Introduction
Therapists’ Emotions Towards Patients: A Key Ingredient of the Therapeutic Relationship
Overwhelmed/Disorganized | A desire to avoid or flee the patient and strong negative feelings, including dread, repulsion, and resentment |
Helpless/Inadequate | Feelings of inadequacy, incompetence, hopelessness, and anxiety |
Positive/Satisfactory | Experience of a positive working alliance and close connection with the patient |
Special/Over-involved | A sense of the patient as special relative to other patients and includes “soft signs” of problems in maintaining boundaries, including self-disclosure, ending sessions on time, and feeling guilty, responsible, or overly concerned about the patient |
Sexualized | Sexual feelings toward the patient or experiences of sexual tension |
Disengaged | Feeling distracted, withdrawn, annoyed, or bored in sessions |
Parental/Protective | Wish to protect and nurture the patient in a parental way, above and beyond normal positive feelings toward the patient |
Criticised/Devalued | Being unappreciated, dismissed, or devalued by the patient |
The Therapeutic Relationship: A Neglected Dimension in Psychotherapy for OCD
The Therapeutic Relationship and Therapists’ Perfectionism
Rationale and Hypotheses of the Study
Role of Therapists’ Socio-Demographics and Patients’ Comorbid Personality Disorders
Method
Participants and Procedure
Measures
Therapists’ Emotional Response to Patients
Therapists’ Perfectionism
Statistical Analysis
Results
Sample’s Characteristics
Therapists’ characteristics | n (%) | Mean (SD) |
---|---|---|
Gender | ||
Female | 74 (78.70) | |
Male | 20 (21.30) | |
Age (years) | 42.07 (10.17) | |
Marital status | ||
Single | 44 (46.80) | |
Cohabitant/married | 44 (46.80) | |
Separated/divorced | 4 (4.30) | |
Psychotherapeutic orientation | ||
CBT | 47 (50) | |
Psychodynamic therapy | 47 (50) |
Patients’ demographic and clinical characteristics | n (%) | Mean (SD) |
---|---|---|
Gender | ||
Female | 41 (43.60) | |
Male | 53 (56.40) | |
Age | 34.67 (11.19) | |
Presence of a comorbid personality disorder | ||
No | 79 (84) | |
Yes | 15 (16) | |
Presence of a comorbid Axis disorder | ||
No | 77 (81.90) | |
Yes | 17 (18.10) |
Bivariate Associations Between Therapists’ Perfectionism and Emotional Responses in the Whole Sample
2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | |
---|---|---|---|---|---|---|---|---|---|---|---|---|
1.MPS Concern over Mistakes and Doubts about Actions | .084 | .489** | .429** | .217* | .284** | .070 | .295** | .323** | .248* | .267** | .093 | .174 |
2. MPS Concern with Precision, Order and Organization | .327** | .144 | − .161 | − .117 | .049 | − .067 | − .117 | − .183 | − .148 | − .087 | − .192 | |
3. MPS Excessively High Personal Standards | .436** | .045 | .027 | .119 | .128 | − .054 | .161 | .207* | − .142 | − .020 | ||
4. MPS Excessive Concern with Parents’ Expectations and Evaluation | .148 | .124 | − .005 | .211* | .124 | .188 | .112 | − .056 | .063 | |||
5.TRQ Helpless/Inadequate | .670** | − .236* | .553** | .665** | .378** | .220* | .169 | .623** | ||||
