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"#0!%)<0!):!2<<$2*70!$*!(#0!%0<2($)*6#$1!30(Z00*!(#0%21$6(! 7)910(0*70!2*&!)B(7)90!$*!F%$0:!/647#)&4*29$7!/647#)(#0%214!
O061<2*&_!i>Ea>_!&0!5)(0*_!e>_!O%2102B_!@>_!8B%%2(_!">_!F0%0((2_!V>_!G!I%290%_!R>![+,,\^>!"#0!%)<0!):!2<<$2*70!$*! (#0!%0<2($)*6#$1!30(Z00*!(#0%21$6(!7)910(0*70!2*&!)B(7)90!$*!3%$0:!1647#)&4*29$7!1647#)(#0%214>! N">#+@B&"!& 0%#<">(&@+*&Z%+,@B&;)(%@(%O&Idb [.^_!Pg+EPgd>!&)$?!-,>-,\dua@O>,3,-P0P-b-2+,b]\! >-001(3! Therapist competence is a key variable for psychotherapy research. Empirically, the relationship between competence and therapeutic outcome has shown contradictory results and needs to be clarified, especially with regard to possible variables influencing this relationship. A total of 78 outpatients were treated by 15 therapists in a very brief 4-session format, based on psychoanalytic theory. Data were analyzed by means of a nested design using hierarchical linear modeling. No direct link between therapist competence and outcome has been found, however, results corroborated the importance of alliance patterns as moderator in the relationship between therapist competence and outcome. Only in dyads with alliance change over the course of treatment was it clear that competence is positively related to outcome. These findings are discussed with regard to the importance for outcome of therapist competence and alliance construction processes. The results support to a large extent our 3 hypotheses. The results also indicate that no direct relationship exists between level of competence and outcome in BPI. This means that even after training in BPI and years of experience, a high level of therapist competence does not guarantee a positive outcome (Barber et al., 2006; Sandell, 1985). This also means that other variables, or variable combinations, account better for outcome variation. Results indicate that competent therapists tend to establish a growing alliance over the course of BPI, compared with less competent therapists. The highly significant coefficients indicate the important contribution of the therapist’s level of competence in alliance construction processes. The latter are conceived as coconstruction processes, based on patient-dependent, therapist-dependent and dyad-specific variables. One could say that within the context of relational progression (growing alliance), the more competent the therapist, the better the outcome, whereas, paradoxically, within the context of relational stagnation (stable alliance), the more competent the therapist, the less positive the outcome (small symptom reduction, no change, or deterioration). For the latter, the exact opposite holds true; competence does have a direct effect on outcome, but no interaction effect has been found. Thus, the more competent the therapist is on the subscale of general psychotherapeutic attitude, the better the outcome. This result might reflect that the therapist’s basic interactional and therapeutic skill of empathic, nonjudgmental consideration towards the patient is a necessary, but as such, an insufficient therapeutic ingredient in psychodynamic psychotherapy. It seems that alliance has an influence on the relationship between competence and outcome. We find, on the one hand, for the subsample with relational progression over the 4 sessions of BPI, therapist competence is of importance in the sense that low competence yields low outcome. As the level of training is related to competence, in the cases of relational change, more training in BPI, for example, in the form of more frequent case supervisions should help to produce a positive outcome. It also indicates that competence is certainly a necessary condition for treatment outcome, but as such insufficient; alliance evolution, as an emergent characteristic of a successful therapeutic
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