Is there an optimal adjustment of interpretation to the patients' level of defensive functioning?

In this process-outcome study, we explored whether the therapists' Adjustment Ratio of interpretation would be predictive of the development of working alliance in brief dynamic psychotherapy (N = 39, max 40 sessions). Therapist interventions were rated in an early session (7th) and in the mid-phase of therapy (16th session). We found that, what was assumed to be an optimal Adjustment Ratio in relation to patients' defensive functioning, was associated with lower quality of working alliance, whereas what was assumed to be a poor Adjustment Ratio was associated with a more favorable alliance. The general finding was that when relatively more supportive interventions were given to patients with higher ODF, the working alliance was improved. Implications of the findings are discussed.