Thursday, July 10, 2008

Theory-based research for understanding dynamic psychotherapy

Luborsky, L., Barber, J.P., & Crits-Christoph, P. (1990). Theory-based research for understanding the process of dynamic psychotherapy. Journal of Consulting and Clinical Psychology, 58, 3, 281-287.

This article reviews empirical support for 6 basic theoretical assumptions central to psychodynamic psychotherapy. (1) A therapeutic alliance must develop. The strength of therapeutic alliance (the collaborative and affective bond between therapist and client) is shown to predictive of positive outcomes. (2) Patients display transference. Trends from existing studies show central relationship patterns exist which are largely consistent over time and may be projected onto the therapist. (3) Accurate interpretations of transference by the clinician lead to increased benefits for the client. Findings are inconsistent on this point, specifically on the relation between increased number of transference interpretations and outcomes. Mediators may exist, such as how the patient responds to the interpretation. (4) The patient will benefit more from more accurate interpretations. Accurate interpretations correlate with "better" sessions. Accuracy of interpersonal aspects of interpretation predicted outcomes best. (5) Increased insight about themselves and their relationships with others leads to better outcomes. Gaining an understanding about the therapist and others is associated with outcomes. An understanding of self and parents does not seem to be as well correlated. (6) Improved patients show greater change in their transference patterns. Results are consistent with the theory that transference still exists but is under better control and mastery. Patients' expectations of how others will respond becomes less negative and their mental health improves.

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