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Adherence, Flexibility, and Outcome in Psychodynamic Treatment of Depression

This study examined the relationship between adherence flexibility early in treatment and outcome within psychodynamic psychotherapy of depression. For this purpose, we used multilevel modeling (MLM) to examine the relationship between adherence to global psychodynamic-interpersonal (PI) technique early in treatment with outcome, the impact of flexibly incorporating some limited cognitive-behavioral (CB) interventions, as well the role of therapist effects. Our sample included 46 outpatients who were consecutively enrolled in individual psychodynamic psychotherapy, received a Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM–IV; American Psychiatric Association [APA], 1994) Axis I diagnosis of a depressive spectrum disorder, and were assessed pre- and posttreatment through self-report of depressive symptoms. Psychotherapy sessions were videotaped and 3rd and 9th sessions were independently rated on the Comparative Psychotherapy Process Scale (CPPS) for use of PI and CB techniques, with excellent interrater reliability (intraclass correlation coefficient [ICC] > .75). Mean technique ratings across the two early treatment sessions (3rd and 9th) were calculated. Our findings suggest that flexibly incorporating a limited amount of CB strategies early in psychodynamic therapy for depression can add some benefit to the unique positive relationship between PI adherence and outcome. Implications for clinical work and future research directions are discussed.