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How Does Addressing Patient’s Defenses Help to Repair Alliance Ruptures in Psychodynamic Psychotherapy?: An Exploratory Study

Gerostathos, Antonios MD; de Roten, Yves PhD; Berney, Sylvie MD; Despland, Jean-Nicolas MD; Ambresin, Gilles MD

The Journal of Nervous and Mental Disease: May 2014 - Volume 202 - Issue 5 - p 419–424
doi: 10.1097/NMD.0000000000000112
Original Articles

Interpreting or addressing defenses is an important aspect of psychoanalytic technique. Previous research has shown that therapist addressing defenses (TADs) can produce a positive effect on alliance. The potential value of TADs during the process of alliance rupture and resolution has not yet been documented. We selected patients (n = 17) undertaking a short-term dynamic psychotherapy in which the therapeutic alliance, measured with the Helping Alliance Questionnaire and monitored after each session, showed a pattern of rupture and resolution. Two control sessions (5 and 15) were also selected. Presence of TADs was examined in each therapist interpretation. Compared with control sessions, rupture sessions were characterized by fewer TADs and especially fewer TADs addressing specifically intermediate—essentially neurotic—defenses. Resolution sessions were characterized by more TADs addressing specifically intermediate defenses. This confirms the link between therapist technique and alliance process in psychodynamic psychotherapy.

Institute for Psychotherapy, Department of Psychiatry, University Hospital Center and University of Lausanne, Lausanne, Switzerland.

Antonios Gerostathos, MD, and Yves de Roten, PhD, contributed equally to this work.

Send reprint requests to Yves de Roten, PhD, Institut Universitaire de Psychothérapie, Avenue de Morges 10, CH-1004 Lausanne, Switzerland. E-mail:

© 2014 by Lippincott Williams & Wilkins