Relationship Between Clinicians’ Inclination Toward Patients at Risk for Suicide (PRS) and Self-reported Countertransference

Abstract

Objectives

We investigate the relationship between clinicians’ inclination toward treating patients at risk for suicide (PRS), and self-reported countertransference (CT). We consider these observed group differences to explore two competing interpretations for observed CT patterns from a primary study; whether CT patterns are more consistent with defensive attitudes or an adaptative CT montage.

Method

We used one-way ANOVA, Tuckey post-hoc, and t-test, to compare clinicians (n = 267) grouped by self-ratings of positive, neutral or non-positive inclination toward working with PRS, with regard to their level of endorsement of the Therapist Response Questionnaire (TRQ) with PRS. We hypothesized that positively inclined clinicians would demonstrate greater CT literacy skills than other clinicians, reflected in lower endorsement of negative/hindering CT and higher endorsement of positive/facilitating CT to PRS.

Results

Compared to non-positively inclined clinicians, positively inclined clinicians endorsed significantly lower levels of two potentially negative/hindering CT dimensions, factor 1: entrapped/rejecting and, factor 5: protective/overinvolvement, and higher levels of the only positive/facilitating CT dimension, factor 2: fulfilled/engaging. Neutral clinicians reported similar CT patterns to positively inclined clinicians.

Conclusions

Hypothesis of greater CT literacy from positively inclined clinicians appears supported. Observed differences in CT endorsement by inclination group tend to support the CT montage interpretation of our original findings more than the defense mechanism interpretation proposed. Similarities in CT patterns between positively inclined and neutral clinicians suggest that positive inclination to PRS, as assessed in this study, may not be countertransferential per se.

Keywords:

• Clinical suicidology
• countertransference
• countertransference montage
• psychotherapy process
• positively inclined clinicians

ACKNOWLEDGMENTS

Acknowledgment to Dr Dalice Sim for providing statistical expertise

Additional information

Funding

This research was supported by the Suicide and Mental Health Research Group, Department of Psychological Medicine, University of Otago Wellington [Doctoral fellowship]; and by the Center for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices (CRISE), Department of Psychology, University of Québec in Montréal (UQÀM) [Postdoctoral fellowship].

Notes on contributors

Tess Soulié

Tess Soulié, Suicide and Mental Health Research Group, Department of Psychological Medicine, University of Otago, Wellington, New Zealand, Centre for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices (CRISE), Department of Psychology, University of Québec in Montréal (UQÀM), Canada, Department of Psychological Medicine, University of Otago, Wellington, New Zealand. Gabrielle Jenkin, Suicide and Mental Health Research Group, Department of Psychological Medicine, University of Otago, Wellington, New Zealand. Sunny Collings, School of Health, Te Herenga Waka Victoria University of Wellington, New Zealand. and Elliot Bell, Rehabilitation Teaching & Research Unit, Department of Medicine, University of Otago, Wellington, New Zealand, 5Department of Psychological Medicine, University of Otago, Wellington, New Zealand.  

Gabrielle Jenkin

Tess Soulié, Suicide and Mental Health Research Group, Department of Psychological Medicine, University of Otago, Wellington, New Zealand, Centre for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices (CRISE), Department of Psychology, University of Québec in Montréal (UQÀM), Canada, Department of Psychological Medicine, University of Otago, Wellington, New Zealand. Gabrielle Jenkin, Suicide and Mental Health Research Group, Department of Psychological Medicine, University of Otago, Wellington, New Zealand. Sunny Collings, School of Health, Te Herenga Waka Victoria University of Wellington, New Zealand. and Elliot Bell, Rehabilitation Teaching & Research Unit, Department of Medicine, University of Otago, Wellington, New Zealand, 5Department of Psychological Medicine, University of Otago, Wellington, New Zealand.  

Sunny Collings

Tess Soulié, Suicide and Mental Health Research Group, Department of Psychological Medicine, University of Otago, Wellington, New Zealand, Centre for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices (CRISE), Department of Psychology, University of Québec in Montréal (UQÀM), Canada, Department of Psychological Medicine, University of Otago, Wellington, New Zealand. Gabrielle Jenkin, Suicide and Mental Health Research Group, Department of Psychological Medicine, University of Otago, Wellington, New Zealand. Sunny Collings, School of Health, Te Herenga Waka Victoria University of Wellington, New Zealand. and Elliot Bell, Rehabilitation Teaching & Research Unit, Department of Medicine, University of Otago, Wellington, New Zealand, 5Department of Psychological Medicine, University of Otago, Wellington, New Zealand.  

Elliot Bell

Tess Soulié, Suicide and Mental Health Research Group, Department of Psychological Medicine, University of Otago, Wellington, New Zealand, Centre for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices (CRISE), Department of Psychology, University of Québec in Montréal (UQÀM), Canada, Department of Psychological Medicine, University of Otago, Wellington, New Zealand. Gabrielle Jenkin, Suicide and Mental Health Research Group, Department of Psychological Medicine, University of Otago, Wellington, New Zealand. Sunny Collings, School of Health, Te Herenga Waka Victoria University of Wellington, New Zealand. and Elliot Bell, Rehabilitation Teaching & Research Unit, Department of Medicine, University of Otago, Wellington, New Zealand, 5Department of Psychological Medicine, University of Otago, Wellington, New Zealand.