Grande T, Porsch U, Rudolf G
Abteilung für Psychotherapie und Psychosomatische Medizin, Universitätsklinikums Charlottenburg, Freien Universität Berlin.
Z Psychosom Med Psychoanal. 1988;34(1):76-100.
Drawing on 121 cases of inpatient psychotherapy, this study investigates the evaluation of therapeutic cooperation by both patient and therapist and the predictions that can be made about the success of therapy on the basis of these evaluations. The authors discuss four different patterns of therapeutic cooperation that differ in the degree of positive judgment expressed and in relation to correlations and contradictions in the evaluations of the two parties to the dyad. The psychological characterization of these patterns makes it clear that they are specific types of mutual relational offers that correspond with the background of the personality structure of the patient in question. Factors of therapy motivation and expectations with regard to therapy, as well as certain defensive reactions, (e.g., denial) and the social class of the patient play an important role. In the second part of the discussion, the authors study the question of how the evaluations of the therapeutic working relationship and the four relational patterns are connected to results of therapy as determined at the end of therapy as well as in a catamnestic examination; it is shown that the degree of the relationship is dependent on the type of changes (structural vs. symptom-centered) that are measured, as well as on the person (therapist or patient) making the evaluation of success.
