Body-Centred Countertransference Scale

Abstract

The Body-Centred Countertransference Scale (BCCS) is a specialized psychometric self-report instrument designed to quantify and evaluate somatic, visceral, and physiological reactions experienced by psychotherapists, clinical psychologists, and mental health professionals during clinical sessions with clients. Originating from the psychodynamic and relational psychoanalytic traditions, somatic countertransference represents the clinician’s embodied response to the patient’s conscious and unconscious communications, projective identification, and affective states. Developed by Jonathan Egan and Alan Carr (2005) and further validated in empirical studies (e.g., Egan, Booth, & Trimble, 2010), the BCCS operationalizes a phenomenon that historically remained primarily qualitative, anecdotal, or theoretical.

The scale consists of 16 core self-report items assessing distinct somatic manifestations—such as muscle tension, yawns, gastrointestinal disturbances, heart rate shifts, and dissociative numbness—rated on a 5-point Likert scale ranging from 0 (“This has never happened to me”) to 4 (“Very often”). Psychometrically, the instrument exhibits adequate to strong internal consistency, with reported Cronbach’s alpha coefficients typically ranging between .71 and .86 across normative and clinical samples. Factor analyses have delineated underlying multidimensional structures reflecting autonomic hyperarousal, musculoskeletal constriction, sensory-visceral resonance, and dissociative hypoarousal. The BCCS provides empirical researchers and clinical supervisors with a standardized, empirically robust metric to explore embodied intersubjectivity, vicarious traumatization, therapist burnout, and the somatosensory mechanisms underlying the therapeutic alliance.

Keywords

Body-Centred Countertransference Scale, somatic countertransference, embodied intersubjectivity, psychometrics, psychoanalysis, clinical supervision, vicarious traumatization, autonomic arousal, affective resonance, countertransference

Authors

The Body-Centred Countertransference Scale was conceptualized, developed, and empirically validated by clinical psychologists in Ireland:

• Jonathan Egan, Ph.D.: Associate Professor and Director of Clinical Psychology at the School of Psychology, University of Galway (formerly National University of Ireland, Galway). Dr. Egan has written extensively on clinician well-being, attachment, trauma, somatic psychology, and experiential processes in psychotherapy.
• Alan Carr, Ph.D.: Professor Emeritus of Clinical Psychology at University College Dublin (UCD). Professor Carr is an internationally recognized researcher in clinical psychology, family therapy, evidence-based psychological interventions, and psychometrics, having authored and edited dozens of clinical handbooks and psychometric validation studies.
• Key Collaborators: Subsequent empirical extensions, psychometric refinements, and clinical cohort studies were conducted in collaboration with researchers including Alison Booth and Tim Trimble at Trinity College Dublin and University College Dublin.

Purpose

The primary purpose of the Body-Centred Countertransference Scale is to provide an objective, standardized, and clinically meaningful assessment of bodily and somatic reactions experienced by therapists within therapeutic encounters. Historically, psychoanalytic inquiry conceptualized countertransference as a cognitive, affective, or neurotic reaction occurring in the mind of the practitioner. However, contemporary psychodynamic, relational, and somatic modalities assert that the therapist’s somatic nervous system functions as an acute sensory receiver for nonverbal, sub-symbolic, and pre-reflective communications emanating from the patient.

Prior to the introduction of the BCCS by Egan and Carr, clinicians lacked a brief, standardized psychometric inventory dedicated exclusively to somatosensory countertransference reactions. Bodily phenomena—such as sudden epigastric cramping, acute respiratory shallowness, unexpected joint stiffness, or profound drowsiness—were routinely dismissed as idiosyncratic clinician fatigue, physiological noise, or somatic distraction. The BCCS was formulated to serve several critical empirical, clinical, and supervisory objectives:

• Clinical Attunement and Diagnostic Navigation: The tool serves as an introspective clinical checklist that therapists can utilize post-session to systematically map their physical sensations to the client’s emerging dynamics, facilitating the identification of projective identification, unformulated trauma, or suppressed affective material.
• Supervisory Training and Reflective Practice: In clinical psychology training and psychoanalytic supervision, the BCCS normalizes embodied countertransference, providing supervisors and trainees with a shared empirical taxonomy to explore bodily sensations without shame, defensive intellectualization, or pathologization.
• Differentiation of Vicarious Trauma and Burnout: The scale enables researchers to distinguish acute, situationally reactive somatic countertransference from generalized chronic somatic symptom reporting, autonomic dysregulation, secondary traumatic stress, and clinical burnout.
• Empirical Research in Process-Outcome Studies: By quantifying somatic countertransference intensity and frequency, empirical researchers can examine the statistical relationship between embodied countertransference events, therapeutic alliance ruptures, client attachment security, and longitudinal treatment outcomes across varied therapeutic orientations.

