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Transference patterns in the psychotherapy of personality disorders: empirical investigation

Departments of Psychology and Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia, USA

Correspondence: Professor Drew Westen, Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA 30322, USA. E-mail: dwesten{at}emory.edu

Declaration of interest None. Funding detailed in Acknowledgements.

Background The concept of transference has broadened to a recognition that patients often express enduring relational patterns in the therapeutic relationship.

Aims To examine the structure of patient relational patterns in psychotherapy and their relation with DSM–IV personality disorder symptoms.

Method A random sample of psychologists and psychiatrists (n=181) completed a battery of instruments on a randomly selected patient in their care.

Results Exploratory factor analysis identified five transference dimensions: angry/entitled, anxious/preoccupied, avoidant/counterdependent, secure/engaged and sexualised. These were associated in predictable ways with Axis II pathology; four mapped on to adult attachment styles. An aggregated portrait of transference patterns in narcissistic patients provided a clinically rich, empirically based description of transference processes that strongly resembled clinical theories.

Conclusions The ways patients interact with their therapists can provide important data about their personality, attachment patterns and interpersonal functioning. These processes can be measured in clinically sophisticated and psychometrically sound ways. Such processes are relatively independent of clinicians’theoretical orientation.

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