Exploring In‐Session Focus on the Patient–Therapist Relationship: Patient Characteristics, Process and Outcome

Abstract

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.

Client engagement in psychotherapeutic treatment and associations with client characteristics, therapist characteristics, and treatment factors

“…Client engagement with treatmenttherapist relationship (Kuutmann & Hilsenroth, 2012) were not related to the therapeutic alliance. These findings indicate that as with participation (e.g.…”

“…Therefore, while greater examination of the treatment factors associated with homework compliance is required, there is an indication that therapist characteristics influencing motivation may be of greater relevance to homework compliance than program factors, and requires further research. emphasis there is on the development of this relationship, which was greater among clients with greater personality pathologies and interpersonal problems but less so among clients with greater expressed aggression (Kuutmann & Hilsenroth, 2012). It is likely that the symptoms of particular dysfunctions that are inherently antisocial (e.g.…”

“…It is likely that the symptoms of particular dysfunctions that are inherently antisocial (e.g. hostility, aggression) naturally pose a challenge to the development of the therapeutic relationship, whereas it is easier among clients with greater capacities to address their problems, such as social compliance , treatment compliance , and confidence (Kuutmann & Hilsenroth, 2012;Simpson et al, 2009). The findings indicate that motivated, pro-treatment clients are easier to work with but these clients are also likely, by virtue of their higher capacities to address their problems, to provide higher ratings of the therapeutic alliance.…”

Cechy pacjenta, jego doświadczenia z przebiegu psychoterapii i skuteczność psychoterapii

“…Cechy pacjenta są powszechnie uznawane za ważne predyktory jego doświadczeń w procesie psychoterapii, zwłaszcza takie cechy, jak płeć, wiek, zgła-szane problemy, dolegliwości, zahamowania czy inne trudności w kontaktach z ludźmi, kłopoty z uczeniem się, a także cechy temperamentu i osobowości (Aleksandrowicz i Sobański, 2004;Cosden, Patz i Smith, 2009;Constantino, Penek, Berncker i Overtree, 2014;Grzesiuk, 2006;Kuutmann i Hilsenroth, 2012).…”

“…Badania ujawniają także, że cechy pacjenta, z jakimi przystępuje do psychoterapii, mają wpływ na przebieg procesu psychoterapeutycznego, zwłaszcza na początku terapii (Kuutmann i Hilsenroth, 2012). Terapeuci, którzy mają do czynienia z pacjentami silniej zaburzonymi, a także przejawiającymi zaburzenia w relacjach interpersonalnych, bardziej koncentrują się na relacji terapeutycznej przede wszystkim na początku psychoterapii.…”