Evaluation of the therapeutic alliance and patient-therapist emotional exploration in time -limited therapy.

摘要

This study investigated the relationship between the patient-therapist working alliance and depth of in-session psychological exploration for both patient and therapist in the early phase (first six sessions) of brief psychotherapy protocols. It examined 29 psychotherapy dyads who completed a 30-session treatment protocol. The strength of the working alliance was measured by the patient- and therapist-rated Working Alliance Inventory, Short Form (WAI-S; Tracey & Kokotovic, 1989). Depth of psychological exploration for patient and therapist was assessed by an observer-rated measure, The Experiencing Scale (EXP; Gendlin, 1961; Klein, Coughlin, and Kiesler, 1986). The study's primary objective was to demonstrate that patients and therapists who endorsed high working alliance scores over the first three treatment sessions would be rated as having high levels of psychological exploration in the subsequent three sessions. Additionally, the study investigated three other hypotheses: (1) patient ratings of the working alliance would be a better predictor of their own depth of psychological exploration; (2) discrepancies between patient and therapist ratings of working alliance would predict a lower level of psychological exploration for both patient and therapist, and (3) level of patient exploration would be positively associated with level of therapist exploration. Another objective of the study was to demonstrate that patients who were rated as having high levels of psychological exploration would be associated with a reduction in symptomatology, as assessed by two outcome measures, the Symptom Checklist 90-Revised (SCL-90 R; Derogatis, 1983), and the Inventory of Interpersonal Problems-32 (IIP-32; Barkham, Hardy, & Startup, 1996). Results demonstrated that: (1) higher working alliance scores were not associated with greater depth of psychological exploration for either patients or therapists in the early phase of treatment, (2) patient working alliance ratings did not better predict patient level of exploration; (3) patients and therapists did not substantially differ in their ratings of alliance, and consequently, discrepancy scores did not predict depth of exploration for either member of the dyad, and (4) observer ratings of patient and therapist levels of psychological exploration were strongly associated with each other. Additionally, patients who displayed high levels of psychological exploration demonstrated a reduction in symptomatology as measured by the SCL-90, but did not when symptomatology was assessed using the IIP-64. Implications and recommendations for future research are discussed.