ABSTRACT
Although supportive techniques play an important role in supportive-expressive psychodynamic psychotherapy, little is known about the mechanisms responsible for their effect on treatment success. In this study, we propose and investigate a model according to which the mechanism of change underlying the effect of supportive techniques on therapeutic improvement is the strengthening of the therapeutic alliance. According to the proposed mediation model, the implementation of supportive techniques brings about strengthening in the alliance, which in turn results in subsequent reduction in symptoms. The present study was designed to test the proposed mediation model. Analyses were conducted on a sample of 61 patients diagnosed with major depressive disorder and enrolled in an ongoing psychotherapy trial. For each patient, Session 4 of the supportive-expressive treatment was coded for therapist adherence to supportive techniques, using the Penn Adherence-Competence Scale. The therapeutic alliance was assessed using a self-report scale, and the Hamilton Rating Scale for Depression was used to assess the subsequent change in symptoms. The analyses suggest a significant mediation model, according to which the implementation of supportive techniques resulted in improvements in the alliance, which in turn resulted in reduction in symptoms at the subsequent session (bootstrapping for the indirect effect, 95% confidence interval [-1.96, -0.16]). The findings support the proposed mediation model, suggesting that the alliance may act as a mechanism of change underlying the effect of supportive techniques on treatment success. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Subject(s)
Depressive Disorder, Major , Psychotherapy, Psychodynamic , Therapeutic Alliance , Depressive Disorder, Major/therapy , Humans , Longitudinal Studies , Professional-Patient Relations , Treatment OutcomeABSTRACT
Independent judges rated transference, countertransference, therapist emotional expression, and session quality, in videotaped sessions of Supportive Expressive Psychotherapy for Depression over time. Based on 44 patients and four therapists, HLM analyses suggested that negative transference predicted therapist expression of negative affect. While negative transference predicted a rough session, positive transference predicted a deep session. Positive countertransference and positive affect predicted a smooth but superficial session, with positive transference sometimes acting as a moderator. Sessions became less deep and smoother over time, with therapist emotional expression moderating the relationship between treatment phase and depth. The results suggest that positive countertransference behaviors and feelings have a particularly negative impact on a session and that transference contributes to a deep and rough session.
Subject(s)
Countertransference , Depressive Disorder/therapy , Emotions , Professional-Patient Relations , Psychotherapy , Transference, Psychology , Adult , Female , Humans , Male , Middle Aged , Process Assessment, Health CareABSTRACT
The influence of treatment preferences on the development of the therapeutic alliance was investigated. Seventy-five patients were followed while participating in a randomized controlled trial comparing supportive-expressive psychotherapy with sertraline or pill placebo in the treatment of major depressive disorder. Therapeutic alliance was assessed before treatment and at the 3rd, 5th, and 9th weeks of treatment. Among patients initially preferring psychotherapy, those receiving psychotherapy experienced increases in their alliance over time, whereas those receiving active medication or placebo experienced decreases. Among patients preferring pharmacotherapy, there were no differences in alliance development whether they received psychotherapy, active medication, or placebo. These relations were observed even when controlling for symptom severity. Thus, the congruence of patients' treatment preference and the treatment that they ultimately received influenced the development of the therapeutic alliance. Because alliance is a robust predictor of outcome, treatment preferences may need to be carefully considered in randomized controlled trial settings.
