Accuracy of therapist perceptions of patients' alliance: Exploring the divergence.

OBJECTIVE: The therapeutic alliance is a well-established predictor of psychotherapy outcome, yet much research has shown that therapists' and patients' views of the alliance can diverge substantially. Therapists systematically underestimate their patients' perceived level of alliance, and the correlation between therapist and patient estimates of patient alliance is only moderate. The present study explored the divergence between therapists' and patients' perspectives on patients' alliance experience, and its relations to therapists' concurrent work involvement and session process experiences. METHOD: Data from 98 patients treated by 26 therapists with psychodynamic psychotherapy were analyzed. RESULTS: Therapist-patient divergence was significantly related to therapists' case-wise work involvement, but not to therapist's views of session process. The best predictor of therapist-patient divergence was therapists experiencing a "distressed practice" work involvement pattern. CONCLUSION: Although therapists' work involvement experiences are not commonly investigated, they can be a relevant predictor of therapy processes.

Psychotherapists' personal identities, theoretical orientations, and professional relationships: elective affinity and role adjustment as modes of congruence.

Research shows psychotherapists espousing different theoretical approaches differ in mentality (e.g., cognitive styles, beliefs and epistemologies) and personality (e.g., neuroticism). However, studies have not investigated the association between professional relational style prescribed by therapists' theoretical orientations and therapists' manner of relating in personal life. Analyses of over 4000 therapists of varied nationalities, professions and career levels having different theoretical preferences indicate: (i) therapists' self-experience in close personal relationships was significantly associated with the manner their theoretical orientations prescribed for relating with clients; (ii) therapists were less accepting, less tolerant and more demanding in their personal relationships than with clients; and (iii) therapists adjusted their professional relational manner in practice to meet the specific expectations of their preferred orientations.

Stressful involvement in psychotherapeutic work: therapist, client and process correlates.

We examined potential predictors of therapists' "Stressful Involvement" (SI) among variables reflecting the psychotherapy process, therapist characteristics, patients' symptom severity or context variables (treatment setting). Ninety-eight sequences from individual psychodynamic treatments conducted by 26 therapists were studied. Data were analyzed using mixed regression models. Between-therapist and within-therapist variance accounted for most of the difference in SI. SI was strongly associated with negative feelings of the therapist about patient and therapy in the time between sessions. Therapists with more 'unassertive' and 'vindictive' interpersonal styles were also more prone to experiencing SI. The strong association of SI with therapist rather than patient characteristics and process ratings indicates the importance of further study of the therapist as a person and participant in psychotherapy.