Therapist's interventions and therapeutic alliance: A single case study

Therapist's interventions and therapeutic alliance: A single case study Daniela Gentile, Sapienza University of Rome, Italy; Veronica Di Donato; Antonello Colli; Vittorio Lingiardi; Mark Hilsenroth As reviewed by Hilsenroth, Cromer and Ackerman (2012), there are specific therapist's interventions that can improve or deteriorate therapeutic alliance. However, few studies have examined the association between specific therapist's interventions and within session collaboration level. This study, that represents an extension of a previous research by Mayotte-Blum et al. (2012), examines the relationship between therapist's interventions with therapeutic alliance ruptures and resolution processes in a long-term case of psychodynamic psychotherapy, The sample consisted of 16 sessions over 4 years of treatment (first 4 sessions, 4 sessions from year 1, 4 sessions from year 3, the last 4 sessions). Prior to treatment the client signed a consent form to participate in research. All sessions from treatment were videotaped and conducted at a university-based clinic. Patient. Ann, was a 25 year-old single White female enrolled in a master's of arts program for Social Work. She originally entered psychotherapy experiencing four acute stressors within the same month: the death of her grandmother, the end of a long-term relationship with a boyfriend, problems in her graduate program, and difficulties with her externship supervisor. Therapist. Dr. M was a 35-year-old married White male at the beginning of treatment with Ann. He was a licensed and board-certified clinical Ph.D. psychologist with (at that time) 9 years of postdoctoral experience. Raters. Two groups of independent raters evaluated the sessions. The raters are Clinical PhD graduate students with excellent reliability in the use of the CPPS (ICC = .78) and CIS-R (ICC = .83).Measures The Brief Symptom Inventory (BSI; Derogatis, 1993) was used for the assessment of symptoms distress, at the beginning and at the end of treatment. The Social Adjustment Scale (SAS; Weissman & Bothwell, 1976) was used as an outcome indicator of social/occupational functioning and the Inventory of Interpersonal Problems (IIP; Horowitz, Rosenberg, Baer, Ureno, & Villasenor, 1988) for the assessment ofinterpersonal functioning. The Collaborative Interactions Scale (Colli & Lingiardi, 2009) was used for the evaluation of therapeutic alliance ruptures and resolution processes and therapist's interventions have been evaluated with the Comparative Psychotherapy Process Scale (Blagys & Hilsenroth, 2000, 2005).Results. Ann had demonstrated clinically significant change (Jacobson et al., 1999) in overall symptomatology, interpersonal functioning, social and occupational functioning. Dyadic analysis of data showed the association between patient's collaboration level and therapist's techniques and underlined the mutual and reciprocal influence between patient and therapist. Clinical utility of these results will be discussed.