Differential effects of interventions on the therapeutic alliance with patients with personality disorders

The goal of this study was to examine the relationship between clearly defined therapist interventions and the therapeutic alliance with personality-disordered patients. Transcripts of one psychotherapy session for each of 5 subjects taking part in a long-term psychotherapy research project were rated for therapist interventions and therapeutic alliance to determine if specific interventions were followed by enhanced or diminished therapeutic work. Transference interpretations were followed by a deterioration in the therapeutic alliance when the alliance was weak, but by enhanced work when the alliance was solid. In patients with both strong and weak alliances, defense interpretations and supportive interventions enhanced therapeutic work without increasing defensiveness. Supportive interventions seemed to prepare the way for exploration and to repair ruptured alliances.