The current study examines the relationship between therapist interpretations in the early stages of psychodynamic psychotherapy and subsequent outcomes for 76 outpatients. Pre-treatment characteristics of global symptomatology, personality pathology, insight, and level of object relations were examined as possible significant patient characteristics. Independent clinicians reliably rated therapist use of interpretations over two early treatment sessions (third and ninth). Patient-rated alliance was also examined as a possible psychotherapy process predictor of change. Therapy outcomes were measured based on patients' changes in global symptomatology and estimates of improvement across a broad range of functioning at the end of treatment. An examination of the study independent variables revealed significant relationships between pre-treatment personality disorder symptomatology with patient object relations (OR), patient OR with pre-treatment insight, and pre-treatment insight with use of therapist interpretation. Pre-treatment symptomatology and early treatment interpretations predicted reliable change in global symptomatology. Patients' estimates of improvement across a broad band of functioning were most significantly impacted by quality of alliance. Analysis of these outcome relationships controlled for therapist effects. Statistical implications of therapist effects are discussed in regard to this area of research and future directions for investigation are explored.

This study examined the relationship between adherence flexibility early in treatment and outcome within psychodynamic psychotherapy of depression. For this purpose, we used multilevel modeling (MLM) to examine the relationship between adherence to global psychodynamic-interpersonal (PI) technique early in treatment with outcome, the impact of flexibly incorporating some limited cognitive-behavioral (CB) interventions, as well the role of therapist effects. Our sample included 46 outpatients who were consecutively enrolled in individual psychodynamic psychotherapy, received a (4th ed.; American Psychiatric Association [APA], 1994) Axis I diagnosis of a depressive spectrum disorder, and were assessed pre- and posttreatment through self-report of depressive symptoms. Psychotherapy sessions were videotaped and 3rd and 9th sessions were independently rated on the Comparative Psychotherapy Process Scale (CPPS) for use of PI and CB techniques, with excellent interrater reliability (intraclass correlation coefficient [ICC] > .75). Mean technique ratings across the two early treatment sessions (3rd and 9th) were calculated. Our findings suggest that flexibly incorporating a limited amount of CB strategies early in psychodynamic therapy for depression can add some benefit to the unique positive relationship between PI adherence and outcome. Implications for clinical work and future research directions are discussed. (PsycINFO Database Record

The present study sought to investigate the impact of psychotherapy integration, that is, the integration of some cognitive-behavioral (CB) techniques with psychodynamicinterpersonal (PI) techniques, on short-term psychodynamic psychotherapy (STPP) treatment outcomes in a sample of 75 patients. PI and CB techniques were assessed using independent videotape ratings of therapy sessions and aspects of the alliance were determined using patient-rated scores. Several significant findings were observed. First, the direct impact of integrating CB and PI techniques on global treatment outcomes was not significant. However, the relation between integrative technique use and reliable change in global symptoms varied at different levels of the alliance facets, specific to Goals and Task Agreement (GTA) as well as Confident Collaboration (CC), where higher levels of these alliance facets were related to better outcomes. GTA as well as CC aspects of the alliance also each independently predicted patient change in a broad range of patient functioning. Implications are discussed for clinicians, clinics, and psychotherapy research, alike.

This study utilized the American Psychological Association (APA) PsycTHERAPY digital video database of therapy masters working with participants on problems related to either anxiety or depression. Thirty-four APA master sessions were included. Therapist primary orientation included Cognitive–Behavioral (CB), Psychodynamic–Relational (P/R), and Person Centered-Experiential (PC/E), the last of which served as a comparison group to contrast the former 2 samples. All sessions were evaluated using the Comparative Psychotherapy Process Scale (CPPS) by 4 independent clinical raters who demonstrated excellent (>.75; Fleiss, 1981) reliability in the rating of these sessions. Results demonstrated significant differences on the CPPS Psychodynamic-Interpersonal (CPPS-PI) and Cognitive-Behavioral (CPPS-CB) subscales in the expected directions between the APA master CB and P/R sessions. APA master PC/E sessions did not rate as highly on either CPPS-PI or CPPS-CB subscales than therapists from the respective modalities. A subsample Integrative (IN) group was created using APA master therapist secondary orientation to further analyze the relationship between technique use and integration. Findings demonstrated that IN master therapists utilized significantly more CPPS-CB techniques than P/R therapists, and significantly more CPPS-PI techniques than CB therapists, supporting the IN orientation. Further, CB-3rd wave (Schema, ACT, Mindfulness) APA master therapist sessions demonstrated a significantly greater integration (i.e., use) of CPPS-PI items, particularly those related to participant emotional expression and exploration, identifying patterns of experience, and facilitating insight, than the traditional CB APA master therapist sessions. Clinical implications with regard to training and practice will be discussed.