Therapeutic immediacy across long-term psychodynamic psychotherapy: an evidence-based case study.

C. E. Hill (2004) recently developed the concept of therapist immediacy to capture discussion by the therapist about the therapeutic relationship that occurs in the here-and-now of a therapy session. This concept has been expanded to include discussion about the therapeutic relationship by both the client and therapist, captured by the term therapeutic immediacy (K. Kuutmann & M. Hilsenroth, 2011). Although prior research has examined the use of therapeutic immediacy across short-term treatment, the present study is the first to examine the use of immediacy across a long-term (4 years) psychotherapy. Also, this is the first study to assess the interrater reliability of therapeutic immediacy, which was found to achieve good to excellent levels across raters. The most frequently used categories of client and therapist immediacy are presented. Finally, the authors provide an in-depth qualitative examination of 5 therapeutic immediacy segments across the treatment judged by the raters to have high levels of depth/intensity (4.5 or higher out of 5) to examine the role of therapeutic immediacy in exploring meaningful treatment issues. Clinical utility, potential limitations, and future research on therapeutic immediacy are discussed.

Interpersonal dependency in borderline personality disorder: clinical context and empirical evidence.

Personality theorists and practicing clinicians agree that high levels of interpersonal dependency play a role in Borderline Personality Disorder (BPD), and this link has been codified in several editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Although there is widespread agreement that dependency is linked to BPD, there has never been a systematic review of empirical evidence bearing on this issue. This article reviews research in three areas: (1) the comorbidity of Dependent Personality Disorder (DPD) and BPD; (2) the association between trait dependency and BPD; and (3) differences in free-response (i.e., Rorschach) dependency scores in BPD and non-BPD patients. Results support DSM assertions of DPD-BPD comorbidity, confirm that high levels of trait dependency are associated with BPD traits and symptoms, and show that high levels of implicit dependency needs are present in BPD-diagnosed inpatients, but not BPD outpatients. Theoretical, clinical, and empirical implications of these patterns are discussed.