Countertransference in the treatment of patients with eating disorders

J Eat Disord. 2025 Oct 27;13(1):240. doi: 10.1186/s40337-025-01439-z.

ABSTRACT

BACKGROUND: People with eating disorders (EDs) such as anorexia nervosa (AN) and bulimia nervosa (BN) can trigger intense affective reactions and impulses to act in their counterparts and in those treating them (countertransference, CT). The aim was to summarize the existing evidence on CT in the treatment of EDs by conducting a scoping review oriented on the model of J. Hayes. This model describes CT according to five dimensions: therapist characteristics, triggers, manifestations, effects and management of CT.

METHOD: The PubMed and EBSCOhost databases were systematically searched for publications on CT in EDs up to October 2024. Studies were screened according to the PRISMA guidelines and findings extracted oriented on Hayes´ dimensions, distinguishing between quantitative and qualitative studies.

RESULTS: From 5346 publications identified, 27 were included in the review (18 quantitative and nine qualitative studies). Even though positive CT reactions predominate, a range of negative reactions (such as helplessness, anger, fear) are described, in particular in the treatment of AN. Therapist variables (professional background, experience), patient´s characteristics (type of the eating disorder, traumatization, personality) and relationship building as well as conditions of the treatment setting are related to the type of CT reactions and its management.

CONCLUSION: Patients with ED are a difficult group to treat, partly due to the intense CT reactions they can trigger. Therapists should be trained to recognize, mentalize and deal with these reactions and have sufficient time for exchange and supervision during a treatment process.

PMID:41146362 | DOI:10.1186/s40337-025-01439-z