6.TRQ Overwhelmed/Disorganised | .079 | .617** | .631** | .615** | .581** | .299** | .369** | |||||
7.TRQ Positive/Satisfactory | − .166 | − .138 | .248* | .572** | .079 | − .243* | ||||||
8.TRQ Hostile/Angry | .617** | .441** | .279** | .280** | .496** | |||||||
9.TRQ Criticised/Devalued | .406** | .249* | .367** | .406** | ||||||||
10.TRQ Special/Over-involved | .612** | .343** | .204* | |||||||||
11.TRQ Parental/Protective | .240* | − .016 | ||||||||||
12.TRQ Sexualised | .093 | |||||||||||
13.TRQ Disengaged | 1 |
Bivariate Associations Between Therapists’ Perfectionism and Emotional Responses in the Separate Groups
2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1. Therapist’s age (years) | .273 | .391** | − .052 | − .058 | − .041 | .101 | .126 | − .148 | − .047 | .056 | .146 | .038 | − .188 | − .041 | − .031 |
2. Number of sessions | 1 | .205 | − .003 | .126 | − .012 | − .031 | − .058 | .108 | .106 | .037 | .098 | .019 | .185 | .213 | − .031 |
3. Patient’s age (years) | .019 | 1 | .000 | − .191 | − .209 | − .070 | − .048 | − .230 | − .213 | − .104 | .065 | − .030 | − .173 | .083 | − .141 |
4. MPS Concern over Mistakes and Doubts about Actions | − .061 | .098 | 1 | .166 | .548** | .431** | .280 | .349* | − .027 | .355* | .450** | .175 | .283 | − .094 | .114 |
5. MPS Concern with Precision. Order and Organization | − .081 | .155 | − .043 | 1 | .348* | .089 | − .141 | .106 | .298 | .067 | − .174 | − .103 | .146 | − .080 | − .252 |
6. MPS Excessively High Personal Standards | .123 | .017 | .433** | .232 | 1 | .477** | .233 | .214 | .160 | .288 | .100 | .255 | .344* | − .156 | .038 |
7. MPS Excessive Concern with Parents’ Expectations and Evaluation | − .105 | .146 | .522** | .126 | .496** | 1 | .250 | .192 | − .125 | .390** | .268 | .227 | .186 | − .128 | .081 |
8. TRQ Helpless/Inadequate | .123 | .191 | .242 | − .153 | − .033 | − .035 | 1 | .575** | − .336* | .493** | .696** | .303* | .135 | − .033 | .649** |
9. TRQ Overwhelmed/Disorganised | .116 | .201 | .288* | − .242 | − .059 | .074 | .742** | 1 | .041 | .517** | .570** | .414** | .534** | .055 | .337* |
10. TRQ Positive/Satisfactory | .056 | − .085 | .093 | − .146 | .080 | .197 | − .061 | .219 | 1 | − .359* | − .204 | .094 | .479** | .012 | − .40** |
11. TRQ Hostile/Angry | .409** | .274 | .336* | − .096 | .094 | .136 | .631** | .652** | .133 | 1 | .514** | .274 | .083 | .022 | .588** |
12. TRQ Criticised/Devalued | − .005 | .148 | .258 | .012 | − .132 | .028 | .637** | .615** | − .052 | .695** | 1 | .368* | .205 | .120 | .379* |
13. TRQ Special/Over-involved | .210 | − .034 | .377** | − .189 | .173 | .268 | .415** | .730** | .497** | .522** | .381** | .705** | .491** | .142 | .148 |
14. TRQ Parental/Protective | .182 | − .098 | .260 | − .298* | .141 | .134 | .304* | .616** | .699** | .397** | .221 | .462** | 1 | − .032 | − .060 |
15. TRQ Sexualised | − .057 | − .226 | .231 | − .073 | − .163 | − .035 | .353* | .415** | .172 | .461** | .508** | .276 | .408** | 1 | − .029 |
