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Research on standard methods of therapist training has found mixed evidence to as to whether standard training methods are effective. This study investigated the impact of a novel, research-informed training protocol that integrated elements of alliance-focused training (AFT) and facilitative interpersonal skills (FIS). Beyond traditional training techniques of didactics and lecture, the AFT/FIS intervention incorporated empirically supported video simulations of therapy, which were reinforced by role plays and deliberate practice on key therapeutic interpersonal skills. Fifty-eight graduate-level therapy trainees and professional therapists from various helping fields were randomized to one of two brief trainings in a multi-site RCT: (i) the AFT/FIS workshop or (ii) a more traditional demonstration training (DT) workshop. Participants were assessed on critical, relational therapeutic skills before and after the training. After controlling for relevant covariates, participants in the AFT/FIS training saw a marginally higher post-intervention level of overall therapeutic skills. Subsequent exploratory analyses revealed AFT/FIS participants also had significantly higher levels of specifically targeted post-training therapist skills (i.e., empathy, alliance bond capacity, and alliance rupture-repair responsiveness) compared to participants in DT. Implications for future empirical investigations and training initiatives are discussed.

A rupture is a deterioration in the therapeutic alliance, manifested by a disagreement between the patient and therapist on treatment goals, a lack of collaboration on therapeutic tasks, or a strain in their emotional bond. We present the most frequently used measures of alliance ruptures and clinical examples to illustrate their repair. To examine the relation of rupture repairs to outcome, and the impact of rupture resolution training on outcome, we conducted two meta-analyses. In the first meta-analysis, we examined 11 studies (1,314 patients) that examined the relation between rupture repair episodes and patient treatment outcomes. Results yielded an effect size of r = .29, d = .62, 95% confidence interval [.10, .47], p = .003, indicating a moderate relation between rupture resolution and positive patient outcome. Our second meta-analysis examined the impact of rupture resolution training or supervision on patient outcome. We examined 6 studies (276 trainees/supervisees) that compared the outcomes of trainees who received rupture resolution training with a comparison group. Results did not find a significant relation, r = .11, d = .22, 95% confidence interval [-.09, .30], p = .28. Moderator analyses indicated that the relation between training and outcome was stronger when the sample included fewer patients with personality disorders, when the training was more closely aligned with cognitive behavioral therapy than psychodynamic therapy, and when the treatment was brief. The article concludes with limitations of the research, diversity considerations, and research-informed therapeutic practices for repairing ruptures in ways that contribute to good treatment outcome. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

OBJECTIVE: In order to improve success rates in psychotherapy, an alliance-focused training (AFT) protocol was developed and evaluated with regard to patient-therapist interpersonal behavior in a 30-session protocol of cognitive-behavioral therapy for outpatients comorbid with Axis I and II conditions conducted in a medical center setting. METHOD: Participants included 40 patients treated by 40 therapists in a multiple baseline design in which novice therapists trained to fidelity standards in CBT were introduced to AFT at different time intervals (after either 8 or 16 sessions) during a 30-session CBT protocol. Interpersonal behaviors were assessed with a simplified version of the Structural Analysis of Social Behavior (SASB) on videotaped sessions sampled from the early (between sessions 6–8), mid (14–16), and late (22–24) phases of therapy. RESULTS: As predicted, several significant interactions were observed between within-subject interpersonal change and between-group differences in exposure to AFT. Specifically, there were decreases in patient dependence and in therapist control (including criticism), plus increases in patient expressiveness and in therapist affirmation and expressiveness, all of which could be attributed to AFT. The predictive relationship of several of these variables to session-level and overall treatment outcome was also demonstrated. CONCLUSIONS: This study demonstrates that novice CBT therapists can be trained to improve their interpersonal process with patients who present with comorbid diagnoses, including a personality disorder. PUBLIC HEALTH SIGNIFICANCE: Demonstrating the efficacy of a protocol designed to develop novice therapists’ alliance-focused abilities has important implications for professional training, as well as for outcome in psychotherapy.

