The Relationship Between Interpersonal Functioning and the Development and Growth of the Therapeutic Alliance

The therapeutic alliance is a powerful component of the therapeutic process, contributing to positive factors such as treatment compliance, higher attendance rates, patient satisfaction, and treatment outcome. Most of the research relies on self-report to identify patient correlates to the development of the alliance. The present study aimed to expand upon the current literature base by approaching this question differently, using the Rorschach Performance Assessment System, a performance-based measure of personality functioning, to identify patient variables related to the development of the alliance over time. Results demonstrate that the Rorschach has the capability to predict aspects of the therapists\u27 early ratings of alliance, but not patients\u27. Patients characterized by more oppositionality (SR) and aggressive interpersonal views (AGC), poorer object relations (MAP), and higher degrees of psychological impairment (EII-3) had lower therapist ratings initially. Patients with more interpersonal needs (T) and defensiveness (PER) had higher therapists\u27 ratings on certain alliance scales. At the three-month follow-up, initial Rorschach scores reflective of dependency (ODL%) and aggressive expectations (AGC) were associated with lower patient ratings, and there were no significant findings with therapists\u27 ratings. Greater understanding of self and others (Sum H and H) was associated with higher patient-rated alliance scores at the follow-up. Patients with initial Rorschach protocols depicting greater deficits in object relations (MAP), but more adaptive interpersonal capacity (H) experienced the greatest growth in certain aspects of patient-rated alliance at the follow up. Finally, ego impairment had mixed findings on patient-therapist agreement. Patients with higher degrees of ego impairment disagreed more with their therapists on the quality of the alliance, providing lower scores. These results are discussed for their implications to the field of school-clinical psychology, limitations, and indications for areas of future research