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Relationship Between SWAP-200 Patient Personality Characteristics and Patient-Rated Alliance Early in Treatment

Smith, Scott W. PhD*; Hilsenroth, Mark J. PhD, ABAP; Fiori, Katherine L. PhD; Bornstein, Robert F. PhD

The Journal of Nervous and Mental Disease: May 2014 - Volume 202 - Issue 5 - p 372–378
doi: 10.1097/NMD.0000000000000134
Original Articles

Research on the therapeutic alliance suggests patient personality characteristics to be plausible correlates of alliance formation. To date, research has largely focused on the relationship between the alliance and facets of patient personality measured via patient self-report, versus personality syndromes.

In the present study, we assess patient personality using a clinician-rated measure—the Shedler-Westen Assessment Procedure–200 (SWAP-200; Shedler and Westen [Assessment 5:335–355, 1998; Am J Psychiatry 161:1350–1365, 2004; Am J Psychiatry 161:1743–1754, 2004]; Westen and Shedler [Am J Psychiatry 156:258–272, 1999; Am J Psychiatry 156:273–285, 1999])—and investigate the extent to which empirically derived personality configurations correlate with patient-rated alliance. The study sample consisted of 94 patients receiving psychodynamic psychotherapy at an outpatient clinic.

The SWAP-200 Dependent Clinical Prototype and Dysphoric: Dependent-Masochistic Q-Factors were found to significantly correlate with early alliance. Also identified were specific SWAP-200 items that independently correlated with early alliance scores.

The results of the present study demonstrate a relation between patient personality characteristics and therapeutic alliance that may serve to further a conceptual understanding of the alliance.

*Pathways to Housing, New York, NY; and †Department of Psychology, Derner Institute of Advanced Psychological Studies, Garden City, NY.

Send reprint requests to Scott W. Smith, PhD, 212 South Oxford St, Apt. 7B, Brooklyn, NY 11217. E-mail:

© 2014 by Lippincott Williams & Wilkins