16. TRQ Disengaged | .035 | .150 | .279 | − .309* | − .043 | − .092 | .639** | .436** | − .096 | .558** | .479** | .705** | .088 | .153 | 1 |
Comparisons Between Therapist Groups on Emotional Responses
Perfectionism (MPS scales) | Therapist’s orientation | Mean | SD | 95% CI | F(1. 93) | p-value | |
---|---|---|---|---|---|---|---|
Lower | Upper | ||||||
Concern over Mistakes and Doubts about Actions | CBT | 31.89 | 10.793 | 28.72 | 35.06 | 0.490 | 0.486 |
Psychodynamic | 30.53 | 7.843 | 28.23 | 32.83 | |||
Concern with Precision. Order and Organization | CBT | 22.45 | 4.889 | 21.01 | 23.88 | 3.746 | 0.056 |
Psychodynamic | 20.57 | 4.481 | 19.26 | 21.89 | |||
Excessively High Personal Standards | CBT | 22.26 | 5.507 | 20.64 | 23.87 | 2.045 | 0.156 |
Psychodynamic | 20.85 | 3.873 | 19.71 | 21.99 | |||
Excessive Concern with Parents’ Expectations and Evaluation | CBT | 17.87 | 7.444 | 15.69 | 20.06 | 0.037 | 0.847 |
Psychodynamic | 17.60 | 6.364 | 15.73 | 19.46 |
Emotional response to the patient (TRQ scales) | Therapist’s orientation | Mean | SD | 95% CI | F(1. 93) | p-value | |
---|---|---|---|---|---|---|---|
Lower | Upper | ||||||
Helpless/Inadequate | CBT | 16.02 | 6.825 | 14.02 | 18.03 | 5.254 | 0.024 |
Psychodynamic | 19.09 | 6.114 | 17.29 | 20.88 | |||
Overwhelmed/Disorganised | CBT | 16.91 | 5.633 | 15.26 | 18.57 | 6.927 | 0.010 |
Psychodynamic | 20.45 | 7.274 | 18.31 | 22.58 | |||
Positive/Satisfactory | CBT | 22.70 | 6.175 | 20.89 | 24.52 | 1.883 | 0.173 |
Psychodynamic | 21.00 | 5.846 | 19.28 | 22.72 | |||
Hostile/Angry | CBT | 11.05 | 4.799 | 9.65 | 12.46 | 7.980 | 0.006 |
Psychodynamic | 14.23 | 5.984 | 12.45 | 16.01 | |||
Criticised/Devalued | CBT | 9.51 | 3.296 | 8.54 | 10.48 | 8.617 | 0.004 |
Psychodynamic | 11.77 | 4.108 | 10.56 | 12.97 | |||
Special/Over-involved | CBT | 8.74 | 2.907 | 7.89 | 9.59 | 1.754 | 0.189 |
Psychodynamic | 9.60 | 3.375 | 8.60 | 10.61 | |||
Parental/Protective | CBT | 12.15 | 3.816 | 11.03 | 13.27 | 1.743 | 0.190 |
Psychodynamic | 13.30 | 4.587 | 11.95 | 14.64 | |||
Sexualised | CBT | 4.69 | 1.078 | 4.38 | 5.01 | 0.596 | 0.442 |
Psychodynamic | 4.90 | 1.503 | 4.46 | 5.35 | |||
Disengaged | CBT | 9.23 | 3.919 | 8.08 | 10.38 | 0.031 | 0.860 |
Psychodynamic | 9.38 | 4.240 | 8.14 | 10.63 |
Comparison Between Theoretical Orientation and Therapists’ Demographics and Patients’ Characteristics
Therapist’/patient’s characteristics | Therapist’s orientation | Mean | SD | 95% CI | F(1. 93) | p-value | |
---|---|---|---|---|---|---|---|
Lower | Upper | ||||||
Age of the therapist (years) | CBT | 42.62 | 10.584 | 39.51 | 45.72 | 0.265 | 0.608 |
Psychodynamic | 41.53 | 9.835 | 38.64 | 44.42 | |||
Number of sessions with the patient | CBT | 69.25 | 127.311 | 30.54 | 107.96 | 0.108 | 0.743 |
Psychodynamic | 76.88 | 82.002 | 51.33 | 102.43 | |||
Age of the patient (years) | CBT | 33.24 | 11.729 | 29.76 | 36.72 | 1.530 | 0.219 |
Psychodynamic | 36.13 | 10.546 | 32.97 | 39.30 |
CBT (n) | Psychodynamic (n) | Total | χ2(1) | p-value | ||
---|---|---|---|---|---|---|
Therapist’s gender | Male | 10 | 10 | 20 | 0 | 1.000 |
