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

Smith, Scott W. PhD; Levy, Saryn R. MA; Hilsenroth, Mark J. PhD, ABAP; Fiori, Katherine PhD; Bornstein, Robert F. PhD

The Journal of Nervous and Mental Disease: June 2016 - Volume 204 - Issue 6 - p 437–444
doi: 10.1097/NMD.0000000000000526
Original Articles

In the present study, we assess the extent to which patient personality features and prototypes are associated with early treatment therapist-rated alliance. The study sample consisted of 94 patients receiving psychodynamic psychotherapy at an outpatient clinic. Clinicians completed the Working Alliance Inventory (J Couns Psychol 36:223–233; Psychother Res 9:405–423) to assess their views of early alliance and the Shedler-Westen Assessment Procedure 200 (SWAP-200; Assessment 5:333–353, Am J Psychiatry 161:1350–1365, 1743–1754; Am J Psychiatry 156:258–272, 273–285) to assess patient personality. The SWAP-200 Narcissistic Clinical Prototype, Dysphoric Q-Factor, and Dysphoric/High-Functioning Neurotic Q-Subfactor significantly correlated with early therapist-rated alliance. Correlations that trended toward significance were also found. Also identified were specific SWAP-200 items that were found to relate to high early therapist-rated alliance scores. These results demonstrate some relationship, albeit small, between patient personality characteristics and therapists’ views of the alliance that may serve to further a conceptual understanding of the alliance, specific personality syndromes, and the associated impact on the therapeutic interaction.

*York College, City University of New York, Jamaica; and †Derner Institute of Advanced Psychological Studies, Adelphi University, Garden City, NY.

Send reprint requests to Saryn R. Levy, MA, The Derner Institute of Advanced Psychological Studies, Adelphi University, 302 Weinberg Bldg, 158 Cambridge Ave, Garden City, NY 11530-0701. E-mail:

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