Bridges and barriers in the psychodynamic treatment of personality disorders

Two thematic analyses of therapist responsiveness and non-responsiveness from clinicians’ and patients’ perspectives

Bibliographic Data

ID21624778
AuthorsAnnalisa Tanzilli (0000-0002-6098-2304, Sapienza University of Rome, corresponding author), Flavia Fiorentino (0009-0002-5954-1736, Sapienza University of Rome), Eleonora Innocenzi (0009-0001-5490-4035, Sapienza University of Rome), Gabriele Lo Buglio (0000-0003-2425-8383, University of Ottawa), Ivan Gualco (0000-0001-7277-2294), Vittorio Lingiardi (0000-0002-1298-3935, Sapienza University of Rome), Marianna Liotti (0000-0002-5986-4538, Sapienza University of Rome)
Year2026
Volume45
Issue13
Publication date2026-07-01
Open AccessYes
TypeARTICLE
VenueCurrent Psychology (JOURNAL)
Journal identifiersISSN: 1046-1310 • E-ISSN: 1936-4733
PublisherSpringer Science and Business Media LLC (PUBLISHER)
DOI10.1007/s12144-026-09725-y
OpenAlexW7167289144
LanguageEN
References cited69

Introduction: Therapist responsiveness promotes favorable treatment outcomes and contributes to a deeper understanding of the mechanisms of change in psychodynamic psychotherapy for patients with personality pathology. At the same time, non-responsiveness may disrupt the clinical process and undermine the conditions for meaningful therapeutic progress. Design: This study examined therapist responsiveness and non-responsiveness in psychodynamic treatments of patients with personality disorders, integrating complementary perspectives from both clinicians and patients within a dual-perspective qualitative design. Methods: 54 clinicians and 54 patients each responded to two open-ended questions describing specific moments of responsiveness and non-responsiveness. Two separate thematic analyses were conducted within a critically realistic framework. Results: Therapists were perceived as responsive when patients felt deeply heard, recognized, and helped to develop greater self-awareness and new perspectives. Non-responsiveness was primarily associated with negative countertransference reactions, misattunement, and misalignments in expectations and shared understanding of the treatment. A substantial proportion of patients reported no experience of non-responsiveness—a finding interpreted in light of specific relational dynamics, social desirability bias, and idealizing transference processes. Conclusions: Therapist responsiveness is a fundamental clinical competence in the psychodynamic treatment of personality disorders, fostering a holding environment in which patients feel safe, accepted, and supported in developing insight and deeper reflective capacities. Training and supervision should focus on enhancing clinicians’ attunement, interpersonal sensitivity, countertransference awareness, and metacommunicative skills. Collaboratively negotiating expectations, priorities, and shared understandings of treatment may reduce alliance ruptures. In addition, helping clinicians recognize and work through non-responsive moments may transform perceived failures into opportunities for professional growth and improved patient engagement

Alliance · Countertransference · Personality · Psychodynamic psychotherapy · Psychodynamics · Thematic analysis · Therapeutic relationship · Personality Disorders and Psychopathology · Psychotherapy Techniques and Applications · Transactional Analysis in Psychotherapy

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