OBJECTIVE It has been demonstrated that patient perspective on alliance can predict subsequent treatment outcome as reported by the therapist but not the other way around. This study aimed to investigate the circumstances in which therapists can provide estimations of alliance capable of predicting patient perceptions of subsequent session outcome. The study focused on 2 potential indicators: time in treatment and treatment efficacy. METHOD Data of 107 treatment completers assigned to either cognitive-behavioral therapy or alliance focused therapy were analyzed. Data included session-to-session assessments of alliance and the session outcome measure across the 30 weeks of treatment as well as pretreatment to posttreatment assessments of treatment efficacy using the Symptom Checklist-90-Revised. An actor-partner interdependence model of longitudinal hierarchically nested data, disentangled for within- and between-patients effects, was used. The interactive effects of time and treatment efficacy and their combined effect were examined. RESULTS At the sample level, as expected, the therapist perspective of alliance did not significantly predict patient perception of subsequent session outcome, but significant interaction effects were detected. Therapists' perspective on the alliance was a stronger predictor of patients' perception of subsequent session outcome when therapy was more rather than less effective. This effect was evident mainly early in treatment, during which greater variability across dyads was found. CONCLUSIONS Findings suggest that although therapists' ratings of the alliance are not consistently predictive of patients' rating of subsequent session outcome, they are better predictors in more than in less effective treatments. (PsycINFO Database Record

Objective: In this paper, we test the reliability and validity of two novel ways of assessing mentalizing in the therapy context: the Reflective Functioning scale (RF) applied to code psychotherapy transcripts (In-session RF), and the Exploring scale of the Patient Attachment Coding System (PACS), which measures in-session autonomy and is linked with secure attachment in psychotherapy. Method: Before treatment, 160 patients in different types of psychotherapy and from three different countries were administered the Adult Attachment Interview (AAI), which was rated with the RF scale. One early psychotherapy session for each patient was independently rated with the In-session RF scale and with the PACS Exploring scale. Results: Both scales were found to be reliable and to have concurrent validity with the RF scale rated on the AAI, with the PACS Exploring scale found to be a better predictor of RF on the AAI. Conclusions: These results suggest that the PACS Exploring scale might be a practical method for assessing RF in psychotherapy research and a way for researchers and clinicians to track patients' RF on an ongoing basis. These results also provide information regarding the ways in which differences in RF manifest during psychotherapy sessions. Clinical or methodological significance of this article Researchers and clinicians can assess patients' mentalizing based on any single psychotherapy transcript, in many therapeutic modalities The Exploring scale of the Patient Attachment Coding System can yield a reliable measure of reflective functioning based on any single psychotherapy transcript, in many therapeutic modalities Client differences in mentalizing manifest in part independently of the therapist's contributions.

The working alliance is one of the most consistent predictors of outcome. Yet, little empirical knowledge exists on how therapists can use this association to maximize the outcome of cognitive behavioral therapy (CBT) for individual clients. The present study aimed to examine pre-treatment client interpersonal characteristics that determine what function the alliance should fulfill in order to maximize its effect on outcome. We did so by identifying moderators of the within- and between-clients effects on outcome. Data of 185 clients receiving CBT treatment was disaggregated to study the effects of the within- and between-clients alliance on outcome. Findings suggest that for clients who described themselves as overly cold and were described by their therapists as low on intrusiveness, state-like strengthening of alliance predicted better outcome, and that for clients not overly cold but overly exploitable, the general tendency of the client to report stronger alliance was associated with better outcome.