Female | 37 | 37 | 74 | |||
Patient’s gender | Male | 29 | 24 | 53 | 1.081 | 0.298 |
Female | 18 | 23 | 41 | |||
Patient with a comorbid personality disorder | No | 40 | 39 | 79 | 0.079 | 0.778 |
Yes | 7 | 8 | 15 |
Multivariate Effects of Therapists’ Orientation and Perfectionism on Emotions Towards Patients
Outcome: TRQ Helpless/Inadequate | 95% CI | ||||
---|---|---|---|---|---|
β | Lower | Upper | Wald’s χ2(1) | p-value | |
Intercept | 16.185 | 6.559 | 25.812 | 10.860 | .001 |
Therapist’s male gender | 1.760 | − .757 | 4.276 | 1.878 | .171 |
Therapist’s female gender | 0a | ||||
Therapist’s age (years) | − .002 | − .126 | .121 | .001 | .971 |
CBT orientation | − 3.118 | − 5.642 | − .595 | 5.867 | .015 |
Psychodynamic orientation | 0a | ||||
Absence of a comorbid personality disorder | − 3.121 | − 6.511 | .270 | 3.254 | .071 |
Presence of a comorbid personality disorder | 0a | ||||
MPS Concern over Mistakes and Doubts about Actions | .078 | − .091 | .247 | .821 | .365 |
MPS Concern with Precision. Order and Organization | − .217 | − .500 | .066 | 2.264 | .132 |
MPS Excessively High Personal Standards | .175 | − .154 | .503 | 1.087 | .297 |
MPS Parents’ Expectations and Evaluation | .079 | − .137 | .295 | .516 | .473 |
Patients’ age (years) | .040 | − .074 | .155 | .476 | .490 |
Outcome: TRQ Overwhelmed/Disorganized | 95% CI | ||||
---|---|---|---|---|---|
β | Lower | Upper | Wald’s χ2(1) | p-value | |
Intercept | 18.516 | 8.846 | 28.187 | 14.083 | .000 |
Therapists’ male gender | 1.781 | − .747 | 4.309 | 1.907 | .167 |
Therapists’ female gender | 0a | ||||
Therapists’ age (years) | − .070 | − .194 | .054 | 1.238 | .266 |
CBT orientation | − 3.856 | − 6.392 | − 1.321 | 8.890 | .003 |
Psychodynamic orientation | 0a | ||||
Absence of a comorbid personality disorder | − 1.278 | − 4.684 | 2.129 | .540 | .462 |
Presence of a comorbid personality disorder | 0a | ||||
MPS Concern over Mistakes and Doubts about Actions | .147 | − .023 | .317 | 2.890 | .089 |
MPS Concern with Precision. Order and Organization | − .055 | − .339 | .229 | .145 | .704 |
MPS Excessively High Personal Standards | − .022 | − .352 | .308 | .017 | .897 |
MPS Parents’ Expectations and Evaluation | .091 | − .125 | .308 | .685 | .408 |
Patients’ age (years) | .017 | − .099 | .132 | .081 | .776 |
Outcome: TRQ Positive/Satisfactory | 95% CI | ||||
---|---|---|---|---|---|
β | Lower | Upper | Wald’s χ2(1) | p-value | |
Intercept | 13.551 | 4.370 | 22.732 | 8.368 | .004 |
Therapists’ male gender | 1.224 | − 1.176 | 3.625 | .999 | .317 |
Therapists’ female gender | 0a | ||||
Therapists’ age (years) | .027 | − .090 | .145 | .210 | .647 |
CBT orientation | .558 | − 1.849 | 2.964 | .206 | .650 |
Psychodynamic orientation | 0a | ||||
Absence of a comorbid personality disorder | 2.352 | − .882 | 5.586 | 2.033 | .154 |
Presence of a comorbid personality disorder | 0a | ||||
MPS Concern over Mistakes and Doubts about Actions | − .023 | − .184 | .138 | .078 | .779 |
MPS Concern with Precision. Order and Organization | .133 | − .136 | .403 | .937 | .333 |
