The Hindering Effect of Countertransference on the Psychotherapy Process

Aim: Several studies highlighted the negative effect of nonconscious and unmanaged countertransference on psychotherapy outcome. However, little is known about the specific impacts of countertransference reactions on the in-session communication and emotion processing. This study investigated the impact of countertransference reactions on the linguistic style adopted by patient and therapist during the session. The assumption, in accordance with the multiple code theory (Bucci, 1997, 2020), was that linguistic style revealed the quality of speakers’ referential process, i.e. their ability to translate into words and symbolically handle the automatic emotional activation, one of the main goals of psychotherapy. Methods: Twenty-three in-training psychotherapists were asked to rate their emotional reactions through the Therapist Response Questionnaire at the end of 69 counselling sessions, the first three they would have with a patient. The 69 sessions were also recorded, transcribed and evaluated by three external raters who applied the Countertransference Behavior Measure. Finally, the transcripts were also analyzed by applying the computerized linguistic measures of the referential process. Results: There was a large impact of each individual countertransference reaction – both when evaluated by external raters and psychotherapists – on the patients' language style. Overall, countertransference reactions were predictor of patients’ speeches with lower clarity, specificity, concreteness and imagery (i.e. lower referential activity) and with lower reorganization/reflection activity. Countertransference reactions, on the other hand, did not have significant impact on the therapist's linguistic style. Discussion: These results pave the way for more in-depth studies of the impact of each individual countertransference reaction on the psychotherapy process.