A rupture is a deterioration in the therapeutic alliance, manifested by a disagreement between the patient and therapist on treatment goals, a lack of collaboration on therapeutic tasks, or a strain in their emotional bond. This chapter presents the most frequently used measures of alliance ruptures and clinical examples to illustrate their repair. To examine the relation of rupture repairs to outcome, the authors conducted a meta-analysis on 11 studies (1,314 patients) that compared the treatment outcomes of patients with rupture-repair episodes to those of patients with unrepaired ruptures. Results yielded an effect size of r = .29, d =.62, 95% confidence interval [.10, .47], p =.003, indicating a moderate relation between rupture resolution and positive patient outcome. To examine the impact of rupture resolution training or supervision on patient outcome, the authors examined 6 studies (276 trainees/supervisees) that compared the outcomes of trainees who received rupture resolution training with a comparison group. Results did not find a significant relation, r = .11, d = .22, 95% confidence interval [-.09, .30], p = .28. Moderator analyses indicated that the relation between training and outcome was stronger when the sample included fewer patients with personality disorders, when the training was more closely aligned with cognitive behavioral therapy than psychodynamic therapy, and when the treatment was brief. The chapter concludes with limitations of the research, diversity considerations, and research-informed therapeutic practices for repairing ruptures in ways that contribute to good outcome in therapy.

Objective This study examines the validity of the Alliance Negotiation Scale (ANS) in a psychotherapy research program. Analyses were designed to evaluate the relationship between the ANS and psychotherapy process and outcome variables. Method Data were collected in a metropolitan psychotherapy research program. Participants completed 30 sessions of therapy, postsession assessments, and a battery of measures at intake and termination. Results Relationships were found between the ANS and session outcome, working alliance, and the presence of ruptures and their resolution. Relationships emerged between the ANS and treatment outcome on measures of psychiatric distress and interpersonal problems. Conclusions The ANS demonstrated relationships with several psychotherapy process and outcome variables. The ANS was the most differentiated from the working alliance on measures of interpersonal functioning and in discriminating personality disorder pathology. These results extend previous findings on the ANS’ psychometric integrity, and offer new data on the relationship between negotiation and treatment outcome.

Our aim was to examine the reliability and validity of the Rupture Resolution Rating System (3RS), an observer-based measure of alliance ruptures and resolution processes.We used the 3RS to rate early sessions from 42 cases of cognitive behavior therapy. We compared the 3RS to a simplified version of the Structural Analysis of Social Behavior (SASB), as well as patient and therapist self-reports of ruptures and the alliance.Coders achieved high rates of interrater reliability on the frequency of confrontation and withdrawal ruptures and resolution strategies (ICCs = .85 to .98), as well as ratings of the therapist's contribution to ruptures and the extent to which ruptures were resolved (ICC = .92). Predictive validity analyses found that confrontation markers (d = .74), successful resolution (d = .67), and ratings of the therapist's contribution to ruptures (d = .61) predicted dropout from therapy. Analyses of convergent validity with the SASB failed to meet predictions; however, we observed theoretically coherent relations between 3RS and SASB variables. Confrontation rupture markers were significantly associated with patient self-report of rupture (d = 1.54) and therapist self-reported alliance (r = -.50, p = .002).This study provides evidence that the 3RS is a reliable and useful tool for examining psychotherapy process and predicting dropout. Clinical or methodological significance of this article: This study provides evidence of the reliability and validity of the 3RS, an observer-based measure of alliance ruptures and resolution processes. The 3RS can be used to identify problems in the therapeutic relationship that are associated with premature dropout from therapy.

In this article, we examine how the different attachment patterns enable or hinder the resolution of ruptures in the therapeutic alliance. We try to show that secure and insecure patients alike may experience ruptures in the therapeutic alliance, but that their ability to participate in resolving such ruptures differ markedly. Recent findings with the Patient Attachment Coding System (PACS) show that attachment classifications manifest in psychotherapy as distinct ways of communicating about present internal experience. Secure patients disclose their present experience openly and invite attunement from the therapist, while insecure patients either minimize their contributions to the dialogue (avoidant) or the contributions of the therapist (preoccupied). Using examples from session transcripts, we demonstrate how secure patients are particularly responsive to resolution strategies that focus on here-and-now experience, while insecure patients' characteristic ways of communicating pose significant challenges to the resolution process.