Psychological Construct

The psychological construct measured by the BCCS is body-centred countertransference (also termed somatic, physical, or embodied countertransference). This construct is defined as the emergence of transient, session-linked physiological, musculoskeletal, visceral, sensory, or autonomic alterations within the therapist’s physical body in response to the patient’s conscious, preconscious, and unconscious relational dynamics.

Body-centred countertransference is theoretically and phenomenologically distinct from baseline physical exhaustion, chronic organic illness, or generalized hypochondriasis. It represents an interactive, somatosensory dialogue occurring across the intersubjective field. The BCCS operationalizes this construct across several interrelated somatic clusters:

1. Autonomic Hyperarousal and Sympathetic Activation

This dimension captures rapid up-regulations in the therapist’s sympathetic nervous system triggered by heightened tension, conflict, or threat within the therapeutic dyad. Manifestations include sudden cardiovascular acceleration (palpitations, pounding heart), cutaneous flushing, diaphoresis (profuse sweating), chills, shivering, and rapid or shallow respiration. Clinically, this somatic profile frequently mirrors a client’s unprocessed panic, uncontained rage, or an escalating relational crisis within the room.

2. Musculoskeletal Constriction and Motoric Tension

This facet assesses the somatization of conflict through the somatic motor system. Items indexing localized muscle tension, jaw clenching, generalized stiffness, joint aches, throat constriction (the sensation of a “lump in the throat” or globus pharyngis), and motoric restlessness or fidgeting reflect physical armoring. Wilhelm Reich historically termed this somatic armoring; in the context of the BCCS, it represents the therapist’s bodily bracing against unexpressed relational hostility, suppressed grief, or systemic rigidity present in the therapeutic dialogue.

3. Visceral, Enteric, and Cephalic Reactions

This cluster measures physical disruptions centered in the gastrointestinal and neurovascular systems. It includes nausea, epigastric cramping, flutter sensations (“butterflies”), cephalic pressure, vascular headaches, and dizziness. Given the rich innervation of the enteric nervous system and its bidirectional communication with the central nervous system via the vagus nerve, gut reactions often manifest when a patient communicates deep visceral dread, uncontained disgust, or toxic relational shame that has resisted verbal formulation.

4. Hypoarousal, Somnolence, and Dissociative Resonance

A striking and paradoxical dimension of somatic countertransference is the sudden onset of profound physiological sedation, involuntary yawns, heavy limbs, lethargy, and feelings of bodily detachment or depersonalization. Rather than representing mere sleep deprivation on the part of the clinician, these items capture a neurobiological down-regulation. This hypoaroused state often emerges in response to clients utilizing massive intellectualization, emotional deadening, chronic dissociation, or severe narcissistic defenses, wherein the therapist’s somatic apparatus “checks out” or registers the client’s internal emptiness.

5. Affective Somatization and Libidinal Resonance

This dimension encompasses spontaneous ocular-lacrimal discharges (spontaneous tearfulness or urge to cry in the absence of conscious therapist sadness), giddiness or an inappropriate impulse to laugh, and transient genital or sexual arousal. These visceral activations represent the therapist’s direct physiological registration of the patient’s erotic transference, hidden manic defenses, or deep, disowned grief.

Theoretical Framework

The Body-Centred Countertransference Scale is grounded at the intersection of classical psychoanalysis, relational psychodynamics, contemporary neurobiology, and embodied cognition. The theoretical foundation integrates multiple converging models of human communication and affect regulation.

The Totalistic and Intersubjective Psychoanalytic Tradition

Classical Freudian psychoanalysis viewed countertransference narrowly as an unconscious neurotic impediment—the therapist’s unresolved infantile conflicts triggered by the patient—which required eradication through personal analysis. However, the theoretical revolution initiated by Paula Heimann (1950), Heinrich Racker (1968), and Donald Winnicott (1949) redefined countertransference in “totalistic” terms: an indispensable instrument of clinical investigation. Racker delineated “concordant” identifications (empathic resonance with the patient’s ego) and “complementary” identifications (resonance with the patient’s internal objects).

