Defense work, therapeutic alliance and their interaction as interventions to achieve insight and reduce inhibitory affects among clients with cluster C personality disorders

Abstract

The aim of this study was to examine whether a stronger emphasis on defense work, the therapeutic alliance, and their interaction early in short-term dynamic psychotherapy (STDP) and cognitive therapy (CT) with cluster C personality disorders predicted higher levels of insight and lower levels of inhibitory affects. We also wanted to examine potential three-way interaction effects between higher emphasis on defense work in the context of a good therapeutic alliance and therapy condition (CT vs. STDP). The patient sample consisted of forty-nine clients with cluster C personality disorders from a randomized controlled study examining the effectiveness of STDP and CT. Assessment of defense work was done with the Inventory of Therapeutic Strategies (Gaston & Ring, 1992) in session six, and the therapeutic alliance was assessed with the Helping Alliance Questionnaire (Luborsky, Crits-Christoph, Alexander, Margolis & Cohen, 1983) after session four. The Achievement of Therapeutic Objectives Scale (McCullough, Larsen, Schanche, Andrews, Kuhn et al., 2003) measured levels of Insight and Inhibitory Affects during session six. The results indicated that a stronger emphasis on defense work early in treatment was associated with significantly higher levels of Inhibitory Affects, but unrelated to levels of Insight in both STDP and CT. Moreover, there was no evidence of any three-way interaction between defense work, the therapeutic alliance and treatment condition (CT, STDP) on levels of Insight and Inhibitory Affects.