Countertransference in Forensic Inpatient Settings: An Empirical Examination of Therapist Responses to Patients With Psychotic Disorders.

OBJECTIVE: Countertransference in forensic inpatient settings has received little empirical attention despite frequent emotional reactions in staff members, such as anger, disgust, or fear. In this exploratory study, we investigated countertransference in two forensic medium-secure units for patients with psychotic disorders. METHOD: We measured countertransference using the Therapist Response Questionnaire and measured staff personality using the Ten-Item Personality Inventory. Our design allowed all staff members to participate anonymously. RESULTS: One hundred thirty-four Therapist Response Questionnaire forms, along with data on patient and staff characteristics, were collected. Staff characteristics such as profession, experience, and personality were associated with different countertransference reactions. Psychologists and psychiatrists tended to report more countertransference feelings than nursing staff. Patient and staff variables (such as patient having committed violent offenses or a diagnosis of personality disorder and staff experience or gender) were associated with more negative countertransference feelings and subscale scores as well as less positive countertransference feelings such as parental, protective, and satisfying countertransference feelings. Some patient and staff variables (such as patient cooperativeness, staff personality trait agreeableness) had the inverse effect on countertransference feelings. CONCLUSION: We discussed several conceptual problems inherent to measuring countertransference (in forensic inpatient settings) and the clinical implications of our findings.

An assessment of personality disorders with the Five-Factor Model among Belgian inmates.

Many international studies report a high prevalence of personality disorders among inmates on the basis of (semi)-structured diagnostic interviews. The present study proposes a self-reported evaluation of personality disorders using the NEO PI-R. The sample consists of 244 male and 18 female inmates (N=262) who were psychologically assessed. The analysis of the five psychological domains shows that the French-speaking Belgian inmates are as stable, as extroverted, more closed, more agreeable and more conscientious than the normative sample. The NEO PI-R facets are also analyzed. The mean Cohen's d (.26) is small. Two personality disorders have medium effect sizes: obsessive compulsive personality disorder (high) and histrionic personality (low). Small effect sizes exist for antisocial personality (low), psychopathy (low), narcissistic personality (low), schizoid personality (high) and borderline personality (low). In our view, the context of the assessment can partially explain these results but not entirely. The results do not confirm previous studies and question the high rates of psychiatric prevalence in prison.