Patient personality and relational patterns in psychotherapy. Factor structure, reliability, and validity of the Psychotherapy Relationship Questionnaire

The aim of this study was to examine the factor structure and the psychometric properties of the Psychotherapy Relationship Questionnaire (PRQ; Bradley, Heim, & Westen, 2005), a clinician report instrument that measures a wide spectrum of thoughts, feelings, motives, conflicts, and behaviors expressed by patients toward their therapists in psychotherapy. A national sample of psychiatrists and clinical psychologists (N   = 314) of different theoretical orientations completed the PRQ, as well as the Shedler–Westen Assessment Procedure–200 (SWAP–200; Westen & Shedler, 1999a, 1999b) to assess the personality of a patient in their care. Factor-analytic procedures identified 6 transference dimensions that showed excellent internal consistencies: (a) hostile, (b) positive/working alliance, (c) special/entitled, (d) anxious/preoccupied, (e) avoidant/dismissing attachment, and (f) sexualized. Factor scores were significantly related to patients’ personality characteristics and psychological functioning, regardless of the clinicians’ orientations. The findings support that the PRQ is a valid and reliable tool for evaluating the patients’ relational patterns emerging in clinical practice in a clinically coherent and psychometrically robust way. Clinicians’ careful understanding of these patterns can be very useful for making accurate diagnostic formulations, as well as for providing a roadmap for effective therapeutic intervention.