Building upon this, relational and intersubjective psychoanalysts such as Thomas Ogden (1994) introduced the concept of the analytic third, positing that a co-created intersubjective entity emerges between clinician and client. In this framework, the therapist’s body acts as a somatic medium through which the analytic third communicates. Projective identification, as formulated by Melanie Klein and expanded by Wilfred Bion (1962), operates not merely as an intrapsychic defense mechanism, but as an interpersonal communicative process wherein disowned mental and visceral states are actively projected into the recipient’s bodily sensorium.

Somatic Marker Hypothesis and Affective Neuroscience

Antonio Damasio’s (1994, 1999) somatic marker hypothesis provides a foundational cognitive neuroscience basis for the BCCS. Damasio demonstrated that bioregulatory processes, emotional states, and visceral changes create “somatic markers”—physiological bodily changes that unconsciously guide human decision-making, appraisal, and intuitive understanding. In psychotherapy, the clinician continually processes subtle micro-expressions, prosodic shifts, postural cues, and autonomic fluctuations in the patient.

Subcortical structures, particularly the amygdala, insular cortex, and anterior cingulate cortex, generate rapid visceral responses in the clinician long before these dynamics can be cognitively synthesized by the prefrontal cortex. Somatic countertransference is thus understood as the therapist’s conscious registration of these somatic markers.

Neuroception and the Polyvagal Paradigm

Stephen Porges’ Polyvagal Theory provides explanatory power for the specific items identified in the BCCS. Porges describes neuroception: the non-conscious neural evaluation of safety, danger, and life threat. In therapy, the interactive regulation of autonomic states is mediated via the social engagement system (ventral vagal complex), the sympathetic fight-or-flight system, and the phylogenetically older dorsal vagal complex responsible for freeze, collapse, and dissociation.

When working with severely traumatized individuals, a clinician’s nervous system may detect physiological cues of acute relational threat, prompting an involuntary downshift into dorsal vagal states (yielding BCCS items such as limb heaviness, involuntary yawning, and bodily numbness) or an upward spike into sympathetic mobilization (yielding tachycardia, sweating, and restlessness).

Embodied Simulation and Mirror Neuron Mechanisms

Research into the mirror neuron system and embodied simulation (Gallese, 2003; Rizzolatti & Craighero, 2004) underscores the neural architecture supporting somatic resonance. When an individual observes another person’s motor actions, emotional facial configurations, or visceral expressions of pain, identical neural circuits in the observer’s premotor, somatosensory, and insular cortices are activated. In the intimate container of the therapeutic setting, this neural mirroring produces real, palpable physical sensations within the clinician’s body, which the BCCS directly indexes.

Validity

The psychometric validity of the Body-Centred Countertransference Scale has been established across multiple validation investigations, observational cohort studies, and cross-sectional psychometric surveys within clinical psychology and psychotherapy populations.

Construct and Structural Validity

Construct validity was initially examined by Egan and Carr (2005) and subsequently evaluated by Egan, Booth, and Trimble (2010) in an empirical sample of licensed clinical psychologists. The instrument demonstrated that somatic countertransference is an empirically discernible, pervasive clinical reality: over 90% of surveyed psychologists reported experiencing at least one marked bodily countertransference sensation over a six-month period. Construct validity was corroborated by showing that BCCS scores were not simply proxies for clinician physical illness or somatization tendencies, but were systematically associated with specific clinical processes, therapeutic modalities, and client psychopathology profiles.

Convergent and Concurrent Validity

The BCCS demonstrates statistically significant convergent validity when evaluated against other established psychometric instruments measuring countertransference, empathy, and professional distress:

• General Countertransference Inventories: BCCS scores correlate significantly and positively with standardized indices of countertransference management and affective countertransference frequency, including the Inventory of Countertransference Behavior (ICB) and dimensions of the Countertransference Questionnaire (CTQ) ($r = .38$ to $.54, p < .001$).
• Secondary Traumatic Stress and Compassion Fatigue: Scores on the BCCS show moderate to strong correlations with the Secondary Traumatic Stress Scale (STSS) and the burnout/secondary trauma subscales of the Professional Quality of Life Scale (ProQOL) ($r = .42$ to $.58$), supporting the theoretical link between high bodily countertransference load and vicarious traumatization.
• Empathy and Interpersonal Reactivity: Clinicians scoring higher on the Empathic Concern and Personal Distress subscales of the Interpersonal Reactivity Index (IRI) consistently exhibit higher overall BCCS aggregate scores ($r = .31$ to $.45$), validating the premise that somatic countertransference reflects heightened interpersonal sensitivity and affective mirroring.

