Véronique Beretta

Patient's and Therapist's Views of Early Alliance Building in Dynamic Psychotherapy: Patterns and Relation to Outcome.

Patients and therapists have somewhat divergent perspectives of alliance. Usually in psychotherapy research, the focus is on the patients view of alliance, predicting parts of outcome. This study questions this hypothesis by applying the shape-of-change procedure to patients and therapists view of alliance-building processes in dynamic psychotherapy. The results of this naturalistic study indicate that none of the 3 patient patterns is related to outcome at the end of psychotherapy, but a specific therapists pattern--out of 2--is linked to positive symptom change. These results are discussed in the context of present research on therapeutic alliance, especially in terms of level and process, its measurement, and potential in predicting outcome in dynamic psychotherapy. (PsycINFO Database Record (c) 2008 APA, all rights reserved)

Alliance patterns over the course of short-term dynamic psychotherapy: The shape of productive relationships

Abstract The shape of alliance processes over the course of psychotherapy has already been studied in several process–outcome studies on very brief psychotherapy. The present study applies the shape-of-change methodology to short-term dynamic psychotherapies and complements this method with hierarchical linear modeling. A total of 50 psychotherapies of up to 40 sessions were included. Alliance was measured at the end of each session. The results indicate that a linear progression model is most adequate. Three main patterns were found: stable, linear, and quadratic growth. The linear growth pattern, along with the slope parameter, was related to treatment outcome. This study sheds additional light on alliance process research, underscores the importance of linear alliance progression for outcome, and also fosters a better understanding of its limitations.

The role of alliance in the relationship between therapist competence and outcome in brief psychodynamic psychotherapy.

Therapist competence is a key variable for psychotherapy research. Empirically, the relationship between competence and therapeutic outcome has shown contradictory results and needs to be clarified, especially with regard to possible variables influencing this relationship. A total of 78 outpatients were treated by 15 therapists in a very brief 4-session format, based on psychoanalytic theory. Data were analyzed by means of a nested design using hierarchical linear modeling. No direct link between therapist competence and outcome has been found, however, results corroborated the importance of alliance patterns as moderator in the relationship between therapist competence and outcome. Only in dyads with alliance change over the course of treatment was it clear that competence is positively related to outcome. These findings are discussed with regard to the importance for outcome of therapist competence and alliance construction processes.

The Influence of Patient's Interpersonal Schemas on Early Alliance Building.

Influence of patient’s interpersonal schemas on the establishment of the therapeutic alliance is examined on a sample of 60 outpatients during first dynamic psychotherapy sessions. To assess interpersonal characteristics, we used the Inventory of Interpersonal Problems (Horowitz et al., 1988) and the patient’s conflictual relationship themes (CCRT; Luborsky & Crits-Christoph, 1998). Alliance was measured with the Helping Alliance Questionnaire. The results show that therapeutic alliance is associated with patient’s wish to be close, to perceive others as being trustworthy and as helpful. Patients with low alliance more often express the wish to be close to others, but perceive others’ responses more negatively, as indicated by their representations of others as “hurtful and untrustworthy” and “unhelpful”. They also present more interpersonal problems linked to a diminished capacity for affiliation. Clinical implications of the results are discussed.

Clinical significance and patients' perceived change in four sessions of brief psychodynamic intervention: characteristics of early responders.

This study investigated Tingey, Lambert, Burlingame, and Hansens (1996) extension of Jacobson, Follette and Revenstorfs (1984) proposal for assessing clinical significance. Seventy (N=70) outpatients with/without Cluster C personality disorders treated with a brief psychodynamic intervention (BDI) were included in the study. Results showed that 33% of patients demonstrated clinically significant change on the Global Severity Index. Patients who improved reported more perceived subjective change, greater satisfaction with the treatment, and greater improvement on the Social Adjustment Scale than patients who did not improve (60%) or deteriorated (7%). Further analyses showed that clinical significance achieved in a four session ultra-brief therapy is associated with patient characteristics such as co-morbid personality disorders, level of defensive functioning, and specific interpersonal problems. Results were maintained at 3 month and 6 month follow-ups. Findings are discussed in reference to Howards suggestions on remoralization and remission.

Defense Styles of Pedophilic Offenders

This pilot study investigated the defense styles of pedophile sexual offenders. Interviews with 20 pedophiles and 20 controls were scored using the Defense Mechanisms Rating Scales. Results showed that pedophiles had a significantly lower overall defensive functioning score than the controls. Pedophiles used significantly fewer obsessionallevel defenses but more major image-distorting and action-level defenses. Results also suggested differences in the prevalence of individual defenses where pedophiles used more dissociation, displacement, denial, autistic fantasy, splitting of object, projective identification, acting out, and passive aggressive behavior but less intellectualization and rationalization.

Defensive Flexibility and Its Relation to Symptom Severity, Depression, and Anxiety

Numerous studies have examined which individual defense mechanisms are related with mental health, and which are linked with psychopathology. However, the idea that a flexible use of defensive mechanisms is related to psychological wellbeing remained a clinical assumption, which this study sought to test empirically. A total of 62 (N = 62) outpatients participated in the study and were assessed with the Symptom Checklist-90R and the Social Adjustment Self-rated Scale. A subsample of 40 participants was further assessed using the Hamilton Depression (HAMD-21) and Anxiety scales (HAMA-21). The first therapy session of all participants was transcribed and rated using the Defense Mechanisms Ratings Scales (Perry, 1990b), and the Overall Defensive Functioning (ODF) score, which indicates the maturity of ones defensive functioning, was computed. An indicator of flexible use of defenses was also calculated based on the Gini Concentration C measure. Results showed that defensive flexibility, but not ODF, could predict anxiety scores. Symptom severity was predicted by both ODF and defensive flexibility, although in directions opposite to our predictions. Results suggest that defensive flexibility captures another aspect of an individuals functioning not assessed by the ODF, and that it is a promising new way of documenting defensive functioning.