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Seventy-three students were referred from a university mental health center to a hospital-based treatment and research clinic for twice-weekly psychodynamic psychotherapy. The first year of treatment was assessed with regard to symptom improvement, development of a therapeutic alliance, and shifts in defense style. The authors hypothesized (1) that symptoms of depression and anxiety would decrease; (2) that
use of mature defenses would increase, while use of immature and neurotic defenses would decrease; and (3) that the therapeutic alliance would strengthen over the course of the year. In addition, the relation-ships among symptoms, defenses, and therapeutic alliance were investigated.
Data were collected at three points during the year. At entry into treatment, Axis I and II diagnoses were assessed, as were levels of depression, anxiety, and defense styles. At two months, the early therapeutic alliance was measured. At one year, levels of depression, anxiety, therapeutic alliance, and defense style were reevaluated.
Results indicated that subjects began treatment with high levels of depression and anxiety, in addition to substantial Axis I and II psychopathology. At entry into treatment, those who carried both Axis I and II diagnoses were more depressed, more anxious, and more likely to use immature defenses than those who carried an Axis I diagnosis only or received no diagnosis. This suggests an interaction between Axis I and II that heightens psychopathology.
When assessed at two months, the level of therapeutic alliance was found to be both strong and unrelated to diagnosis, indicating the capacity of those with even substantial DSM-IV symptomatology to form a therapeutic connection. Contrary to expectation, the therapeutic alliance did not become stronger over the year in treatment, perhaps due to the high level at which it started. However, an unexpected relationship between defenses and therapeutic alliance emerged. Those who scored high in use of mat