Exploring mental health professionals’ emotional responses with individuals diagnosed with antisocial personality disorder or psychopathy: a scoping review

AimsTo conduct a scoping review of primary research studies on clinicians’ emotional responses (i.e., countertransference) when working with individuals with antisocial personality and/or psychopathy traits or disorders. A secondary aim is to map clinicians’ personal opinions on managing these indiv...

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Main Authors: Gabriele Lo Buglio, Leonardo Zaninotto, Renan Göksal, Uyangakhishig Bayasgalan, Alice Barsanti, Brad D. Booth, Nicola Carone, Anmar Mighri, Alessandro Miola, Laura Muzi, Vittorio Lingiardi, Marco Solmi, Tommaso Boldrini
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Language:English
Published: Frontiers Media S.A. 2025-06-01
Series:Frontiers in Psychology
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Online Access:https://www.frontiersin.org/articles/10.3389/fpsyg.2025.1501273/full
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author Gabriele Lo Buglio
Leonardo Zaninotto
Renan Göksal
Uyangakhishig Bayasgalan
Alice Barsanti
Brad D. Booth
Brad D. Booth
Nicola Carone
Anmar Mighri
Alessandro Miola
Alessandro Miola
Laura Muzi
Vittorio Lingiardi
Marco Solmi
Marco Solmi
Marco Solmi
Marco Solmi
Marco Solmi
Tommaso Boldrini
Tommaso Boldrini
author_facet Gabriele Lo Buglio
Leonardo Zaninotto
Renan Göksal
Uyangakhishig Bayasgalan
Alice Barsanti
Brad D. Booth
Brad D. Booth
Nicola Carone
Anmar Mighri
Alessandro Miola
Alessandro Miola
Laura Muzi
Vittorio Lingiardi
Marco Solmi
Marco Solmi
Marco Solmi
Marco Solmi
Marco Solmi
Tommaso Boldrini
Tommaso Boldrini
author_sort Gabriele Lo Buglio
collection DOAJ
description AimsTo conduct a scoping review of primary research studies on clinicians’ emotional responses (i.e., countertransference) when working with individuals with antisocial personality and/or psychopathy traits or disorders. A secondary aim is to map clinicians’ personal opinions on managing these individuals clinically, as they can influence clinical decision-making.MethodsA PRISMA-ScR compliant scoping review was conducted. PubMed, Web of Science, and EBSCO/PsycINFO were searched for studies published from 01/01/1990 to 06/12/2023, including clinicians providing clinical care to individuals with antisocial or psychopathy traits or disorders assessed via standardized and validated tools and focusing on their cognitive, emotional and behavioral responses, with no restriction regarding context/location and study design (protocol: https://osf.io/eaquj).ResultsTwelve studies were included, mostly from Europe, mainly focusing on clinicians working with individuals with ASPD. Only two studies addressed psychopathy. Key findings were organized into four concepts: (a) “common emotional responses,” which included nervousness, fear of aggression, detachment, and frustration experienced by the clinician; (b) “willingness to deliver clinical care,” indicating the key role of clinicians’ confidence in their perceived knowledge and skills to provide effective psychological treatment and highlighting that clinicians working in forensic mental health settings exhibit a higher motivation to provide clinical care compared to those in non-forensic settings; (c) “emotional responses related to misogynistic behaviors,” showing additional challenges for assigned female therapists in group therapy; (d) “opinions about clinical management and therapeutic alliance,” emphasizing the crucial role of the clinician’s respect, recognition, and flexible yet firm boundaries.ConclusionIndividuals with antisocial and psychopathy traits or disorders pose significant challenges in terms of clinicians’ emotional responses, highlighting the need for tailored training and supervision to enhance their competence and confidence. The absence of cohort studies and randomized controlled trials on this subject, along with the limited evidence on psychopathy, warrants for further research.Systematic review registrationhttps://osf.io/eaquj.
