Predicting Quality of Alliance in the Initial Psychotherapy Interview

A constellation of theoretically relevant pretherapy patient variables—object relations, psychological mindedness, hope for success, psychic pain, and intrapsychic flexibility—were used to predict patient therapeutic alliance readiness during the initial psychoanalytic psychotherapy interview. Therapeutic alliance readiness was viewed as a dual concept, assessed by psychological freedom, a variable measuring patient expressiveness, and quality of alliance, a variable measuring patient collaborativeness. A significant amount of the variance (approximately 40%) in the combined dependent alliance readiness variables was predicted from the pretherapy constellation of variables. As anticipated by psychoanalytic theory and related psychotherapy research, quality of object relations accounted for the greatest part of the variance (about 30%) in both the expressive and collaborative dimensions of psychoanalytic alliance readiness behavior. These findings are discussed in terms of predictor variables specific to alliance behavior, and eventually to outcome, as anticipated by the theory within any particular form of psychotherapy. A model for future psychotherapy research, based on a prediction-type equation approach, is presented.