Therapeutic alliance evaluation in personality disorders psychotherapy

This preliminary study examined the relationship among personality disorders, therapeutic alliance, psychiatric symptoms, and dropout behaviour. Forty-seven adult personality disorder outpatients seeking psychotherapeutic treatment were evaluated. The authors found that ( a) the strength of specific early therapeutic alliance indices ( Working Strategy Consensus and Therapist Understanding and Involvement) are significantly associated with later dropout; (b) Diagnostic and Statistical Manual of Mental Disorders (4th edition) Cluster A patients have difficulty establishing working alliance; ( c) therapists evaluate alliance with Cluster B patients negatively; and (d) therapists' evaluations are always lower than patients' evaluations. The implications of these results are discussed.