Testing a mediation model of psychotherapy process and outcome in psychodynamic psychotherapy: Previous client distress, psychodynamic techniques, dyadic working alliance, and current client distress

• Published in: Psychotherapy research Vol. 29; no. 5; pp. 581 - 593
• Main Authors: Kivlighan, Dennis M., Hill, Clara E., Ross, Katherine, Kline, Kathryn, Furhmann, Amy, Sauber, Elizabeth
• Format: Journal Article
• Language: English
• Published: England Routledge 03.09.2019; Taylor & Francis Ltd
• Subjects: Adolescent; Adult; Aged; aliança de trabalho; alleanza terapeutica; angústia do cliente; análise de mediação; Behavioral Symptoms - therapy; client distress; Clinical research; disagio del paziente; Family counseling; Female; Humans; Interpersonal problems; Male; mediation analysis; Middle Aged; Outcome Assessment, Health Care; psychodynamic techniques; Psychological Distress; Psychotherapeutic Processes; Psychotherapy; Psychotherapy, Psychodynamic; tecniche psicodinamiche; Therapeutic Alliance; Therapeutic alliances; técnicas psicodinâmicas; working alliance; Young Adult; 心理治療技術、工作同盟、案主的痛苦、中介分析; mediation analysis; psychodynamic techniques; client distress; working alliance
• ISSN: 1050-3307; 1468-4381
• DOI: 10.1080/10503307.2017.1420923

To test a sequential model of psychotherapy process and outcome, we included previous client distress, therapist psychodynamic techniques, dyadic working alliance, and current client distress. For 114 sets of eight-session segments in 40 cases of psychodynamic psychotherapy, clients completed the Outcome Questionnaire-45 and Inventory of Interpersonal Problems-32 after the first and final session, judges reliably coded one middle sessions on the Psychodynamic subscale of the Multitheoretical List of Therapeutic Interventions, and clients and therapists completed the Working Alliance Inventory after every session. Results indicated that higher use of psychodynamic techniques was associated with higher levels of the working alliance, which in turn was associated decreased client distress; and working alliance was higher later in psychotherapy. There was a significant indirect effect of psychodynamic techniques on decreases in distress mediated by the working alliance. Implications for theory, practice, and research are provided. Clinical or methodological significance of this article: Conducted a longitudinal, latent variable examination of the relationships of psychodynamic techniques and working alliance on client distress. Psychodynamic techniques have an indirect effect on decreases in client distress through the dyadic working alliance.