Instant Countertransference Affects Assessment and Treatment Recommendations for Depression in Patients Openly Professing Religious Faith

Assessment for depression involves ascertaining whether patients meet criteria but also estimating the degree of impairment brought along by the disease, which in turns affects the intensity of treatments suggested. As such, the diagnosis and management of depression is not objective. Openly professing religious faith introduces a layer of subjectivity influencing provider feelings, construed as instant countertransference (CT). The aim of this study was to study the relationship between instant CT and diagnosis and severity assessment in patients professing religious faith versus not. Twenty-five psychiatrists and 18 therapists viewed three videotaped interviews with standardized patients of different religious belief systems (Christian, Muslim, and no religion/"no-religion") and then rated the severity of the patients' depression (via Patient Health Questionnaire-9 [PHQ-9]), selected treatment choices, and completed the Therapist Response Questionnaire (dividing countertransference into eight dimensions). Tree-based feature selection and multivariate analysis of variance were used for analysis. Physicians and therapists rated the "no-religion" patients as less depressed than the religious ones (p < .001) and rated depression as more severe for the Muslim vignette (p < .05). More providers recommended pharmacotherapy for the Christian and Muslim vignettes (76.47% and 88.24%) compared to the no-religion vignette (40.54%). Tree-based feature selection revealed a stronger relationship between protective, overwhelmed, positive, disengaged CT and physician-scored PHQ-9 and protective, positive, helpless, disengaged CT for therapist-scored PHQ-9 scores. Results suggest that physicians and therapists may develop instant CT within minutes, related in part to a patient's professed religion, and that instant CT can color assessment of depression and influence treatment decisions.