Therapist actions that address initially poor therapeutic alliances in psychotherapy

Abstract

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