The relationship between patient object relations and the therapeutic alliance in a naturalistic psychotherapy sample

Abstract

Treatment may benefit from more attention to the quality of patients' object relations. If patients present with high levels of alienation and insecure attachment, therapists may need to pay especially close attention to the therapeutic alliance, and prudently address any ruptures in its quality. When monitoring the alliance quality, it is important to consider that patients and therapists may have different perspectives. Therapists relying solely on their own perceptions are at risk of missing alliance difficulties, and patients' object relations may be uniquely predictive of their own sense of the alliance. Therefore, it may be helpful to ask patients in session and through standardized measures for feedback on how they perceive the goals and tasks of treatment and the emotional bond with their therapist. Again, any alliance tensions could then be addressed directly as a means to maintaining engagement in the service of better outcome.

Early development of mechanisms of change as a predictor of subsequent change and treatment outcome: The case of working alliance.

“…They are encoded in internal representations of the self and of others and later serve as the basis for future interactions, including the relationship with the therapist (Bowlby, 1988). The present findings are also consistent with those of previous studies showing that patients’ pretreatment interpersonal characteristics can predict specific session alliance snapshots (Errázuriz et al, 2015; Levin et al, 2012; Zilcha-Mano et al, 2014) as well as patterns of alliance development (Siefert & Hilsenroth, 2015; Zilcha-Mano, McCarthy, et al, 2015). Note, however, that although pretreatment measures were able to significantly predict a portion of the alliance development patterns, most pattern variance could not be predicted pretreatment and may be the result of the interactions with the therapists.…”

“…In contrast, most of the studies demonstrating the beneficial effect of linear strengthening have included lower percentages of patients with personality disorders (e.g., de Roten et al, 2004; Kramer et al, 2009). It may be that those who arrive for treatment with more adaptive representations of self and others, as well as better capability for forming satisfactory relationships with others, are better able to create a strong alliance early in the treatment and maintain its level throughout, with minimal fluctuations (Errázuriz, Constantino, & Calvo, 2015). Such patients may benefit most from a relatively stable and strong alliance early in treatment.…”

Dimensional measure of self and interpersonal functioning: Comparisons with treatment alliance and readiness for inpatient psychotherapy

“…This results suggest a pattern of associations among adolescents that is similar to the findings obtained with adults. Disruptions in relational functioning have been linked to problems establishing alliance in adults seeking psychotherapy (Ackerman et al, ; Errazuriz, Constantino, & Calvo, ; Pinsker‐Aspen et al, ). In other words, adults who were more differentiated, logical in thought process, more capable of understanding others, invested in relationships, and better able to manage aggression effectively have been found to form stronger alliances.…”

Validación Chilena del Cuestionario de Evaluación de Apego en el adulto CaMir versión abreviada

“…Específicamente en nuestro país, se ha producido un aumento significativo de la investigación en años recientes, especialmente en el ámbito del apego adulto, permitiendo un crecimiento importante de resultados que profundizan y enriquecen los conocimientos del área (Costa-Cordella et al, 2022;Dagnino et al, 2017;Domic-Siede et al, 2023;Errázuriz et al, 2014;Espinoza et al, 2022;Fernández y Dufey, 2015;Fernández et al, 2019;Garrido-Rojas et al, 2013;Garrido-Rojas et al, 2015;Garrido-Rojas et al, 2016;Guzmán-González y Trabucco, 2014;Guzmán-González et al, 2015;Guzmán-González et al, 2016;Guzmán-González et al, 2019;Guzmán-González et al, 2020;Guzmán-González et al, 2022;Heresi et al, 2013;Lafontaine et al, 2018;Olhaberry et al, 2013;Pimentel y Santelices, 2017;San Cristóbal et al, 2017;Santelices et al, 2011;Varela et al, 2021;Yárnoz-Yaben et al, 2018).…”