RESEARCH REPORT POSTER DISPLAY

COUNTERTRANSFERENCE TRIGGERS AND RESPONSES OF PHYSICAL THERAPISTS AFFECTING THE PATIENT/THERAPIST RELATIONSHIP. Allen R¹, Koshi L², Ashley O³, Dreier D⁴, Carter C⁵; ¹University of Puget Sound, Tacoma, WA, USA. ²Apple Physical Therapy, Tumwater, WA USA. ³Bay State Physical Therapy, Newton, MA USA. ⁴Kadlec Medical Center, Richland, WA USA. ⁵Harrison Medical Center, Bremerton, WA USA

PURPOSE: The purpose of the present study was to identify internal and external triggers that initiate countertransference responses in physical therapists and resulting behavioral manifestations that may impact quality of patient care. RELEVANCE: Countertransference (CT) refers to a therapist’s emotional reactions to a patient and/or the patient’s circumstances. These unconscious emotional reactions may influence the therapist’s behavior, impacting success of the patient/therapist relationship, as well as the quality and equity of patient care. Abundantly addressed in the field of psychology, the study of CT among other medical practitioners has been limited to nurses and physicians. Studies exploring CT responses and behaviors in physical therapy settings are not apparent in the literature. PARTICIPANTS: Participants included thirty-eight volunteer licensed physical therapists (experience range = 0.5–30 years, mean = 10.3 years) attending a continuing education course on CT responses to patients with systemic pathology. METHODS: During the CT course, subjects participated in four brainstorming sessions. Two of the four sessions were used for data collection regarding triggers and behaviors. During the first session, participants were asked to anonymously record patient characteristics associated with both successful and uncomfortable patient/therapist interactions. The second session involved small group discussion and the creation of an anonymous list of behaviors influenced by, or the result of, their emotional responses to the patient. ANALYSIS: Participants’ responses were entered into QSR N6 Non-numerical Unstructured Data Indexing, Searching and Theorizing (Nud*ist) software for data management and coded a priori using pilot study generated codes. Responses were then subjected to a code/recode process by four raters. New codes were generated according to the distinct content of participants’ responses. Final themes were displayed as a hierarchical organizational tree. RESULTS: Triggers that led to successful or uncomfortable patient-therapist interactions fell within seven distinct categories. The four most frequently recurring themes included the therapist’s perception of the patient, patient motivation, compliance, and associations the therapist made between the patient and a member of his/her own family. Behaviors fell within five different categories. The most frequently reported themes were personal openness, limiting interaction to professional issues, and effort invested in the patient. The following themes appeared as both triggers and behaviors: avoidance behaviors, treatment time, and body language. CONCLUSIONS: Findings indicate that physical therapists report manifesting CT responses to their patients. These responses may be triggered by patient characteristics, or by internal associations the therapist projects onto the patient. Behavioral responses associated with successful interactions tended to result in therapists providing more personal approaches to treatment including increased treatment time, effort, and quality of care. Uncomfortable patient/therapist interactions led to specific behaviors such as decreased treatment time, effort, and personal involvement. IMPLICATIONS: Physical therapists’ CT responses impact the quality and equity of patient care. By becoming aware of their own CT reactions and behaviors, physical therapists will be better equipped to provide equitable patient care. From an understanding of CT dynamics, therapists may learn to convert frustrating circumstances into mutually productive clinical interactions. KEYWORDS: Countertransference, Patient-therapist Relationship. FUNDING ACKNOWLEDGEMENTS: This study was supported by a Student Research Award grant from the University Enrichment Committee of the University of Puget Sound, Tacoma, WA, USA. CONTACT: rallen@ups.edu

ETHICS COMMITTEE: Institutional Review Board, University of Puget Sound, Tacoma, WA