Personalidade do/a paciente e contratransferência do/a psicoterapeuta em contexto clínico: scoping review

Abstract

The notion of countertransference was presented by Freud in 1910 as an influence of the patient on the analyst's unconscious. However, this took on more complex and controversial contours compared to the original definition, with four major perspectives standing out - classical, totalistic, complementary and integrated. In view of objective countertransference, a systematic search was carried out - systematic scoping review - in order to map the typical emotional responses of psychotherapists at the developmental level; the personalities that make up the clusters; and the mediating effect of symptoms. At the developmental level, it was found that the more severe the level of personality organization, the more the psychotherapist feels powerless, disorganized, overloaded and less able to develop a satisfactory therapeutic alliance, with the most significant predictors being helpless, positive emotional response/ satisfactory (inverted) and overloaded. At the cluster level, Cluster A is positively associated with the criticized/mistreated emotional response. Cluster B is significantly associated with an emotional response that is overloaded/disorganized, helpless/inadequate, positive (inversely), sexualized, and criticized/mistreated. Cluster C is associated with a parental/protective emotional response. At the level of personalities, the results were discussed and related to psychodynamic aspects from the theory. In terms of the mediating effect of symptoms, the severity of patients' symptoms is positively associated with a criticized/mistreated, helpless/inadequate, overloaded/disorganized and special/involved emotional response. Still, it is negatively associated with a parental/protective, positive/satisfactory and disengaged response. It was concluded that countertransference is a clinically useful resource when recognized and well managed by the psychotherapist, as well as transmitting information about the patient's object relations.