The relationship of patient defensive functioning and alliance with therapist technique during short-term psychodynamic psychotherapy

Abstract

This study investigates the relationship of patient defensive functioning, therapeutic alliance and therapists' use of technical interventions in Short-Term Psychodynamic Psychotherapy (STPP; Book, 1998; Luborsky, 1984; Strupp & Binder, 1984; Wachtel, 1993). Participants in this study were 44 patients admitted for individual psychotherapy at a university based outpatient community clinic. Patient defensive functioning was assessed with the Defensive Functioning Scale (DFS) of the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994). Therapeutic alliance was assessed using patient ratings from the Combined Alliance Short Form (CASF; Hatcher & Barends, 1996). External raters coded videotaped sessions using the Comparative Psychotherapy Process Scale (CPPS; Hilsenroth, Blagys, Ackerman Bonge & Blais, in press) to assess the use of Psychodynamic–Interpersonal (PI) and Cognitive–Behavioral (CB) techniques early (third or fourth session) in psychotherapy. Patient Overall Defensive Functioning (ODF) was found to predict therapists' overall use of PI interventions, as well as specific PI and CB interventions. Additionally, patients who utilized fewer adaptive defenses were found to receive more PI interventions in general. The implications of these findings for treatment planning and intervention are discussed. Copyright © 2006 John Wiley & Sons, Ltd.