical practice. As the litterature indicates great importance to outcome, associated with even small proportions of negative reactions towards patients with personality disorders, it is recommended to thoroughly examine and manage emotional reactions towards patients. The finding of differences between individual and group therapies calls for further research to clarify circumstances connected to these differences, as well as possible confounding variables. The analysis of subsamples might be influenced by therapists’ individual differences, whereas conclusions to these results should be made with caution.