Revisão sistemática de estudos sobre contratransferência em psicoterapia de adultos

Machado, Diogo de Bitencourt; Coelho, Fábio Monteiro da Cunha; Giacomelli, Augusto Dutra; Donassolo, Mariana Almeida Lopes; Abitante, Morgana Sonza; Dall'Agnol, Tatiane; Eizirik, Cláudio Laks

doi:10.1590/2237-6089-2014-1004

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Trends in Psychiatry and Psychotherapy

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Review Articles • Trends Psychiatry Psychother. 36 (4) • Oct-Dec 2014 • https://doi.org/10.1590/2237-6089-2014-1004 copiar

Revisão sistemática de estudos sobre contratransferência em psicoterapia de adultos

Autoria SCIMAGO INSTITUTIONS RANKINGS

INTRODUÇÃO:

Contratransferência, definida como a reação emocional do psicoterapeuta em relação ao paciente, é um elemento técnico importante da psicoterapia. Esta revisão sistemática procura identificar e descrever os principais achados de estudos que avaliaram a contratransferência na psicoterapia de adultos.

MÉTODOS:

Realizou-se uma busca sem restrição de língua ou data de publicação nas bases de dados Embase, PubMed, PsycINFO e Web of Knowledge.

RESULTADOS:

Dos 1.081 estudos encontrados nas bases de dados, 25 foram selecionados. A maioria trata de psicoterapia psicodinâmica e os resultados indicam que a contratransferência positiva, isto é, os sentimentos de proximidade com o paciente, está associada a resultados positivos, tais como a melhora dos sintomas e o desenvolvimento de uma boa aliança terapêutica.

CONCLUSÕES:

Apesar de poucos estudos terem sido encontrados na literatura, a contratransferência parece ser uma fonte importante para o conhecimento do resultado do tratamento, estilo de apego, aliança terapêutica, sintomas e diagnóstico, dentre outros aspectos.

Psicoterapia; contratransferência; revisão

Data base	Options selected
Embase	Explosion of terms; MEDLINE; humans; article; neurology and psychiatry; age 18 or older; human, clinical study, controlled study, normal human, major clinical study, questionnaire, outcomes research, human experience, qualitative research, clinical trial, control group, correlational study.
PubMed	Humans; 18 years old or more; clinical trial, comparative study, controlled clinical trial, meta-analysis, randomized controlled study and systematic reviews.
Web of knowledge	Psychology, psychiatry, neuroscience neurology; articles.
PsycINFO	Human; journal; age 18 or older.

Associação de Psiquiatria do Rio Grande do Sul Av. Ipiranga, 5311/202, 90610-001 Porto Alegre RS/ Brasil, Tel./Fax: (55 51) 3024 4846 - Porto Alegre - RS - Brazil
E-mail: trends@aprs.org.br

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[1] Correspondence: Diogo Machado Rua Padre Anchieta, 1988/101 96015-420 - Pelotas, RS - Brazil E-mail: db_machado@yahoo.com

Study	Country	Theoretical framework of CT concept	Therapists	Patients	Setting	Psychotherapy
Bandura et al.¹⁹	USA	Psychoanalysis; patient expresses feelings that are perceived as threatening by therapist, who tends to avoid anxiety-provoking interaction.	Psychology students.	Parents of children treated in a children’s hospital.	Children’s hospital.	Not described.
Betan et al.²⁰	USA	Psychoanalysis; clinician’s emotional response as a source of insight into patient functioning.	Psychologists and psychiatrists with 3 years oftraining, paid to participate.	Each clinician selected most recent patient in psychotherapy.	80% in private practice.	40%, psychodynamic 30% eclectic, 20% CBT, 10% others.
Cutler²¹	USA	CT understood as therapist’s transference.	Therapists with different experience.	Description of 5 patients without any other detail.	A veteran’s hospital and a university outpatient service.	Not described.
Dahl et al.²²	NOR	Psychoanalysis; CT is a phenomenon that can be evaluated clinically and psychometrically through analysis of conscious reaction of therapist toward patient.	Therapists with 10 to 25 years of experience.	Patients without psychosis, substance abuse, or bipolar disorder.	Not described.	Manualized psychotherapy lasting 1 year.
Eizirik et al.²³	BRA	Psychoanalysis; CT and importance of supervision of short-term PP.	Psychiatry residents.	6 cases, 3 of which described in details.	Outpatient clinic.	Short-term PP, 15-20 sessions.
Eizirik et al.²⁴	BRA	Psychoanalysis; CT as a tool for understanding and communication, including pharmacological treatment.	Psychiatry residents.	Female victims of sexual violence in childhood or currently, or other trauma.	Outpatient clinic for violence victims.	Not described.
Eizirik et al.²⁵	BRA	Psychoanalysis; growing debate over therapist’s mind, therapeutic field and creation of therapeutic dyad.	Psychiatry residents.	Female victims of sexual violence	Outpatient clinic for violence victims.	Short-term PP.
Faller²⁶	GER	Psychoanalysis; association between diagnosis and therapist reactions in CT.	Physicians and psychologists.	Mean age: 34 years; main diagnosis: depression, followed by somatoform disorders.	Outpatient clinic.	Insight-oriented PP and CBT.
Gelso et al.²⁷	USA	CT should be observed, understood and managed; five CTM characteristics: self-insight, self-integration, anxiety management, empathy, and conceptualizing skills.	Therapist-trainees under supervision.	Students.	Outpatient clinic for students.	Clinical psychology, psychological counseling and community counseling.
Hafkenscheid²⁸	NET	Interpersonal theory, psychoanalysis and CBT; CT defined as “impact message”: what therapists experience when communicating with patients, such as feelings and fantasies.	Psychologists, psychiatric nurses, art therapist and other therapists.	Most with personality disorder; first and second generation survivors.	Hospital for World War II victims, Jewish and non-Jewish.	Interpersonal group therapy 1-2 times a week.
Hartkamp et al.²⁹	GER	Psychoanalysis.	2 men and 2 women; 26-57 years, two of them with vast experience.	Patients 19-68 years; personality disorders, depression, anxiety and somatoform disorders.	Psychosomatic medicine outpatient clinic.	Interpersonal PP.
Hayes et al.³⁰	USA	CTM; greater CT awareness results in better treatment outcomes.	Psychology students (22- 46 years), paid to participate, together with their supervisors.	Psychology students (19-46 years), with stress or relationship and career problems.	Outpatient clinic for psychology students.	Psychological counselling.
Hayes et al.³¹	USA	Psychoanalysis; review of psychoanalytic clinical research; CTM theory emphasizing five factors: origins, triggers, manifestations, effects and management.	Therapists with 5 to 42 years of experience.	Responders to announcement of free psychotherapy for women with self-esteem problems; 32-60 years.	Outpatient clinic.	Short-term psychotherapy; no details about interventions.