Therapist actions that address initially poor therapeutic alliances in psychotherapy

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.

Therapists' actions that influence their perceptions of "good" psychotherapy sessions

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.