Aim: Research showed that alliance is the best predictor of outcome in
psychotherapy. In psychodynamic psychotherapy, therapist's
interventions do not initially aim at addressing the alliance. Instead, we
found in a previous study that high early alliance was related to
therapist's interventions that (1) are adjusted to the patient's dynamic
characteristics, and (2) adequately address these characteristics when
problematic. This study aims at exploring the link between therapist
interventions and patient defenses during the mid-phase of the therapy,
which is more related to rupture-repair sequences.
Method: The sample included 50 students with adjustment
disorder (AD) during short term dynamic psychotherapy. Patient and
therapist filled in the Helping Alliance questionnaire after each
session. Rupture and repair pattern was defined as a session with an
alliance at least 1.5 S.D. lower than the mean alliance, followed by a
session with a raising of the alliance of more than 1 S.D. Adjustment
was measured using the Psychodynamic Intervention Rating Scale and
the Defense Mechanism Rating Scales.
Results: The pilot study on 15 cases showed a curvilinear relation
between adjustment and alliance, ruptures being related to underadjustment
(the therapist is too supportive according to the patient's
defensive functioning) or over-adjustment (the therapist is too
interpretive) (R Sq = .31). Rupture-repair sequences are also
characterized by the specific defenses addressed during these sessions.
Discussion: Alliance is not-or not only-a common factor in
psychotherapy but also a very specific one, emerging from the
adequate use of psychodynamic interventions according to the context.