This study explored the amount of in-session focus on the patient-therapist relationship during early treatment with patient pre-treatment interpersonal style, personality pathology, patient ratings of session process and outcome. The sample consisted of 76 outpatients engaged in short-term psychodynamic psychotherapy. Results showed that higher levels of pre-treatment personality pathology and interpersonal problems were positively related to a greater focus on the patient-therapist relationship early in treatment. This was especially true for patients with a cold/distant interpersonal style and low self-esteem. Moreover, these two patient pre-treatment characteristics demonstrated a significant change over the course of therapy. These post-treatment changes also demonstrated a significant relationship with greater early treatment focus on the patient-therapist relationship. In addition, we found an interaction effect between quality of object relations (i.e., higher levels of object relations) and greater early treatment focus on the patient-therapist relationship with subsequent changes in patient cold/distant interpersonal problems. Greater in-session focus on the therapeutic relationship was not significantly related to patient ratings of session process. Implications for clinical practice and future research are discussed.
While graduate clinician's personal therapy alliance was not significantly related to their patients' ratings of alliance, it was related to their patients' ratings of outcome. Trainee satisfaction with or quality of their personal therapy may be a more relevant than the amount or duration of their treatment in regard to the process and outcomes of their patients. The findings from retrospective clinician surveys on the helpfulness of their personal therapy may not be entirely consistent with empirical examination of these issues. The relation of personal therapy and outcome may work through improving the therapist's level of adaptive functioning (i.e., psychological-relational-emotional health) and future research should examine this simpler, more parsimonious, explanation for our findings.
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