Transference patterns and working alliance during the early phase of psychodynamic psychotherapy

Abstract

Background/Aim. Working alliance, as a collaborative part of the therapeutic relationship has been proven to be one of the most powerful therapeutic factors in psychotherapy in general, regardless many technical differences between numerous psychotherapeutic modalities. On the other hand, transference is the basic concept of psychodynamic psychotherapy, and, according to the psychoanalytic theory and practice, it forms a major part of the therapeutic relationship. The aim of our paper was to determine the differences between the groups of patients with low, middle, and high working alliance scores and the dropout group in transference patterns, sociodemographic and clinical parameters, during the early phase of psychodynamic psychotherapy. Methods. Our sample consisted of 61 non-psychotic patients, randomly selected by the method of consecutive admissions and treated with psychoanalytic psychotherapy in the outpatient clinical setting. The patients were prospectively followed during 5 initial sessions of the therapeutic process. The working alliance inventory and Core conflictual relationship theme method were used for the estimation of working alliance and transference patterns, respectively. According to the Working Alliance Inventory scores, four groups of patients were formed and than compared. Results. Our results show a significant difference between the groups of patients with low, middle, and high working alliance inventory scores and the dropout group on the variable - transference patterns in the therapeutic relationship. Conclusion. Disharmonious transference patterns are more frequent in patients who form poor quality working alliance in the early phase of psychotherapy, or early dropout psychotherapy. It is of great importance to recognize transference patterns of a patient at the beginning of the psychotherapeutic process, because of their potentially harmful influence on the quality of working alliance.Uvod/Cilj. Dokazano je da je radni savez, kao saradnicki deo psihoterapijskog odnosa, jedan od najmocnijih terapijskih faktora u psihoterapiji uopste, bez obzira na mnoge razlike u tehnici koje postoje medju brojnim psihoterapijskim pravcima. Sa druge strane, transfer je osnovni koncept psihodinamicke psihoterapije, i prema psihoanalitickoj teoriji i praksi, cini veliki deo terapijskog odnosa. Cilj naseg rada bio je da utvrdimo razlike izmedju grupa bolesnika sa niskim, srednjim i visokim skorom radnog saveza i grupe bolesnika koji su prekinuli terapiju, i to u odnosu na transferne obrasce u terapijskom odnosu, kao i sociodemografske i klinicke karakteristike. Metode. U ovu studiju bio je ukljucen 61 nepsihoticni bolesnik, slucajno izabran metodom konsekutivnih prijema i tretiran psihoanalitickom psihoterapijom u ambulantnim uslovima. Bolesnici su prospektivno praceni tokom pet pocetnih seansi terapijskog procesa. Za procenu radnog saveza i transfernih obrazaca korisceni su Upitnik radnog saveza i Metod jezgrovne konfliktne teme u odnosima. Na osnovu visine skora na Upitniku radnog saveza, formirane su i uporedjivane cetiri grupe bolesnika. Rezultati. Nasi rezultati pokazuju da postoji znacajna razlika izmedju bolesnika sa niskim, srednjim i visokim skorom radnog saveza i grupe bolesnika koji su prekinuli terapiju, i to u odnosu na ponavljanje transfernih obrazaca u terapijskom odnosu. Zakljucak. Disharmonicni transferni obrasci cesci su kod bolesnika koji u ranoj fazi psihoterapije, formiraju radni savez loseg kvaliteta, ili rano prekidaju psihoterapiju. Veoma je znacajno transferne obrasce bolesnika na pocetku psihoterapijskog procesa, zbog njihovog potencijalno stetnog uticaja na kvalitet radnog saveza.