Clinical and research implications of patient-therapist interaction in brief psychotherapy

The study of immediate in-session processes and outcomes as possible change events as they vary across context has become an important research focus. In this paper we examined transference and nontransference interpretations, as well as clarifications (in-session processes) followed by patient affect or defensive behavior (in-session outcomes). Transference interpretations followed by affect are associated with a positive outcome, while interpretations and clarifications followed by patient defensive behavior are correlated with poor outcome. On a clinical level these patient responses can be thought of as sub-outcome markers. An affective response to a transference interpretation should serve as an indicator to the clinician that he/she is on the right track. Conversely, repeated defensive behavior by the patient should alert the therapist to consider a change in approach. Highly defensive patients generally have a lower level of object relations, less psychological flexibility, and diminished access to feelings. Careful exploration of the multiple factors operating simultaneously (and which are only slowly becoming evident to us), hopefully will yield data to guide future clinicians when clinical intuition is not able to make fine enough discriminations.