Weakenings and repairs of the working alliance in short-term psychotherapy.

Abstract

The purpose of this study was to investigate how the weakening and repair of the working alliance in short-term psychotherapies relate to change in therapy. In six short-term, timelimited therapies, weakenings and repairs were identified with a unitized process ratings scale. Though the data must be considered preliminary, interesting relations emerged. Patients with greater ego strength had a higher initial quality of alliance with their therapist and were better able to work to repair any weakenings. These patients also exhibited a growing use of observing ego in their increasing ability to initiate talk about weakenings. Highest levels of patient alliance were preceded by high levels of therapist repair action. The success with which weakenings and repairs were handled was predictive of the general outcome of therapy. Surprisingly, more frequent interpretations of transference allusions were associated with poor outcome. The working alliance is defined as the relatively nonneurotic, rational rapport between the patient's observing ego and the analyst's analyzing ego. An essential aspect of this alliance is the ability to split one's observing ego from one's experiencing ego, and to ally the observing ego with the therapist's analytic stance (Dickes, 1975; Freud, 1933; Sterba, 1934; Zetzel, 1956). The ability to form and maintain a working alliance is related to the soundness of a person's object relations or psychological health (Dickes, 1975; Greenson, 1965; Ryan, 1973; Zetzel, 1956). Development of the alliance is benefited by active therapist participation in fostering the alliance (Greenson, 1965; Lehrke, 1978; Sterba, 1934), and is diminished by resistances. However, analysis of resistance can strengthen the development of the alliance (Sandier, Dare, & Holder, 1973). The strength of the alliance should be expected to vary over the course of any given therapy. Bordin (1976, 1980) proposed the idea that psychotherapy was best understood as the building and repair of a strong working alliance. He viewed this building and repair as the mutual resolution of difficulties in working together, and considered it to be the process that allowed change to occur. In this context, the building and repair of the alliance