This study investigates the utility and psychometric properties of a new measure of psychotherapy process, the Alliance Negotiation Scale (ANS; Doran, Safran, Waizmann, Bolger, & Muran, 2012). The ANS was designed to operationalize the theoretical construct of negotiation (Safran & Muran, 2000), and to extend our current understanding of the working alliance concept (Bordin, 1979). The ANS was also intended to improve upon existing measures such as the Working Alliance Inventory (WAI; Horvath & Greenberg, 1986, 1989) and its short form (WAI-S; Tracey & Kokotovic, 1989) by expanding the emphasis on negative therapy process. The present study investigates the psychometric validity of the ANS test scores and interpretation-including confirming its original factor structure and evaluating its internal consistency and construct validity. Construct validity was examined through the ANS' convergence and divergence with several existing scales that measure theoretically related constructs. The results bolster and extend previous findings about the psychometric integrity of the ANS, and begin to illuminate the relationship between negotiation and other important variables in psychotherapy research. (PsycINFO Database Record

There is a vital dialectic between agency and surrender in life and in the analytic process. Without an ability to will, one cannot choose one’s actions; one becomes a passive victim of circumstances rather than an agent who can influence one’s own destiny. On the other hand, an exaggerated sense of agency fails to take into account the limits of our ability to control life, and is associated with a type of narcissistic omnipotence that can be linked with an experience of isolation. In this article I explore some of the subtleties of the interplay between willing and surrendering in the analytic process. I also examine the way in which an inability to surrender can impede the patient’s ability to take in what the analyst has to offer. And finally I adapt the concept of grace from theological discourse to highlight a dimension of the analytic process that involves an emergence of the patient’s capacity to make constructive use of the analyst’s interventions.

Alliance-focused training (AFT) aims to increase therapists' ability to recognize, tolerate, and negotiate alliance ruptures by increasing the therapeutic skills of self-awareness, affect regulation, and interpersonal sensitivity. In AFT, therapists are encouraged to draw on these skills when metacommunicating about ruptures with patients. In this article, we present the 3 main supervisory tasks of AFT: videotape analysis of rupture moments, awareness-oriented role-plays, and mindfulness training. We describe the theoretical and empirical support for each supervisory task, provide examples based on actual supervision sessions, and present feedback about the usefulness of the techniques from trainees in our program. We also note some of the challenges involved in conducting AFT and the importance of maintaining a strong supervisory alliance when using this training approach.

In this article, we provide an overview of our research program on therapeutic impasses and alliance ruptures. Beginning in the mid-1980s at the University of Toronto, and continuing in New York at Beth Israel Medical Center since the early 1990s, we have focused our efforts on trying to illuminate the processes associated with resolving ruptures in the alliance and working through therapeutic impasses. Influenced both by the relational turn in psychoanalysis and findings emerging from our own research on the process of change, we have developed and evaluated an approach to short-term treatment that appears promising. We are also developing and evaluating the effectiveness of training methods for enhancing therapists’ capacities to work constructively with negative therapeutic process, regardless of the particular “brand” of treatment they are practicing. Finally, we summarize some preliminary findings regarding the impact of therapists’ capacity for mentalization on both treatment process and out...

There is currently little empirical evidence regarding how patients' attachment patterns manifest in individual psychotherapy. This study compared the in-session discourse of patients classified secure, dismissing, and preoccupied on the Adult Attachment Interview (AAI). Rather than focusing on content or form alone, this study analyzed how patients' discourse elicits and maintains emotional proximity with the therapist. The AAI was administered to 56 patients prior to treatment and one session for each patient was rated with the Patient Attachment Coding System (PACS) by four independent raters, blind to patients' AAI classification. Significant differences were found in the discourse of patients with different attachment patterns. Namely, secure and preoccupied patients showed more contact-seeking behavior than dismissing patients, who avoided emotional proximity more, while preoccupied patients resisted therapists' help more than did secure and dismissing patients. These results suggest that the different attachment patterns may have distinctive manifestations in the psychotherapy process that can be tracked by external observers.

