Mary Beth Connolly

Therapeutic alliance as a predictor of outcome and retention in the National Institute on Drug Abuse Collaborative Cocaine Treatment Study.

The authors examined the relation between therapeutic alliance, retention, and outcome for 308 cocaine-dependent outpatients participating in the National Institute on Drug Abuse Collaborative Cocaine Treatment Study. High levels of alliance were observed in supportive-expressive therapy (SE), cognitive therapy (CT), and individual drug counseling (IDC), and alliance levels increased slightly but significantly from Session 2 to Session 5 in all groups. In contrast to other studies, alliance was not a significant predictor of drug outcome. However, alliance did predict patient retention differentially across the 3 treatments. In SE and IDC, either higher levels of alliance were associated with increased retention or no relationship between alliance and retention was found, depending on the time alliance was measured. In CT, higher levels of alliance were associated with decreased retention.

Retention in Psychosocial Treatment of Cocaine Dependence: Predictors and Impact on Outcome

This report describes retention in treatment in the National Institute on Drug Abuse Collaborative Cocaine Treatment Study (CCTS), a multi-site trial of four psychosocial treatments for 487 cocaine dependent patients. Younger, African-American, and unemployed patients were retained in treatment for fewer days than their counterparts. African-American patients who lived with a partner were retained in treatment for less time than if they lived alone. Higher psychiatric severity kept men in treatment longer but put women at risk for dropping out sooner. Patients who completed the full treatment used drugs less often than patients who dropped out, but outcome did not differ at each month. Patients in the drug counseling condition stayed in treatment for fewer days than patients in psychotherapy, but they were more likely to be abstinent after dropout. Patients with higher psychiatric severity were more at risk for continuing to use drugs after dropout.

Relation of Transference Interpretations to Outcome in the Early Sessions of Brief Supportive-Expressive Psychotherapy

Transference interpretations have been considered an important technique in models of short-term dynamic psychotherapy. The purpose of the current investigation was to explore the role of transference interpretations in the early sessions of 29 patients treated with Supportive-Expressive (SE) psychotherapy for depression. Hierarchical multiple regressions were used to evaluate the relationship between proportion of transference interpretations and treatment outcome measured across levels of quality of interpersonal relationships. High levels of transference interpretations were significantly associated with poor treatment outcome for patients with poor interpersonal functioning. The results suggest that transference interpretations should be used sparingly in the early sessions of SE psychotherapy with patients who demonstrate a poor quality of interpersonal relationships prior to treatment. Ubertragungsdeutungen gelten als wichtige Technik in den Modellen fur psychodynamische Kurzpsychotherpie. Ziel der ...

ALLIANCE AND TECHNIQUE IN SHORT-TERM DYNAMIC THERAPY

We review existing studies on the extent to which the alliance and techniques predict the outcome of short-term dynamic psychotherapy (STDP). Although the alliance has been found to relate to outcome in diverse psychotherapies, evidence for its role in STDP is more inconsistent. Studies of technique factors have provided support for the relation of competence with exploratory interventions to outcome. Less support for the role of specific transference interpretations was found. Little empirical support exists for the notion that the technical factors are most potent in the context of a positive alliance, although adequate studies of this interaction are scarce. Similarly, adequate studies that attempt to tease apart the extent to which technical factors influence the alliance, and vice versa, are also rare. Despite the methodological limitations of research in this area, the fact that there are some consistent findings relating techniques to outcome suggests that nonspecific relationship factors do not by themselves account for the changes found over the course of STDP. Moreover, such findings encourage additional efficacy and process research on STDP. Some suggestions for future research are presented.

The Reliability and Validity of a Measure of Self-Understanding of Interpersonal Patterns.

Change in self-understanding of maladaptive interpersonal patterns has been an important mechanism of symptom change in theories of dynamic psychotherapy and has been specified as an important treatment outcome by psychotherapy clients. The current investigation evaluated the reliability and validity of a new self-report measure of Self-Understanding of Interpersonal Patterns (SUIP). The measure was administered to 3 clinical samples and a student sample. The measure demonstrated good internal consistency, test-retest reliability, and discriminant validity. The SUIP further demonstrated convergent validity with measures of analytical and self-improving personality traits in a clinical sample. Finally, there was significantly greater change in self-understanding in a dynamic psychotherapy as compared with a medication treatment condition, despite comparable symptom change across both treatment conditions.

Cluster Analysis of Patient Reported Psychotherapy Outcomes

The purpose of the present investigation was to explore the patients perspective of important psychotherapy outcomes. Eighty patients, following 25 sessions of dynamically oriented psychotherapy, were asked in writing to describe the most important changes they had received from psychotherapy. Ninety distinct changes were reported by this sample. A dissimilarity matrix of these changes was analyzed using hierarchical cluster analysis. The cluster analysis revealed four clusters: improved symptoms, improved self-understanding, improved self-confidence, and greater self-definition. Further, these four clusters formed two superclusters corresponding to improvements in symptoms and self-concept. The results of this investigation indicate that a complete outcome battery, designed to encompass all changes important to patients treated in dynamically oriented psychotherapy, should include not only symptom change measures, but also measures of change in self-concept.

Interpersonal Narratives in Cognitive and Interpersonal Psychotherapies

The purpose of the current investigation was to explore the predictors of the frequency and completeness of interpersonal narratives in psychotherapy. Narratives were extracted from 548 sessions of 72 patients who received either cognitive (CT) or interpersonal therapy (IPT) for depression. Consistent individual differences in narrative frequency, length, completeness, and number of therapist words per narrative were found. IPT sessions contained significantly more narratives than CT sessions, and CT sessions contained a higher proportion of therapist words per narrative. The alliance was positively related to the number of patient words per narrative, and patients with more involved interpersonal styles elicited more therapist words per narrative. Expectations about the causes of depression and helpfulness of focusing on interpersonal issues in therapy influenced narrative frequency and completeness more in CT than in IPT. Ziel der hier beschriebenen Untersuchung war eine uberprufung des pradiktiven Char...

Alliance predicts patients’ outcome beyond in-treatment change in symptoms

The authors examined the relations among therapeutic alliance, outcome, and early-in-treatment symptomatic improvement in a group of 86 patients with generalized anxiety disorders, chronic depression, or avoidant or obsessive-compulsive personality disorder who received supportive-expressive dynamic psychotherapy. Although alliance at Sessions 5 and 10, but not at Session 2, was associated with prior change in depression, alliance at all sessions significantly predicted subsequent change in depression when prior change in depression was partialed out. The results are discussed in terms of the causal role of the alliance in therapeutic outcome.

Reliability and base rates of interpersonal themes in narratives from psychotherapy sessions.

We present an analysis of the reliability and base rates of the interpersonal contents of narratives told by patients in psychotherapy. Trained judges rated two samples, including 60 opiate-dependent patients in cognitive or psychodynamic therapy and 72 depressed patients in cognitive or interpersonal therapy. Using a comprehensive system based upon a circumplex model and involving 104 separate categories, we found that most categories of interpersonal behavior could be rated reliably. Potential problem categories were identified and strategies for increasing reliability are discussed. In particular, categories related to the concept of the introject (what the self does to the self) had low reliability. An analysis of the base rates of interpersonal themes revealed that issues related to autonomy/ assertion were most prevalent, although some differences between the two samples were evident. The implications of the results for research on narratives and models of psychotherapy are discussed.