The relationship between alliance and process in psychodynamic psychotherapy.

This exploratory study of the relationship between the alliance and process in psychodynamic psychotherapy provided evidence in support of the following hypotheses: (1) that the alliance, as rated by therapist and patient at the end of each session, varies throughout the course of treatment, and that low-alliance points are indicative of difficult moments in the therapy relationship; and (2) that there are sets of processes that covary with the alliance across time--some of which are consistent with the Bordin-Safran model of alliance strain and repair, and others of which indicate that the model may not provide a full and adequate description of what happens in difficult psychotharapy sessions. The Bordin-Safran model holds that strains are precipitated by the therapist's responding in a way that confirms some aspect of the patient's maladaptive interpersonal schemata, in response to which the patient evinces one of several possible strain markers. The strain is repaired when the therapist, noticing the strain marker, helps the patient explore and understand the nature of the difficulties in the interaction between them. The study had three parts. Part I consisted of a group comparison design, in which a high-alliance and a low-alliance session was drawn from each of 23 different therapies. The process of the sessions was characterized by rating audiotapes of the sessions with Jones' Psychotherapy Process Q-Sort. Comparisons across the two groups of high- and low-alliance sessions allowed for the identification of processes characteristic of strain and repair activity associated with low-alliance sessions. Part II was an intensive single-case analysis in which 44 consecutive sessions from one of the therapies were rated with the Psychotherapy Process Q-Sort. This allowed for the identification of aspects of the process that shifted with the alliance across the treatment. In Part III, three-session sequences of sessions drawn from two therapies, in which the alliance moved from a higher to lower to higher value, were qualitatively analyzed by clinicians, in order to identify the cause of the alliance strains in these sessions and the means by which they were repaired by patient and therapist.PhDClinical psychologyPsychologyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/131397/2/9909863.pd