Difficult dyads and unsuccessful treatments: A comparison of dropout, poor, and good outcome groups in brief psychotherapy.
Item
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Title
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Difficult dyads and unsuccessful treatments: A comparison of dropout, poor, and good outcome groups in brief psychotherapy.
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Identifier
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AAI9908358
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identifier
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9908358
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Creator
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Samstag, Lisa Wallner.
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Contributor
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Adviser: Paul L. Wachtel
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Date
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1998
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Language
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English
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Publisher
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City University of New York.
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Subject
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Psychology, Clinical
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Abstract
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The focus of this study was interpersonal processes of difficult patient-therapist dyads and early identification of treatment failures in 30-session psychotherapy protocols. Forty-eight dyads were equally divided into premature dropout (DO), poor outcome (PO), or good outcome (GO) conditions. Patients were treated at Beth Israel Medical Center and most met criteria for anxious-avoidant personality disorders. Groups were compared on: (1) the patient- and therapist-rated Working Alliance Inventory (WAI-12; Horvath & Greenberg, 1986; Tracey & Kokotovic, 1989); (3) the observer-rated Structural Analysis of Social Behavior (SASB; Benjamin, 1974; Benjamin, Giat, & Estroff, 1981); and (3) observer-rated Narrative Coherency from the Adult Attachment Interview (AAI; Main & Goldwyn, unpublished manuscript).;Results showed that subscores of each measure significantly differentiated outcome groups, and that the DO condition was not consistently found to have the most difficult therapeutic relationships, as hypothesized: while the DO group had the most problematic alliances compared to PO and GO groups, respectively, and the most incoherent narratives compared to the GO group, the PO condition demonstrated the highest level of hostile complementarity relative to the GO condition. PO patients also reported fewer early attachment losses and traumas at intake compared to GO patients. Significant intercorrelations among measures found: (1) direct relationships among patient WAI-12 Bond and Total scores with Narrative Coherency; (2) indirect relationships among patient WAI-12 Goal, Task, and Total scores with SASB Negative Complementarity; (3) indirect relationships among all therapist WAI-12 scores with SASB Negative Complementarity; (4) indirect relationships between Narrative Coherency with both SASB Negative and Neutral Complementarity; and (5) a direct relationship between Narrative Coherency and SASB Positive Complementarity.;These findings suggest qualitative interpersonal differences among dyads in the three outcome groups and that patients and therapists do not consider similar aspects of the relationship to carry therapeutic importance. Narrative Coherency, adapted from the AAI and first used here in psychotherapy, points to a possible relationship between a patient's attachment system and their capacity to bond with a therapist. Overall, these results speak to the highly complex nature of the therapeutic relationship and have clinical implications for time-limited treatment of personality disordered patients at risk for treatment failure.
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Type
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dissertation
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Source
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PQT Legacy CUNY.xlsx
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degree
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Ph.D.
