[The therapeutic relationship within the scope of inpatient psychotherapy]

Within psychotherapy-research a kind of paradigm has almost established itself, maintaining that--with high probability--a positive therapeutic relationship early on permits to expect a favourable therapeutic outcome. These conclusions were mainly derived from an outpatient psychotherapy setting of under 30 hours. In our own study we wanted to examine whether an early prognosis of success under such conditions was also possible for psychoanalytically oriented inpatient psychotherapy. We examined a sample--representative by age, sex and diagnosis--of 76 patients with an average duration of treatment of 12 weeks. For the patients' self-rating of therapeutic alliance we translated a questionnaire from Luborsky (1984) into German, whereas for the therapists' rating we conceived our own questionnaire. Contrary to our expectations, we were not able to demonstrate clinically significant correlations between the initial quality of the therapeutic relationship and therapy success later on (patients' rating: r = 0.28, p < 0.01, therapists' rating: r = 0.09, p > 0.10). One hypothesis on this surprising finding seems to be especially plausible: In our opinion a substantial strength of inpatient psychotherapy (regardless of it being shaped more by psychoanalytic or behavioral orientation) is the following: it offers less motivated patients of lower social status and level of education an opportunity to experience essential processes of communicative learning and motivation especially within the first weeks of treatment.