TYPE Original Research PUBLISHED 28 November 2022 DOI 10.3389/fnhum.2022.1037486 OPEN ACCESS EDITED BY Filippo Cieri, Neurological Institute, United States REVIEWED BY Andrea Scalabrini, University of Bergamo, Italy Elena V. Mnatsakanian, Institute of Higher Nervous Activity and Neurophysiology (RAS), Russia *CORRESPONDENCE Cristina Trentini cristina.trentini@uniroma1.it SPECIALTY SECTION This article was submitted to Cognitive Neuroscience, a section of the journal Frontiers in Human Neuroscience RECEIVED 05 September 2022 ACCEPTED 02 November 2022 PUBLISHED 28 November 2022 CITATION Tanzilli A, Trentini C, Grecucci A, Carone N, Ciacchella C, Lai C, Sabogal-Rueda MD and Lingiardi V (2022) Therapist reactions to patient personality: A pilot study of clinicians’ emotional and neural responses using three clinical vignettes from in treatment series. Front. Hum. Neurosci. 16:1037486. doi: 10.3389/fnhum.2022.1037486 COPYRIGHT © 2022 Tanzilli, Trentini, Grecucci, Carone, Ciacchella, Lai, Sabogal-Rueda and Lingiardi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Therapist reactions to patient personality: A pilot study of clinicians’ emotional and neural responses using three clinical vignettes from in treatment series Annalisa Tanzilli 1 , Cristina Trentini 1 *, Alessandro Grecucci 2 , Nicola Carone 3 , Chiara Ciacchella 1 , Carlo Lai 1 , Miguel David Sabogal-Rueda 4 and Vittorio Lingiardi 1 1 Department of Dynamic, Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy, 2 Clinical and Affective Neuroscience Lab, Department of Psychology and Cognitive Sciences, University of Trento, Rovereto, Italy, 3 Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy, 4 Department of Psychology, Catholic University of Sacred Heart, Milan, Italy Introduction: Therapists’ responses to patients play a crucial role in psychotherapy and are considered a key component of the patient–clinician relationship, which promotes successful treatment outcomes. To date, no empirical research has ever investigated therapist response patterns to patients with different personality disorders from a neuroscience perspective. Methods: In the present study, psychodynamic therapists (N = 14) were asked to complete a battery of instruments (including the Therapist Response Questionnaire) after watching three videos showing clinical interactions between a therapist and three patients with narcissistic, histrionic/borderline, and depressive personality disorders, respectively. Subsequently, participants’ high-density electroencephalography (hdEEG) was recorded as they passively viewed pictures of the patients’ faces, which were selected from the still images of the previously shown videos. Supervised machine learning (ML) was used to evaluate whether: (1) therapists’ responses predicted which patient they observed during the EEG task and whether specific clinician reactions were involved in distinguishing between patients with different personality disorders (using pairwise comparisons); and (2) therapists’ event- related potentials (ERPs) predicted which patient they observed during the laboratory experiment and whether distinct ERP components allowed this forecast. Results: The results indicated that therapists showed distinct patterns of criticized/devalued and sexualized reactions to visual depictions of patients with different personality disorders, at statistically systematic and clinically meaningful levels. Moreover, therapists’ late positive potentials (LPPs) in the hippocampus were able to determine which patient they observed during the EEG task, with high accuracy. Frontiers in Human Neuroscience 01 frontiersin.org