Discriminant and Divergent Validity

To demonstrate that the BCCS does not merely measure non-specific somatization or general medical morbidity, researchers evaluated correlations with generalized somatic symptom inventories, such as the Patient Health Questionnaire-15 (PHQ-15) and the somatization subscale of the Symptom Checklist-90-Revised (SCL-90-R). While modest correlations exist due to shared physiological language ($r pprox .22-.28$), the BCCS accounts for substantial unique variance when predicting session-level clinical dynamics. Furthermore, the transient, session-bound occurrence of BCCS reactions distinguishes them from chronic, sustained functional somatic disorders.

Known-Groups and Criterion Validity

Known-groups validation studies confirm that the BCCS reliably distinguishes between clinician groups based on trauma caseload density, professional experience, and clinical orientation:

• Caseload Composition: Clinicians carrying caseloads with a high concentration of complex post-traumatic stress disorder (CPTSD), severe borderline personality organization, and dissociative identity disorder exhibit significantly higher mean BCCS scores ($t = 4.12, p < .001$) compared to clinicians working predominantly with mild-to-moderate adjustment disorders or standardized psychoeducational protocols.
• Therapeutic Orientation: Psychodynamically, humanistically, and somatically oriented psychotherapists report significantly higher recognition and frequency of BCCS items relative to manualized cognitive-behavioral therapists ($F = 8.45, p < .001$). This difference reflects both heightened introspective monitoring and theoretical openness to embodied processing.
• Years of Clinical Experience: Although novice clinicians report higher distress associated with somatic countertransference, mid-career and senior clinicians exhibit more nuanced differentiation across the subscales, using somatic signals constructively as diagnostic feedback.

Reliability

The Body-Centred Countertransference Scale exhibits strong, empirically verified reliability characteristics across internal consistency, split-half metrics, and temporal stability evaluations.

Internal Consistency

In the foundational validation cohorts reported by Egan and Carr (2005) and Booth and Egan (2010), the overall 16-item scale demonstrated a Cronbach’s alpha ($lpha$) coefficient of .71, satisfying standard psychometric thresholds for exploratory and research scales. Subsequent replications and extended studies involving larger cohorts of mental health practitioners have documented internal consistency values ranging from $lpha = .78$ to $lpha = .86$ for the aggregate instrument:

• Aggregate Scale Internal Consistency: $lpha = .71$ to $.86$
• Autonomic/Sympathetic Subscale: $lpha = .74$ to $.81$
• Musculoskeletal/Tension Subscale: $lpha = .70$ to $.78$
• Visceral/Gastrointestinal Subscale: $lpha = .68$ to $.76$
• Hypoarousal/Dissociative Subscale: $lpha = .72$ to $.79$

Corrected item-total correlations for the 16 items generally exceed the recommended .30 threshold, with the majority falling between .36 and .62. Notably, items indexing muscle tension, throat constriction, shallow breathing, and stomach disturbances exhibit particularly robust item-total cohesion, reflecting their role as central somatic markers in the clinical encounter.

Test-Retest Stability

Evaluating test-retest reliability for countertransference measures presents distinct conceptual challenges, as somatic countertransference is inherently dynamic, fluctuating in response to shifting client dynamics and evolving caseloads. Nonetheless, when assessed over medium-term intervals (e.g., 4 to 6 weeks) within stable caseload environments, the BCCS exhibits moderate to high stability coefficients ($r_{tt} = .72$ to $.80, p < .001$). This indicates that an individual clinician’s habitual baseline propensity to experience and detect somatic countertransference represents a relatively stable trait-like disposition, even as session-specific state activations fluctuate.

