- Transference interpretations do not result in a
greater degree of affective experience in the
patient as compared with other types of inter-
pretations or other types of interventions.
When followed by affective responses, how-
ever, transference interpretations appear to be
related to positive outcome. - Interpretations by the therapist are more likely
to result in defensive responding on the part of
the patient than are other types of interven-
tions. Frequent transference interpretations
may damage the therapeutic relationship. - Clinicians’accuracy of interpretations may be
lower than was previously believed.
The authors conclude:“The available findings
challenge some dearly held beliefs. In short, trans-
ference interpretations do not seem uniquely effec-
tive, may pose greater process risks, and may be
counter-therapeutic under certain conditions”
(W. P. Henry et al., 1994, p. 479).
This is not to say that transference interpreta-
tions are always harmful and should be avoided.
Rather, the existing research suggests that the rela-
tionship between interpretation and outcome is a
complex one that is likely to depend on factors
such as patient characteristics, clinician interpersonal
style, timing of interpretations, and accuracy of
interpretations (W. P. Henry et al., 1994).
Curative Factors
What, then, seems to be responsible for positive out-
comes that sometimes follow psychodynamic psycho-
therapy? The empirical evidence points to the quality
and strength of the therapeutic alliance (Henry et al.,
1994). Although the quality of the therapeutic
alliance is related to outcome across a number of ther-
apeutic modalities (e.g., client-centered, cognitive-
behavioral), it is interesting to note that the importance
of the clinician–patient relationship was recognized by
Freud (1912/1966). Although various definitions of
thetherapeutic alliancehave been proposed, this term is
generally used to refer to the patient’saffectivebondto
the therapist. A positive relationship or strong bond
facilitates self-examination by the patient and permits
interpretation. Presumably, a strong therapeutic alli-
ancemakesitlesslikelythatapatientwillreactdefen-
sively to interpretations by the clinician. Research
evidence suggests a direct link between alliance and
outcome, whether short-term or long-term psycho-
dynamic treatments are examined and regardless of
the particular outcome measure used (Henry et al.,
1994).
One study highlighted several influences on the
therapeutic alliance and outcome. In a sample of 50
adults, Hilliard, Henry, and Strupp (2000) tested
the hypothesis that both the patient’s and the thera-
pist’s early parental relations (i.e., indicators of each
participant’s object relations) influence the quality
of the therapeutic alliance (a therapy process vari-
able) as well as treatment outcome. Results gener-
ally supported their hypotheses. The patients’and
the therapists’reports of their early parental rela-
tions, respectively, were significantly related to
their ratings of the therapeutic alliance. Further,
patients’ratings of outcome were also significantly
related to their early parental histories, and this
effect held even after controlling the ratings of the
therapeutic alliance. Therefore, this study highlights
that importance of patient’s early parental histories
on both the process and outcome of psychody-
namic psychotherapy.The Lack of Emphasis on Behavior
The stereotypic practitioner of psychoanalytic psy-
chotherapy plays a relatively passive role except for
interpretation. The failure to deal with behavior, to
make suggestions, or to adopt a generally more
activist posture would seem to prolong psychother-
apy unnecessarily. For example, it may be true that
a male patient’s unhappy heterosexual adjustment
or lack of skills with women stems from uncon-
scious generalizations from past unfavorable com-
parisons with a dominant brother. But simple
insight into the childhood origins of the problem
does not provide the skills that are lacking. The
patient’s expectations for success in establishing
relationships with women will continue to be low
and a source of anxiety until a heterosexual behav-
ioral repertoire is established. An active therapistPSYCHOTHERAPY: THE PSYCHODYNAMIC PERSPECTIVE 363