MPS Excessively High Personal Standards | .182 | − .132 | .495 | 1.288 | .256 |
MPS Parents’ Expectations and Evaluation | .035 | − .170 | .241 | .114 | .736 |
Patients’ age (years) | − .039 | − .149 | .070 | .493 | .483 |
Outcome: Hostile/Angry | 95% CI | ||||
---|---|---|---|---|---|
β | Lower | Upper | Wald’s χ2(1) | p-value | |
Intercept | 4.688 | − 3.081 | 12.457 | 1.399 | .237 |
Therapists’ male gender | 1.790 | − .247 | 3.826 | 2.966 | .085 |
Therapists’ female gender | 0a | ||||
Therapists’ age (years) | − .001 | − .100 | .099 | .000 | .990 |
CBT orientation | − 3.243 | − 5.289 | − 1.198 | 9.655 | .002 |
Psychodynamic orientation | 0a | ||||
Absence of a comorbid personality disorder | − .445 | − 3.187 | 2.297 | .101 | .751 |
Presence of a comorbid personality disorder | 0a | ||||
MPS Concern over Mistakes and Doubts about Actions | .064 | − .072 | .200 | .846 | .358 |
MPS Concern with Precision. Order and Organization | − .035 | − .265 | .194 | .091 | .763 |
MPS Excessively High Personal Standards | .101 | − .165 | .367 | .550 | .458 |
MPS Parents’ Expectations and Evaluation | .189 | .013 | .365 | 4.419 | .036 |
Patients’ age (years) | .061 | − .032 | .155 | 1.643 | .200 |
Outcome: TRQ Criticised/Devalued | 95% CI | ||||
---|---|---|---|---|---|
β | Lower | Upper | Wald’s χ2(1) | p-value | |
Intercept | 8.112 | 3.199 | 13.026 | 10.473 | .001 |
Therapists’ male gender | 1.517 | .232 | 2.801 | 5.358 | .021 |
Therapists’ female gender | 0a | ||||
Therapists’ age (years) | .043 | − .019 | .106 | 1.833 | .176 |
CBT orientation | − 1.833 | − 3.121 | − .545 | 7.782 | .005 |
Psychodynamic orientation | 0a | ||||
Absence of a comorbid personality disorder | − 1.404 | − 3.135 | .326 | 2.530 | .112 |
Presence of a comorbid personality disorder | 0a | ||||
MPS Concern over Mistakes and Doubts about Actions | .116 | .029 | .202 | 6.902 | .009 |
MPS Concern with Precision. Order and Organization | − .057 | − .201 | .087 | .603 | .437 |
MPS Excessively High Personal Standards | − .124 | − .292 | .044 | 2.094 | .148 |
MPS Parents’ Expectations and Evaluation | .092 | − .018 | .202 | 2.674 | .102 |
Patients’ age (years) | .008 | − .051 | .066 | .065 | .799 |
Outcome: TRQ Special/Over-Involved | 95% CI | ||||
---|---|---|---|---|---|
β | Lower | Upper | Wald’s χ2(1) | p-value | |
Intercept | 5.406 | .798 | 10.015 | 5.288 | .021 |
Therapists’ male gender | .664 | − .545 | 1.872 | 1.159 | .282 |
Therapists’ female gender | 0a | ||||
Therapists’ age (years) | .001 | − .058 | .060 | .002 | .969 |
CBT orientation | − 1.226 | − 2.439 | − .012 | 3.919 | .048 |
Psychodynamic orientation | 0a | ||||
Absence of a comorbid personality disorder | 1.655 | .029 | 3.282 | 3.980 | .046 |
Presence of a comorbid personality disorder | 0a | ||||
MPS Concern over Mistakes and Doubts about Actions | .012 | − .069 | .093 | .085 | .770 |
MPS Concern with Precision. Order and Organization | − .131 | − .268 | .005 | 3.571 | .059 |
MPS Excessively High Personal Standards | .140 | − .018 | .298 | 3.029 | .082 |