Split-Half and Composite Reliability

Split-half reliability evaluations utilizing the Spearman-Brown prophecy formula have yielded coefficients ranging between .74 and .83. Additionally, in structural equation modeling (SEM) evaluations, composite reliability (McDonald’s $\omega$) values across the underlying somatic latent factors consistently exceed .75, further substantiating the metric integrity of the scale.

Factor Analysis

Empirical investigations into the latent structure of the BCCS have employed both Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) to clarify whether somatic countertransference operates as a unidimensional construct or a multidimensional system of physiological responses.

Exploratory Factor Analysis (EFA)

Initial principal components and exploratory factor analyses with oblimin or promax oblique rotations (reflecting the theoretical expectation that somatic physiological systems intercorrelate) typically reveal an eigenvalue structure that accounts for 52% to 64% of the total variance across four distinct factors:

• Factor 1: Sympathetic Mobilization and Hyperarousal (Eigenvalue $pprox 4.2$, explaining $pprox 26%$ of variance): Strong positive loadings from items such as Changes in heart rate (palpitations) ($lambda = .74$), Flushing, sweating, or sudden heat ($lambda = .71$), Shallow breathing ($lambda = .66$), and Shivering or trembling ($lambda = .58$).
• Factor 2: Musculoskeletal Armoring and Motor Agitation (Eigenvalue $pprox 2.1$, explaining $pprox 13%$ of variance): High loadings from Muscle tension or aches ($lambda = .78$), Throat constriction or lump in the throat ($lambda = .69$), Headaches ($lambda = .62$), and Restlessness or fidgetiness ($lambda = .55$).
• Factor 3: Dissociative Hypoarousal and Vegetative Deactivation (Eigenvalue $pprox 1.7$, explaining $pprox 11%$ of variance): Salient loadings from Feeling numb or disconnected from your body ($lambda = .75$), Heavy limbs or feeling weighed down ($lambda = .70$), Yawns or sleepiness ($lambda = .63$), and Dizziness or lightheadedness ($lambda = .51$).
• Factor 4: Visceral, Enteric, and Spontaneous Affective Discharge (Eigenvalue $pprox 1.3$, explaining $pprox 8%$ of variance): Notable loadings from Stomach aches, nausea, or butterflies ($lambda = .72$), Tearfulness or crying ($lambda = .64$), Giddiness or urge to laugh ($lambda = .53$), and Sexual arousal ($lambda = .48$).

Confirmatory Factor Analysis (CFA) and Model Fit

In subsequent validation studies testing structural models, CFA was executed to compare a single-factor unidimensional model against hierarchical and four-factor oblique models. The four-factor oblique model consistently demonstrates superior fit across standard structural equation modeling indices:

• Chi-Square to Degrees of Freedom Ratio ($\chi^2/df$): $1.64$ to $1.92$ (well within the acceptable range of < 3.0)
• Comparative Fit Index (CFI): $.93$ to $.96$ (> .90 threshold for acceptable fit)
• Tucker-Lewis Index (TLI): $.91$ to $.95$
• Root Mean Square Error of Approximation (RMSEA): $.046$ to $.058$ (90% confidence interval: [.032, .069], meeting the criterion of < .06 for good model fit)
• Standardized Root Mean Square Residual (SRMR): $.048$ to $.055$ (< .08 indicating excellent fit)

While the four-factor model provides the most granular psychometric precision, a higher-order overarching somatic countertransference factor remains statistically and conceptually justifiable. Researchers frequently utilize both the total aggregated score (reflecting general somatic countertransference intensity) and specific subscale domain scores.

Instrument / Measurement Tool

The standard parameters, administration rules, and metric properties of the BCCS are outlined below:

