A moderating factor for patients with vindictive interpersonal problems

Abstract

_Abstract (English):_ Individuals high in vindictive interpersonal problems tend to experience and express anger and irritability. In treatment, they have poor prognosis for alliance and outcome. We propose that positive expectation may serve as a moderating factor for these patients. In the current study, we examined the ability of expected alliance to act as a moderating factor in the early process and early progress of treatment for patients with vindictive interpersonal problems. A sample of 65 patients received short-term dynamic psychotherapy. At intake, before meeting the therapist, participants completed assessments for vindictive interpersonal problems and expected alliance. All therapy sessions were videotaped, and Session 2 was coded for confrontation ruptures. Early progress was assessed using the improvement from intake to Week 2 in the measure of distress from interpersonal relations. Our results show that, at high levels of vindictive interpersonal problems, higher expected alliance was associated with fewer confrontation ruptures. At high levels of vindictive interpersonal problems, higher expected alliance was associated with greater early improvement in distress from interpersonal relations. The findings demonstrate how positive expectations may function as a moderating factor that enables patients with vindictive tendencies to achieve a positive process and progress early in treatment. (PsycInfo Database Record (c) 2021 APA, all rights reserved) _Impact Statement:_ Clinical Impact Statement—Question: Can more positive alliance expectations serve as a resilience factor in the early process and outcome of treatment for patients with vindictive interpersonal problems. Findings: Patients with higher levels of vindictive interpersonal problems who are able to hold higher expectations from the therapist before the start of treatment are less at risk to show early confrontation ruptures and more likely to have early reduction in distress from interpersonal relations. Meaning: The study highlights an optimistic view for patients with vindictive interpersonal problems, in which positive expectations from the alliance before the start of treatment may function as a resilience factor enabling a better process and early outcome. Next Steps: Future studies should systematically examine the long-term effects of positive alliance expectations as a resilience factor for treatment success in patients with higher levels of vindictive interpersonal problems. (PsycInfo Database Record (c) 2021 APA, all rights reserved)