Object representation quality, therapeutic alliance, and psychotherapy process

Avihay Sanders, Mark Hilsenroth, J. Christopher Fowler

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


This is the first study to demonstrate the existence of a relationship between patient pretreatment object relations functioning as measured by the Mutuality of Autonomy (MOA) Scale and patient-rated therapeutic alliance. Specifically, MOA scores were related to a patient-rated alliance Bond score (lower, more adaptive object-relations representations were associated with a stronger alliance). In addition, higher MOA scores indicating more malevolent object relations were related to a greater use of psychodynamic techniques. Specific psychodynamic techniques focused on the patient's relationships with the therapist as well as cyclical patterns in actions, feelings, and experiences. Implications for clinical practice and future research are discussed.

Original languageEnglish (US)
Pages (from-to)197-227
Number of pages31
JournalBulletin of the Menninger Clinic
Issue number3
StatePublished - 2014

ASJC Scopus subject areas

  • Phychiatric Mental Health
  • Clinical Psychology
  • Psychiatry and Mental health


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