This study examined the relationship of pre-treatment personality disorder diagnosis to the quality of early therapeutic alliance in 145 patients randomly assigned to either cognitive behavioral therapy or brief relational therapy. The pre-treatment diagnosis was established by DSM-IV (SCID) and Wisconsin Personality Inventory. Quality of the alliance was assessed by patient and therapist reports using the 12-item Working Alliance Inventory, Session Evaluation Questionnaire, and direct questions of ruptures. Results indicated that pre-treatment personality disorder as determined by SCID predicted no variables of early psychotherapy process. Factor scores yielded from a PCA of the WISPI indicated that high impulsivity, dysregulation, and lability were associated with lower patient and therapist ratings of session depth of exploration and higher patient ratings of rupture intensity.

Ken Frank's compelling and eloquently argued essay is a valuable clarion call for action at time when psychoanalysis is in a state of crisis. In my commentary I argue that it is important for us to extend the boundaries of our understanding of the nature of this crisis, and attempt to delineate some of the broader concerns that are important for us to consider in our health-care system and our culture in general. I argue that it is important for us to cast our gaze outside of the traditional boundaries of psychoanalysis, not only to revitalize the field of psychoanalysis, but also to think about the most valuable function we can serve within the broader system.

Although numerous studies have investigated the relationship between the therapeutic alliance and dropout, most have focused on the relationship between alliance quality and psychotherapy outcomes. Objective: To compare sessions with therapeutic alliance ruptures and two sessions prior to treatment dropout (pre-dropout) in terms of rupture subtypes, psychotherapists’ behavior, attitudes, and session content. Method: We implemented quantitative methods to select the sessions and qualitative methods to analyze them. We analyzed 16 temporary rupture sessions from 12 therapist–patient dyads and 16 pre-dropout sessions from 8 different therapist–patient dyads. The sessions originate from clinical psychology Master’s or Doctoral students under supervision in either cognitive behavioral or schema therapy. Pre-dropout sessions were considered unrepaired rupture sessions while rupture sessions were subsequently repaired. Results: Results revealed apparent differences and similarities between the session types in positive and negative psychotherapist behaviors, content intensity, and the type and frequency of ruptures. We explored three new rupture subtypes: attributing positive developments to other sources, indirect speech, and sarcastic hostility. Conclusions: A striking implication is that the frequency of positive and negative psychotherapist behaviors, ruptures, and session content is more likely to decrease in the pre-dropout sessions than in the temporary rupture sessions. © 2016, © 2016 Society for Psychotherapy Research., Türkiye Bilimsel ve Teknolojik Araştirma Kurumu: SOBAG104K082, This work was supported by the Türkiye Bilimsel ve Teknolojik Arast irma Kurumu [TÜBITAK-· SOBAG104K082]. This study was awarded with the “Prof. Dr. Isı¸ k Savası¸ r Clinical Psychology Research Incentive Award” by the Turkish Psychological Association.

This study examines the validity of the Alliance Negotiation Scale (ANS) in a psychotherapy research program. Analyses were designed to evaluate the relationship between the ANS and psychotherapy process and outcome variables.Data were collected in a metropolitan psychotherapy research program. Participants completed 30 sessions of therapy, postsession assessments, and a battery of measures at intake and termination.Relationships were found between the ANS and session outcome, working alliance, and the presence of ruptures and their resolution. Relationships emerged between the ANS and treatment outcome on measures of psychiatric distress and interpersonal problems.The ANS demonstrated relationships with several psychotherapy process and outcome variables. The ANS was the most differentiated from the working alliance on measures of interpersonal functioning and in discriminating personality disorder pathology. These results extend previous findings on the ANS' psychometric integrity, and offer new data on the relationship between negotiation and treatment outcome.

