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Published on: January 17, 2025
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Patient attachment and reflective functioning as predictors for therapist in-session feelings
Fredrik Falkenström1, Jonatan Bjerén1, Fredrik Björklund1
1Department of Psychology, Linnaeus University.
Journal of Counseling Psychology
|February 15, 2024
Summary
Patients' ability to mentalize, not attachment style, influences therapist feelings during psychotherapy. Lower mentalization predicted more negative therapist emotions later in treatment, impacting the therapeutic process.
Area of Science:
- Psychology
- Psychotherapy Research
- Clinical Psychology
Background:
- Therapists' in-session emotions offer insights into therapeutic relationships and processes.
- Understanding patient pretreatment characteristics influencing therapist feelings is crucial for effective management.
- Limited research exists on how patient mentalization and attachment predict therapist emotional responses.
Purpose of the Study:
- To investigate if patients' pretreatment mentalization ability and attachment style predict therapists' in-session emotional reactions.
- To enhance the understanding of therapist emotional experiences within the psychotherapeutic setting.
- To explore the influence of patient characteristics on the therapeutic process.
Main Methods:
- A sample of 87 therapy dyads undergoing interpersonal psychotherapy or cognitive behavioral therapy for depression was studied.
- Patient mentalization was assessed using Reflective Functioning (RF); attachment was measured via the Experiences in Close Relationships (ECR) scale.
- Multilevel modeling analyzed the predictive relationship between patient pretreatment characteristics and therapist feelings (Feeling Word Checklist-24), controlling for confounders.
Main Results:
- Lower patient mentalization ability (RF) predicted more negative therapist feelings in mid- to late-treatment phases.
- Reduced mentalization also predicted less positive therapist feelings in the late-treatment phase.
- Patient attachment style (anxiety or avoidance) did not significantly predict therapist in-session feelings.
Conclusions:
- Patients' capacity to mentalize is a significant factor influencing therapists' emotional responses during psychotherapy.
- Therapists' feelings can be affected by patient mentalization, highlighting its importance in the therapeutic process.
- Future research should further explore the interplay between patient characteristics and therapist emotional experiences.
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