Nichols,
Stephanie (4/09) The process of internalization in psychotherapy and its
relationship to the working alliance and therapeutic change (Nicholas
Papouchis, Ph.D.; Howard Mcguire, Ph.D.; Linda Penn, Ph.D.)
Internalization is widely theorized to be
a key process in the creation and maintenance of psychotherapeutic gains. The
goal of the following study was to examine the process of internalization, as
measured by the Therapist Involvement Scale (TIS) of the Therapist
Representation Inventory (TRI), over a course of psychotherapy for a diverse
sample of university clinic clients. This process was examined alongside the
therapeutic alliance, as measured by the Working Alliance Inventory - Short
Form (WAI-S). This study sought to determine the relationship between these two
processes and their impact on in-treatment therapeutic change, as measured by
intake and later treatment scores on the SCL-90-R, IIP, and Target Complaints
Form. Given the difficulties of gathering complete data for a psychotherapy
population, collateral analyses attempted to 'validate' the results of the
small group of subjects who completed all of the measures by means of
point-to-point comparisons with the larger set of subjects who did not have
entirely complete data. It was hypothesized that greater positive
internalizations would be associated with positive change and, conversely, that
greater negative internalizations would be associated with negative change.
Results supported only the latter. Internalization ratings appeared to be
related to attachment style, with fearful-avoidant clients reporting more
between-session use of their representations. The hypothesized relationship
between the strength of the working alliance and the degree of positive
internalization was not supported, suggesting that these are separate processes
within psychotherapy. The relationship between degree of internalization and
treatment duration was not supported for short-term treatment, but was
supported for longer-term therapy, suggesting the value of long-term treatment
models. Implications and areas for further study are discussed.