Objective Better alliance is known to predict better psychotherapy outcomes, but the interdependent and interactive effects of both therapist- and patient-reported alliance levels have yet to be systematically investigated. Method Using actor-partner interdependence model analysis the authors estimated actor, partner, and 2 types of interactive effects of alliance on session outcome in a sample of 241 patient-therapist dyads across 30 sessions of cognitive-behavioral and alliance-focused therapy. Results Findings suggest that the most robust predictors of session outcome are within-treatment changes in patient reports of the alliance, which predict both patient and therapist report on outcome. Within-treatment changes in therapist reports of the alliance, as well as differences between patients and between therapists in their average ratings of alliance levels across treatment, predict outcome as reported by the specific individual. Although alliance was found to be a significant predictor of outcome in both treatments, for therapist-reported alliance and outcome it had a stronger effect in alliance-focused therapy than in cognitive-behavioral therapy. Additionally, dyads with the highest pooled level of alliance from both partners fared best on session outcome. Conclusions The results are consistent with a 2-person perspective on psychotherapy, demonstrating the importance of considering the interdependent and interactive nature of both patient and therapist alliance levels on session outcome. (PsycINFO Database Record

Irwin Z. Hoffman's (2009) “Doublethinking our way to ‘scientific’ legitimacy” is an important and thought-provoking paper that tends to evoke passionate and polarized responses. Important threads running throughout his paper include the pitting of objectivist against constructivist perspectives and a concern that the objectivist epistemology underlying most systematic empirical research endangers important psychoanalytic values. In this paper I underscore and elaborate on the importance of certain aspects of Hoffman's paper, while at the same time arguing for a less polarized perspective, by appealing to contemporary developments in the philosophy of science that seek a middle ground between objectivism and constructivism. This middle ground recognizes that science has an irreducibly social, hermeneutic, and political character, and that data are only one element in an ongoing conversation between members of a scientific community. I also argue that the rules and standards of practice are worked out and m...

The present study investigated the association between therapist dispositional mindfulness and therapist self-affiliation, the therapeutic alliance, and treatment outcome. Total therapist mindfulness was associated with therapist self-affiliation, r=.413, p

This interview was conducted from New York via Skype with Morris Eagle at his home in Los Angeles. Safran: Hi Morris. Thanks for joining us this afternoon. As we were setting up the Skype connection, I was thinking about your most recent book, From Classical to Contemporary Psychoanalysis, and your book Recent Developments in Psychoanalysis, published in 1984, and it seems to me that they make nice bookends. Recent Developments in Psychoanalysis was a real classic. In some ways, it’s linked in my mind with Greenberg and Mitchell’s 1983 book, Object Relations in Psychoanalytic Theory, as marking an important shift that was starting to take place in psychoanalysis toward more interpersonal and relational perspectives. I think your most recent book has the makings of a similar type of classic. It provides a clear, comprehensive perspective on where psychoanalysis began and how it has evolved. It’s synthetic, balanced, and at the same time, in your trademark style, very critical, in a constructive way. Thinking back to where psychoanalysis was at the time that your 1984 book was published, I was wondering, what, from your perspective, stands out as the most important changes that have taken place? What’s happened in the field that has surprised you? Have there been developments that you did not anticipate, or are there developments that looked promising then and now look disappointing to you? Eagle: My sense right now is that what’s happened mainly in the last 25 or so years has largely been a continuation of what was apparent then. That is, the emergence of a relational point of view and its increasing influence in psychoanalysis, a continuation of a self-psychology perspective, and so on. You noticed in the most recent book I don’t have much to say about the work of Bion or Lacan, which I know is very popular in certain circles. I’ll explain why in a moment—although the easy answer is that I’ve made attempts to try to understand both and life is relatively short and one has to prioritize. In both cases, I have not entirely given up, but in both cases I have at least tentatively given up. But I’ll elaborate more in a moment. But more directly to your question, I think a number of things have happened. For one, in many ways the key relational theorists have now become part of the mainstream. For example, Jay Greenberg is now the editor of Psychoanalytic Quarterly. The work of theorists like Adrienne Harris, Lewis Aron, and Jessica Benjamin is now reasonably well

[Clin Psychol Sci Prac 18: 357–371, 2011] This survey evaluated the impact of empirical research findings on the clinical practice of a sample of psychotherapists who are also actively engaged in the consumption, critical evaluation, and production of psychotherapy research. On the one hand, we found that even this sample of researcher–clinicians perceives empirical research to be less helpful to them as clinicians than a variety of other sources of information, including their ongoing experience working with clients. On the other, we found that they do value empirical research, but consider it as one source of information among others to be incorporated into the clinical decision-making process. Implications of the findings are discussed with respect to a number of dimensions, including the nature of professional expertise.

