| Abstract
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This study examined the relationship between psychotherapy patients' initial perceptions of their therapist as dominant or affiliative and both the process and outcome of time-limited therapy. It was completed through the Brief Psychotherapy Research Program at Beth Israel Medical Center in New York City. Patients were treated with psychodynamically oriented therapy, cognitive therapy, or brief relational therapy, which focuses on the patient-therapist relationship. Of the 84 patients who began treatment, 62 of them completed the full 30-session treatment. Patients' initial interpersonal perceptions of their therapist remained quite stable across treatment. Patients viewed their therapists as low in dominance and moderately affiliative. These interpersonal schemas of their therapist were highly desirable throughout treatment. The level of alliance, session depth, and session smoothness increased across treatment, with a linear trend for both the alliance and session depth, and with a quadratic U-shaped trend for session smoothness. Patients' symptoms, target complaints, and interpersonal problems decreased by the end of treatment. Although the initial schemas of a mildly dominant and moderately warm therapist were associated with in-session process, they did not appear related to treatment outcome. Dominance had a positive association with the alliance, session depth, session smoothness, less tension in sessions, and resolution of tension in sessions when tension occurred. Affiliation had a positive association with the alliance, session depth, and session smoothness. When looking at the relationship between process and outcome, patients' early experience of smooth sessions and therapists' early experience of deep sessions were associated with patient improvement. Overall, more positive associations between in-session process and outcome occurred during the middle and terminal phases than during the initial phase: the alliance, session depth, session smoothness, and resolution of tension in these later phases were related to improvement. The study indicated that very early in treatment patients begin to form interpersonal schemas of their therapist. For this group of patients their schemas were relatively benign and were associated with developing and maintaining a positive therapeutic alliance. Furthermore, patient improvement involved more than developing an alliance and appeared to relate to exploration and resolution of difficulties in the patient-therapist relationship.
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