Exploring In‐Session Focus on the Patient–Therapist Relationship: Patient Characteristics, Process and Outcome

Abstract

This study explored the amount of in‐session focus on the patient–therapist relationship during early treatment with patient pre‐treatment interpersonal style, personality pathology, patient ratings of session process and outcome. The sample consisted of 76 outpatients engaged in short‐term psychodynamic psychotherapy. Results showed that higher levels of pre‐treatment personality pathology and interpersonal problems were positively related to a greater focus on the patient–therapist relationship early in treatment. This was especially true for patients with a cold/distant interpersonal style and low self‐esteem. Moreover, these two patient pre‐treatment characteristics demonstrated a significant change over the course of therapy. These post‐treatment changes also demonstrated a significant relationship with greater early treatment focus on the patient–therapist relationship. In addition, we found an interaction effect between quality of object relations (i.e., higher levels of object relations) and greater early treatment focus on the patient–therapist relationship with subsequent changes in patient cold/distant interpersonal problems. Greater in‐session focus on the therapeutic relationship was not significantly related to patient ratings of session process. Implications for clinical practice and future research are discussed. Copyright © 2011 John Wiley & Sons, Ltd. Key Practitioner Message Greater levels of pre‐treatment patient personality pathology and interpersonal problems were positively related to a more here‐and‐now focus on the patient–therapist relationship in early treatment. This was especially true of patients with a cold and withdrawn interpersonal style or lower levels of self‐esteem. These patient pre‐treatment characteristics, cold/distant interpersonal style and low self‐esteem, exhibited significant change over the course of psychodynamic psychotherapy. The amount of change in these specific patient characteristics, cold/distant interpersonal style and low self‐esteem, was significantly related with a greater focus on the patient–therapist interactions that occurred in early sessions. For those patients with less impaired object relations, greater patient–therapist focus helped improve a cold/distant interpersonal style even more.

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