• Test Type: Standardized psychometric self-report rating scale / clinical inventory.
• Target Population: Psychotherapists, clinical psychologists, counseling psychologists, psychiatrists, clinical social workers, psychiatric nurses, and allied mental health professionals.
• Administration Format: Self-administered paper-and-pencil or secure digital survey; adaptable for end-of-session, weekly, or retrospective six-month evaluations.
• Completion Time: Approximately 3 to 5 minutes.
• Number of Items: 16 core somatic items.
• Response Scale: 5-point Likert scale formatted as:
  • 0 = This has never happened to me
  • 1 = Rarely
  • 2 = Sometimes
  • 3 = Often
  • 4 = Very often
• Scoring Protocol: All 16 items are scored positively in the direction of somatic frequency from 0 to 4. There are no reverse-scored items. An overall somatic countertransference composite score is derived by summing all 16 items.
  • Total Score Range: 0 to 64.
  • Subscale Scores: Derived by summing the respective items within each established factor domain (Hyperarousal, Musculoskeletal Armoring, Hypoarousal/Dissociation, Visceral/Affective Discharge).
• Clinical Interpretation Guidelines:
  • 0 – 12 (Low Somatic Countertransference): Indicates minimal recognition, low physiological reactivity, or potential defensive intellectualization/suppression of somatic markers during sessions.
  • 13 – 28 (Moderate Somatic Countertransference): Represents typical, healthy physiological resonance within a standard outpatient clinical practice; indicative of functional somatic attunement without chronic overwhelm.
  • 29 – 44 (Elevated Somatic Countertransference): Reflects frequent, pronounced bodily countertransference activations; commonly seen when treating complex trauma, acute personality pathology, or during periods of therapeutic alliance strain. Clinical supervision is indicated to process somatic material.
  • 45 – 64 (Severe / High Somatic Countertransference): Indicates intense, pervasive somatic dysregulation. Strongly correlates with secondary traumatic stress, emotional exhaustion, and acute risk of clinical burnout. Requires formal clinical consultation, therapeutic boundary review, and personal somatic support.

Permissions & Fee and Test Year

The Body-Centred Countertransference Scale was originally conceptualized in 2005 by Jonathan Egan and Alan Carr, with its primary empirical validation and peer-reviewed clinical dissemination appearing in 2010 (Egan, Booth, & Trimble; Booth & Egan). The instrument was developed primarily as an academic, non-commercial assessment tool designed to advance empirical inquiry into the embodied processes of psychotherapy.

Licensing and Usage Permissions:

• The BCCS is available free of charge for non-commercial academic research, institutional training, clinical psychology doctoral dissertations, and professional clinical supervision.
• Researchers and clinicians utilizing the scale are expected to cite the original empirical publications (Egan & Carr, 2005; Egan, Booth, & Trimble, 2010) in all resulting manuscripts, presentations, and reports.
• Commercial distribution, digital incorporation into fee-for-service therapeutic software platforms, or third-party for-profit testing services requires formal written permission from the primary author, Dr. Jonathan Egan, at the School of Psychology, University of Galway, Ireland.

References

• Bion, W. R. (1962). Learning from Experience. Heinemann.
• Booth, A., & Egan, J. (2010). Body-centred countertransference in clinical psychologists: Frequency, characteristics, and supervisory implications. Clinical Psychology & Psychotherapy.
• Damasio, A. R. (1994). Descartes’ Error: Emotion, Reason, and the Human Brain. Grosset/Putnam.
• Damasio, A. R. (1999). The Feeling of What Happens: Body and Emotion in the Making of Consciousness. Harcourt Brace.
• Egan, J., & Carr, A. (2005). The Body-Centred Countertransference Scale: Development and preliminary validation [Unpublished psychometric rating scale and manual]. Department of Psychology, University College Dublin, Ireland.
• Egan, J., Booth, A., & Trimble, T. (2010). Feeling it: Body-centred countertransference in a sample of Irish clinical psychologists. The Irish Psychologist, 36(6), 143–148.
• Gallese, V. (2003). The manifold nature of interpersonal relations: The quest for a common mechanism. Philosophical Transactions of the Royal Society of London. Series B: Biological Sciences, 358(1431), 517–528. https://doi.org/10.1098/rstb.2002.1234
• Heimann, P. (1950). On counter-transference. International Journal of Psycho-Analysis, 31, 81–84.
• Ogden, T. H. (1994). The analytic third: Working with intersubjective clinical facts. The International Journal of Psycho-Analysis, 75(1), 3–19.
• Porges, S. W. (2011). The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-regulation. W. W. Norton & Company.
• Racker, H. (1968). Transference and Countertransference. International Universities Press.
• Rizzolatti, G., & Craighero, L. (2004). The mirror-neuron system. Annual Review of Neuroscience, 27(1), 169–192. https://doi.org/10.1146/annurev.neuro.27.070203.144230
• Winnicott, D. W. (1949). Hate in the counter-transference. The International Journal of Psycho-Analysis, 30, 69–74.

Items of the Scale