Am J Psychiatry 1985; 142:922-926
Copyright © 1985 by American Psychiatric Association
Therapist actions that address initially poor therapeutic alliances in psychotherapy
SA Foreman and CR Marmar
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.
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