Therapist Perceptions of Process in Psychodynamic Therapy Treating Compulsive Sexual Behavior Disorder and Comorbid Borderline Personality Disorder

This study examined the relations between therapist perceptions of psychodynamic therapy (PDT) process, adherence to PDT principles, and interaction structures formed between therapist and patient. A graduate student therapist treated a 28-year-old man diagnosed with compulsive sexual behavior disorder and borderline personality disorder with PDT (N = 52 sessions). Following each session, the therapist completed the Psychotherapy Process Q-Set (PQS) to capture his perceptions of session process. Independent coders completed the PQS from session audio-recordings. Preceding each session, the patient completed the Outcome Questionnaire to measure psychological distress. The therapist was most discrepant on items pertaining to his own attitudes and behavior (including interventions), indicating countertransference. Therapist agreement with the independent coders was positively correlated with PDT session adherence and negatively correlated with untherapeutic interaction structures (i.e. reciprocal patterns of interaction) identified in a previous study. Simulation modeling analysis revealed that increased therapist agreement and psychological distress independently preceded increases in a potentially therapeutic interaction structure observed one session later. Therapist agreement was associated with PDT session adherence and interaction structures, suggesting routine monitoring to protect treatment fidelity and therapeutic interaction structures.