The concept of emotional intelligence (EI) describes a set of emotional skills that may comprise efficacious therapist variables. The present study is the first to investigate EI among psychotherapists. Based on conceptual overlaps between the EI model and psychotherapy models, as well as a review of empirical evidence from both literatures, we make several predictions of how therapist EI impacts treatment. In a small pilot study, we assessed psychotherapist EI to determine its relation to psychotherapy outcome and process. Therapists with higher ratings of EI achieved better therapist-rated outcome results and lower drop-out rates compared with therapists with lower ratings of EI. Though not hypothesized, higher therapist EI was significantly associated with increased patient assessment compliance. There was no relationship between early working alliance ratings and therapist EI. Findings offer preliminary support for the relevance of therapist EI to psychotherapy.

Prima che l’asino se ne sia andato, il cavallo e gia arrivato - In this article I explore some of the implications of the Buddhist perspective on nonduality and acceptance for psychoanalytic practice. Nonduality is a mode of experiencing that breaks down the distinction between categories that are conventionally regarded as opposites8e. g., good versus bad, pure versus impure, sacred versus profane, heaven and hell). The Buddhist perspective on nonduality is that the natural human tendency to think about things in dualistic terms is at the heart of the problem and that wisdom is the ability to experience things nondualistically. As long as we distinguish between things as they should be in some idealized state versus things as they are, we are unable to be fully open to, and appreciate the present situation for what it has to offer. I attempt to convey a sense of way in which the cultivation of a nondual perspective can lead to a radical and paradoxical perspective on the role of acceptance in the analytic process.

Safran: What do you think that psychoanalysis will look like 10 or even 20 years from now? Aron: In some ways it depends on what you mean by psychoanalysis, because I think one of the ways that we’ve gotten ourselves into so much trouble is by defining psychoanalysis in contrast to psychotherapy. So, if we’re defining psychoanalysis in this very limited or narrow way, as opposed to psychoanalytic therapy or other analytic therapies, then the question of what the discipline of psychoanalysis will look like would lead you to one answer, which I do not think would be a very optimistic one. But I tend to think that it’s a mistake to define it that way, and that we need to think of psychoanalysis as a broad continuum of treatments with different frequencies and differences in variables of other types, all based on psychoanalytic ideas. And if we define psychoanalysis more broadly in this way, then I have a much more optimistic perspective on the future of psychoanalysis. Not everyone would agree with me on this. Kernberg, for example, defines psychoanalysis in the more narrow sense, and takes the position that psychoanalysis is for the very few and that most people are either too ill or too healthy for psychoanalysis. Thus, from his perspective, and from the perspective of many others, many people need some other treatment, an analytically modified kind of treatment. From his perspective, psychoanalysis is an appropriate treatment for very few people, and he believes that the most important contribution we can make as psychoanalysts is to develop a broad range of analytic treatments or therapies. Safran: I didn’t realize that was Kernberg’s position. Aron: Yes, I did a panel with him last year where he took that position . . . . And I think this position is based on a choice he makes to keep the definition of psychoanalysis rather narrow and very specific. But I think that’s a mistake. Merton Gill, for example, in his final book before he died, took the position that he didn’t differentiate between psychoanalysis and psychodynamic therapy. He spoke of all forms of psychoanalysis as consisting of a range of different forms of therapies, varying with respect to variables such as frequency, intensity, and so on. And I think there are many advantages to this type of perspective. For one thing, I think that it really is very troubling for analysts who spend most of their working lives doing what would have to be called modified analytic therapy (from Kernberg’s perspective) and then end up having a tremendous identity problem about what it means to be a psychoanalyst, since they’re not really doing “psychoanalysis.” And the statistics in the field are very clear. A number of surveys have shown that the great bulk of psychoanalysts are doing something other than psychoanalysis, as it was

