Therapeutic alliance and therapist performance on patients' tests

Abstract

This study examined the relationship of psychotherapist performance on patients' tests of the therapist and immediate changes in therapeutic alliance/working capacity levels. Therapeutic alliance (i.e., the behaviors and attitudes of patient and therapist that facilitate therapeutic progress) has been shown to be a powerful predictor of psychotherapy outcome. The concept of "testing" was developed by Joseph Weiss as part of his cognitive dynamic theory ("control-mastery").;Typewritten transcripts were taken from three brief psychotherapy cases that were part of a larger psychotherapy process study. Ratings of therapists' performance on patients' tests (a continuum of pass vs. fail) were also provided by the larger study. Two raters reliably rated therapeutic alliance immediately before (114 segments) and after (114 segments) therapists responded to patients' tests. A working capacity subscale was also extracted by factor analysis from the general alliance scale and rated to examine its relationship to therapist test performance.;It was hypothesized that therapist test performance would have immediate effects on posttest measures of therapeutic alliance and working capacity. The hypothesis was not confirmed. However, a multiple regression analysis yielded statistical trend in the direction of the hypothesis (multiple R =.45, p {dollar}<{dollar}.07) when potential interaction between pretest therapeutic alliance and test performance was examined. A weak negative but statistically significant relationship was found between pretest therapeutic alliance and therapist test performance multiple R =.23, r = {dollar}-{dollar}23, p {dollar}<{dollar}.01. A similar relationship was found between pretest working capacity and test performance. Findings were discussed in terms of how therapists conduct of therapy may be influenced by patients' behaviors. Particular attention therapist test performance multiple R =.23, r = {dollar}-{dollar}23, p {dollar}<{dollar}.01. A similar relationship was found between pretest working capacity and test performance. Findings were discussed in terms of how therapists conduct of therapy may be influenced by patients' behaviors. Particular attention was focused on how therapist "errors" such as failing patient tests may promote patient progress. This was related to modern dynamic theories and contrasted with more traditional analytic ideas about therapist neutrality.;Alliance and working capacity were found to be highly correlated. They were found to be stable over the short periods of time examined in the testing sequences. This is consistent with some alliance literature that suggests once it is formed, alliance remains relatively constant over longer periods of time.