Connected to Others and Kind to Self: Social Connection and Self-Affiliation Change in Open-Ended Psychotherapy

Social connection predicts health, but remains largely underexplored as an outcome of psychotherapy. A friendly relationship to oneself is linked to positive relationships to others, but it is not clear how they influence each other across time during and after treatment. This study evaluates change in a measure of social connection and support, the Quantity and Quality of Social Relations (QQSR), and investigates its longitudinal associations with the Structural Analysis of Social Behavior Introject self-affiliation.

370 adult outpatients in Norway with various presenting problems were assessed before and after open-ended psychotherapy, with up to 2.5 years follow-up. We fitted latent growth curves and structured residual models.

There was significant growth in QQSR across long-term follow-up, particularly in support and non-family relationships. There was no change from pre- to posttreatment, and significant between-patient variation in both intercepts and growth rates. Improved QQSR after treatment predicted improved self-affiliation in the next follow-up, which in turn predicted improved QQSR. These effects were robust to detrending and controlling for pretreatment personality disorder. Pretreatment QQSR correlated with self-affiliation growth.

On average over a long timespan, patients' social connection shows gradual positive growth, and reciprocal lagged associations with self-affiliation. The QQSR might measure relatively stable characteristics and between-patient differences relevant to self-affiliation change. Clinicians might screen for social and self-relationships throughout therapy, both as outcomes and resources.