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

Although psychodynamic therapy has a well-articulated model of therapeutic change for anxiety, few empirical studies have examined specific treatment interventions related to symptom improvement. We examined the degree of adherence to a psychodynamic model of therapy (Blagys and Hilsenroth [Clin Psychol 7:167-188, 2000) related to changes in anxiety symptoms across early treatment process. Secondary analyses also examined the use of specific psychodynamic techniques across early treatment process in relation to symptom change. The current study sought to extend the findings of , who found a relationship between the use of psychodynamic techniques in the third session (independent clinical ratings) and reduction in anxiety symptoms at posttreatment (r = 0.46, p = 0.04). Using the same sample of anxiety disorder patients (N = 20), we found a significant relationship between psychodynamic technique and posttreatment change in anxiety symptoms at the ninth session (r = 0.49, p = 0.03) and the mean levels of psychodynamic technique across both third and ninth sessions (r = 0.53, p = 0.02). In addition, specific psychodynamic techniques demonstrated significant relationships or moderate to large effects with posttreatment changes in anxiety symptoms at the third and ninth sessions as well as mean ratings across early treatment (third and ninth sessions). These findings indicate that therapist focus on cyclical intrapersonal patterns in patient actions, feelings, or experience as well as suggestions of alternative ways to understand these experiences or events not previously recognized by the patient (i.e., interpretation) in the early treatment process were particularly helpful in reducing posttreatment anxiety symptoms. Clinical implications and areas for future research will be discussed.

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.

In recent years, there has been growing interest in examining the stimulus pull effects on respondent narratives to the Thematic Apperception Test (Murray, 1943) using standardized coding methods such as the Social Cognition and Object Relations Scale–Global Rating Method (SCORS‐G; Stein, Hilsenroth, Slavin‐Mulford, & Pinsker, 2011; Westen, 1995). The present study expands on prior work by examining sources of variance in SCORS‐G dimensions and card pull effect patterns in an adult clinical sample characterized by high psychiatric comorbidity and clinical severity. A sample of 158 adult psychiatric patients in long‐term residential treatment provided narratives to 10 TAT cards (five of which have not previously been studied for pull effects). Cards 2 and 7BM pulled for significantly more adaptive narratives (positive pull), whereas Card 13MF pulled for more pathological stories (negative pull). Like prior studies, variance in cognitive dimensions of the SCORS‐G was most explained by person effects, whereas the largest source of variance for all other dimensions was best explained by a combination of the card and the person effects on the narrative. Finally, exploratory analyses of card pull effects within different gender groups were conducted. The implications of these findings for performance‐based future studies and possible clinical applications of card pull findings are discussed.