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spelling doaj-art-828460968ea14be29234b5beab51b5372025-08-20T03:26:57ZengFrontiers Media S.A.Frontiers in Psychology1664-10782025-06-011610.3389/fpsyg.2025.15012731501273Exploring mental health professionals’ emotional responses with individuals diagnosed with antisocial personality disorder or psychopathy: a scoping reviewGabriele Lo Buglio0Leonardo Zaninotto1Renan Göksal2Uyangakhishig Bayasgalan3Alice Barsanti4Brad D. Booth5Brad D. Booth6Nicola Carone7Anmar Mighri8Alessandro Miola9Alessandro Miola10Laura Muzi11Vittorio Lingiardi12Marco Solmi13Marco Solmi14Marco Solmi15Marco Solmi16Marco Solmi17Tommaso Boldrini18Tommaso Boldrini19Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, ItalyLocal Health Unit No. 6 ("Euganea"), Department of Mental Health, Padua, ItalyDepartment of Developmental Psychology and Socialization, University of Padova, Padua, ItalyDepartment of Developmental Psychology and Socialization, University of Padova, Padua, ItalyDigital Commons Lab, Fondazione Bruno Kessler, Trento, ItalyDivision of Forensic Psychiatry, Department of Psychiatry, University of Ottawa, Ottawa, ON, CanadaThe Royal Ottawa Mental Health Centre, Ottawa, ON, CanadaDepartment of Systems Medicine, University of Rome Tor Vergata, Rome, ItalyDepartment of Developmental Psychology and Socialization, University of Padova, Padua, ItalyDepartment of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United StatesDepartment of Neuroscience, University of Padova, Padova, Italy0Department of Philosophy, Social Sciences, Humanities, and Education, University of Perugia, Perugia, ItalyDepartment of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy1Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada2Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany3Regional Centre for Treatment of Eating Disorders, and On Track: Champlain First Episode Psychosis Program, Department of Mental Health, Ottawa Hospital, Ottawa, ON, Canada4Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada5School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada1Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada6Department of Psychology and Educational Science, Pegaso Telematic University, Naples, ItalyAimsTo conduct a scoping review of primary research studies on clinicians’ emotional responses (i.e., countertransference) when working with individuals with antisocial personality and/or psychopathy traits or disorders. A secondary aim is to map clinicians’ personal opinions on managing these individuals clinically, as they can influence clinical decision-making.MethodsA PRISMA-ScR compliant scoping review was conducted. PubMed, Web of Science, and EBSCO/PsycINFO were searched for studies published from 01/01/1990 to 06/12/2023, including clinicians providing clinical care to individuals with antisocial or psychopathy traits or disorders assessed via standardized and validated tools and focusing on their cognitive, emotional and behavioral responses, with no restriction regarding context/location and study design (protocol: https://osf.io/eaquj).ResultsTwelve studies were included, mostly from Europe, mainly focusing on clinicians working with individuals with ASPD. Only two studies addressed psychopathy. Key findings were organized into four concepts: (a) “common emotional responses,” which included nervousness, fear of aggression, detachment, and frustration experienced by the clinician; (b) “willingness to deliver clinical care,” indicating the key role of clinicians’ confidence in their perceived knowledge and skills to provide effective psychological treatment and highlighting that clinicians working in forensic mental health settings exhibit a higher motivation to provide clinical care compared to those in non-forensic settings; (c) “emotional responses related to misogynistic behaviors,” showing additional challenges for assigned female therapists in group therapy; (d) “opinions about clinical management and therapeutic alliance,” emphasizing the crucial role of the clinician’s respect, recognition, and flexible yet firm boundaries.ConclusionIndividuals with antisocial and psychopathy traits or disorders pose significant challenges in terms of clinicians’ emotional responses, highlighting the need for tailored training and supervision to enhance their competence and confidence. The absence of cohort studies and randomized controlled trials on this subject, along with the limited evidence on psychopathy, warrants for further research.Systematic review registrationhttps://osf.io/eaquj.https://www.frontiersin.org/articles/10.3389/fpsyg.2025.1501273/fullcountertransferencetherapist emotional responseantisocial personality disorderpsychopathyscoping review
spellingShingle Gabriele Lo Buglio
Leonardo Zaninotto
Renan Göksal
Uyangakhishig Bayasgalan
Alice Barsanti
Brad D. Booth
Brad D. Booth
Nicola Carone
Anmar Mighri
Alessandro Miola
Alessandro Miola
Laura Muzi
Vittorio Lingiardi
Marco Solmi
Marco Solmi
Marco Solmi
Marco Solmi
Marco Solmi
Tommaso Boldrini
Tommaso Boldrini
Exploring mental health professionals’ emotional responses with individuals diagnosed with antisocial personality disorder or psychopathy: a scoping review
Frontiers in Psychology
countertransference
therapist emotional response
antisocial personality disorder
psychopathy
scoping review
title Exploring mental health professionals’ emotional responses with individuals diagnosed with antisocial personality disorder or psychopathy: a scoping review
title_full Exploring mental health professionals’ emotional responses with individuals diagnosed with antisocial personality disorder or psychopathy: a scoping review
title_fullStr Exploring mental health professionals’ emotional responses with individuals diagnosed with antisocial personality disorder or psychopathy: a scoping review
title_full_unstemmed Exploring mental health professionals’ emotional responses with individuals diagnosed with antisocial personality disorder or psychopathy: a scoping review
title_short Exploring mental health professionals’ emotional responses with individuals diagnosed with antisocial personality disorder or psychopathy: a scoping review
title_sort exploring mental health professionals emotional responses with individuals diagnosed with antisocial personality disorder or psychopathy a scoping review
topic countertransference
therapist emotional response
antisocial personality disorder
psychopathy
scoping review
url https://www.frontiersin.org/articles/10.3389/fpsyg.2025.1501273/full
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