Testing and therapeutic alliance

According to Control-Mastery Theory, people come to therapy with an unconscious plan, to overcome their pathogenic beliefs and achieve adaptive goals. One of the primary ways patients work in therapy to disconfirm their pathogenic beliefs is by testing their validity in the therapeutic relationship. The clinician or researcher, based on the transcripts of the first hours of therapy, can reliably formulate the patient's plan using the Plan Formulation Method (Curtis & Silberschatz, 2007). Previous studies suggest that therapeutically effective interventions to patient tests are those compatible with the patient's plan, i.e., those that disconfirm his/her pathogenic beliefs and support him/her in achieving his/her goals (Silberschatz & Curtis, 1993; Silberschatz, 1986; Silberschatz et al., 1986; Horowitz et al.,1975). The aim of this study is partly to replicate the results of previous empirical research, suggesting that therapist’s pro-plan interventions to patient tests are predictive of patient’s within-session progress, but also to investigate whether these interventions are predictive of treatment outcome and of the positive working alliance. The transcripts of five brief psychodynamic psychotherapies were rated. For each case, patient's plan was formulated, patient-initiated critical incidents (tests) were identified, the case-specific accuracy of the therapist's responses to these incidents was rated, and the impact of these interventions on subsequent patient’s affect and behavior, on working alliance and on treatment outcome was measured. If these predictions are confirmed, the results of this study may increase our understanding of the link between psychotherapy processes and treatment outcomes.