Relationship Between Interpretation, Alliance, and Outcome in Psychodynamic Psychotherapy

Abstract

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.

Association Between Insight and Outcome of Psychotherapy: Systematic Review and Meta-Analysis

“…The random-effects model for the association between insight and outcome estimated an average true population effect size (r) of 0.31 (95% CI=0.22-0.40, p,0.05). Effect sizes and 95% confidence intervals of the studies (27,29,31,33,35,37,39,(41)(42)(43)(54)(55)(56)(57)(58)(59)(60)(61)(62)(63)(64)(65) are presented in a forest plot in Figure 2. Eleven of the 23 reported individual effect sizes were nonsignificant within the primary study.…”

“…The least concerns were present for risk of reporting bias, as most studies gave explanations for missing data, presented data clearly and accurately, and showed no indicators of selective reporting. Only three studies reported therapist effects, and they controlled for them using a multilevel modeling approach (54,64,65). None of the studies had a preregistered study protocol, and none explicitly stated taking preventive actions against possible researcher allegiance effects, such as blind ratings of insight or blind data analysis.…”

Psychodynamic technique early in treatment related to outcome for depressed patients

“…Achieving a better understanding of one's cyclical patterns of thinking, feeling, and relating is regarded as essential in contributing to outcome across therapy modalities, although historically psychodynamic and interpersonal therapies have put more of an emphasis on achieving this understanding through therapist interpretations in comparison to other types of treatment (Blagys & Hilsenroth, ; Høglend, Engelstad, Sørbye, Heyerdahl, & Amlo, ; Kivlighan, Multon, & Patton, ; Vargas, ). Levy, Hilsenroth, and Owen () recently examined the relationship between therapist interpretations early in STPP with improvement in global symptomatology over the course of therapy and found that early use of moderate amounts of interpretation has significant implications for improvement within this type of therapy. There have also been recent findings supporting the relationship between gaining better insight into relational patterns and therapy outcomes.…”

What interpersonal problems are related to different therapeutic techniques early in treatment?

“…Additionally, as mentioned previously, the present study did not examine therapy outcomes. However, other studies from our laboratory have demonstrated broad-based therapy outcome changes across a variety of domains (Katz & Hilsenroth, 2017;Kuutmann & Hilsenroth, 2012;Levy, Hilsenroth, & Owen, 2015;Mullin et al, 2016;Mullin, Hilsenroth, Gold, & Farber, 2018;;Pitman & Hilsenroth, 2016). It is worth noting that these studies utilized subsamples that overlap significantly with the patients examined in the current study.…”