MPS Parents’ Expectations and Evaluation | .099 | − .005 | .204 | 3.479 | .062 |
Patients’ age (years) | .005 | − .051 | .060 | .026 | .871 |
Outcome: TRQ Parental/Protective | 95% CI | ||||
---|---|---|---|---|---|
β | Lower | Upper | Wald’s χ2(1) | p-value | |
Intercept | 9.323 | 2.977 | 15.669 | 8.292 | .004 |
Therapists’ male gender | .797 | − .862 | 2.456 | .886 | .347 |
Therapists’ female gender | 0a | ||||
Therapists’ age (years) | − .023 | − .104 | .058 | .307 | .580 |
CBT orientation | − 1.737 | − 3.400 | − .073 | 4.188 | .041 |
Psychodynamic orientation | 0a | ||||
Absence of a comorbid personality disorder | .694 | − 1.541 | 2.929 | .371 | .543 |
Presence of a comorbid personality disorder | 0a | ||||
MPS Concern over Mistakes and Doubts about Actions | .062 | − .050 | .173 | 1.173 | .279 |
MPS Concern with Precision. Order and Organization | − .072 | − .258 | .115 | .570 | .450 |
MPS Excessively High Personal Standards | .186 | − .031 | .402 | 2.824 | .093 |
MPS Parents’ Expectations and Evaluation | .053 | − .089 | .195 | .536 | .464 |
Patients’ age (years) | − .019 | − .095 | .057 | .246 | .620 |
Outcome: TRQ Sexualised | 95% CI | ||||
---|---|---|---|---|---|
β | Lower | Upper | Wald’s χ2(1) | p-value | |
Intercept | 5.371 | 3.348 | 7.394 | 27.083 | .000 |
Therapists’ male gender | .122 | − .413 | .657 | .200 | .655 |
Therapists’ female gender | 0a | ||||
Therapists’ age (years) | − .007 | − .033 | .019 | .272 | .602 |
CBT orientation | − .186 | − .718 | .345 | .471 | .492 |
Psychodynamic orientation | 0a | ||||
Absence of a comorbid personality disorder | .318 | − .394 | 1.031 | .766 | .381 |
Presence of a comorbid personality disorder | 0a | ||||
MPS Concern over Mistakes and Doubts about Actions | .009 | − .026 | .045 | .271 | .603 |
MPS Concern with Precision. Order and Organization | .004 | − .056 | .063 | .014 | .907 |
MPS Excessively High Personal Standards | − .043 | − .112 | .026 | 1.507 | .220 |
MPS Parents’ Expectations and Evaluation | .010 | − .036 | .055 | .168 | .682 |
Patients’ age (years) | − .004 | − .028 | .020 | .109 | .742 |
Outcome: TRQ Disengaged | 95% CI | ||||
---|---|---|---|---|---|
β | Lower | Upper | Wald’s χ2(1) | p-value | |
Intercept | 12.846 | 6.736 | 18.956 | 16.979 | .000 |
Therapists’ male gender | .411 | − 1.186 | 2.009 | .254 | .614 |
Therapists’ female gender | 0a | ||||
Therapists’ age (years) | − .040 | − .118 | .038 | 1.004 | .316 |
CBT orientation | .002 | − 1.600 | 1.604 | .000 | .998 |
Psychodynamic orientation | 0a | ||||
Absence of a comorbid personality disorder | − .566 | − 2.718 | 1.586 | .266 | .606 |
Presence of a comorbid personality disorder | 0a | ||||
MPS Concern over Mistakes and Doubts about Actions | .053 | − .054 | .160 | .930 | .335 |
MPS Concern with Precision. Order and Organization | − .224 | − .404 | − .045 | 5.995 | .014 |
MPS Excessively High Personal Standards | .047 | − .162 | .256 | .194 | .659 |
MPS Parents’ Expectations and Evaluation | − .016 | − .153 | .121 | .052 | .820 |
Patients’ age (years) | .016 | − .057 | .089 | .187 | .665 |