Early identification of treatment failures in short-term psychotherapy. An assessment of therapeutic alliance and interpersonal behavior.

Early sessions of patients categorized as dropouts (n = 25), good outcome (n = 28), and poor outcome (n = 20) completers of a 40-session protocol of short-term psychotherapy were compared to determine predictive validity of in-session measures of therapeutic alliance and interpersonal behavior (Working Alliance Inventory, Session Evaluation Questionnaire, and Interpersonal Adjective Scale). A number of significant differences were found among the three groups: both patients and therapists in the dropout group rated the relationship as more problematic than those in the good outcome group, and patients in the dropout group also rated the relationship as more problematic than those in the poor outcome group, while therapists' ratings did not distinguish dropouts from poor outcome. Differences between good and poor outcome groups were nonsignificant. These findings have clinical significance, particularly in early identification of patients at risk for treatment failure.