Faculty Bibliography

The authors studied six patients treated in time-limited dynamic psychotherapy who had initially poor therapeutic alliance scores; three patients went on to have improved alliances and good outcomes, and three had unimproved alliances and poor outcomes. The therapist actions that most strongly differentiated the two groups and occurred more frequently in the cases with improved alliances and good outcomes were 1) addressing the patient's defenses, 2) addressing the patient's guilt and expectation of punishment, 3) addressing the patient's problematic feelings in relation to the therapist, and 4) linking the problematic feelings in relation to the therapist with the patient's defenses

The authors studied two groups of persons who had experienced either the death of a mother or father. One group consisted of patients who had sought treatment because of pathological aspects of bereavement. The other group consisted of volunteers selected from a review of hospital death records, which indicated the recent death of their parent. The study used a nonequivalent groups design, where both groups were followed over time. The field subjects were initially seen much sooner after the death than the patients. The patient group received a time-limited dynamic therapy focused on the stress response syndrome induced by the death. At the pretherapy evaluation point, the patient sample had significantly higher levels of symptomatic distress than did the nonpatient sample. The distress declined over a 13-month period, so that patients had comparable levels of distress to that of the field subjects. After adjusting for initial values, the main difference was that patients reduced their avoidant operations more than did the field subjects. Intervening variables were assessed for the prediction of change in symptoms over time as related to the parental death. The variables that showed significant correlations to symptomatic change were cumulative negative life events from varied sources, occupation, social class, developmental level of the self-concept, identity of the deceased parent, and attribution of blame for the death. Social support did not relate to change in symptoms over time

We studied the relationship of dispositional and process variables with outcome in 52 bereaved patients given time-limited dynamic psychotherapy. Outcomes were generally favorable in symptom relief and improvement in relationship and occupational functioning. Patients' symptoms improved more than did their social and work functioning. Pretreatment levels of impairment or distress were significantly related to outcome, but most demographic and dispositional variables did not predict outcome. Process variables examined in relation to outcome--therapeutic alliance and actions by the therapist--were not significantly related to either type of outcome. When we considered the same process variables in interaction with two dispositional variables, motivation for dynamic therapy and developmental level of the self-concept, we found significant predictions of outcome. The major findings suggest that more exploratory actions were more suitable for highly motivated and/or better-organized patients and less suitable for patients with lower levels of motivation or organization of self-concept. More supportive actions were more suitable for patients at lower dispositional levels and less therapeutic for patients at higher levels

Psychotherapists' and an independent observer's ratings of the 'good' to 'poor' quality of therapy sessions were correlated with their ratings of various therapist actions. As predicted, significant positive correlations were obtained between the goodness ratings and the emphasis given by therapists to actions encouraging patients' expression of thoughts and feelings and the exploration of their reactions. For a number of other actions, however, therapists and the independent observer disagreed about whether emphasis of the actions correlated with 'good' or 'poor' sessions. Some possible causes and implications of these differences are discussed

Correlated the ratings of therapists and an independent judge for 27 psychotherapy sessions to determine if therapists could reliably rate their own actions using the Therapist Action Scale. 25 patients (mean age 36.8 yrs), all undergoing treatment for stress response syndromes after parental bereavement, were seen in the sessions. Data indicate a wide range of correlations, with the generally weak magnitude of relationships suggesting that therapists may be poor reporters of their own actions. Some possible sources of therapist-observer discrepancies are discussed, and the need for caution is emphasized when evaluating the reports of therapists as descriptions of actual clinical process. (24 ref)

The authors describe the development of patient and therapist alliance scales and their application to the therapies of selected patients with good and poor outcomes following brief psychodynamic psychotherapy. They focus on therapist and patient contributions to the attitudinal-affective climate of the therapy rather than on specific therapist techniques. The findings support the value of separating the contributions to the therapeutic alliance made individually by the therapist and the patient. Only the patient's contribution to the therapeutic alliance was predictive of outcome. Patients who developed and maintained positive attitudes toward the therapist and the work of therapy achieved the greatest gains

A cohort of patients seeking help at a clinical research center providing time-limited brief therapy for posttraumatic stress disorders was assembled. The single life event experienced by each was death of a parent. A nonequivalent comparison group was gathered by review of hospital death records. Both groups received the same type of evaluation interview and completed the same measures, which were similar to those done for both groups by the clinical interviewer. These data indicated that while both groups contained persons with medium to high distress levels, the patient group was most uniformly composed of such persons; when compared with the field-study group, the patient group had significant and important elevations of distress levels