• This study demonstrates good psychometric properties of the WAI-SR in outpatients and inpatients.• The WAI-SR is ready to be used by psychotherapists interested in the therapeutic alliance, for supervision and process research.

As an addition to the ongoing discussion concerning the magnitude of therapist effects on outcome in psychotherapy, we investigated therapist variability in a large inpatient psychotherapy sample. We included global symptomatic outcome (Global Severity Index of the Symptom Checklist-90 Revised [SCL-90-R]; German version, Franke, 1995) and alliance (Helping Alliance Questionnaire; German version, Bassler, Potratz & Krauthauser, 1995) ratings of 2554 inpatients who were treated by 50 psychotherapists. Multilevel regression analyses (HLM; Raudenbush, Bryk, Cheong, & Congdon, 2004) were used for analyses. Overall, therapists accounted for a much greater variability on alliance (33%) than on outcome (3%). Therapists were differentially effective with regard to their patients' symptom severity at the beginning of treatment, and therapists differed in the degree that a positive alliance was associated with therapeutic outcome. The relatively small therapist effect on outcome is attributed to compensatory mechanisms in the specific context of inpatient therapy.

No abstract

Aufgewachsen ohne jeglichen Kontakt zu Gleichaltrigen, wusste sie nicht, dass etwas ungewöhnlich war in ihrem Leben. Jahrelang ignorierte sie Zeitlücken und Verletzungen an ihrem Körper. Die Vergewaltigungen durch den Vater, den Hass und die Schläge der Mutter übernahmen andere Persönlichkeitsanteile für sie, ebenso wie die unter Folter erlernten Konditionierungen und die enge Bindung an den Kult, in den sie hineingeboren war. Als Frau L. die Folgen der Gewalt nicht mehr ausreichend abspalten konnte, dekompensierte sie mit einer schweren Posttraumatischen Belastungsstörung (PTBS) und Dissoziativen Identitätsstörung (DIS).

Especially for patients who are primarily not open to receiving psychotherapy, e.g., in psychiatric hospitals or general hospitals, OPD can be an important basis for structuring motivating interventions. A stepwise procedure is proposed which is adapted to the usage of OPD in such contexts. Furthermore, also for these contexts, simplified ratings are proposed and discussed for the axes relationships, conflicts and structure. However, complete OPD remains recommended when determining the focus of a psychotherapeutic treatment.