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Early change in maladaptive defense style and development of the therapeutic alliance

Author(s): Ambresin G, de Roten Y, Drapeau M, Despland JN

Abstract

This study examined the early change in maladaptive defence style (MDS), the development of the therapeutic alliance and the relationship between MDS and alliance in a short psychodynamic intervention. Sixty-eight outpatients from a psychiatric clinic completed a four-session psychodynamic intervention. Defence and alliance measures were collected at the intake and the final session. Patients who began the intervention with a poor alliance but ended with a good alliance (linear growth therapeutic alliance group) significantly decreased their use of maladaptive defences over the course of therapy, while patients in the high and low alliance groups did not. Results showed that at the end of the intervention, MDS and alliance were related across all patients. This relation concerned particularly the linear growth therapeutic alliance profile. These results suggest that the developing therapeutic alliance might reflect the collaborative work between the patient and the therapist as they try to understand the causes of the crisis. This understanding might help reduce maladaptive defences that were initially activated to ward off anxiety and distress.

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