Patient Participation in Psychodynamic Psychotherapy: Contributions of Alliance and Therapist Technique

The aim of this research is to investigate the relationship among patient participation, technique, and the working alliance during early sessions of psychodynamic psychotherapy. Participants in this study (N=88) were representative of those actually seeking outpatient treatment at a university-based community clinic. Results demonstrated that greater use of psychodynamic techniques is related to greater patient participation in early session process during psychodynamic psychotherapy (r=.23, p=.03). Moreover, greater use of two specific psychodynamic interventions was found to be significantly related to patient participation: “The therapist encourages the exploration of feelings regarded by the patient as uncomfortable” (r=.24, p=.03),” and “The therapist focuses attention on similarities among the patient’s relationships repeated over time, settings or people” (r=.33, p=.001). The relationship between overall working alliance and patient participation was also found to be significant (r=.50, p<.0001). In addition, results demonstrated that higher levels of various facets of the working alliance are related to greater patient participation: Goals and Tasks (r=.43, p<.0001), Confident Collaboration (r=.39, p=.0002), Bond (r= .37, p=.0003) and Idealized Relationship (r=.34, p=.001). Finally, in order to highlight the relative contribution among alliance, technique, and participation, an examination of mediation was conducted. Results demonstrated that although both alliance and technique independently related to patient participation in a significant manner, alliance and technique were not significantly related to one another, indicating that the criteria for a meditational model were not met.