Interaction Between Alliance and Technique in Predicting Patient Outcome During Psychodynamic Psychotherapy

Abstract

The current study examined whether alliance interacted with psychodynamic interventions to predict patients' psychotherapy outcomes. A prospective study of psychodynamic psychotherapy with 68 outpatients who were treated by 23 therapists was used. The patients rated the alliance with their therapist early in treatment. Therapist use of psychodynamic techniques was reliably rated by independent clinicians for the same sessions. The therapy outcomes were measured at the end of treatment based on the patients' global symptomatology as well as estimate of improvement across a broad range of functioning. In all models, we controlled for the patients' pretherapy psychiatric severity. Analyses were conducted using multilevel modeling to account for therapist effects. Results revealed that patient rated alliance was significantly related to improvement on a measure of broad band functioning. In addition, alliance and psychodynamic interventions interacted to predict this scale of multidimensional therapy outcome. Further, results showed that several individual psychodynamic techniques interacted with alliance that were meaningfully related to this measure of broad band outcome including (1) linking current feelings or perceptions to the past; (2) focusing attention on similarities among patient's relationships repeated over time, settings, or people; and (3) identifying recurrent patterns in patient's actions, feelings, and experiences. In this sample of outpatient psychodynamic treatments, the dynamic techniques were most effective when provided in the context of strong alliances.

Goldilocks on the couch: Moderate levels of psychodynamic and process-experiential technique predict outcome in psychodynamic therapy

“…Some researchers have productively explored the interaction of dynamic techniques and therapeutic alliance in predicting outcome (e.g., Barber et al, 2008;Gaston et al, 1998;Høglend et al, 2011;Owen & Hilsenroth, 2011). Others have examined how competent delivery of dynamic techniques relates to symptom change (e.g., .…”

Addressing Mental Health Disparities With Asian American Clients: Examining the Generalizability of the Common Factors Model

“…Our findings in no way suggest that clients' perceptions of their counselors' cultural competencies are not important. Indeed, previous studies, including those with mainly Asian American client samples, have demonstrated that clients' perceptions of their counselors' cultural orientation are associated with better therapy outcomes (e.g., Owen, Leach et al, ; Owen, Tao et al, ). Rather, this study was aimed at understanding whether specific therapeutic factors may be endorsed more favorably by Asian Americans.…”

“…Although a lot of attention has been commensurate with this idea, there is still literature that identifies effective counseling practice as consisting of specific interventions and therapeutic processes. Such suggestions are tantamount to promoting stereotypes and could contribute to microaggressions in therapy (Constantine, ; Owen, Imel et al, ). Although more research is needed to strongly assert one way or another about the evidence base for culturally specific interventions, our research suggests that there are no significant differences in helpful interactions and, as such, there is no reason to believe that implementing culturally adapted treatments with Asian American clients will reduce mental health disparities.…”

The Role of Therapist Activity in Psychodynamic Psychotherapy

“…These results imply that an engaged therapist, who reviews the problems to be addressed and participates actively in the change process, is viewed by patients as most helpful. Owen and Hilsenroth (2011) demonstrated that patient-rated alliance in the psychodynamic treatment of 68 outpatients was significantly related to improvement on a measure of broad functioning. Specific psychodynamic techniques, including linking current feelings or perceptions to those from the past, focusing on repetitive relational patterns over time, and identifying recurrent patterns in the patient's actions, feelings, and experiences, were all found to enhance alliance in ways that improved outcome (Owen & Hilsenroth, 2011).…”

“…Owen and Hilsenroth (2011) demonstrated that patient-rated alliance in the psychodynamic treatment of 68 outpatients was significantly related to improvement on a measure of broad functioning. Specific psychodynamic techniques, including linking current feelings or perceptions to those from the past, focusing on repetitive relational patterns over time, and identifying recurrent patterns in the patient's actions, feelings, and experiences, were all found to enhance alliance in ways that improved outcome (Owen & Hilsenroth, 2011). In another study by this same team (Owen, Hilsenroth, & Rodolfa, 2012), alliance measures from both cognitive-behavioral and psychodynamic treatments were obtained and compared, leading the authors to conclude that the specific and active psychodynamic techniques utilized in both groups were associated with postsession change.…”