The article shows the results of an empirical study on the relationship between patients’ pathology and level of psychological functioning and therapists’ emotional responses. A random Italian sample of 203 psychiatrists and clinical psychologists (some of our associated members too) completed the "Therapist Response Questionnaire" (TRQ; Zittel Conklin, Westen, 2003) to identify patterns of therapists’ emotional response, and Shedler-Westen Assessment Procedure-200 (SWAP-200; Westen, Shedler, 1999; Shedler, Westen, 2007; Shedler, Westen, Lingiardi, 2014) to assess personality disorders and level of psychological functioning in a patient currently in their care. The study showed significant and specific relationships between therapists’ responses and patients’ personality pathology (e.g.: between borderline personality and overwhelmed/disorganized, helpless/inadequate, and special/overinvolved countertransferences; or narcisistic personality and disengaged countertransference, and so on). In general, therapists’ stronger negative feelings were associated with lower-functioning patients.