Working through problematic countertransference: Senior clinicians' narratives from long‐term treatment of severe personality pathology

Abstract

Psychotherapy with patients presenting severe personality disorders (PD) is emotionally demanding, with countertransference (CT) often being a central clinical challenge. While psychoanalytic theory has deeply elaborated the uses of CT, less attention has focused on how clinicians describe the processes through which problematic CT is recognized, enacted and transformed in long‐term treatments. This qualitative study examines the CT experiences of 13 senior psychodynamic clinicians working with PD patients. Using narrative data from an open‐ended questionnaire and analysed through directed content analysis, the study explores markers of emerging problematic CT, patterns of enactment and repair, and psychological capacities required to work through these experiences. Findings suggest that problematic CT may unfold as a dynamic, embodied process, often preceded by subtle affective, somatic, attentional and attitudinal shifts that may contribute to enactments when unrecognized. However, when adequately reflected upon, particularly within supervision, these experiences may become clinically meaningful tools and sources of professional growth. By articulating phenomenological markers and core capacities for CT management, this study aims to enhance awareness of the emotional demands in this work and contribute to the training of psychodynamic clinicians treating patients with PD.