This study examined the relationship of early alliance ruptures and their resolution to process and outcome in a sample of 128 patients randomly assigned to 1 of 3 time-limited psychotherapies for personality disorders: cognitive-behavioral therapy, brief relational therapy, or short-term dynamic psychotherapy. Rupture intensity and resolution were assessed by patient- and therapist-report after each of the first 6 sessions. Results indicated that lower rupture intensity and higher rupture resolution were associated with better ratings of the alliance and session quality. Lower rupture intensity also predicted good outcome on measures of interpersonal functioning, while higher rupture resolution predicted better retention. Patients reported fewer ruptures than did therapists. In addition, fewer ruptures were reported in cognitive-behavioral therapy than in the other treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

The aim of the study described in this paper was to develop a method for measuring the therapeutic alliance from an intersubjective perspective and to evaluate the efficacy of the measure in predicting psychotherapy outcome. We conducted the study using data from 22 patient-therapist dyads engaged in a 30-session protocol of a brief relational therapy. The alliance measure chosen for this purpose was the short form of the Working Alliance Inventory. We used the subjective patient and therapist versions of the measure and created a correlation index representing the intersubjective congruence between patients and therapists on their ratings of the alliance. We examined the relations among the measures, as well as their predictive relation to an outcome measure. The results showed significant intercorrelations among the three alliance measures, suggesting that all captured aspects of the therapeutic alliance. In addition, all three measures were significantly predictive of outcome, with the correlation index appearing more powerful.

The aim of this study was to investigate the interrelationships of three measures of the therapeutic relationship and their validity in predicting treatment outcome, including the early identification of two treatment-failure conditions. Forty-eight patient-therapist dyads, in 30-session therapies for personality-disordered patients, were classified as premature dropout (DO), poor outcome (PO), or good outcome (GO) cases. Poor and Good Outcomes were determined by a reliable change score. Dropout cases were terminated during the first third of treatment, and patients cited dissatisfaction with the therapy or therapist. Assessment of working alliance, interpersonal behavior and a new measure of narrative coherency in the first third of treatment revealed that DO dyads had significantly poorer alliances and less coherent narratives in early sessions, while PO dyads, who ultimately completed the 30-session treatment protocol, unexpectedly demonstrated the highest degree of hostile complementarity. Clinical implications of the results are discussed.

Psychoanalytic authors have traditionally been skeptical of nomothetic studies, in which group averages obscure the uniqueness of individual cases. Several relational psychoanalytic authors have expressed more pronounced skepticism, affirming, for example, that given the uniqueness of each therapist-patient dyad, systematic empirical research is particularly problematic. In this article we highlight the potential synergy between relational thinking and today's psychotherapy research, by exploring some of the ways in which the work of relational authors has influenced relational psychotherapy research, shifting the focus of study from validation of the models of treatment to the study of the clinical variables such as: countertransference, therapist empathy, self-disclosure, rupture and resolution in therapeutic alliance, intersubjective negotiation, and the patient-therapist attachment relationship. In conclusion, the aim of this article is to facilitate the dialogue between relational psychoanaly...

As a requirement of APA accreditation, many PhD programs in applied psychology subscribe to some variant of the scientist-practitioner model. However, critics have argued that integrating science into an applied psychology curriculum may be too challenging a task. This article describes the development of The New School Psychology Bulletin, a student-operated journal dedicated to publishing original research articles written by psychology graduate students. We argue that the process of publishing a student-operated journal can have a positive effect on students' attitudes toward research and has the potential to serve as a model to foster integration of research and training experiences in an applied psychology program.