Systematic review finds 12 transference assessment tools, only two patient-based

A systematic review of instruments used to assess transference in psychoanalytic psychotherapy identified 12 tools across 31 eligible studies, but only two considered the patient’s perspective, and neither of those self-report instruments achieved high levels of psychometric quality across the evaluated criteria. Transference is defined in the reviewed literature as the possibility that, during psychotherapy, a patient relives unconscious impulses and fantasies awakened in the therapeutic relationship that originated in relationships with people in earlier life. Although this process plays an essential role in psychoanalytic treatments, researchers have relied on multiple approaches for assessing it.

The review set out to identify and describe the main instruments reported in the literature, with particular attention to measures that elicit responses directly from patients rather than relying exclusively on another perspective. The researchers searched PubMed/Medline, PsycInfo, Scopus, SciELO, Cochrane, Web of Science, BVS and Embase. Their search combined descriptors including “Transference,” “Psychotherapy,” “scale” and “instruments,” together with related terms.

No language or publication-date restrictions were applied. The review protocol was registered with PROSPERO under the identifier CRD42024596027. The search returned 1,812 articles, of which 31 met the inclusion criteria and yielded 12 different instruments for assessing transference in psychoanalytic psychotherapy.

Most of the identified instruments did not explicitly incorporate the patient’s perspective, while two were self-report measures designed to do so. One of the two had the more robust statistical analysis concerning the quality of the proposed instrument. Even so, neither reached high levels of psychometric quality across the criteria evaluated by the review.

The result does not show that transference itself lacks clinical importance, nor does it establish that a particular treatment works or fails. Instead, it describes a weakness in the measurement instruments available for studying the transference process and the quality of evidence produced with them. The geographic distribution of the eligible studies was also uneven.

None of the studies included in the review was published in Latin America, Oceania or Africa. This pattern describes the evidence retrieved and selected by the search; it should not be interpreted as a direct comparison of transference, psychotherapy practice or instrument use across those regions. The authors conclude that future research should develop scientifically rigorous tools that can better demonstrate the transferential process in psychotherapy.

Such tools would need to address the psychometric shortcomings identified in the review while giving fuller consideration to how transference is experienced and reported by patients.

Subject of Research: Psychometric quality and patient perspective in transference assessment instruments for psychoanalytic psychotherapy

Article Title: Self-report instruments for assessing transference in psychoanalytical research: a neglected or avoided concept? – A systematic review

Article References: Evaldt, V. M. T., Wickert, M., Dutra, P. H., & da Rocha, N. S. (2026). Self-report instruments for assessing transference in psychoanalytical research: a neglected or avoided concept? – A systematic review. BMC Psychology. https://doi.org/10.1186/s40359-026-05516-z

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DOI: 10.1186/s40359-026-05516-z

Keywords: transference, psychoanalytic psychotherapy, self-report measures, psychometrics, systematic review, assessment instruments, patient perspective, psychotherapy research, Self-report, instruments, assessing, psychoanalytical