Therapeutic bond, as a component of the alliance, is considered a common factor in psychotherapy; however, it may operate differently in various treatments. This article investigates therapist actions, particularly affect focus, in the formation of the bond and on reduction of symptoms in short-term dynamic psychotherapy (STDP) and cognitive therapy (CT) for cluster C patients. Forty-six cases (23 STDP and 23 CT) were assessed using the Psychotherapy Process Q-Sort, the Helping Alliance Questionnaire, and the Symptom Checklist 90. These scores were used to determine (a) therapist actions that predict formation of the bond, (b) the relation of the bond to symptom reduction, and (c) how therapist actions and bond interacted to reduce symptoms. Multiple regressions were applied to the total sample and to the STDP and CT cases. Psychotherapy Process Q-Sort items describing avoidance of affects were positively related to the bond in the total sample, STDP and CT. However, the relation between therapist actions, bond, and symptom reduction differed for the two treatments. For STDP, avoidance of affect suppressed the relation of bond to symptom reduction and also negatively influenced symptom reduction. On the other hand, in CT, avoidance of affect was positively related to both the formation of the bond and to symptom reduction. Although the bond is a common factor and important component of the alliance, it appears to operate differently in STDP and CT. A focus on affect is important to the benefits of STDP but interferes with the benefits of CT.

In the short-term dynamic psychotherapy model termed "Affect Phobia Treatment," it is assumed that increase in patients' defense recognition, decrease in inhibitory affects (e.g., anxiety, shame, guilt), and increase in the experience of activating affects (e.g., sadness, anger, closeness) are related to enhanced self-compassion across therapeutic approaches. The present study aimed to test this assumption on the basis of data from a randomized controlled trial, which compared a 40-session short-term dynamic psychotherapy (N = 25) with 40-session cognitive treatment (N = 25) for outpatients with Cluster C personality disorders. Patients' defense recognition, inhibitory affects, activating affects, and self-compassion were rated with the Achievement of Therapeutic Objectives Scale (McCullough et al., 2003b) in Sessions 6 and 36. Results showed that increase in self-compassion from early to late in therapy significantly predicted pre- to post-decrease in psychiatric symptoms, interpersonal problems, and personality pathology. Decrease in levels of inhibitory affects and increase in levels of activating affects during therapy were significantly associated with higher self-compassion toward the end of treatment. Increased levels of defense recognition did not predict higher self-compassion when changes in inhibitory and activating affects were statistically controlled for. There were no significant interaction effects with type of treatment. These findings support self-compassion as an important goal of psychotherapy and indicate that increase in the experience of activating affects and decrease in inhibitory affects seem to be worthwhile therapeutic targets when working to enhance self-compassion in patients with Cluster C personality disorders.

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This study examined whether 49 patients from a randomized controlled trial developed insight during therapy and whether insight predicted long-term outcome in short-term dynamic psychotherapy (STDP) and cognitive therapy (CT) for Cluster C personality disorders. Videotaped sessions early and late in treatment were analyzed using the Achievement of Therapeutic Objectives Scale. Patients' level of insight increased significantly during STDP but not CT. After controlling for early symptom change and early insight, insight near the end of therapy predicted improvement of symptom severity and interpersonal functioning during a 2-year follow-up period. These results support the theoretical assumption that insight may be a factor in the change process, central to STDP. Within CT, gain of insight did not predict long-term improvement.

Therapist-patient interactions in 16 cases of brief psychotherapy were examined. Three types of therapist intervention (patient-therapist interpretations, patient-significant other interpretations, and clarifications) were compared in terms of the frequency of patient affective or defensive behavior that occurred in the three minutes following each. In addition, therapist-intervention and patient-response episodes were investigated to determine their relationship to outcome at termination of therapy. Results indicate that patient-therapist interpretations followed by patient affect bears a significant relationship to improvement at termination, whereas an intervention (of any type) followed by defensiveness correlates negatively with outcome. These findings suggest that an examination of patient-therapist interaction episodes may be more productive than examining process variables in isolation.

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An integrative model of short‐term dynamic psychotherapy (STDP) is presented that assimilates interventions from a variety of therapy orientations to accelerate patient improvement. Affect phobia therapy (APT) is a name given to McCullough's STDP to highlight the main treatment focus and to guide therapists to the most efficient and effective interventions. This treatment model is based on the hypothesis that conflicts about feelings, or “affect phobias,” are the fundamental issues underlying many Axis I and Axis II disorders. Systematic desensitization, or stepwise exposure to feelings and defense response prevention, is hypothesized to be the fundamental agent of therapeutic change. APT focuses primarily on the resolution of affective conflicts in a psychodynamic framework, but videotape review and process studies of this STDP model have discovered that interventions from cognitive, behavior, Cestalt, and experiential therapy, as well as self‐psychology, have been instrumental in patient change. Therapy is made briefer by clarifying treatment objectives, simplifying the selection criteria, and using principles of systematic desensitization for the resolution of affect phobias.

This article investigates whether patients' sense of self and therapists' interventions aimed at orienting patients toward affect produce an affective activation in the patient. Both the independent contribution of sense of self and therapist intervention, as well as sense of self's moderating effect on therapist interventions, were investigated. Fifty cluster C patients were analyzed using 2 psychotherapy process measures and multilevel modeling. The results indicate that patients' affect experience increases over time. Both the therapist orienting the patient toward affect and the patient's sense of self predicted affect activation for the within-person effect (i.e., the patient's or therapist's standing in any given session relative to his or her baseline), but only sense of self was significant for the between-person effect (i.e., the patient's standing relative to all other patients). The relationship between a therapist orienting the patient toward affect and the patient's affective response was moderated by the patient's sense of self. The results have implications for therapists who want their patients to experience affect in a session.