The role of the therapeutic alliance, transference work, and their interaction in reducing cold-submissive interpersonal problems among psychotherapy patients with Cluster C personality disorders

The aim of the present study was to examine whether early ratings of the therapeutic alliance, transference work, and their interaction predicted a reduction in cold-submissive interpersonal problems at treatment termination. Forty-nine patients with Cluster C personality disorders, from a randomized controlled trial investigating the effectiveness of short-term dynamic psychotherapy and cognitive therapy, were included. The therapeutic alliance was measured with the Helping Alliance Questionnaire (Luborsky, Crits-Christoph, Alexander, Margolis & Cohen, 1983), while transference work was measured with the Inventory of Therapeutic Strategies (Gaston & Ring, 1992). Higher ratings of the therapeutic alliance and less intense transference work both predicted a positive outcome independently. An interaction effect between the therapeutic alliance and transference work was also demonstrated, indicating that more intense transference work with patients with lower therapeutic alliance ratings was associated with poorer treatment outcomes. Clinical implications of the findings are discussed.