Bordin's (1979) theory suggests that therapist techniques that call for client introspection and self-observation will be more effective when the working alliance (WA) is stronger. Psychodynamic therapists use expressive techniques to elicit this introspection and self-observation. We examined whether therapists' use of expressive skills (e.g., encouraging expression of thoughts and feelings; helping clients understand the reasons behind their thoughts, feelings, and behaviors) when the WA is high, versus low, was related to client outcome in open-ended, psychodynamic treatment. Ten therapists rated the WA with their 47 clients, who rated their perceptions of helping skills, after 2,284 counseling sessions. Clients also completed the Outcome Rating Scale (ORS) in reference to the week following each session. We examined time-ordered relationships by creating lagged variables for WA (T-2) and therapist expressive skills (TES; T-1) and used these scores to predict ORS ratings (T) in a three-level Hierarchical Linear Modeling (HLM) analysis (sessions nested within clients, nested within therapists). Lagged WA (T-2) and expressive skills (T-1) were decomposed into between-therapist, within-therapist, and within-clients components. We found a 3-way interaction for within-therapist working alliance, within-client WA at T-2, and expressive skills at T-1 predicting ORS at T. When clients who had a weaker WA with their therapist than the therapists' other clients, had a session with a stronger WA than the client's usual WA, then more expressive skills in the next session was related to better psychological well-being in the subsequent session. Implications and future directions are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

中文翻译：

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心理动力学治疗中的工作联盟、治疗师表达技巧和客户结果。

Bordin (1979) 的理论表明，当工作联盟 (WA) 更强大时，需要来访者内省和自我观察的治疗师技术会更有效。心理动力学治疗师使用表达技巧来引发这种内省和自我观察。我们检查了治疗师在 WA 高或低时使用表达技巧（例如，鼓励表达思想和感受；帮助来访者了解其思想、感受和行为背后的原因）是否与开放式治疗中的来访者结果相关。结束，心理动力学治疗。在 2,284 次咨询后，10 位治疗师与他们的 47 位客户一起评估了他们对帮助技能的看法。客户还参考每个会话后的一周完成了结果评定量表 (ORS)。我们通过为 WA (T-2) 和治疗师表达技能 (TES; T-1) 创建滞后变量来检查时间顺序关系，并使用这些分数来预测三级分层线性建模 (HLM) 中的 ORS 评分 (T)分析（嵌套在客户中的会话，嵌套在治疗师中）。滞后的 WA (T-2) 和表达技能 (T-1) 被分解为治疗师之间、治疗师内部和客户内部的组成部分。我们发现治疗师内部工作联盟、客户内部 WA（T-2）和 T-1 表达技能（预测 T 的 ORS）的 3 向互动。当客户与治疗师的 WA 比治疗师的其他人弱时客户的 WA 比客户通常的 WA 更强，那么下一个会话中更多的表达技巧与下一个会话中更好的心理健康有关。讨论了影响和未来的方向。（PsycInfo 数据库记录 (c) 2022 APA，保留所有权利）。